Keto Myths Part 2 of 2
SUMMARY KEYWORDS
fatty liver disease, ketogenic diet, liver, called, people, diets, protein, inflammation, liver failure, ketogenic, high protein diets, kidneys, eating, fat, keto, kidney function, increased, tests, improve, questions
SPEAKERS
Jack Heald, Dr. Philip Ovadia
Jack Heald
Welcome back. This is part two of me asking Dr. Ovadia about keto. So this is the Stay Off My Operating Table podcast Dr. Phillip Ovadia is the resident expert. I’m Jack Heald, the talking hairdo.
Dr. Philip Ovadia
Good to be back again, Jack
Jack Heald
So, last week we had a really good conversation in my mind about some of the common myths about the keto diet and being in ketosis. I loved that. I know we really went down a rabbit hole with cholesterol, but man, for me that was that was really educational. I encourage our listeners if you haven't done so, man, listen to that episode. Really good.
So let's jump in some more of the fairly common myths about keto. Some of these I've heard some of them I haven't. Some of them, I've wondered about myself. Here's one, keto will cause inflammation, true or false?
Dr. Philip Ovadia
Definitely false. And to the contrary, ketogenic diets can be one of the best treatments for inflammation, inflammatory conditions, we have seen evidence of things like rheumatoid arthritis, which is an inflammatory condition improving with ketogenic diet, autoimmune conditions, which oftentimes have a strong inflammatory component to them. Again, we have seen many of these improved and or reversed with ketogenic diet. And there really is no reason to think that ketogenic diets are going to cause inflammation.
The one caution that I guess we need to give around this is as we talked about last week, in the first episode, ketogenic diets, can, can have in them things that are not desirable to eat overall, and specifically, when we start talking about the vegetable and seed oils, which can get incorporated into ketogenic diets, I mean, they are a form of fat. And obviously, on the ketogenic diet, you're going to be usually increasing your fat intake. And if you do this with low quality processed fats like vegetable and seed oils, those can be pro inflammatory.
But I again, those are a major component of the standard American diet. So there's no reason that the ketogenic diet is going to be more inflammatory than the standard American diet. And that's another pretty important point, I think, is that the standard American diet is very pro inflammatory, with all of the processed food that it incorporates. So this is one of those myths that I'm not sure where it would even come from. And in reality, we see that the direct opposite of it is true. And if you have inflammation, then a ketogenic diet is often going to be a solution to your problem, and certainly not worse than it.
Jack Heald
Quick question, and I realize this may be outside your realm of expertise, but I'm going to ask it anyway. Is there a simple self-test that we can do at home for inflammation? Or is that just one of those things where go on a ketogenic diet and see if you feel better?
Dr. Philip Ovadia
Inflammation can be a little bit difficult to assess. There are blood markers, certainly that can be checked as part of your blood work. The one that I probably use most frequently is a blood marker called CRP, C-reactive protein. It's a general inflammation marker, there are some others that you can check as well. at home tests one marker of inflammation is puffiness anyone who's injured themselves, let's say twisted your ankle, and it gets inflamed, and it gets puffy. We all know that as inflammation. And it turns out that people who are walking around with high levels of inflammation, I commonly see it in the face, and you have that kind of puffy face, and then people go on these ketogenic, low carbohydrate, whole real food diets and before they even start losing weight, people will start asking them, “What are you doing? You look so much better.”
And they don't really realize what's going on. But you can really see it in the face. And when I start working with my patients, that's oftentimes the first thing. I'll see obviously I work with my patients via telemedicine, and we'll get on the, the Zoom call for the appointment. And right away, I'll be saying, oh I can tell you're doing great, I can just see it in your face. And they're always kind of surprised by that, but so that I think maybe in terms of an at home test, is sort of the best way to assess your level of inflammation, if that makes sense.
Jack Heald
As I got married in November last year. And I wanted a wedding ring. And so DeLawn and I spent a lot of time trying to pick out wedding rings, I ended up ordering this one while ordering one that was actually a half size bigger than that. Got it in and tried it on it was it was too big. And sent back for the next size down and got that one. That was November, right. So starting in Jan, on January 1, I started inspired by you, I went full carnivore, just to try it. And I lost a little bit of weight. I loved how I felt. But the thing that really kind of blew my mind was this ring that used to fit just fine. Now is way too big. I was in the shower the other day, and it literally just fell off my finger.
