9

Ketogenic Diet Expert Dr. Jeff Volek – CHTV 104


Meredith:Welcome to Cellular Healing TV.
This is Episode 104, and I have Dr. Pompa
here, and we have special guest Dr. Jeff Volek
on the call.
We have an awesome topic for you guys today,
and we’re going to be talking about the
Ketogenic Diet.
And how it not only can impact disease and
improve our health, but also impact our athletic
performance.
So that’s a subject we haven’t really
delved into a lot on the show yet so really
exciting topic.
Before I introduce Dr. Volek, I’d like to
read his bio, so you guys can learn a little
bit more about what he’s doing.
So Dr. Jeff Volek is a registered dietician
and professor in the Department of Human Sciences
at Ohio State University.
For the last two decades he’s been performing
cutting-edge research elucidating how humans
adapt to diets restricted in carbohydrates
with a dual focus on clinical and performance
applications.
His work has contributed to the existing robust
science of ketones and ketogenic diets, their
use as a therapeutic tool to manage insulin
resistance, plus their emerging potential
to augment human performance and resiliency.
This research indicates that well-formulated
ketogenic diets result in substantial improvements
in insulin resistance and the myriad of cardio-metabolic
biomarkers associated with metabolic syndrome,
cholesterol, and lipoprotein profiles.
He’s also performed seminal research on
a wide range of dietary supplements that can
augment performance and recovery.
He’s accumulated an enormous amount of laboratory
and clinical data as it pertains to biomarker
discovery and formulation of personalized,
effective, and sustainable low-carbohydrate
diets.
His team is currently exploring the role of
nutritional ketosis induced by and/or supplements
to: 1) reverse type-2 diabetes, 2) alter gut
microbiota, 3) favorably impact tumor metabolism
and help outcomes in women with advanced breast
cancer, and 4) extend human and physical and
cognitive capabilities in elite athletes and
military personnel.
Dr. Volek has secured several million dollars
in research funds from federal sources, industry,
and foundations.
He’s been invited to lecture on his research
over 200 times at scientific and industry
conferences in a dozen countries.
And his scholarly work includes 300 plus peer-reviewed
scientific manuscripts and 5 books, including
a New York Times Best Seller.
So a very impressive bio, and welcome to the
show, Dr. Volek.
Thanks so much for joining us.
Dr. Volek:Thank you, Meredith.
Pleased to be here.
Dr. Pompa:Yeah.
Yeah.
Hey, Jeff, yeah, and I just want to thank
you myself.
Yeah, I said years ago, I read this.
We think 2011, 2012, and if you look through
it, oh my gosh, all the notes and the studies.
And it was just one of the best studied and
referenced books on low-carbohydrate diets
and ketosis that I have ever read.
So this is one of many.
But thank you so much for the research you
do.
I don’t know if I should call you professor
or just call you Jeff.
Dr. Volek:Please do, yes.
Yeah, first name basis.
Dr. Pompa:Okay.
But yeah, Jeff, we have a lot in common that
I’m on one side teaching doctors around
the country to do what we do, and ketosis
is a tool that we use in conditions that you
study from diabetes, to heart disease, to
fixing the gut, which you mentioned the microbiota.
We utilize ketosis in so many ways, and so
I’m sure we’ve referenced a lot of your
research.
So with that said, I have to ask you.
I mean, that’s been the area of study for
you for the longest time.
I mean diabetes and heart disease.
Speak just a little bit about that.
Because I believe that, especially with heart
disease, most people would think a high-fat
diet would be the cause of heart disease.
Jeff, we grew up in the time where saturated
fat was evil, and cholesterol is still evil,
and it was a cause of heart disease.
Your research shows the opposite.
Dr. Volek:Yeah, well, first of all, thanks
for having me here, and I’m very pleased
that you enjoyed the book.
We actually wrote it for physicians so my
colleague and I, Steve Phinney, and other
healthcare professionals, including dieticians,
and nurses, and really, any educated folks
that are interested in nutrition.
And we wrote it primarily because the ketogenic
diet is not taught in any curriculum and,
really, anywhere.
So we wanted to give people information about
the science and also the art.
Because it really transcends the science in
many ways when you get into the weeds in how
you would actually implement this.
So I’m glad you thought it was helpful and
useful.
So, yeah, in regards to the issue of diabetes
and heart disease, I guess I’d like to start
and just talk a little bit about the history
of this problem.
Because I think people may be generally aware
of where all this started and where we’re
at.
But just briefly, the first Dietary Guidelines
came out in 1980, and that really started
the low-fat diet-heart hypothesis, and the
offspring of that was, of course, the low-fat
diet.
And so we’ve now got 35 years of this paradigm
that we have—or experiment, if you will,
that we began in the 80s or, really, the 70s
with Ancel Keys prior to the Dietary Guidelines.
Dr. Pompa:Yeah.
He’s the one who wrote saturated fat.
Dr. Volek:Exactly.
And so if you think of this as a massive experiment
in Americans, you look at what’s happened
today.
Two-thirds of adults in the U.S. are overweight.
One-third are obese.
Now this is staggering.
Fifty percent of adults in the U.S. have prediabetes,
and so we just have this massive suffering.
And it really extends beyond that.
There’s a financial burden on this.
We spend about $300 billion today just managing
diabetes alone.
So I think it’s time to stop this experiment.
The problem is no one’s really wanting to
be accountable, and we’re still fighting
the government, USDA, and Dietary Guidelines
which are trying to continue to promote this
low-fat paradigm and demonizing saturated
fat, demonizing meat, and all the dogma that
we’ve been hearing for 35 years, which just,
quite frankly, hasn’t worked at all.
It’s been an epic failure, and you need
to—we need to embrace, really, 15 solid
years of research that has been supporting
an alternative approach which is really focused
more on reducing carbohydrate and finding
a—for each person, finding their correct
level of carbohydrate that matches their tolerance,
and that’s really what we should focus on.
But that doesn’t get reflected in any professional
organization, any of their position statements,
or any of the Dietary Guidelines.
So that’s what’s frustrating from my perspective.
Because there’s been a lot of great scientist
and researchers publishing work in this area,
and it’s being ignored.
Dr. Pompa:Yeah.
Dr. Volek:And we need more physicians like
you that are challenging the dogma and going
against the grain, literally.
Dr. Pompa:Yeah.
