Dr. Stephen Phinney on the Safety and Benefits of a Ketogenic Diet (Part 2)

– Nutritional ketosisis a very powerful tool. And it can be used to achieve metabolic state andwell-being in people who have maladies associated with insulinresistance or rash. Now, there are lots ofmyths and misconstrues about ketogenic foods andabout nutritional ketosis and I wanna really focuson the technical proof around safety and efficacy ofthis approach to nutrition. And I realize it’s hardfor people to commit to this kind of endeavor ifpeople around you are saying, “Oh, this is dangerous soyou shouldn’t be doing it.” So you need to be confidentthat if you accept this that you’re doing it in asafe and efficacious way.In study after study, not just ours but others, a well-formulated ketogenicdiet when compared to a standard calorierestricted low fat diet has a greater effect on weight loss and particularly loss ofabdominal adipose tissue and it’s the adipose tissue ora fat mass within the abdomen that is the most dangerousfat that we carry in our mas. For speciman, a study thatI did with Dr. Jeff Volek and Dr. Cassandra Forsythe, one of his graduate students, we equated a high carbohydrate low-fat calorie limited dietto a ketogenic diet that beings followedwhere their teach was to eat to satiety, that is not count calories and don’t curb calories but munch enough to feel like they had had enough food and they weren’t hungry.And we led studies and research for 12 weeks. And at the end of 12 weeks, the weight loss in the high-pitched carbohydratelow-fat group was about half the weight loss in theketogenic nutrition group. Now, some connoisseurs willsay that well, when you go into ketogenic diet, a lotof your weight loss is water. But we actually did carefulmeasurements of body fat and the sea loss on the ketogenic nutrition was exclusively about 1/5 of the difference so five kilograms on thecarbohydrate rich low-fat diet and 10 kilograms on the ketogenic food and simply about 1/5 ofthat difference was ocean, the remain was organization solid. More importantly, we usedthe dual x-ray absorptiometry so announced DEXA technique tomeasure body fat content. There is a significantly greater reduction in abdominal fatty, soit’s not just total solid, it’s not fatty from under the skin, but it’s some of the most dangerous overweight is more rapidly mobilizedwhen someone gets the ketogenic food right.The next most common effect is for people who have either slightlyor markedly hoisted blood glucose levels, soeither prediabetes or diabetes, a prompting response of the ketogenic nutrition is a reduction in blood glucose. Now, that concludes sense becauseif you gobble less carbohydrate in a diet, there’sgoing to be less glucose produced by digestion andthe level of sugar coming into the blood is gonna be reduced, that’s what we commonly find. Nonetheless, in Dr. Forsythes study … Now, these are parties with prediabetes but their blood sugars arestill slightly hoisted. We discovered a marked reduction in blood glucose in the people on the ketogenic food and no change in bloodglucose in the people who were on the highcarbohydrate low-fat diet. What’s more interestingis that we also calibrated blood insulin status. And insulin’s a hormone thatmakes glucose go into cells, so if the blood sugarcame down, you’d think that the body was forming more insulin to make it go into the cells. But it was the opposite of what we saw.And that is that insulinlevel came down dramatically, blood glucose came down. And the only way you canmake sense out of that is that the ketogenic dietimproved insulin sensitivity, that is the body’s responseto any one molecule of insulin is markedly greater. And that’s a consistent observe we’ve seen across numerou studies and that’s the findings and conclusions thathas cause us to the concept that we can actuallyreverse the root cause of Type 2 diabetes. Another effect of awell-formulated ketogenic food is to change the blood lipid costs that are characteristicof metabolic ailment. And, by the way, metabolicsyndrome is too referred to as prediabetes.Typically we’d see with metabolic condition a reduced good cholesterol, an increasing number of triglycerides and a greater proportionof the small dense or bad LDL cholesterol. And when we looked at that in this cohort, we looked that triglycerides sunk. Now, they was downed in both groups but they went down more than twice as much in individual patients on the ketogenic nutrition. And by they way, theywere feeing more fatty, and hitherto the blood flab levels sagged. HDL exited up about 13% which is greater than anyHDL response we can get from any treats that we have available, that we can write as a drug. So this is a pretty much unique benefit to a well-formulated ketogenic nutrition. And then the small dense LDL which are the most dangerous didn’t go down.If anything they wentdown somewhat in the group who were eating the high-pitched carb low-fat diet and went down aggressively in the group on the ketogenic diet. So again, all the lipid alterations are going in the right direction infavor of the ketogenic diet. So again, the concern abouteating a high fat nutrition, chewing maybe eggs and meat and dairy which