I'm not somebody that anybody would say is fat or overweight, but my knuckles actually have gotten smaller. This is my grandfather's ring. And I really couldn't wear it. prior to January when I when I went on this carnivore diet. I noticed when I realized this finger had gotten smaller, I thought “I bet I could wear my grandfather's ring.” Sure enough. So just a little anecdotal evidence.
Dr. Philip Ovadia
Yeah, no, I mean, that that is another thing that I noticed as well is I've had the same experience and had to downsize my rings as well. And the days after I might eat something a typical for me, I'll often times notice the wedding ring gets a little tighter. And so I think you're onto something. So that's a common reaction common. Yeah, I think it is a common reaction. And it kind of points out the fact that so many of us don't realize what optimal health really looks like and feels like again, we've repeated this statistic ended endlessly, that 88% of us are not metabolically healthy. And so we have just come to accept as normal and being unhealthy. And that might not be as overt, as being diagnosed with a medical condition, but just kind of walking around with inflammation. And that pain in the joints or being tired. these are oftentimes some of the things that we don't realize we're experiencing until we fix them, and to realize how much better we really can and should feel every day.
Jack Heald
Yeah, well. I'm a believer. Alright, let's talk about internal organs. Now, I have heard this one. And in fact, almost every time I talk about following a ketogenic diet, somebody will say to me, “Well, aren't you worried about…” And these are the these are the things: “keto will harm the liver,” “keto will harm the kidneys,” “keto will increase your liver fat.”
I don't believe any of that, but I'm not a doctor. So what's the real story?
Dr. Philip Ovadia
Yeah, so once again when you look at the experience, and you look at the scientific literature, what you see is that ketogenic diets, specifically, I'll say low carbohydrate diets are one of the most effective treatments for fatty liver disease. And so not only do they not increase liver fat, or liver inflammation and as they improve it, and again, this is a consistent thing that I see with my patients. It's one of the things that I actually measure we look at their levels of fatty liver disease using blood tests and scans. And we consistently see it improve if they are, as their metabolic health is improving, if they are following these diets.
Jack Heald
So can I interrupt you there real quick? Yep. Talk a little bit more about fatty liver disease. I'd never heard of that. This until six years ago, when a dear friend ended up well, she ended up in the hospital and died in less than a week. And apparently, she had a severe case of I think it was fatty liver disease is what they said, I've never I never heard of it. Until then I have no idea what that means. Talk a little more about that. I educate me, please.
Dr. Philip Ovadia
Yeah, so fatty liver disease is actually exactly what it sounds like. And you start to get fat infiltration into the liver, the liver really shouldn't have any fat in it. But as we become metabolically unhealthy, one of the things that can happen is you start to get fat in places that it doesn't belong. And one of those places that it will show up most commonly is in the liver. fatty liver disease. Over time has gone through many different sorts of names, it used to be known as basically nonalcoholic fatty liver disease. And that was to differentiate it from the changes that we see with alcoholism that ultimately lead to cirrhosis, which is actually scarring of the liver.
But it will start with fatty infiltration into the liver. nonalcoholic, fatty liver disease, as I think it's most commonly referred to these days, has become a very common cause of liver failure. It has become now or is at least close to becoming the most common indication for liver transplantation. In the United States. What we have seen is that the rates of alcohol induced liver disease had decreased hepatitis, which is also another major cause of liver failure, we now have effective treatments for so the incidence of needing liver transplants from hepatitis has gone down. And we are now left with diet induced fatty liver disease, which is probably what it should be called as one of the leading causes of liver failure in the United States. So it's a very common problem. And again the treatment for it is the primary treatment, the most effective treatment for it is low carbohydrate, ketogenic diets. And I have never seen any evidence to suggest that these diets are going to worsen liver function or increase liver fattiness. So that one I think we can definitively say is an unfounded myth.
Jack Heald
So there's your there's also some blood tests that you do for fatty liver disease, is that correct?
Dr. Philip Ovadia
So liver function tests are part of a fairly standard bloodwork panel that most physicians are going to get, most commonly it's going to be part of something called a comprehensive metabolic panel. And there are three basic liver tests that we look at. One is called A S T. One is called A LT, and the other one is called alkaline phosphatase. And they're all slightly different measures of liver function.
An important thing to recognize when you're going through bloodwork if you've gotten it yourself or you're going through it with your doctor, is that the liver function tests, the ASTD ALT, are one of these tests that what's considered to be the “normal” range has increased over time. And again, this goes back to we define “normal” on blood tests as what the majority of the population has their results are.