Yeah, I mean, it’s interesting you say that
because, really, it’s new to humans the
amount of carbohydrates that we’re eating.
I mean, if you look back at the history of
humans and the diets they’ve eaten, I mean,
this is a new thing, high-carbohydrate diets.
I mean, even the amount of grain or just even
grain in the human diet is really a new thing
when you look at the evolution of humans.
It really is, Jeff.
And do you believe that some of the increases
in diabetes and heart disease are because
of what we’re doing, the amount of carbohydrates
we’re eating in a modern diet?
Dr. Volek:Absolutely.
So the diet-heart hypothesis and the low-fat
diet was intended to lower cholesterol which
in turn was supposed to lower risk for heart
disease.
But what happened, it really backfired, was
that as people were trying to restrict fat,
they replaced those calories with more carbohydrate,
including a lot of sugar and processed carbohydrates.
And so instead of lowering cholesterol and
reducing heart disease, what we did is we
created an epidemic or, really, pandemic around
the planet of prediabetes and diabetes, which
in turn is a strong risk factor for heart
disease.
So we have this unintended consequence of
over emphasizing restriction in fat that has
really caused this unintended consequence
of metabolic syndrome in diabetes.
And so we really need to rethink the whole
process and paradigm, and in my mind, it’s
overconsumption of carbohydrate relative to
a person’s tolerance that is driving almost
all chronic disease, including diabetes, heart
disease, and probably cancer, and Alzheimer’s,
and Parkinson’s.
Dr. Pompa:Yeah.
Dr. Volek:And you can really have remarkable
effects when you back off on the carbohydrates.
How much do you need to back off?
That gets into really complex issues, but
at least getting that message across to folks
I think would do a great deal of benefit for
a large number of people, and give them—empower
them or enable them to be able to eat more
fat and restrict carbs does a tremendous amount
of benefit to your health.
Dr. Pompa:Jeff, when I read—and by the way,
folks, this is “The Art and Science of Low-Carbohydrate
Living,” and then the other book that I
tore up of yours is “The Art and Science
of Low-Carbohydrate Performance,” which
is the white book that I was digging for.
I think I leant it out, and there’s all
my notes in there.
I better get it back.
But anyways, in this book, I remember you
stating that some of the criticism with a
high-fat, or a keto diet, or even just a low-carbohydrate
diet with heart disease I think was the critique,
maybe even diabetes, when you looked at the
studies and me too of what they called a low-carbohydrate
diet, for you and I, it would either be a
moderate-carbohydrate diet or even a high-carbohydrate
diet.
I mean, some of these studies, Jeff, that
I saw were looking at carbohydrate diets 180,
200 carbohydrates daily.
Now, to me, that’s a high-carbohydrate diet.
What’s your take on that?
Dr. Volek:Oh, absolutely.
I think everything’s relative.
So if they were eating 400 grams, then maybe
they get some benefit by going down to 200.
But for many, many folks, 200 is nowhere near
low enough to really regain metabolic health.
And so most of my work over the last two decades,
we’ve been looking at diets that are under
50 grams per day, and for most people, that
induces a metabolic state of nutritional ketosis.
And we continue to learn more about just incredible
health benefits associated with being in a
state of nutritional ketosis.
And so very few of these studies that you’re
referring to had carbohydrate levels low enough
to induce ketosis, but the ones that have,
the results are just absolutely remarkable
in terms of reversal of diabetes, improvements
in all sorts of cardio-metabolic risk factors.
And as you were alluding to, even on the endurance
side and performance side, there’s even
evidence now that that may be more optimal
for certain athletes.
Dr. Pompa:Yeah.
Talk about some of the improvements that you
see with diabetes and heart disease.
Because a lot of folks watching our shows,
obviously, they have those concerns, and we
utilize ketosis as a tool in those conditions
and, obviously, others.
I mean, we’ve had conversations with Professor
Seyfried about cancer.
But talk a little bit about those because
you’ve studied a lot about diabetes and
heart disease.
Dr. Volek:Well, if you can get a person that
has diabetes into nutritional ketosis—and
we can certainly do that.
I don’t want to trivialize it, but I also
want to make the point that a ketogenic diet,
although it’s less than 50, probably less
than 40 grams for a type-2 diabetic to induce
ketosis, that actually has quite a bit of
variety in it.
It’s not a burdensome diet.
Dr. Pompa:Yeah.
Dr. Volek:You’d be absolutely amazed at
how much variety and how pleasurable and palatable
a ketogenic diet can be.
So we can certainly get these diabetics to
consume this type of diet, and not just short-term,
on a long-term basis.
Dr. Pompa:Yeah.
Dr. Volek:And when you do that, we can normalize
hemoglobin A1c in blood sugar levels in the
vast majority of people with diabetes in three
to six months.
Dr. Pompa:Yeah.
I’ve done that as well, Jeff.
Dr. Volek:So that in and of itself is remarkable,
but the other really important part of that
is we do that while they’re getting off
medication and while they continue to lose
weight because most of them are also overweight
or obese.
Dr. Pompa:Yeah.
Dr. Volek:And that’s exactly the opposite
of what happens when you try to really control
blood sugar using standard of care, which
is to give more medication.
And when you give more insulin and more diabetes
medications, the side effect is weight gain,
and we know that there’s a lot of other
undesirable effects of overmedicating to control
blood sugars.
So there’s really [00:14:35] an incredibly
powerful tool that is getting diabetics off
medication, allowing them to lose weight,
and normalize their condition.
So that’s really powerful.
I mean, we spend four times as much money
managing diabetes as we do cancer, but it
doesn’t seem to get the same attention.
And just the level of suffering in this country
and, really, around the world, this is not
something that’s isolated to the U.S. by
any means.
All developed countries are suffering from
increases in diabetes and obesity.
So this is something that can be employed
around the planet to help our colleagues across
the sea, and China, now, has 100 million people
with type-2 diabetes.
India, I think, has similar levels.
So this is something that’s affecting over,
really, half the population has some level
of diabetes, whether that be pre- or full
on type-2 diabetes.
Dr. Pompa:Hey, Jeff, speak a little bit about—because
we had a conversation with Professor Seyfried
about cancer, and he always says the key is
lowering glucose, right?
If you don’t lower glucose, people don’t
lose weight.
If you don’t lower glucose, tumors don’t
shrink.