contains cholesterol, the actual, the cholesterol in the blood and the blood lipids arechanging all in a beneficial course when one does this nutrition right. If you’re eating low-spirited carbohydrateand moderate protein, the majority of your dietarycalories is just coming up solid. And a good deal of the fatsthat people eat normally come from animal commodities or from dairy and chocolate butter and things, who the hell is saturated fats.And so the question is iseating a lot of saturated solid risky when you’re on a ketogenic nutrition? And the reason peoplepropose it as dangerous is that we know that whenyou quantify blood the different levels of saturated fatty, thatthe higher the blood level of saturated solid, thegreater the risk of diabetes, a heart attack and overall mortality. And so if you assume thateating saturated offsets establishes the blood rank come up, that would suggest this is dangerous. But beings hadn’t everactually looked at what happens to the blood levels with saturated solid when they’re going toketogenic food, we are therefore did. And what the hell is experienced was, even if they are, the person or persons on the high-pitched overweight diet, the ketogenic nutrition were feeing three times asmany grams of saturated solid per period, their bloodlevels of saturated fat actually were lower than the group eating the lower saturatedfat intake high carb diet. And again, this is a head scratcher. It appears that we’ve disconnected intake from blood positions. And that infringes the lawthat all dietitians tell you that you are what you eat. In actuality, you are whatyou save from what you eat.And the neat thingabout the ketogenic nutrition is it learns your organization toburn overweight more efficiently. How effectively? Well, we did a study where we looked at highly trained athletessome of whom were following a traditional high-pitched carbohydrateloading diet regimen and the other half of them “ve been following” a well-formulated ketogenic food. And these people had beenfollowing these diets for at least six months or longer, which means that theywere fully keto-adapted for the ones on the lowcarbohydrate or ketogenic nutrition. And when we looked at the resting proportion of solid oxidation, it was about double as much on the low carbohydrate ketogenic diet as it was on the high carbohydrate diet. So again, highly trainedathletes, theoretically, their bodies are highlyconditioned to burn overweight for fuel during activity and hitherto, only the difference of diet doubled their own bodies’ abilityto burn fat for fuel. And then as they … We had them do greater andgreater levels of exercise, the people on theketogenic diet revealed remarkable ability to use overweight for fuel.The competitors like thatbecause they can run on body fat collects muchbetter than trying to eat and laden with carbohydrate which means that when you’re keto-adapted, your form has a capability ofgetting rid of saturated fat and so the amount youeat is not important, it’s how much your bodysaves from what you eat. And clearly, the bodydoesn’t save saturated solid when you’re keto-adapted, which meant that saturatedfats are not dangerous when eaten, if you’re keto-adapted. Another very importantarea of current experiment is in the topic ofinflammation because we know that when we measurebiomarkers of rednes, and there have beensome that we’ve weighed over the last century, like white blood cell count and some that are morerecent additives to our ways of measuring inflammation. That those levels predictthe later onset of cancers like coronary thrombosis, Type 2 diabetes, Alzheimer’s disease and manyof the common forms of cancer.And so in make the studywith Dr. Volek and Forsythe, we really measured everybiomarker we could think of and we came up with 14 differentbiomarkers of sorenes. And when we compared them for the inhabitants of the high carb dietversus people adapted to the low-grade carb high-pitched fat nutrition , none of the levels ofinflammation went down more in the people who were onthe high-pitched carb low fat diet. In contrast, 7 of those 14 were significantly reduced for the person or persons on thewell-formulated ketogenic diet.That is on average therewas a marked reduction in inflammation with theketogenic diet, indicating that this has a wide-rangingantiinflammatory impression. Now, up until recently, that’s been what the hell is scientists call a phenomenon. We see it’s happeningbut we don’t know why. And it turns out thatthere is a particular gene, it’s kind of like a traffic policeman gene, it regulates the flow oftraffic around sorenes. And this gene is targeteddirectly by the ketone that we have circulating … A primary ketone in our blood which is called -hydroxybutyrate, or BHB. And this is a place whereketones talk to your genes and your genes turn downthe heat, if you will, through a adjusted series of events to reduce inflammation of the body and that has the likelihood ofhaving very positive effects not just on reducing insulin resistance but also shortening other commonchronic diseases, as well. Now we not only know thatthe inflammation goes down, but we know why it goes downand why it is so effective and even modest levelsof