So, “normal” doesn't necessarily mean optimal. And if you're at sort of the high end of normal on these tests, I always consider those to be a warning sign because that will oftentimes correlate with fatty liver disease. And then if you are worried about fatty liver disease the next sort of tests that we usually get is going to be an ultrasound of the liver. are actually looking at the liver. And you can start to see these this fatty infiltration. There are some more specialized tests that you can do as well. But those are sort of the basics.
Jack Heald
And ultrasounds are super easy.
Dr. Philip Ovadia
Yeah, ultrasound is noninvasive, super easy. It won't always detect fatty liver disease. They have newer types of ultrasounds. There is something called a fibroscan that is a more specific. It's still noninvasive. It's done similar to an ultrasound, but it's looking at some different ways to measure the liver by ultrasound that can be more sensitive for fatty liver disease.
Jack Heald
I want to follow this rabbit just a little farther down the trail, because it affected me personally. Let's talk about what the dangers from fatty liver disease are, what can happen. My friend, I think she'd been in the hospital three months earlier with severe dehydration. And she was very obviously not healthy. But she went from - I think we got the call on a Friday afternoon, and she was gone by Tuesday morning. She was in the hospital on Friday, put in the hospital on Friday and was gone by Tuesday morning. So obviously, rapid onset of death is one of the things you can be aware of.
But let's assume you don't have it quite so bad. What else is going on with fatty liver disease? What are you? What's the experience of it?
Dr. Philip Ovadia
Yeah, so there's really two issues with fatty liver disease, there's the problem with the liver itself. And then there's the larger problem that indicates is going on. So within the liver itself, we know that a fatty liver disease continues to progress. And this is usually a long-term process over many years. You're eventually going to end up with scar tissue in the liver. That can lead to a condition we call cirrhosis that I mentioned before, where now your liver is no longer able to function adequately. The liver has many important roles in the body in terms of filtration and making hormones. And so liver failure ends up having widespread effects throughout the body and certainly can lead to death.
Jack Heald
Hormones?
Dr. Philip Ovadia
Yeah, the liver is involved in the process of making cholesterol and recycling cholesterol. Cholesterol gets turned into many of the hormones in our body. So the liver turns out to be very important for many of the functions in our body. And if your liver fails, you can't live without a liver. So that's why we start talking about things like liver transplant and things like that.
The other problem with fatty liver disease is just that it's an indicator of poor metabolic health. That also implies that you're at high risk for things like heart disease and many forms of cancer and diabetes and Alzheimer's disease. So, it is not uncommon that people with fatty liver disease have these other issues as well, which can progress and become life threatening.
So fatty liver disease in and of itself is a problem. But it's also a warning sign about a you know about other things that are going on within the body. And it's one of those unfortunate situations where sometimes those dots don't get properly connected. And someone will say, “Oh, well, you just have fatty liver disease”, and they kind of don't pick up on those other problems that may be coming down the line.
Jack Heald
Well, I gotta say, listeners, don't fool around with that. This was a young woman. Shouldn't happen.
All right, and then when it comes to kidneys, I've also heard the same thing “Oh, eating all that protein is going to hurt your kidneys.”
Dr. Philip Ovadia
Yeah, the kidney issue comes up a lot with ketogenic type diets, and it is usually discussed in the context of high protein. Again, one of these medical dogmas that I heard very frequently throughout my medical school education in my early career was that eating too much protein is damaging to the kidneys. And again, when we actually look at the science, when we look at the studies, we find the opposite to be true.
There are studies that have shown that high protein diets can actually improve kidney function. And there is really no good evidence that protein in and of itself is damaging to the kidneys. There are two reasons that I think this myth came into being. One is that one of the blood tests that we use to measure kidney function commonly, it's called the creatine, the blood Creatinine level, can get elevated if you eat a lot of protein. And I find this is especially true of people when they first start high protein diets.
But it turns out that creatine is not the most direct measurement of kidney function. And in that situation, it's often the case that the Creatinine is elevated, but it's not actually correlating to poor kidney function.
There is another blood test that can be used, it's not as common, but your doctor can order it. It's called “systatin-C.”. So systatin, dash, the letter C. And that measures kidney function more directly without the influence of protein intake.
Oftentimes, I'll have people who reach out to me, or I'll see it in my patients as well, that they're creatinine goes up, when they first start these high higher protein diets. And then we just checked the statin level, and we see that their kidney function is just fine. And typically, over time, the Creatinine level starts to come back down as well.
The other issue is just that as when you look at consumption patterns over the past 30 to 40 years protein, specifically meat is not being consumed by itself. The most common way probably in the US that people consume meat is as a hamburger, which includes the bun and all the toppings, and the French fries that were fried in vegetable and seed oils, and the sugary beverage with it.
