ketoacidosis diet

so gary, thank you very much for the interview.and, in a nutshell, what makes us fat? in a nutshell, the argument i'm making is prettysimple. it's 'obesity is a growth disorder', just like any other growth defect. the hormoneinvolved is insulin, and if insulin is involved, you have to assume it's the carbohydrate contentof the diet. and... for... 50 to 150 years, depending on how you what to look at it, oralmost 20 years now, there has been this conventional wisdom that carbohydrates are fattening. andthere's evidence that if you take the carbs out of the diet, and replace them with fat,you can lose weight pretty easily, and without hunger and without the kind of deprivationyou feel on other diets. so i would say carbohydrates make us fat. ok. i've talked to some peoplethat are sort of in the 'diet realm', but

haven't investigated it fully. and the firstthing they say when i say, "well, what do you consider about a low carbohydrate diet?"and the first thing they say is, "well, then your body goes into ketosis and that's so,so horrible. you can't possibly live like that!" they're confusing 'ketosis' with 'ketoacidosis',which is a condition you get in diabetes where ketone levels skyrocket. it's like, you know,ketosis is a pretty normal state. i mean, in the morning when you wake up your bodyis secreting, your liver is pumping out some ketones. not as much, so... you know, it'sa kind of knee jerk response that this has to be bad because if your'e an uncontrolleddiabetic your ketone levels will be ten times as high. and... it's a primitive, kind of,response to why this diet must be bad for

you. and you know, again, i'm not arguingthat you have to be in ketosis. i'm saying that carbohydrates are fattening - don't eatthem. one way to deal with that is to do a diet where, again, you increase fat consumptionsufficiently so that you are in ketosis. and if you are overweight, really obese, it'sprobably a good idea to do that. but it's not necessary. yea, the point of the bookis not that everybody should be in a ketotic state. the point of the book is that we shouldn'teat refined grains and sugars, and we'll be a lot healthier. so that's what i'm arguing.so, if you were put in charge of, like, public health policy - you woke up the next morningand you were in charge of u.s. dietary health, what would you do? what's, like, the firstthing you would do? if i was king of the universe,

what would i do? just for the food. i wouldprobably somehow remove sugar from the food supply. sugar and high-fructose corn syrup.and i would do this in part for my children, and all children everywhere. i just... asa parent, it offends me at how difficult it is to buy a food that doesn't have sugar init. and doesn't have far more sugar in it than necessary to make it sweet. and so, yea,if i didn't get rid of sugar entirely i would lower the sugar content of foods by, like,a factor of five. which is probably sufficient. and again, that's speaking as much as a parentof two young sons as it is a person who has done research on nutrition for the past tenyears. ok, well, you've made the argument in your talks that, as far as just the caloricburn from exercise, that's completely... you're

not going to lose weight because of that,and nobody can sustain exercise. but exercise does give you a lot of other benefits... i'mnot... i'm a big believer in exercise. i've been a jock my whole life, i've tried to workout as much as i can. the argument that i'm making is it's not... you don't lose weightby increasing energy expenditure. the clinical trials are pretty clear about that. you cando it temporarily, like on the biggest loser, yea workout 6 hours a day - you'll lose weight.just like you can starve yourself and you'll lose weight. but it's not a sustainable (notthat exercise isn't sustainable), six hours of exercise a day in order to maintain thatweight loss isn't sustainable. and you can't even be guaranteed that the weight won't comeback even though you're doing it six hours

a day. so that's the point. the argument isthat obesity, weight, this excess fat isn't about energy balance. it's about the way yourbody is trying to regulate your fat tissue and fat metabolism. and that's what's gottabe fixed. and you don't fix that by increasing exercise, you fix that by removing the carbohydratesfrom the diet that are driving this insulin secretion. insulin's anabolic effect is notjust limited to fat tissue. it does a lot of other... yea, but you'll get that anaboliceffect from the protein in the diet as well. in fact, one argument... what's interestingis if you do want to eat a ketogenic diet and you workout a lot, the knee-jerk tendencyis to assume 'because i workout a lot i need a lot of protein in the diet', and then theprotein brakes down into amino acids, some

of which are converted to glucose which stimulateinsulin secretion. so if you actually want a ketogenic diet you have to lower your proteinintake as well. and that's why it becomes a high fat diet, rather than a high proteinand high fat diet. but when it actually gets into the minutia of exercise physiology, that'snot my area of expertise. i was just curious about how that [insulin] had other effects.especially, because as far as the health implications of the diet more than just losing 20 or 40pounds... or 200 or 300 or more! or a hundred or 200 or more, as is the case for some people.a lot of the other effects, which are blamed on fat, like heart disease, diabetes, andcancer, especially. i'm just more aware of cancer because people in my family have hadcancer. well, that's what - the argument that

we're looking at here is that all these disordersare associated with obesity and diabetes. so if you're obese or diabetic, type ii diabetic,then you have in increased risk of heart disease and of cancer and of alzheimers, apparently,and so they all have very strong links to insulin, and insulin resistance. and the argumentis, again, that by keeping your insulin levels as low as possible you minimize your riskof these cancers. and this could conceivably explain, again, why isolated populations thatate their traditional diets didn't get cancer, not nearly at anything like the rates we dotoday, and it's because they weren't eating refined grains and sugars and jacking up theirinsulin levels and (sort of) promoting tumor growth, or tumor genesis. so i can make anargument that the ideal cancer prevention

diet is a very low carbohydrate, high fatdiet. is there clinical trial evidence to support that? no. that's a difficult studyto do. that takes a lot of money, because... when you're talking about things like cancer,it takes a long time to get cancer so you need a lot of people in the study and youhave to follow them for a long time, and now you're talking hundreds of millions of dollars...lots of variables. yea, and it's difficult to do the studies right. again, it's arguablethat that's the healthiest diet. and i've met cancer researchers who have told me thatthey're on, in effect, an atkins like diet. it's not because they have to lose weight,but because they don't want to get cancer. so being on that sort of ketogenic diet...what level of carbs do you think is healthy?

