Intro
well thank you very much bro for that very generous introduction and of course I want to thank dr. ken Ford director of the I am IHMC here for the invitation to speak I assume most of you know he has a very special multidisciplinary group here that includes a host of very smart people trying to solve complex problems so I think ken is someone I very much admire and bit jealous of the culture and and an infrastructure he has here to do some very neat research I also think Ken’s a very cool guy and I didn’t realize how cool he was until he mentioned this afternoon he has a fascination of Ford GTS and if you don’t know the Ford GT is a pretty iconic supercar that Ford developed in the 60s to to beat Ferrari at the 24-hour LeMans and I think it’s relevant to what he’s done here you know that was a true example of a American company bringing together all its resources to build a technologically advanced car that literally beat the pants off Ferrari and I think you know that’s something we that’s something we need to inspire more in academia as this concept of team research and accomplishing big goals so so Ken if you ever need a personal chauffeur if you buy that Ford GT I’ll come down here in a heartbeat so there’s only one topic I enjoy talking more about than the Ford GT and that’s ketogenic diets so on that note I spend more or less obsessed with studying how humans respond to restricting carbohydrates for the last 15 years or so and the truth is it’s a bit more complex than I initially thought but we have learned a lot and we’ve really wrapped up a remarkable decade of research on low carbohydrate diets and so I just want to give you a little flavor of that in today’s lecture over the next 45 Outline minutes or so here we go so my sort of approach this evening is to discuss three major themes here first of all I want to provide a little overview from a metabolic perspective on this concept of freeing yourself from carbohydrate addiction because in many ways I hope to convince you that when you eat carbs that more or less locks you into a dependence on on on carbohydrate as a fuel source and so freeing people from this carbohydrate addiction is really a fundamental step in in moving them toward better health and then I want to sort of dispel some common myths about ketosis and this idea of keto adaptation and discuss some of the implications of being in a ketotic state on health and even peak performance and then finally since at the end of the day most people just want to know what do I eat I want to spend some time on what constitutes a well formulated ketogenic diet there’s a lot of casual approaches to restricting carbohydrate not all of those approaches may be effective or even safe and definitely not sustainable so there are some issues that you really need to understand in terms of actually putting together and constructing a diet that’s restricted in carbs that’s healthy and sustainable so if we look at basic metabolism you really have two fuel sources your body can use for energy and those are carbohydrate and fat and in Fuel Stores in the Body terms of carbohydrate we did not evolve to store much carbohydrate in our body we we can we can put away about 2,000 Killick is worth of fuel in the form of glycogen as far as our carbohydrate fuel tank and that’s primary primarily in skeletal muscle as well as a little bit in the liver so so that’s enough to you know if you’re exercising that may last a couple hours and then suddenly you’re out of fuel and that’s what hitting the wall and walking is now contrast that to our ability to store fat we have a remarkable level of ability to enhance our capacity to store fat so on average we can store 2000 K Cal’s worth of fat we even in a lean person we can store well over 10 fold greater amounts of energy in fat if you happen to be a little overweight it may be more like 20 or 50 fold more so if you’re overweight and if you’re obese it’s really this fuel tank that you want to access for fuel and this concept of eating carbs locking you into a dependence on carbs really manifest itself in this in this sort of manner that if if you can’t oxidize the carbs that you’re eating and this is a problem if you’re overweight or obese and you can’t store it because your stores are full there’s only one other option and that’s the carbs get converted to fat and that does happen in Eating carbohydrate locks you into a glucose-dependent metabolism many individuals who are overweight and obese so here’s what happens if you eat carbohydrate your your body digests and absorb that carbohydrate is glucose primarily and so you’ll see an elevation in blood sugar and this spike in blood sugar is followed by an increase in insulin levels in the body and that drives the blood sugar into cells and that often results in a subsequent rebound low blood sugar and we tend to focus a lot on this because this is what you feel when you’re tired after lunch and you want to put your head down and and you you’re hungry and you want to seek out some additional carbohydrates but the other sort of insidious effect here that that occurs because of the insulin response is that you block access to your fat stores so eating carbohydrates and increasing your insulin level essentially blocks your ability to mobilize and burn body fat and just to give you a sense of the physiology here here is a graph of insulin levels versus fat breakdown and this could just as well be fat oxidation so you see first of all this relationships not linear it’s very curvilinear such that small changes in insulin result in large changes in fact breakdown and fat burning so this is the difference between eating you know some carbohydrate at lunch versus not consuming carbohydrate and you’re subsequently either in a state where you’re not burning fat if you’re eating carbs or if you avoid carbs or limit them you can be in a much higher fat-burning state so they’ll promise I won’t go too far here into metabolism but I think it’s important and helpful to understand what happens when you eat just a single meal of carbohydrates so first of all we don’t have much glucose in our blood the total amount of glucose is equivalent to maybe 1 or 2 teaspoons