And so you put all this together, and you end up with poor metabolic health, which does negatively affect the kidneys as well, and the meat got blamed, but it really wasn't the protein or the meat. Again pretty consistent finding that I find that people who do whole real food diets, ketogenic-type diets, that I advocate for, all of their functions get better, which includes the kidneys in the liver.
And as you go through each of these individual organs, we talked about the heart last, the heart and the brain on the last episode, it's really hard to picture a scenario where our bodies would have evolved in such a way that something that is beneficial for one part of our body is going to be harmful to another part of our body. And especially when you look at the foods that we evolved the eating, and again, these were the whole real foods that should be eaten on a ketogenic diet, it's really hard to believe that our bodies would have evolved in such a way that these foods would be damaging to particular organs.
Jack Heald
Yeah. A question occurred to me: what other disease conditions or pathologies would cause elevated creatine? Did I say that right?
Dr. Philip Ovadia
Yeah. So there is a long list of things that can lead to kidney damage. I would say the two most common ones are high blood pressure and diabetes, both often times are associated with kidney problems and worsening kidney function. And when you look at people who ended up in kidney failure and ended up on dialysis, those are probably the two most common reasons that people end up on dialysis.
And what we know about diabetes and high blood pressure, they are both signs of poor metabolic health. They're actually, as we've said many times, two of the five measures of metabolic health. One of them is blood pressure, and one of them is your fasting blood glucose level, which is obviously going to be abnormal in diabetes.
So, even if you think that high protein may have some negative effects on the kidney, you have to look at the net benefit there. And if you're reversing diabetes, and you're improving high blood pressure, both of which are common things that occur with people who improve their metabolic health with these diets, that is certainly going to be a net positive to your kidney function.
And the overall evidence, the overall experience is that these diets do not harm kidney function and probably improve kidney function.
Jack Heald
I know, for the non-believers, it probably sounds like, hey, eating this way, is the solution to all your problems. And that's not really what we're saying. But eating this way, will certainly fix an awful lot of your problems. If your problems are related to messed up metabolism, poor metabolic health, poor metabolic health is what lies at the, at the root of so many of these common diseases that that America is dealing with now?
Dr. Philip Ovadia
Yeah it's one of those areas that I oftentimes need to check myself on. Because I do start to question that I start to sound like a charlatan that almost every condition can be improved by improving your metabolic health. But then it turns out that almost every condition can be improved by improving your metabolic health. And the more I work with patients, the more I go to the medical conferences, I look at the online community and the experiences. And it turns out that the list of conditions that you can find people have improved using these dietary strategies, just keeps getting longer and longer and longer.
Jack Heald
Yeah, well, I know, lots of stories like that.
So the last one, and this is, actually it's a couple here. I've heard that, I've been told, “you can't do keto, if you're engaged in some kind of training where you want to build muscle, because keto will cause muscle loss.” And related to that, “keto will negatively affect your bone density.”
I've heard the muscle loss thing. I haven't heard the bone density thing from anybody till now, what's the story there? I assume those things are related.
Dr. Philip Ovadia
Yeah, they're related. And they both are false, as well. So when we look at building muscle, and actually, when we look at bone health, it turns out that protein is exceedingly important for both of them. And so again, it's hard to conceive that a high protein diet, which most ketogenic diets are, would be damaging. Now, if we go back to the original ketogenic diet that was developed in the 1920s, to treat kids with epilepsy, that actually was a protein restricted diet. And so that did seem to have effects on kids’ muscle growth probably kid kids bone growth as well.
And so low protein, ketogenic diet, there may be some concerns around that. But the reality is that low protein ketogenic diets only need to be used in very specific medical conditions. And it may be the lesser of two evils with that in those situations, so again, protein and, or I'm sorry, muscle growth and bone, health, bone maintenance, are both heavily dependent on protein. And the vast majority of people I know, that are transitioning from a kind of standard American western diet to a ketogenic type diet are increasing their protein intake, and therefore are going to be benefiting their bone health, their muscle health, their muscle health, specifically around the weightlifting question whether or not this basically comes down to whether or not you need carbohydrates for affective muscle building? The answer is certainly no.