So as glucose drops, ketones rise, and I—my
doctors and myself, we realize that, and even
people that are on a—in a keto diet, if
we don’t see a drop in glucose, we seem
to see no weight loss.
So we have noted that restriction is very
important to often times get the glucose down.
Some people—most people that are healthy,
when they go into a keto diet, they start—their
appetite starts to go down as they become
more efficient fat burners.
But that doesn’t happen for everybody, and
therefore, often times their glucose doesn’t
drop because they’re still eating, perhaps,
too much.
What’s your thought on that?
Dr. Volek:Yeah.
I think there’s a lot of, perhaps, holes
in our knowledge here, but our experience,
when you really get the diet correct and the
term I like to use is a well-formulated ketogenic
diet, glucose does normalize in most people.
A lot of people run into problems when they
overconsume protein, and protein can get converted
to glucose and actually inhibit ketosis.
What we find is, when people are keto-adapted,
keto-adaptation is a process that takes at
least several weeks.
Maybe in certain pathways it may take months
or even years to fully keto-adapt.
But one of the most profound metabolic adaptations
to keto-adaptation is you switch fuel to almost
exclusive reliance on fatty acids and ketones.
And the corollary to that is you also significantly
reduce glucose flux or glucose uptake in the
cells.
So when we measure, for example, respiratory
quotient in people who are keto-adapted, they
are at close to .7 or .71, which is an indication
that they’re burning 90% plus of their energy
from fat, and that implies also that there’s
a significant inhibition of glucose metabolism
in uptake in the cells.
Now a lot of people don’t quite—they flirt
with that keto-adaptation, so they’re not
quite there, and I think those are the ones
where the glucose trickles up.
And they—I would imagine—and we haven’t
studied this, and I don’t think there’s
a lot of direct evidence.
But I would imagine you’re not going to
get the full benefits in cancer unless you
become fully keto-adapted and reduce that
reliance and uptake of glucose in cells, and
I think that that’s what Tom has really
got his finger on well.
That to get the full benefits of ketosis—I
mean, we know ketones in and of themselves
have a lot of important cellular effects that
extend beyond just being an alternative fuel
for the brain, which is what the standard
function of ketones are.
But we know now that they’re having potent
drug-like effects or hormone-like effects
in cells that are turning on pathways that
are related to protection from oxidative stress,
for example, that are the same pathways that
are upregulated in the studies that have looked
at longevity and anti-aging.
And so having the ketones is important to
get those signaling effects.
And then the flip side is having low glucose
is equally important, especially for the tumors
that are relying on glucose for fuel.
So I do think Tom really has this right where
it’s the combination of both.
You got to have ketones high, and you got
to have glucose low.
And how we best do that in people I think
we’re still trying to figure out.
Because now we have ketone supplements we
can give people.
There are many different versions of ketogenic
diets that people can play with, and which
ones are ideal for certain types of cancers
and so forth, in humans anyway, we don’t
really understand this very well.
Dr. Pompa:Yeah, we have noted that when we
get the ketones up, the glucose down, that’s
where the magic does happen, right?
Dr. Volek:Yeah.
Dr. Pompa:It’s the ketones turn off bad
genes.
The ketones down regulate cell inflammation.
The ketones do decrease that oxidation, and
then, likewise, the lower glucose, same thing.
So it’s such a win-win, and I always give
three reasons why.
If someone’s not getting into ketosis or
not losing weight, they could—obvious, they
may need to lower their carbohydrates more,
right?
I mean, everyone’s genetically different.
Some people can get in at 50.
Some people, I’ve had people get in at 80,
for goodness sakes.
Some people have to drop it down to 20 or
30.
So that’s a factor.
Second factor you mentioned, eating too much
protein.
Gluconeogenesis, it can turn to sugar.
I’ve seen that as a factor.
In some people, just consuming too much food.
They’re just simply consuming too much food,
and Tom talked a lot about that so three reasons
for people to look at if they’re not getting
the results.
And then, Meredith, you had a question.
Because gender, right, some women have trouble
crossing in, especially in the beginning.
Sometimes I have to move them in and out of
trying to get into ketosis before they break
in.
So gender, does gender play a role, Jeff?
Dr. Volek:Well, I think, yeah, it can.
But our experience is it’s more related
to the level of insulin resistance.
Dr. Pompa:Yeah, okay.
Dr. Volek:So if you have any person, whether
male or female, the higher the level of insulin
resistance, generally, the more difficult
it is to get them in ketosis and the longer
it takes to keto-adapt.
Dr. Pompa:What about the…
Dr. Volek:Importantly, they eventually do,
and that’s what’s really important here.
That no matter how insulin resistant you are,
you retain this metabolic pathway to adapt
to ketosis.
It’s so ancient.
It’s part of our—it’s just so—a huge
part of our human evolution, and it’s almost
always perfectly intact, even in the most
profoundly insulin resistant people, because
burning fat and oxidizing ketones is not dependent
on any of the insulin signally pathways.
So that’s what’s so really elegant about
this tool is it works great in people with
insulin resistance.
It makes them completely able to have ideal
fuel flow, even though they may remain insulin
resistant.
Dr. Pompa:What about thyroid resistance?
Obviously, just general hormone resistance
but we’ve noted, as physicians doing this,
that our thyroid people, like diabetics, have
more trouble getting in.
However, you said it best.
Eventually, they will.
But speak to that a little bit.
Dr. Volek:Well, in general, what we’ve seen
is that sensitivity to many hormones increases
when you’re keto-adapted.
Dr. Pompa:Right, correct.
Dr. Volek:That’s clearly the case with insulin.
You often improve the insulin sensitivity
in folks.
We’ve also seen that with leptin.
That leptin goes down markedly in folks, and
it’s disproportional to the fat loss.
So to me, that’s suggesting an improvement
in leptin sensitivity.
And then we also see a consistent drop in
thyroid hormone, and I think there’s been
a lot of misinterpretation and misinformation
propagated around the thyroid hormone responses
because we see absolutely no functional evidence
that there’s any signs or symptoms of hypothyroidism.
So metabolic rate doesn’t go down, and people
aren’t cold and dry skin and all these types
of things.
So to us, that is an indication that people
are just more sensitive to the thyroid hormone.
So they can get by with having less circulating
T3, and still maintain their metabolic rates.