you may be ingesting in a in a normal carbohydrate meal ten times that and so the body has to has to deal with that and get rid of that incoming glucose and if you’re healthy most of that incoming carbohydrate is taken up by skeletal muscle where it’s either converted to glycogen temporarily and then burned as fuel and oxidized but we now know that in people who have some level of insulin resistance so if you’re obese if you’re type 2 diabetic or you have metabolic syndrome a greater proportion of that incoming dietary carbohydrate gets diverted to the liver where it’s converted to fat in a process called DeNoble lipogenesis so this is sort of a secondary or alternative pathway for carbohydrate to take and in the liver you actually make a saturated fat that gets packaged into a VLDL particle and actually gets released into the blood so in people who have insulin resistance you can actually see several hours after eating carbohydrate that fat levels go up in the blood and this is really a not a benign situation there’s a lot of sort of collateral damage that can occur as a result of this processing of carbs through this pathway and a way to view this functionally is as a form of carbohydrate intolerance if you’re diverting carbs into this pathway you’re essentially carbohydrate intolerant and that’s putting you on a fast track toward type-2 diabetes so in many ways Carb-Based Metabolism what you can do with diet is you can switch your metabolism from a car based metabolism where you’re relying on glucose for fuel to one that’s almost exclusively based on fatty acids and ketones as your primary fuel sources and we’re starting to really learn a lot about the metabolic and health benefits of switching cellular metabolism to a fat based type of metabolism in fact this is you know over 98% of human history we evolved in the context of primarily a fat-burning metabolism it’s only the last 10,000 years that we’ve had agricultural carbohydrates and even a much shorter time period for certain cultures and we’re starting to learn that you know switching a cell to burning fat is associated with less free radicals less reactive oxygen species and generally a more healthy type of metabolic state and so this sort of in a general sense brings up this idea of fat and ketones as preferred or premium fuel and how this might promote better health better performance and better recovery and this has really been my interest over the years in studying how this affects various diseases from type 2 diabetes in metabolic syndrome all the way to the other end of the spectrum where I’ll show you data today how switching over to fat burning is helping athletes not just your average recreational athletes but elite world-class athletes so to kind of give you some evidence and data on the fact that carbohydrates drive fat metabolism this is data from a controlled feeding experiment that we recently completed where we we literally fed people all their food for five and a half months every three weeks they switch diets and you can see we initially drop their carbs down to very low levels and then progressively increase their carbs and what you see here this is respiratory exchange ratio the lower the value here the greater the fat burning so you see right off the bat you see when they we restrict carbs fat oxidation increases as we reintroduce carbs you see decreases in fat oxidation in a pretty linear manner here so the point being carbohydrate intake strongly related to the level of fat burning so I want to spend a little bit of time talking to you about ketones ketones in general are widely misunderstood even among people in the healthcare industry and physicians and even many researchers studying diet partly because ketones were originally discovered in uncontrolled type 1 diabetics where they produce ketones uncontrollably and you end up with ketoacidosis but when you have ketones in a more moderate range and when they’re induced by restricting carbohydrates you have a very different scenario so I want to just make sure you understand a few terms here first of all ketosis you know this is sort of a simple definition ketones are small metabolites that are produced in the liver so their hepatic we derived that can provide fuel to nearly every cell outside of the liver nutritional ketosis is the process of inducing ketosis by restricting carbohydrates and it’s also occurs when you’re in a starvation mode because you’re also limiting carbohydrates in that mode so you have starvation ‘el as well as nutritional ketosis in contrast ketoacidosis is a dangerous side effect when you have insufficient insulin so a type 1 diabetic who does not produce insulin will have sort of this unregulated increase in ketones that can become problematic but in a non type 1 diabetic that virtually never happens and then this term keto adaptation essentially refers to the process of shifting your metabolism over to burnin fatty acids and ketones as a fuel source over a period of several weeks so in essence being in nutritional ketosis for an extended period of time so here is just a little cartoon to kind of give you a better sense of what’s happening so when you’re breaking down fat at a very high rate in your fat cells so you’re breaking down triglycerides into fatty acids those fatty acids enter into the blood and are transported to the liver and in the liver when fatty acids are delivered at such a high rate they can’t be completely oxidized the body essentially turns them into ketones so the process of ketogenesis and the two primary ketone bodies are beta-hydroxybutyrate and acetoacetate and so you can kind of see here these are byproducts of fatty acid metabolism so in essence the fatty acids are just being converted to ketones and then transported back to the blood where they can then be transported to other cells for fuel so it’s sort of a temporary way to provide energy in the form of fat and primarily ketones have been studied in the context of their displacement of glucose in the brain for fuel so when you don’t have carbohydrate available these ketones can now displace glucose as a fuel in the brain and this is a really important adaptation and benefit that allows humans