ketones, the levels that you achieve merely byrestricting carbohydrates to less than 5% of total caloriesand stopping protein moderate.We’re doing a study withIndiana University Health where we banked over 260 parties with Type 2 diabetes and put them on awell-formulated ketogenic nutrition. This study will be going on for two years, but I want to show you merely the early data from the first 10 weeks of studies and research. All these people had thediagnosis of Type 2 diabetes. Some were poorly controlled, some were pretty well controlled, some were very tightly verified. So we divided the biomarkerof diabetes assure announced hemoglobin A1c or HBA1c into high levels, intermediate degrees and well controlled elevations. And in all three cases, after 10 weeks, there was a reduction inthe level of hemoglobin A1c and this effect was greatest in the people who had the highest levels. So people who had the poorestcontrol of their diabetes got the greatest effect, butall three radicals have implications. And the result was that overhalf of these beings moved from having hemoglobin A1clevels in the diabetes range into the non-diabetes range. What’s really intriguing is normally in medical care diabetes, youget better glucose control by opening people more drugs.In this case, we tookaway most of the medications from five of the seven classesof diabetes medications. And the two most dangerous which are insulin and sulfonylurea, those are the two class of drugs that are most likely to cause hypoglycemia which is probably the mostthreatening side effect, short-term side effectof in diabetes control that we either stopped or markedly abbreviated the majority of thosemedicines in these patients. And so here, again, we have the absurdity, little medication, better domination. And the reason we can get better control with less drug is -hydroxybutyrate in ketones, in general, speak to the genes andchange basically how the body affairs, including changing how the body responds to insulin so the bodycan get much greater benefit from far less insulin.And then as a side effect of this, again, we told parties to eat to satiety. It restraint carbs, protein in moderation, as much fatty as they needed, and again, there is an opportunity leant butter on their meat, they can positioned butter ordressing on their vegetables and dip with vegetables, things like that. And so they were eating to satiety, and hitherto 75% of these patients lost more than 5% of their body weight. And on average, the body weight loss was as a little bit over 7 %. And that was just in the first 10 weeks. At six months in this cohort, the weight loss started from 7% to 12%. So this is not a short-termquick loss and then regain, but it appears to be asustained long-term effect. Because, again, people whoare six months into our study are doing the same thing wetold them to do at the onslaught and that is limit carbohydrate, protein in moderation, ingest paunch to satiety and thatgives the body permission to burn a lot of torso fatstores because the body has become so efficientin burning fat for fuel.Just to mention otherconditions that we’ve seen that show improvementwith the ketogenic food, merely general muscle andjoin aches and anguishes. Petulant bowel syndrometypically to do better. Polycystic ovary syndrome in dames. Beings with migraine, headaches mention that either their frequency is down, the vigour is down and somepeople get complete remission of their migraines when theyget the ketogenic food right.As we demo from thestudy of Dr. Forsythe, metabolic ailment orprediabetes has improved along with that liver overweight grades go down which is a side effect ofpoorly ensure diabetes. And we see improvements in fluid retention and blood pressure, as well. This is a very powerful tool. It can have very beneficial effects on a number of chronic conditions, but when a person’s taking medicines for these chronic conditions, those beneficial effects often mandate a sharp-worded and rapid reduction in medication. And that can be dangerous, unless you have the assistance of a physician whounderstands this type of diet and understands how tomanage the drugs. This cannot done in order to a informal style, you can’t start a food and goback and see your physician six weeks later and say, “Sowhat do you think I should do with my diabetes remedy? ” Because typically wehave most of the changes in the first six days whenpeople get the diet right. The concern is finding adoctor who understands this and that is sometimes difficult, but we see increasinginterest in specialists, so if you examine carefully, you can probably find someone who can help you, if youneed that kind of assistance when you’re followingthis type of regimen.So again, for our judgment is a well invented diet is not only safe but it can be very effectivein reversing disease. These impressions are so powerful. Nonetheless, this has to be startedwith careful monitoring. Stated in this directly, you have to find a physician who can help you manage your remedies in the proper way that thisbe done where the benefits far outweigh any potential risks involving changes in medication use ..


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