So I think in those three examples, they all
point to more efficient hormonal regulation
of cellular processes.
So you don’t need to have as much hormone
around.
Dr. Pompa:Jeff, I couldn’t agree more.
I believe hormone sensitivity is the key.
We have most people walking around, even non-diabetics
or even not even diagnosed as pre-diabetic,
still having to many insulin and glucose spikes,
which decrease the sensitivity of hormones.
In vogue today is giving more hormones, whether
it’s thyroid, whether it’s estrogen, testosterone.
That’s in vogue.
But I always say it’s like shouting at the
kids.
Eventually, they start hearing you less.
So giving more hormones often times is needed.
However, most often, it’s not the answer.
The key is becoming more hormone sensitive
at the cell, and that’s what I just heard
you say.
Dr. Volek:Yeah, absolutely.
I think we’re entirely on the same page
there.
Dr. Pompa:Yeah.
I really appreciate that.
So Meredith, I know that you’ve had some
other questions, and I do want you to speak
a little bit about some results about heart
disease.
Because I think there’s a misconception
that these diets are potentially bad for heart
disease, but Meredith, you had a question
on that before we leave that topic.
Meredith:Well, I don’t know.
Actually, I don’t think I did.
I have a lot of questions about the impact
of the ketogenic diet on athletic performance.
So I think once we shift over into that, if
you want to speak to your results on heart
disease, Dr. Volek, that’d be wonderful,
and I’d like to have a conversation on how
it impacts our athletic performance too.
Dr. Pompa:Yeah, great.
Dr. Volek:Sure.
Well, a lot of our work over the years has
focused on understanding cholesterol and lipoprotein
metabolism.
And that is extended into looking at fatty
acid composition, and that’s gotten us into
looking at saturated fat metabolism when a
person is keto-adapted.
And what I can say is that almost every biomarker
of cardiovascular risk improves on a ketogenic
diet.
Dr. Pompa:Yeah.
I agree.
Dr. Volek:And you can just go down the list.
Triglycerides plummet.
HDL goes up in most people, or in some, it
stays the same.
But it’s still a more potent tool than exercise
and weight loss or any drug, really, in terms
of the triglyceride decrease and HDL increase.
So those are obviously positive.
As the inflammatory markers get better, it’s
a potent anti-inflammatory diet.
Oxidative stress goes down.
Now the one response that gets a lot of physicians
nervous and anxious is the LDL cholesterol
response.
Dr. Pompa:I was going to ask.
Dr. Volek:And we spent a great deal of time
studying this.
The reality is if you look at LDL cholesterol,
I mean, I think, in general, we’ve overstated
the importance of LDL cholesterol, and that’s
largely been driven by greedy drug companies
that want everybody to be on a statin.
Dr. Pompa:Yes.
Dr. Volek:But let’s just assume for a second
LDL cholesterol may carry some increased risk
of heart disease.
What you’d see, though, is about half the
people show an increase in LDL, and the other
half show a decrease.
Dr. Pompa:That’s right.
Dr. Volek:But there’s probably about 10-20%
of individuals who show quite a marked increase
in LDL cholesterol.
Dr. Pompa:Yes.
Dr. Volek:Saying over 50 milligrams per deciliter,
some people even higher, and that really alarms
people.
And I get emails every day almost from people.
Should I go on a statin?
My doctor’s going crazy.
So this brings us to an important topic around
LDL cholesterol in that we now have very good
evidence that LDL cholesterol is a heterogenic
particle.
Meaning there’s a lot of different types
of LDL cholesterol that range in size and
range in density and composition.
Dr. Pompa:That’s right.
Dr. Volek:And we have very, very good evidence
now that the small LDL particles are the ones
that are most atherogenic, and these—it’s
many reasons.
They have a longer residence time in the circulation.
They are more prone to oxidation.
They can probably penetrate the arterial wall
easier.
And a low-carb ketogenic diet is more potent
than anything, including statins, at decreasing
these small atherogenic particles.
So even if you’re one of these people that
your total cholesterol and LDL went up quite
a bit, almost all cases, your small LDL particles
almost surely went down, and so that’s a
really important fact that is going to be
relevant in terms of cardiovascular risk.
Dr. Pompa:Now, Jeff, I’m one of those unique
people.
When I—and I’ll explain why in a minute,
but in the summertime, I actually go into
ketosis.
In the wintertime, I actually move out, and
that’s for performance reason, which when
we get there I’ll talk a little bit about.
But I’m one of those odd people that my
LDL does go up.
My triglycerides dramatically go down.
All of my glucose, inflammation markers, dramatically
lower for the better when I’m actually in
ketosis.
However, my particle number of LDL actually
raises.
Now, my smalls don’t change.
So my smalls are normal., but my particle
number goes up.
Now you and I agree.
Total cholesterol doesn’t matter.
Even high LDL, I don’t think it matters.
However, the particle number and the particle
size, those two things lead to more oxidation.
So now what about the particle’s number
going up and not the size?
What’s you’re feeling on that?
Dr. Volek: Well, part of that particle number
is driven by the total concentration increase.
But the fact that your small LDL numbers aren’t
changing or in most people they do go down,
even if their total goes up, that is unlikely
to contribute to higher risk in any of the—we
don’t have the long-term studies.
This is the limitation in most of this research
where we’ve followed people long enough
where you have heart endpoints.
Where you’ve looked at mortality or you’ve
looked at actual heart attacks.
So you always have to look at these intermediates
with a grain of salt because none of them
are that great at predicting heart attack.
I mean, over 50% of people who have heart
attacks have perfectly normal LDL cholesterol.
So that tells you right there that this is
a pretty weak predictor of actual risk.
But this gets into a lot of nuances, and I
think you’ve touched on a few things that
make it more complicated than even particle
size.
And that’s, ultimately, are these particles
oxidized and are they contributing to pro-inflammatory
environment?
Those are the processes that really contribute
to atherosclerosis and plaque development
in the arteries, and so if you’ve got a
lot of cholesterol, even a lot of particles
circulating in the plasma, hey, that’s fine.
You just don’t want them in the arterial
wall.
Dr. Pompa:Yeah.
Dr. Volek:In fact, having higher cholesterol
may confer some protective effects.
Dr. Pompa:Absolutely.
Dr. Volek:I mean, that’s maybe a provocative
statement, but there’s some evidence to
support that.