to survive during long periods of starvation where you can essentially provide fuel for the brain whereas normally the brain is dependent on The brain is not a glucose-dependent organ glucose and you’ve probably heard this before that many experts will tell you the brain is a glucose dependent organ must you’ve got to have carbs for the brain and normally that’s true if you’re eating carbohydrate and you’re preventing ketosis so 100% of the glucose is normally a hundred percent of the brain’s energy needs are met by glucose in a fed state in a person normally eating carbohydrate but in prolonged starvation or in prolonged carbohydrate restriction where you’re producing ketones you can have 2/3 of the energy coming from ketones so clearly the brains energy needs can be met primarily from substances other than glucose in this case ketones so even when you’re not eating you can have a perfectly well-fed brain because of ketones and I’ll come back to why that might be important but this is some really I think a spectacular data here that actually was never published it was buried in a review paper I think because it would be impossible to get IRB approval to do this now anyway but this was work done by George Cahill back in the in the 60s when they were studying starvation ketosis what they did was they took a group of healthy individuals who had been starved for several weeks so that they were producing ketones you see now I’ll talk to you about the levels here but this is very high levels above 5 milli molar beta-hydroxybutyrate and then what they decided to do was infuse insulin into these folks and by infusing insulin that drove their normal fasting blood sugar levels at 70 milligrams per deciliter down to 25 milligrams per deciliter now to put that into perspective in anyone in this room who’s not in ketosis if you had a blood sugar of 25 you’d be on the floor most likely in a coma yet these people had absolutely no signs or symptoms of low blood sugar hypoglycemia so in essence being in a state of ketosis makes you bomb-proof makes you not susceptible to hitting the wall so that’s why athletes are doing this and I’ll come back to that but you know it’s not just athletes that hit the wall I mean you could be sedentary and just be carbon tolerant and you eat a high carb meal and you you know you want to take a nap after that that’s your brain in a fuel crisis that’s sort of hitting the wall so being keto adapted one of the most profound benefits is just having this sustained fuel source for the brain so here’s the main difference between ketosis nutritional ketosis and ketoacidosis it’s one of magnitude so if you’re eating a normal carbohydrate diet and you measure somebody’s ketones they’re less than 0.1 milli mole per liter now if you eat a very low carbohydrate diet and measure ketones or I’m sorry if you’re eating a moderate carbohydrate diet but just measure ketones after an overnight fast they start to go up a little bit maybe up to 0.3 if you fast for several weeks without any food they can go up to five to seven millimolar a very low carbohydrate diet and this varies from person to person but in general less than 50 grams a day would generally put most people between 0.5 and 3 millimolar now there is a well-known phenomenon a post exercise ketosis so you could bump that up even a little further right after exercise but contrast that to the levels seen in ketoacidosis which you will never reach if you’re if you’re restricting carbs and you’re not a type 1 diabetic so we’re talking about an order of magnitude different from the normal carbohydrate fed state to a carbohydrate restricted state but we’re a whole order of magnitude lower than what you see in ketoacidosis so this is really important in terms of understanding why this is not dangerous this is not associated with acidosis or any change in pH in the blood so here’s just another sort of figure to to show you the differences here in nutritional ketosis being in the green here probably starting at about 0.5 extending up to 3 4 millimolar but ketoacidosis is way over here and it’s probably in this range where you have optimal fuel flow optimal into organ fuel exchange and it’s quite elegant system the body has developed and evolved over millions of years that allows this perfect metabolic exchange Monitoring Ketones of fuels so I would argue and I’ll provide you some additional evidence that being in a state of ketosis offers a lot of benefits for people and especially for some people that might have insulin resistance and type 2 diabetes but you might ask how do you know if you’re in ketosis are there ways to measure this and the answer is yes by far the most common method is to measure ketones in the urine so you have a little sort of strip here that you run your urine stream through and if it changes color you’re in varying levels of ketosis but after you’ve been on a ketogenic diet for several weeks turns out the kidneys go through some very important adaptations where they tend to reabsorb more of the ketones so I find urine to not be a very active accurate method and can sometimes provide confusing and discouraging results in other words you can be in ketosis but not be registering ketones in your urine so by far a more accurate and preferred method of measuring this is actually determining it in blood and you can do this quite easily with a couple companies offer a handheld glucometer about the size of this device here that can measure beta-hydroxybutyrate and they’re very accurate and it’s just done with the finger stick and it’s a if you’re patient enough to wait five seconds you actually get a value that tells you you’re in ketosis and I find this is very empowering and informative for people because many people will find their they think they’re in t ptosis but they’re really not so it can help you fine-tune the diet to find that right mix of foods that allows you to be in the right range and then on the horizon are methods to determine breath acetone which is another ketone body or breakdown product of ketones that’s volatile and gets expired in the breath and it does correlate very highly with blood levels so I do think this has some merit and there are