you were saying earlier that fruit, you'renot so hot on some kinds of fruit. but... yea. and again, this is where it gets intoquestions that... it depends. one of the ideas that's sort of inherent in this whole lowcarb/paleo diet world is it goes along with self experimentation. so you find out whatlevel works for you, that keeps you lean and keeps you healthy and your heart disease riskfactors under control. but you're content within, perhaps, depending on the kind ofexercise you do, you might decide to up carb intake. i don't know if it's actually necessary,but people believe it is. so, you know, again, if you're a hundred pounds overweight thenyou're looking at a different situation than if you're 15 pounds overweight, or if youare completely happy with your weight but

you want to live the healthiest possible lifestyle.so, again, those numbers are going to differ for everyone. one of the things that i'm alwayscurious about is, "do you have to actually be in ketosis?" do you have to eat less than,like, 50 grams of carbs a day and 100 grams of protein, or, for some people, is that necessaryto lose weight? if so, what proportion of the population is that? we don't know theanswers to that. although those are easier studies to do than the, well, how do you preventcancer studies. i see. do you know how insulin itself effects irisin and leptin, 'cause themore i've personally been looking at this there seems to be this conglomeration of hormonalactions that influence each other. obviously we can directly control insulin to a degreewe can't with others. well, it's actually

conceivable that we can directly control leptin,that leptin responds to carbohydrate restriction quicker than insulin does. that's an argumentthat ron rosedale has been making, and he may be the only one out there who's measuringleptin, at least on ketogenic diets, and seeing how it responds. it is this kind of, i don'tknow if the word 'conglomeration' captures the sort of intricate, complex dance of hormones.like ecosystem? or... yea, i think of it as this almost incomprehensibly complex web andyou pull a little bit here, and it moves a little bit there, and... yea insulin, or insulinand leptin, are things we can control through our diet. so, you know, at some level leptinis secreted in response to insulin, and the blood sugar being moved into, as i understandit, being moved into fat cells by elevated

levels of insulin. how that feeds back oninsulin secretion, and it does, and on insulin sensitivity, is something i would like totry to understand, but i'm not sure the papers are clear enough. at the moment i don't havethe time, it's that simple. yes. so, is there any evidence, because i know that is somemouse trials they have used ketogenic diets to extend life, the lifespan... well the argumentis... how does calorie restriction extend lifespan? most researchers believe it doesthis, in effect, by surpassing the insulin like growth factor signaling pathways, andsome of the other signaling pathways that feed into that, like mtor. so that when youcalorie restrict animals it's the equivalent, in effect, to carbohydrate restricting humans.with animals, putting them on ketogenic diets

gets a little more tricky because they wouldhave consumed mostly low fat diets through their evolutionary history, and now you'reloading them up with fat you get other phenomena that occur from that. what i'm suggestingin my books is that the benefits of calories restriction in animals would be mimicked inman by carbohydrate restriction, just suppressing insulin and igf as far down as it would go.but if we are going to de-accelerate aging by doing that, then i'd better start seeingeffects soon. or getting more sleep, one or the other. one last question. based on yourpersonal experience, and what you've read, if somebody wanted to start a ketogenic ora low carb diet, do you think they should taper down, or just completely switch, or...that's an interesting question, and again

it depends on the individual. i do tend tothink of this in terms of cigarette smoking, because i used to be a smoker. on one levelyou could argue that i tapered down for a decade before i successfully quit. and infact i went from smoking cigarettes to little cuban cigars that i would only smoke foura day, even though it had the nicotine of, like, three packs of marlboro's. ultimately,you end up going cold turkey. so i'm just not sure really, which - it might depend onthe psychology of the individual, it might depend on the physiology of the individual.it could just be that the easiest thing to do would be to give it all up. in this dayand age you would never tell an alcoholic to 'taper down', i mean alcoholics try todo that all the time. it's usually, "i'm trying

to quit. i'm only drinking wine these days",and it invariably fails. as a former smoker i tapered down, like i said, for decades beforei finally quit. but eventually you just have to go cold turkey. again, i could argue iteither way. i have a friend, a colleague, that thinks tapering down is the way to doit because that's how he did it. but i could argue that cold turkey may be correct foreveryone else. had he tried cold turkey, it might have worked equally well. this is thekind of thing - if we ever win this battle, we get the medical research establishmentto accept that it's carbs that are the problem, all those psychologists who are right nowtrying to get obese people to eat less and exercise more could actually be put to usetrying to do studies to figure out what are

the best ways to restrict carbohydrates, andto ameliorate the psychological side effects of doing this. the dependency. the dependency,yea. all those people who study addiction, instead of thinking about it as food addiction,could think about it as carb addition, or sugar addiction. and actually do somethinguseful. all right. gary, thank you so much for your time. thank you, aaron.