So cholesterol in the blood is good, cholesterol
in the arteries, not good.
What contributes to cholesterol in the arteries?
Well, not so much the concentration but more
the pro-inflammatory environment, the pro-oxidative
environment that contributes to that.
And those almost always get better on a ketogenic
diet.
Even if you happen to be one of these hyper-responders
like yourself.
I’m just the opposite.
I’ve been ketogenic for 20 years, and my
cholesterol is more than 78, and so I don’t
have to worry about it.
But I know there’s a lot of people out there
that—and it’s just genetics.
We don’t understand how to predict those
people, but we certainly see it.
And I personally don’t think it’s a contraindication
or something to worry about because it’s
an isolated increase, and across the board,
you look at every other risk factor, it gets
better.
Dr. Pompa:Well, I think you said it best.
They’re ignoring the obvious.
The glucose, the elevated glucose spikes,
even in nondiabetics, and insulin spikes,
which drive oxidation, is really the bigger
problem than even the small amount of cholesterol
they have is oxidizing.
And oxidized cholesterol is the problem.
Not total cholesterol.
And I think we’re in total agreement there.
Dr. Volek:So, yeah, the other piece of this
that I’d like to mention quickly, it’s
the composition of these particles.
So if you have a lot of saturated fat inside
your cholesterol—or your lipoprotein particles,
that is a consistent risk factor for both
diabetes and heart disease and certain types
of cancer, and so this becomes a very important
topic when it comes to heart disease.
And it starts to tie back to the saturated
fat paradigm.
So it turns out that all the latest evidence
that’s been reviewed in I think, at least,
four or five meta-analysis in the last three
years have shown no correlation between dietary
saturated fat and heart disease.
Dr. Pompa:That’s right.
Dr. Volek:So that, I think, puts the nail
in the coffin of the low-fat paradigm, the
diet-heart hypothesis.
But still, people get very concerned.
Because on a ketogenic diet, now you’re
eating two or three times as much saturated
fat as you may have been on a high-carb diet,
and so we’re interested in what happens
to saturated fat levels in the body on a ketogenic
diet.
So in three separate studies now we’ve shown
that, despite eating two to three times the
level of saturated fat on a ketogenic diet,
saturated fat levels in the blood go down.
Dr. Pompa:Yeah.
Dr. Volek:And again, that’s what’s important.
Because if you are carrying more saturated
fat in your circulation, in your membranes,
that is highly associated and consistently
in studies puts you at higher risk for heart
disease.
So the way—the soundbite we use for this
is, “You aren’t what you eat.
You are what you save from what you eat.”
And if you’re eating saturated fat, that’s
fine.
Saturated fat itself is very benign and contributes
to satiety and pleasure and palatability of
food.
Dr. Pompa:Yeah.
Dr. Volek:What’s the problem is if you eat
it with carbohydrate.
Dr. Pompa:That’s right.
Dr. Volek:It’s the carbs that you’re eating
that are setting you up to store it and accumulate
it in cells.
But if you don’t eat a lot of carbs with
the saturated fat, you actually burn it.
Saturated fat is a preferred fuel on a ketogenic
diet, and so it’s not accumulating and causing
harm.
It’s being oxidized and converted to CO2
in water, and that’s why you see actual
levels go down despite the fact you’re consuming
more.
Dr. Pompa:Well, I think, talk it about…
Dr. Volek:You need it.
You need the saturated fat on a ketogenic
diet for fuel, and those foods that have saturated
fat are ideal foods on a ketogenic diet.
Dr. Pompa:I love to give the example it burns
like natural gas on your stove.
You don’t see smoke as opposed to how glucose
burns.
You look at the wood in your fireplace.
You need a chimney.
That’s glucose.
Dr. Volek:That’s great.
Yeah.
I think I’m going to steal that.
Dr. Pompa:You’re welcome.
Dr. Volek:Ketones and saturated fat, they’re
clean burning fuel.
Dr. Pompa:Yeah.
Yeah.
Absolutely and more efficient.
That’s why those gas carbs can run a long
time.
They’re cleaner and more efficient.
Dr. Volek:Absolutely.
Dr. Pompa:Yeah, absolutely.
Meredith:And I have a quick question too.
I love what you’re saying about saturated
fat, Dr. Jeff, and I eat a very high-diet
myself, and my cholesterol is only 180.
So I was wondering.
Have you seen genetic differences in perhaps
that some people are more suited to ketogenic
diet genetically than others?
Dr. Volek:Yeah.
We were interested in that question about
ten years ago before we had a lot of more
sophisticated Omix tools.
But we did a lot of genotyping in our studies,
and there was a lot of hope and belief that
genetics would be able to predict how people
respond to diets.
But we were very disappointed.
You can explain a very, very small amount
of variability by looking at genotypes in
people.
So I’m more interested in measuring now
dynamically changing biomarkers because your
genotype doesn’t change.
Your snips are the same.
What I’m interested in is studying more
biomarkers that are providing almost real
time information on how people are processing
the carbs they’re consuming on a real time
basis, and that moves us in the direction
of someday having some objective markers that
would tell us if we’re consuming carbs below
our tolerance or above our tolerance.
So yeah, in answer to your question, the genotyping
hasn’t really led to any insights in terms
of responders or not.
I find there’s very few, if any, contraindications
to a ketogenic diet.
So as we were saying earlier, some people
may find it a little more difficult to get
into ketosis and keto-adapt, but outside of
some very rare genetic mutations, everyone
can do it.
Dr. Pompa:Yeah.
We’re going backwards.
Yeah.
Dr. Volek:You may not need to.
If you’re one of the lucky ones and you
can maintain health on a high-carb diet, then
you may not need to.
But at least you can, and that’s where,
if you’re insulin sensitive, you have more
options.
You can probably do fine on a higher carb
diet.
But if you’re insulin resistant and carb
intolerant, you really need to restrict carbohydrates,
but pretty much anyone can adapt.
Dr. Pompa:Well, everyone can adapt because
it’s life or death.
I mean, every human has the ability to go
in and out of ketosis, and I believe it actually
makes us healthier just even moving in and
out of it.
Because this is what our ancestors had to
do.
Often times, they were in states of fasting,
states where they only had this food or that,
and it was forcing them into these variations.
I wrote an article, Jeff.
You should read it, called Diet Variation.
I think you would enjoy it.
It’s on my website.