several companies that are very close to having commercially available products that that would provide a truly non-invasive way to monitor ketones whereas you do have to sort of stick your finger here Provocative Effects of Ketones so here are some of the science of ketones most of the research up until the last few years has really focused on ketones as an alternative fuel source for the brain and other tissues and there’s been some very nice work documenting the sort of biochemical and metabolic effects of burning ketones so when the mitochondria is using ketone they’re generating less reactive oxygen species and that’s really you know that’s really profound because in many ways you could interpret that as ketones are a cleaner burning fuel there’s less exhaust and damaging effects of metabolizing ketones than glucose and other substrates like lactated pyruvate and even fatty acids and and some isolated work in the heart has shown you get more work per unit ATP when you’re burning ketones versus other substrates so there’s greater efficiency and this is again very I think important and whether or not this plays out at the systemic level in humans I don’t think we have that data yet but I think even more provocative is some recent data suggesting that ketones beyond their role as fuel are actually signals that they’re signaling various pathways and affecting gene expression so in other words they’re acting as epigenetic modulators of gene expression in particular controlling expression of genes related to oxidative stress and antioxidant defense and this was really laid out in a recent paper by Eric Burdon as group out at the Gladstone Institute showing that in and in animals who were made ketotic through various protocols including diet and they even implanted a ketone pump to elevate ketones in these animals but they showed these effects of ketones on protection from oxidative stress and of course they worked out the mechanism this was a paper published in science as affecting histone deacetylase so their histone deacetylase inhibitors and this is a very dynamic area of study right now in fact every pharmaceutical company is testing various drugs on their ability to in histone deacetylases and I think if any of them come up with a drug that has the same effective ketones it would be a blockbuster so we’re really looking at nutritional manipulation that can elevate a metabolite that has drug like effects so Weight loss a lot of the focus of very low-carbohydrate ketogenic diets have been on weight loss and clearly that data shows some very promising effects that ketogenic diets can can really be beneficial for for managing weight but to me that’s really the tip of the iceberg more importantly ketogenic diets are have therapeutic effects and most I think obvious is its effects on diabetes and metabolic syndrome or pre-diabetes but also you’re seeing a lot of interest now and other chronic diseases that in many ways are related to oxidative stress and inflammation like cancer and other neurological disorders but I want to talk to you a little bit about diabetes in particular type 2 diabetes because the effects are nothing short of remarkable in that population so just to not sort of burden you with going over a lot of individual studies I just wanted to show you these are a couple meta-analysis that were published in the last couple years in fact coming to the conclusion that low carbohydrate diets are better than low-fat diets and inducing weight loss but also beyond weight loss improving cardiovascular Low carbohydrate diets are more likely to effect global improvement in markers of metabolic syndrome risk factors and in particular I’ve been interested in studying the pre-diabetic condition and this was a randomized study where we we had people consume either a very low-carbohydrate ketogenic diet or a traditional low-fat diet for 12 weeks and we measured everything under the Sun that we could we could figure out how to analyze and I’m just showing you a some of the variables here but in almost every a low carbohydrate diet wins so lipids get better in particular triglycerides HDL increases the good cholesterol the quality of the LDL improves glucose insulin insulin sensitivity leptin levels all improved to a greater extent in particular I’ve had an interest in studying saturated fat metabolism and we actually see saturated fat levels go down more on a well-formulated low carbohydrate diet and I’ll come back to that a little more later but we get across the board improvements in standard as well as emerging risk Diabetes: Current treatments are failing factors with ketogenic diets so type-2 diabetes this is an area that I really focused on at the moment because type-2 diabetes is a huge problem we have a not just an epidemic in the United States but this is a real global problem but in the u.s. we’ve got about 10 percent of the population has type 2 diabetes and this is an enormous burden on our health care system I mean the average additional health cost of associated with treating a type 2 diabetic is about $8,000 a year so about one in five healthcare dollars or 200 billion dollars is spent managing type 2 diabetes and then you know the sort of sad news here is that things are getting worse that current treatments are failing so we’re expected to be spending half a billion or five hundred billion dollars by 2020 and rates will be upwards of 15 20 % of the population will have type 2 diabetes and the current treatment is basically a low fat diet high carbon in high in carbohydrates plus drugs and that’s if anything accessor baiting the problem and making pharmaceutical companies more wealthy and it’s just insanity really either this is these are the educational materials from the American Diabetes Association and American Dietetic Association no and what do you see here this is a lot of carbohydrate I guess you know we’ve got the jelly beans here that diabetics need to have I mean I guess that’s appropriate seeing Easter was last week but really come on we’re promoting a diet that requires you know you take more medication so I it’s really mind-boggling but here’s what can happen and if you if you if you put diabetics on