For the vast majority of us, it is possible that if you are truly going for high level Mr. Olympia type bodybuilding, that it may be useful to incorporate clean, minimally processed carbohydrates when doing that. But for the vast majority of us who are just trying to maintain a decent amount of muscle as we get older, because that, as we've discussed on the show is a big predictor of quality of life and length of life. Life is how well you maintain muscle as you age. Carbohydrates are certainly not necessary for us. And we can point to many examples of very fit individuals, people who have significantly increased their muscle mass on ketogenic, low carbohydrate diets, we've had two of them on the show that I can think of, and Chris Grinnell and PD Mangum, are both in their 50s and 60s, and have significantly increased their muscle mass while doing these types of diets. So I have no concerns and no reason to think that these ketogenic diets are going to be harmful to either muscle health, we'll call it muscle building, or bone building and bone health.
Jack Heald
Well, we know that if you're doing weight training, one of the side effects of weight training is increased bone density. So I guess people who think that a keto diet negatively affects your ability to grow muscle within naturally just assume that it also negatively affects your bone density. But it's probably just one of those utter and complete Ancel Keys types of stories.
I wanted to follow up with this one. Was it the early 20th century when they were treating epilepsy with protein restricted ketogenic diets? What the heck is that? How do you do that?
Dr. Philip Ovadia
Yeah, well, so basically, I mean, it's not that you don't eat any protein, it's just that you eat a lot of fat with your protein.
Jack Heald
Like, you're eating butter and cheese?
Dr. Philip Ovadia
Yeah, you're eating butter, you're eating very fatty cuts of meat today coconut oil will oftentimes be used MCT oil. So these are ketogenic diets with like I said, kind of excessive amounts of fat.
And the concern is that some protein does get converted to glucose and can lower your level of ketosis. Especially I see this most commonly, and people who are lean, they don't have a lot of body fat to burn, they're not eating a lot of fat. So if they're eating more of a high protein ketogenic type diet, what we see is that their blood ketone levels are going to run kind of at low levels. They'll still be in ketosis, but they're not getting that kind of high level of blood ketones that are necessary.
For these children with epilepsy many of these children with epilepsy need to maintain very high blood ketone levels, to effectively keep their seizures under control. And so the way to do that is to really push a lot of fat and they minimize the protein intake to be able to get all that fat, basically,
Jack Heald
Probably not so much that they're trying to keep the protein down as that - given the amount of fat that they need to get into them - if they add anything else to it, they're gonna get into an excessive calories situation and just start putting on weight maybe, I don't know. That makes sense.
Dr. Philip Ovadia
Yeah, it really was, just that concern that you really want to if you want to get as high of blood ketone level as possible, the way to do that is to make the majority of your diet fat. And so these kids were eating like 80% of their calories came from fat. And only 20% is coming from protein which ends up being a low-ish amount of protein.
And so some of those kids you did see some slowing of their growth, or they would fall behind on their growth curves. And that then got carried through to the modern ketogenic diet that that data gets pulled out. And as look what ketogenic diets do to growth, look what they do to muscle and bone. But the reality is, is that most people do and ketogenic diets these days are nowhere near those levels of fat intake, and hopefully not doing such a low level of protein. Because I certainly encourage my patients, and I think, many if not most of the kind of ketogenic practitioners out there, encourage protein intake, and make sure that their patients get enough protein.
Jack Heald
Very good. Well, I think you've, there's probably some more misconceptions wrapped around a diet such as ketogenic diet, I think we've probably hit the big ones. Dr. Romania, if people want to ask you more questions about the ketogenic diet, what's the best way to do that? Would it be on Twitter?
Dr. Philip Ovadia
Yeah, Twitter is where I'm usually most responsive to questions. And again, my I'm at I fix hearts on Twitter, and my DMs are open, and people can always reach out to me with questions there.
Jack Heald
I'd like to recommend folks if you've got questions about any other pathologies or problems associated with being on a ketogenic diet, hit Twitter DM, Dr. Ovadia, I fix hearts, and ask those questions that will allow all of us who follow him to get the benefit of the answers. All right, well, I think that's a good one for today. Unless you got anything else you want to you want to discuss…
Dr. Philip Ovadia
I hope everyone found this week and the prior week useful, and every once in a while, I think moving forward, we'll do some of these sorts of ask me anything type episodes. So again please send in your questions. And if I don't answer them directly, and even if I do answer them directly on Twitter we'll, we'll bring them to the podcast as well.
Jack Heald
Yeah, that'd be a good idea. We'll do our Q&A from listeners episode. All right. Well, for Dr. Philip Ovadia. I’m Jack Heald. This is the Stay Off My Operating Table podcast.
If you would like to do a self-assessed metabolic health test, I suggest you go to Dr. Ovadia's website, “iFixHearts.co.” Go ahead and take that test he's got there. That will get you started on your path to metabolic health.
And we'll talk to y'all next time. See ya