But, yeah, I mean, I agree.
Jeff, I think that there’s too much today
put on these snips in the genotyping whereas,
clinically, I’m just not seeing the value.
I think that the snips, the body—we know
so little that the body epigenetically starts
to change things and move around these snips
and adapt in different ways.
And I think that even in the alternative world,
I think there’s being too much put on that.
What’s your opinion on that?
Dr. Volek:Yeah.
I agree totally, and that’s starting to
go out of vogue, and epigenetics now is the
big thing.
Which as you were saying, it’s that epigenetics
is really looking at how genes are expressed.
And we learned just a couple years ago how
potent ketones are at affecting gene expression.
So a ketogenic diet is having very potent
epigenetic affects.
Dr. Pompa:Yeah, amazing.
Dr. Volek:The primary ketone body, beta-hydroxybutyrate,
was just recently discovered.
This was in the science paper published at
the end of 2012.
So this is really new stuff, and it gives
us a whole different perspective on ketosis.
But they showed in very elegant experiments
that beta-hydroxybutyrate was a potent histone
deacetylase inhibitor, and that’s a long
fancy term.
But that’s a very common and well-studied
target of epigenetic modulation of gene expression.
And I can tell you a lot of drug companies
are desperately trying to find molecules to
develop into drugs that basically target the
same mechanism, and here we have a natural
metabolite that elevates when you restrict
carbs that has the same epigenetic effects.
So it’s really exciting, and it gives us
a whole new perception of how a ketogenic
diet is having therapeutic effects.
Dr. Pompa:I think you said it.
A lot of what I teach is turning off those
bad genes.
Whether you’re a thyroid person, someone
who struggles to lose weight, those can be
genes that can get turned on.
We know utilizing ketosis and ketones turns
off and has the ability to turn off those
genes.
I mean, this is new science, but it’s real
science, and it’s very—it’s really amazing.
And I believe that these dietary shifts, what
I call diet variation, really lead to a lot
of these bad genes getting turned off.
Well, anyway, so this is the performance side
of the talk.
I mean, you wrote the book, “The Art and
Science of Low-Carbohydrate Performance.”
Look, your colleague, Stephen Phinney, I met
him here in Park City, and here in Park City,
we are the endurance capitol, little city,
of the world.
I always say that people here either do one
sport a day or three.
So we have people who run in the morning,
cycle in the afternoon, and go lift weights
somewhere in between.
They are the high-carb group here, Jeff.
I mean, come on.
High-carbohydrate diets and endurance, I mean,
this is—how can it be low-carb?
Dr. Volek:Yeah.
It’s a little bit like the world turned
upside down, and it’s interesting that this
is going on in parallel with what’s happening
in general consumer nutrition and taking on
the Dietary Guidelines and all of the low-fat
paradigm.
In parallel, you’ve got sports nutrition
over here that’s also for the last 40 years
been under the belief that athletes have to
carb load and have to have high-carb diet
to perform optimally and recover, and now
that’s being challenged.
Dr. Pompa:Yeah.
Dr. Volek:And so that is really fascinating
because it’s been so reinforced by the sports
beverage industry and economy that we’ve
got to have these Gatorades and Powerades
after we—even if we run on the treadmill
for 15 minutes, you got to drink Gatorade,
and we’re basically cancelling out all of
the benefits we get.
Dr. Pompa:Jeff, I can argue…
Dr. Volek:So there’s paradigm shifting,
and a lot of it is happening in the grassroots
level.
It’s real athletes that have made the decision
to switch their diet and abandon their carb
loading, and instead embrace a high-fat, low-carb
diet.
And to even my surprise, many of these athletes
are not just able to compete and finish races,
many of them are winning and, in some cases,
setting course and even national records in
ultra-endurance.
Dr. Pompa:What’s the—the Western 100,
what’s the gentleman’s name?
Didn’t he win the last three years the 100-mile
running race?
He’s in ketosis.
Correct?
Dr. Volek: Yeah.
Well, Tim Olson won in 2011, and I had my
lab group out there.
We were studying a whole bunch of athletes
that were on a low-carb diet, and so Tim set
a course record that year, and came back and
won it again in 2012.
And I think he’s definitely on a low-carb
diet, whether he’s in ketosis or not may
be debated.
But there’s no doubt he’s not following
the high-carb approach, and he’s not the
only one.
There are many successful ultra-endurance
runners who are clearly abandoning their carb
loading and benefiting from a high-fat, low-carb
diet.
And we’ve had the opportunity to study many
of these elite athletes in the lab to see
what makes them tick, and they are nothing
but extraordinary.
Dr. Pompa:Yeah.
What’s the—Phinney was involved in the
movie called “Running on Fat,” right?
And the gentleman and his wife rode from California
to Hawaii in ketosis, and that was the movie.
Were you part of that at all, Jeff?
Dr. Volek:Well, I know Sami Inkinen and Merdith
Loring who are married and did row; I think
it was 2,000 miles from California to Hawaii
unsupported.
And they really did that to show that it could
be done without a lot of sugar and carbohydrates.
So they were keto-adapted and did a phenomenal,
unbelievable performance.
Setting a record, actually, and beating out
some three and four-man teams that they were
competing against so just an enormous feat
of endurance done with very little carbohydrate.
Dr. Pompa:Yeah.
What’s the name of the movie?
Dr. Volek:It’s “Fat Chance Run,” was
it?
Dr. Pompa:Yeah.
Dr. Volek:Or no.
Dr. Pompa:I forgot too.
Dr. Volek:Actually, I’m blanking on the
exact title now.
Dr. Pompa:Yeah, me too.
I’m with you.
Dr. Volek:Yeah.
It was all about this paradigm shift in athletes
switching from high-carb to low-carb diets
and experiencing widespread benefits in terms
of their health and performance and recovery
abilities.
Dr. Pompa:Yeah.
It was remarkable.
Well, Meredith, you had a lot of questions
regarding performance because that little
girl’s quite the athlete, and she performs
on a very low-carbohydrate diet in ketosis
often times so, Meredith.
Meredith:Oh, well, I don’t know if I’d
consider myself too much of an athlete, but
ketosis has massively impacted me in a lot
of positive ways.
Something, first of all, what constitutes
a ketogenic diet for athletes that you think
would be well-balanced and well-formulated?
Can you walk us through a day of what that
would look like?