the right diet so these are really well controlled studies this goes back almost 20 years ago now we’re very governor showed in obese type 2 diabetics these are just really short-term diets well controlled though what he said these type 2 diabetics a very low calorie diet 650 kcals that were equal in protein but one was very low in carbs and the other one contained enough carbs where they weren’t in ketosis so you see on the very low carb low calorie they were in nutritional ketosis about 3 millimolar compared to the non-ketotic but low calorie diet and what they showed was it was the ketogenic diet the one low and carbohydrate that resulted in the most profound improvements in fasting blood sugar as well as postprandial blood sugar and they showed a 22% decrease in hepatic glucose output that’s the fundamental problem in type 2 diabetes is their livers produce too much glucose and that raises their blood sugar they may also be insulin resistant in skeletal muscle but very interestingly here they showed a strong correlation between the level of ketones in their blood and the reduction in hepatic glucose output suggesting ketones were really a mediator of this benefit but it also shows just weight loss itself and decreasing your caloric intake is not optimizing the condition you have to consider the quality of the nutrients in this case restricting the carbs to a level that induced ketosis here’s another impatient well controlled metabolic ward study where obese type 2 diabetics were fed a very low carbohydrate diet for two weeks and you see remarkable restrictions remarkable reductions in plasma glucose and plasma insulin levels in the open circles here hemoglobin a1c down in just two weeks and significant 75 percent improvement in insulin sensitivity in that short of time period here’s a longer-term study because people will say well that’s great but nobody can stay on these diets this was actually done in Kuwait and the Middle East in general has a one of the highest rates of diabetes of any region in the world I think 7 out of the 10 countries with the highest prevalence of diabetes are in the Middle East so I think it’s about 20% in Kuwait anyway they fed obese type 2 diabetics a well-formulated ketogenic diet now I don’t use that term lightly because there’s a lot of poorly formulated low-carb diets but they actually embraced fat here they gave them extra fat in the form of olive oil and they kept carbs low and they did that for a year and showed that many of these type 2 diabetics put their disease into remission so they didn’t just prevent type 2 diabetes in existing type 2 diabetics they reversed it and kept it there for a year and there are other studies as well this is work done by Willie Aunty and Eric Westman at Duke showing a low-carbohydrate ketogenic diet was effective in type 2 diabetics Case Study – Canadian First Nations Physician and getting them off medication and there are plenty of case studies as well this was a good friend and colleague who’s a First Nations background and they have a strong propensity to develop type 2 diabetes in fact it’s well over half that population in Canada has type 2 diabetes but he developed type 2 diabetes over a decade ago and sort of came to low carbohydrate diets on his own research and was able to promptly put his disease into remission and control it with a well formulated low-carb diet now he’s profoundly insulin resistant to such that if he brings his carbs back up even 10 grams or more a day from 40 to 50 he starts to lose control and he needs to go back on metformin and eventually insulin but he’s been able to keep his disease in remission now for over a decade with with a well formulated ketogenic diet so but you have to Tim Olsen Wins 2012 Western States 100 realize traditionally in sports nutrition I mean athletes love their carbs and carbs have been promoted as not just optimal but necessary for good performance and recovery and so in this community the fact that there are many athletes who are sort of abandoning this traditional guidance to carb load and emphasize all these sports drinks and gels to a diet that’s entirely the opposite low in carbohydrates is really fascinating and to give you a sense of what’s happening this is Tim Olson who competed in the western states endurance run in 2012 and I had my lab group out there we were trying to study these athletes and he won that race in a record time I don’t know if you can see that it’s 14 hours and 46 minutes he ran a hundred miles this is a trail run through the Sierra Nevada mountains he I think he was about 30 minutes ahead of the previous record and he’s a well described low carb athlete very vocal about it and and here he’s not just competing he’s winning and setting records and it wasn’t an anomaly he came back the following year and won again in 2013 just this last July a little bit slower but this was the second hottest race in their history it was 108 degrees in some parts of the course so absolutely phenomenal what these athletes do and he he’s not the only low carb athlete in this this last race six out of the top I’m sorry three out of the top six podium finishers in the men’s and women’s class were low carb athletes so there are many in fact there’s there’s they’re growing larger all the time this is Zack bitter who we’ve had an opportunity to study who just set the American hundred mile track record so they run 100 miles on a track and he’s a low carb athlete this is probably the one of the greatest low carb athletes of all time he just set the 24 hour record where you basically run as far as you can in 24 hours he ran 172 miles and it’s not just runners I contacted all the time by a range of athletes spanning almost all sports but these are our top downhill skiers bode miller lindsey vonn have both publicly stated they’ve restricted carbs Marty fish probably our top-ranked US tennis player one of the top-ranked I guess the LA Lakers have now switched to low-carb to is Dwight Howard not sure exactly what type of low carb diet but there’s been some articles written about that this is the Norwegian soccer team Strahm God said who won their what I guess the equivalent of our Super Bowl there and their whole team is on a low-carb diet and you know it’s not just myself interested in this and studying it this is Tim Noakes who is really a well-respected prominent scientist from South Africa and physician who has most of his career been advocating high carb diets in fact wrote a book that was considered the Bible for runners called the lore of running where he touted the virtues of carbohydrate but in the last two years he’s completely switched to now promoting a low carbohydrate diet in part because he has a strong history of type 2 diabetes running through his genes and he’s quite an accomplished runner himself and despite all his running could not control his type 2 diabetes it was only through restriction of dietary carbohydrate that he was able to to do that and I have a tremendous respect he’s a very gracious person and he’s actually admitted he was wrong and apologized to all the readers of his book and that is rare in science for any scientist to apologize that they got something wrong so anyway let me show you share a little bit of data because a lot of this is anecdotal and that’s only you know you have to sort of take that with a grain of salt so this is my current lab in Storrs Connecticut where my lab is not so famous even though I’m buried in the basement here but we are the center of the basketball universe so we get some visibility through that we’re doing a very exciting study now I think of all the hundreds of studies I’ve done this by far has been the most enjoyable where we’re bringing in these ultra endurance athletes into our lab we’re flying them from all over the country in a couple cases all over the world these are really the top ultra runners who have switched to a low-carb diet and we’re basically putting them through a battery of tests trying to understand what makes them tick and I can’t share a lot of information with you but I do want to give you a little Runners sort of preview of what these athletes look like so we’re comparing them to their sort of high carb counterparts and we’ve currently tested nine low carb athletes and four high carb athletes on our way to 10 and 10 but you can see their age here mid 30s pretty lean guys don’t have a whole lot of body fat you know high vo2 max is but not extraordinarily high but these guys are are they’re running races triathlon and Beyond so marathon is too short for these guys they have to be exercising for like 8 10 20 30 hours and we’re taking them through a complex series of tests we’re pretty invasive we’re taking muscle biopsies fat biopsies administering isotopes but the real crux of the testing is a 3-hour treadmill run that they do here and we’re measuring their metabolic fuel use and so forth so here they are on the treadmill and this amazes me because we just have them stare at this wall for three hours while they exercise and and then we cut them up with you know with scalpels and stick needles in their legs and take muscle out and they love it and that’s that’s really the truth so let me show you what their fuel use looks like so yeah this is not data from this study but this is data from one of probably the best study out there that shows what the peak rate of fat oxidation is in in athletes and humans and you can see here that you know this is their vo2 max here their maximal aerobic capacity and this is their peak fat burning in grams per minute during exercise you can see it’s pretty scattered but even the very best fat burners these are it’ll include elite athletes in this group of 300 plus people is about one gram per minute be very best here most of them are clustered around point five point six so I’ll show you that this is the peak fat oxidation and nine of those low-carb athletes that we’ve tested you can see they’re literally off the charts from this previous work here’s the high carb they fit right in the scatter here so we’ve got guys that are 50 to 80 percent higher rates of peak vadik sedation than what’s traditionally thought in the literature to be the highest rates that humans can achieve so we’re in many ways going to rewrite textbooks here now here’s their fuel use Fuel use during 3-hr treadmill exercise during three hours of exercise on that treadmill so these are the high carb guys and this is what you would expect they burn about half fat half carbs while they’re exercising these are the low-carb they are prodigious fat burners such that about 90% of their fuels coming from fat and it’s pretty stable across that three hours and that’s really puts them at a huge huge advantage when they’re out running for you know this western states run takes 15 16 hours and the guys who are winning and it’s hard to keep up with eating enough gels and sugar to keep up carbohydrate because your glycogen is gone at that point so the better you can burn fat them you’re in a much better state than than your high carb counterparts okay I guess in the time left I wanted to reserve this time to talk about how do you create a low-carb diet and I hope I’ve convinced you that the science is compelling I mean I’ve just scratched the surface you can sort of study this on your own if you’re not convinced but even so you might be thinking well this is just too restrictive I don’t have the discipline that this is just too much of a compromise that it’s just not doable long term and I want to convince you that that’s probably not the case for most of you in fact I would argue instead of being a restrictive diet that it’s actually a luxurious diet but you Satisfying and Pleasurable have to understand how to construct it so when you do it right it can be very satisfying and pleasurable when they contribute to quality of life but here’s what it looks like it’s very high in fat so you can’t do a well formulated low-carb diet and have it low in fat too because your protein is going to be too high it’s not going to be palatable or sustainable so if you do the percentages we’re upwards of 70 75 % of your calories coming from fat and that that takes a lot for people to get their head around sometimes because we’ve been so just sort of brainwashed into thinking fat is bad and it has to be moderate in protein too and it’s very low in carbs talking under 50 