Dr. Volek:Well, yeah, I think I could probably
do that easier for a ketogenic diet where—I
don’t know if these athletes, all of them
anyway, are truly in ketosis or if they’re
introducing enough carbs around exercise.
There’s no standardized approach all these
athletes are taking.
They’re figuring out what works for them.
So it is varied from athlete to athlete.
But in general, what I consider a well-formulated
ketogenic diet.
Obviously, getting the carbs low enough to
induce ketosis is kind of straightforward
but, also, the protein.
So this is not a high-protein diet, but it’s
not a low-protein diet either.
So you really need to get protein in the right
range where it’s low enough, you induce
ketosis.
But it’s not so low that you’re going
to be in the negative nitrogen balance.
That’s muscle loss, the lean body mass loss.
It’s kind of this Goldilocks state for protein,
and that’s really important.
Beyond that, other things that people don’t
always appreciate which can often result in
side effects or suboptimal responses; one
is the type of fat.
So because carbs and protein are limited,
this is a very high-fat diet, especially if
you’re not restricting calories.
So if you’re one of these athletes who’s
trying to eat enough energy to maintain your
training, this is an extremely high-fat diet
and the type of fat becomes very important.
Because the main function of fat is for fuel
on a ketogenic diet. 
Dr. Pompa:Yeah.
Dr. Volek:And the best fuels are the monounsaturated
and the saturated fats.
The polyunsaturated fats are important.
They’re the essential fatty acids, but you
only need very small amounts of these to meet
your essential requirements.
So they’re more like vitamins and minerals
in my mind, and they’re not tolerated at
high levels.
So you can run into a lot of problems.
Dr. Pompa:Okay, Jeff, for our viewers, let
me just put that in perspective.
So we don’t need as much fish oil, right?
There’s benefits to those polyunsaturated
fats, and vegetable oil, we don’t like anyway.
But what you’re saying is, hey, we need
more grass-fed butter.
We need more of those types of saturated fats,
and then of course, olive oils and other oils
can have some other affects as well.
So putting them in…
Dr. Volek:Yeah, the natural foods that—natural
animal-based foods that are higher in fat
naturally have low PUFA levels.
Where people run into problems is with soybean
oil, and corn oil, and safflower oil, and
peanut oil.
And so it’s easy to not buy those, but where
you end up seeing those is in salad dressings
and mayonnaise.
So it’s very difficult to find versions
of those that don’t have soybean as the
first ingredient.
You’re now starting to see them pop up a
little more.
But that’s really important because it will
make people nauseous if you eat a lot of soybean
oil or a lot of mayonnaise that has soybean
oil in it.
So the types of fat’s important.
The other area is in mineral balance where
you can run into a lot of serious problems
if you don’t understand how to manage sodium
on this diet.
So a lot of people are afraid of salt.
Because we’ve been told we eat too much
salt, and we need to reduce it.
It turns out that science doesn’t support
that and it actually refutes that.
If you restrict sodium, it may actually increase
your risk for heart disease.
But we won’t go down that path right now.
But definitely, when you’re in ketosis,
the kidneys go through a very profound adaptation
where they excrete more sodium, and it’s
called the natriuresis of fasting or, in this
case, the natriuresis of ketosis.
And if you excrete sodium, you also lose fluid
with that, and so that manifests in a contracted
plasma volume or a reduced blood volume.
And that’s what a lot of people feel as—and
they call it the Atkins flu, or they feel
lethargic or tired.
They may get dizzy and faint when they go
from a seated to a standing position.
Some people, they get headaches, even constipation,
and in most cases, they blame it on the lack
of fiber or lack of carbs in their diet.
But nine times out of ten, it’s the lack
of accounting for that extra sodium that’s
lost.
Dr. Pompa:Absolutely.
Dr. Volek:And you have to eat an extra gram
or two of sodium on a ketogenic diet to maintain
plasma volume, and if you’re an athlete,
that’s especially important because it’ll
affect your cardiac output and performance.
And I won’t go into all of the nuances of
this, but if you don’t address this, it’s
not just those inconvenient symptoms.
You end up with a counterregulatory response
where you end up stressing the adrenal glands.
Because the body wants to try to reabsorb
sodium, you secrete aldosterone, and that
causes you to retain more sodium at the expense
of potassium.
So you end up excreting more potassium.
You end up in a negative potassium balance.
And it’s impossible to gain muscle and even
maintain muscle if you’re in a negative
potassium balance, and it ends up affecting
magnesium balance as well.
So you end up with all these mineral imbalances,
and there’s one simple countermeasure.
It’s just, have a little extra salt in your
diet.
So we recommend people consume broth, but
it can really be any source of sodium to make
up for that loss of sodium.
So that’s another big component of a well-formulated
ketogenic diet that can trip people up.
Dr. Pompa:Yeah, I have—we acknowledge that
fully, and I have something called my 2-2-2
Rule.
Just to get the—make sure they’re getting
the better fats.
Two tablespoons of coconut oil a day.
Two tablespoons of grass-fed butter a day,
and two teaspoons of sea salt or some type
of salt.
So just to make sure some of those bases are
hit.
Because if you don’t make it simple for
people, they just simply forget, right, and
then they end up going I’m weak.
I feel tired.
My heart’s palpating.
And it’s typically, like I said, one of
those things, especially the electrolytes
and the mineral imbalance, so very well said.
Jeff, I go into—and I said this earlier
in the show.
I said I go into ketosis in the summer.
Why?
Well, because I love cycling.
I’m an endurance athlete.
But when I do that, I lose my muscle very
easily.
I can eat muscle into sugar pretty quickly.
However, when I’m in ketosis, I don’t.
So two reasons, I keep my muscle, even though
I do high-endurance in the summer, and I’m
“bonk proof.”
I can literally get up.
Not eat.
I am even, partly, later in the day still
not eating.
I can go on a three-hour bike ride, and I
do not bonk because I’m fat-adapted.
So these athletes that—for me, even just
at low-carb, I don’t have that effect unless
I’m absolutely in ketosis, fat-adapted.
Then I can run on fuel.
And maybe it was you that said this, and I
loved the analogy.
Look, the average human can store about 2,000
calories in stored sugar.
However, even as lean as I am, I have at least
probably 80,000 stored calories of fat that
I’m able to tap into.