grams a day if you want to be in ketosis on average that may vary from person to person and here’s where those carbs come from so not a lot of room here for pasta and bread and cereals and starchy foods and sugary foods but if you take a look at those types of foods that fall into those categories you’ve actually got quite a bit of variety so that’s what I’ll try to show you some pictures here to get you salivating a little bit but one question that you inevitably get is okay how much do I have to restrict carbs and you know that’s a somewhat of a difficult question because there’s not a straightforward answer that’s across the board appropriate for everyone you might define a level of car herbs that allows you to be in ketosis and again that varies from person to person so you should actually measure it it could be a level of carbs below which your all your signs and symptoms of metabolic syndrome or type 2 diabetes are put into remission and that might be different from person to person it could be a level of carbs below which you’re converting them to fat and we’re developing some biomarkers that tell us pretty accurately that this process is occurring so we’re pretty close to having a commercially available diagnostic test that will tell you this and we have also a diagnostic tests that’s sensitive to carbon deuced oxidative stress so you know you have to sort of operationally define that and and I think it’s best to have some objective measures to do it otherwise you’re kind of on your own to determine what level works for you as far as protein there’s a lot of different sources of protein that you can get in your diet and again it’s not a high protein diet that’s a huge misconception I suppose it could be if you select foods to make it so but that is not the best way to in my opinion formulate a ketogenic diet first of all proteins anti ketogenic so a lot of people who are restricting carbs very low but are not in ketosis it’s because of their proteins too high so that does have to be moderate it’s not low protein but it has to be you know somewhere in the range of 15 to 20 percent on a normal calorie diet or in absolute terms 1 to 1.5 grams per kilogram reference weight not if you’re really overweight you might over predict based on actual weight so fat now fat is where it gets a little little more opportunity here for research I think to get this right but you know you have to make peace with fat but then you also have to decide more than how much fat you eat is I think it’s more important the quality of fat so we know fat is broken into different classes based on their level of so you have saturated monounsaturated polyunsaturated fat and the question is which ones do you emphasize on a low-carb diet now the essential fats are your polyunsaturated fats which include the omega-6 omega-3 you hear a lot about fish oil and the importance of omega-3 fats in in the diets of typical Americans we’re weigh heavy on omega-6 compared to omega-3 and on average we probably get about 10 times more omega-6 to omega-3 and we really need to bring that more into balance but in the context of low-carb now where the majority of your energy is coming from fat still the question is which ones do you emphasize in what proportions now one way you might go about answering that question is to look at what does the body prefer to store because from an evolutionary perspective you would think that body would store the type of fat that it prefers to burn as fuel so if you look at that so if you take a fact biopsy out of people and measure the fatty acids that are there here’s what most adipose tissue fatty acids look like that didn’t actually come through very well but the point here is that the regardless of your diet most people store the predominant type of fat is monounsaturated fat in their fat cells so the body likes to burn monounsaturated fat and saturated fat to some extent whereas puffers are not really stored appreciably in fat cells so what that translates into is that what we’ve sort of learned up from our research is that on a low carbohydrate diet where the primary function of fat in the diet is for fuel you want to emphasize saturates and monounsaturated although they’re essential this the amount that you need to meet your requirements is about a teaspoon of oil per day it’s very low it X more like a vitamin or mineral in terms of quantity for you to meet your essential require and it turns out emphasizing PUFA is not very palatable you can easily become nauseated by over consuming PUFA and moreover the proof of that you do consume you want to try to have a better balance of omega-6 and omega-3 so what does this mean in terms of food well it means to avoid the PUFA and emphasize the mula you need to avoid these common sources of PUFA so the in this graph the PUFA are the sort of tan bars here so it’s the safflower oil the soybean oil the corn oil which these are pretty ubiquitous in our food system they’re the ones that are PUFA they’re the ones you don’t want to emphasize on a low-carb diet so coconut oil is good butters good beef fat yeah olive oil canola oil and there and there is high oleic safflower oil which is good all those are low and poof oh now the good news is if you’re eating animal foods and most other sources of fat are naturally low in PUFA so you might be surprised to learn for example beef beef fat if you have a nice steak actually most of the fat in that steak is is monounsaturated fat oleic acid and that’s the same fat that’s in olive oil so I’m going to wrap up here and just talk to you about the fact you shouldn’t be concerned with saturated fat because on a low-carb diet your body burns the saturated fat and that’s what’s important it doesn’t accumulate in your body so I’m going to go through this quick but here’s the here’s the soundbite you are what you save from what you eat when you’re on a low-carb diet and you just eat the fat with vegetables and butter or whatever your body is burning that saturated fat it’s not accumulating and it’s not associated with harm full effects so here’s all the fat that you can enjoy now see it’s luxurious I told you one other important point about a well formulated low-carb diet is is it of minerals and in particular I’ll just talk to you about salt normally were fearful of salt too so I’m saying on a low-carb diet not only should you eat saturated fat but you need to emphasize salt and here’s why on a low-carb diet you have low insulin levels low insulin changes the way the kidneys handles salt so you excrete more salt on a ketogenic diet and if you don’t replace that salt the body responds by excreting more and you lose blood sodium as well as plasma volume and that in turn causes a lot of the common side effects to ketogenic diets that people complain about or you’re tired you’re lethargic you might get a migraine or headache you’re dizzy maybe even tachycardia high heart rate and people blame it on the lack of cards but it’s because your plasma volumes down your blood circulation is down and you can easily correct that by replacing it with some extra sodium you know if you don’t here’s what happens the body responds with a compensatory response secretes aldosterone and renin-angiotensin and it starts to waste potassium and that causes other problems so you can get into this myth these mineral imbalances but it’s all fixed by adding a gram or two of extra salt so here’s a diet low in carbs I don’t think you’d feel like you’re suffering if you had you know these meals so again I think this is doable fact this is what our subjects tell us here’s some more meals you can have and I’m over time so here’s one of my favorite meals crustless quiche which you can do all sorts of different versions of put it in the fridge it lasts for three four days got plenty of leftovers here’s what’s happening with keto adaptation it’s fairly complex but a lot of benefits here and it’s this concept of ketones as fuel but also ketones as an anti says a as a signaling molecule Ketones, longevity, and compression of morbidity that’s having a lot of positive effects and this is my last slide and I think this is relevant for everyone in the room so you know biochemically ketones and ketogenic diets are mirroring many of the metabolic pathways that we’ve identified as being associated with caloric restriction and longevity so I can’t think of a better approach a better way to go about achieving an anti-aging effect than to consume a ketogenic diet and that’s sort of my my speculation but that’s what a lot of the basic science is leaning toward so thank you for listening sorry I went over a bit I’d be happy to take a few questions the numerical value what is that deal for a ketone level what is the ideal level of ketones well I don’t think we know exactly what you know what level might I mean my range that I gave you for nutritional ketosis is between 0.5 and say 3 or 4 milli molar I don’t know for sure if being at 3 or 4 is better than 1 to 2 I don’t think those studies have been done so it’s hard for me to to say with confidence that that’s the case but I do think being in that range offers a definite advantage in certain ways compared to being less than 0.5 where you’re in non ketogenic state yeah with such an emphasis on fats in the diet was a gallbladder disease sufferers supposed to do what was the last part gallbladder disease suffer Oh gallbladder disease you know it turns out many individuals who have had their gallbladder removed can tolerate a fairly high level of fat in the diet although that probably needs to be determined on an individual basis but we’ve had many patients who’ve had their gallbladders removed and can tolerate a ketogenic diet fine because they’re still producing bile in their liver they’re just not storing it in the gallbladder so they can still manage fairly sizable quantities of fat without any problems is that what you were okay okay in the background hello I have two part question are you familiar with the Paleo diet and what is your opinion if you are yes of course the the Paleo diet has experienced kind of a resurgence in interest it’s probably inaccurate to try and paint the Paleo is one specific diet because people have differing opinions what that means but in general I sort of see it as in a diet that people are advocating that is based on what our ancestors ate but in general I also tend to hear most of the paleo community does not embrace ketosis because they generally include things like sweet potatoes and they avoid dairy because of their belief that’s what our ancestors did which I don’t really agree with that you know to sort of think that our ancestors did not go through periods of being in ketosis would be inaccurate and that ignoring the tremendous research on ketones would be a mistake so I think in general the paleo diets can be very helpful for a lot of people because it’s getting rid of a lot of the problem foods that are sugars and starches so it is a low carb diet but it’s not low enough in general to induce ketosis so you may not be getting the full spectrum of benefits because you’re allowing enough carbs to prevent that metabolic state so hard here I’ll let you pick if we are interested where would we find suggested menus and references I was a co-author on the latest version of the Atkins book which is called the new Atkins for new you it’s published in 2010 I believe 2009 and it was written by two colleagues and myself and it’s I think very you know it’s a very good book it has a lot of practical sort of information including recipes and menus but it’s written at a pretty low level in terms of the science so so if you just want a book that sort of a hand handheld guide to follow the diet I think that’s one of the better books out there and I’m not getting any huge royalties on that make them might make up I might make a penny for a book so that would be probably my recommendation on a practical level we have time for one last question you know wondered if you would comment on the book the green brain yeah I haven’t read the book so I’m afraid I have to you know reserve judgment on commenting on the book so I’m not not familiar with the details it’s grain brain I forgot the name of the doctor the rotted Pearl matters yeah I’m sorry I don’t have it read the book so I can’t comment I’ll have to put it on my reading list thank you let’s thank our speaker one more time