And when I’m biking for all those hours
without eating—because I didn’t eat through
the night, and I didn’t eat through the
morning, and I had went out with a group probably
about noon one day.
So I had already fasted 15 hours.
We went out and rode for three and a half.
I had not one bite of food, and I didn’t
bonk.
And they were astounded because they predicted
my bonk.
So despite going, whatever that was, 17 hours
without food, even when we were done, I was
still fine.
That’s the beautiful part of being fat-adapted
in ketosis.
Dr. Volek:Yeah.
You summarized it very well.
That ability to be able to access and utilize
your fat stores is one of the most important
adaptations of a ketogenic diet, and that’s
manifest in so many positive outcomes for
these endurance athletes, including cognitive
benefits.
Dr. Pompa:Yeah.
Dr. Volek:Because they become bonk proof,
and their brains are able to utilize the ketones.
So they remain very lucid, and don’t become
disoriented at the end of these races, which
is very common in the high-carb athletes.
Dr. Pompa:Yeah.
Another—I think the bodybuilders and the
weightlifters are coming around to this.
They usually went high-protein, but they’re
realizing the benefit of being in ketosis.
And I do something, Jeff, where I [00:56:48].
Meredith:Dr. Pompa, looks like he’s frozen
there.
Dr. Pompa:Sorry.
I don’t know what happened.
My internet blipped out for a minute.
Anyways, I don’t eat in the morning.
I intermittent fast, and I benefit from my
body’s ability to burn fat and keep burning
fat whereas the old adage, I believe it’s
old, is eat the five or six meals a day.
We never give our body a chance to burn fat.
When we’re fat-adapted, man, we want to
give our body a chance.
And there’s two—and I’m not telling
anyone to do this.
Because the guys, they drop a lot of F-bombs.
But they’re called the Hodgetwins, and these
guys are built like houses, right?
And they’re in ketosis, and they intermittent
fast, and they go 19 hours without eating.
And these guys are like, look, we do it without
taking steroids.
I mean, these guys are massive, and they’re
boasting that it’s all about being in this
intermittent fasting state in ketosis.
And what it does for their growth hormone
and testosterone, and that’s how they’re
able to compete naturally.
If you want a kick, watch it, Hodgetwins,
google it.
But you better be used to a lot of F-bombs
because they’re funny.
They’re funny guys.
I think they’re pretty smart, and it’s
an act.
But they do drop a lot of F-bombs.
But they really—they prove the point that
this raises hormones.
It really makes you more hormone sensitive,
even to testosterone.
Meredith:Awesome.
Well we got started a little bit late.
So maybe we can have a Part 2 because there’s
still questions.
Dr. Volek:Absolutely.
Meredith:And there’s so much on this topic.
It’s really exciting, and your research
is amazing.
So do you want to tell our viewers how to
find out a little bit more about you and your
research?
Dr. Volek:Well, I’m at Ohio State University
now, and as you mentioned, I have a couple
books.
The most recent I wrote with Steve Phinney
called “The Art and Science of Low-Carb
Living,” and the companion to that for athletes
is “The Art and Science of Low-Carb Performance.”
So those are available on Amazon.
Meredith:Awesome, great.
Well, thank you so much for joining the show
and for everything you’re doing.
And we’ll definitely have to schedule you
for a Part 2, and thank…
Dr. Volek:I’d love to come back.
Dr. Pompa:Yeah.
Meredith:Awesome, awesome.
Well, great to meet you.
Thanks for watching everyone.
Stay tuned next week.
We’re going to be interviewing Ben Greenfield
on low-carb fueling for athletes.
So it’s going to be an awesome follow-up
to this topic as well.
We’re going to continue to delve more into
this, and to get you guys the information
you need.
So thanks for watching everyone.
Have a wonderful weekend, and we’ll see
you next time.

William Babineau

9 Comments

  1. I have started this with a keto trained doctor and have had consistent success. It really combats Candida as well.

  2. Type 1 diabetic on a ketogenic diet here. Dr. Jeff Volek and Dr. Stephen Phinney helped me tremendously to educate myself about the ketogenic diet and applied these principles to control my disease. Insulin dosing decreased to 1/4 of what it used to be in a high carb diet, and blood sugar control is very stable Thank you!

  3. I had a small goiter on my thyroid 3 years ago¬† ( tired & losing hair ) Dr's just watched it with no meds . After 6 months it shrank ( was biop. not cancerous ) they never mentioned cruciferous veg . could cause this to happen, but I wasn't eating many good veg. back then ūüôĀ¬† Now after a year on Keto/ lchf the symptoms have returned . So I cut back on those veg. going to ask my Dr. to recheck my thyroid . If it is those veg. it will leave me out on the benefits nutrient ion wise¬†¬†!!¬† Plus the low glycemic known veg. Actually having¬† tree & grass¬†pollen allergies it always limits what I can eat .¬†¬†If this is the case I surly don't want to go on meds due to going Keto . Yes I cook them I read it helps , I'll be very upset either way because the Keto journey has helped me in sooo many other ways:)¬† Any ideas¬†on this issue¬†would be great ..¬† Enjoyed learning more on your interview . Subbed /liked

  4. I haven't read about the diet variation at this point but it seems to make sense as we appear to be created to eat foods that are in season. All you have to do is eat a tomato out of season and then eat a home grown one in season. God bless you.

  5. one thing no one mentions is how to deal with D type2 when a person is not overweight, do they also benefit from this diet?

  6. dr jeff, I worry about the colon health that nobody talks about. Dr. campbell taught in "forks over knives' that cassein protein is cancer causing protein. Now if you say buy organic grass fed protein-great but I never hear that. please address this. Also, for those that test choles after just a couple wks and say it went higher, well even dr atkins taught yes it will go high until the ketosis kicks in. That is the reason to NOT go in and out of it. Stay in ketosis or don't do it.

  7. Thanks guys, good info. It is a struggle with the old dogmas. Doctors will not admit to the idea that the cholesterol theory is dead and no clue about low carbs. Probably due to SOC and legal push back … But going there anyway, with No support from doctors … SAD and getting SADer… prefer LCHF – Low Carb Healthy Fats, since elimination of industrial omega-6 oils is also critical.
    70 Going On 100 … the Centenarian Diet … maybe 70 Going On 128 … the Hayflick Limit … or if a fan of Ray Kurzweil … then this is all a Moot Point.

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