Is the ketogenic diet a cure-all like The Magic Pill documentary on Netflix would have us believe?

Or just another annoying and dangerous diet fad?

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– [Logan] We’re live.

– We are live, what’s up, Z-Pac? It’s your boy ZDoggMD, and we’re live and direct outta Studio Z with my boy, Logan and Tom.

– What’s up? Yo, they canceled Roseanne for being racist.

– What, they did, the new one?

– Mm-hm, it’s canceled now, yep.

– What?

– Roseanne was racist?

– Yeah, she called somebody like a monkey or something on Twitter.

– What, she called a white person a monkey?

– Think she was black, which is why it’s pretty racist.

– That’s not okay. Anyway, so speaking of not okay, we are deluged these days with dietary fads, new diets, people saying, “This is the thing “that’s gonna cure everything.” we did a video about a documentary called What The Health, which purported that a vegan diet could cure everything and was the only way for humans to eat that was first of all ethical and also healthy and also cured everything from chubbiness to cancer to AIDS. Well, it turns out that documentary was a steaming piece of crap, and we called it that. We have nothing here at ZDogg Industries against a vegan diet. It can be an incredibly healthy and powerful way to eat, and there’s some evidence that it can reverse coronary artery disease in certain studies, Dean Ornish et al. See those. However, the counter diet fad and documentary is The Magic Pill now out on Netflix. Many people have asked me to comment on this. It is about the ketogenic diet. So this is a diet that is different from vegan diets to the extent that it focuses on high fat and low carbohydrate, whereas vegan diets tend to by their definition be higher in carbohydrates because a lot of vegetable matter, beans, et cetera, high in carbohydrates. You can actually do a ketogenic diet that is actually vegan as well, but it’s kind of hard. So, what is The Magic Pill? It’s a documentary that talks about the ketogenic diet curing everything. Now, we were gonna do a video where a real doctor watches The Magic Pill and take a crap on it. Then Tom actually watched the video, and I skimmed through it, and I realized, wait, they actually did a lot of things right in the documentary that What The Health did wrong. First of all, they said all of this is based on basically anecdote and conjecture, the studies can be looked at many different ways. Here’s one look at how to look at this. And so they couch it already by saying, look, this isn’t 100% science, this is another way to eat. Is that right, Tom, is that how you interpreted it?

– I mean the What The Health thing, they were making big, bold claims, this one, at the very front, they say, listen, this is mainly anecdote. And they do make some big, bold claims in the documentary. Some of the claims are, for instance, they say that the ketogenic diet in the documentary can help cure, or it’s looking very promising, that it can cure children with severe autism, and they show some images of non-verbal autistic children who suddenly are able to verbalize after they’ve been on the ketogenic diet. And I’ve also hear that this can be good for children with epilepsy, do you know anything about this?

– Okay, so, you know, the documentary aside, let’s back up and see what a ketogenic diet is. Yes, it was initially sort of used in children with intractable seizures, certain types of seizures, to good effect. So something about the brain using predominantly ketones for fuel, which by the way it’s a myth that the brain needs, can only run on glucose, it can actually run on a ketone, which is beta-hydroxybutyrate as well, at least partially. And so this idea that it helps kids with seizures was an early discovery, in the early 20th century. Now let’s back and say, what is this diet, and how should we be eating? Is this a magic pill like the documentary title suggests, which is a clickbait title, just like What The Health was a clickbait title, clickbait documentary. How should we be eating? So, a ketogenic diet works like this, and it’s not a very complicated principle, but you do have to understand a little bit of biochemistry to really get it. When human beings eat mostly fat, get most of their calories from fat, and each gram of fat is nine calories, alright? The way the the body metabolizes that is it’ll break down the fat into free fatty acids and into ketone bodies, and there are two types of those, we don’t need to go into the details of it, and then cells can actually use those ketone bodies for fuel, so directly getting fuel from fat, as opposed to the way that most Americans eat, which is a very carbohydrate based diet where you’re using glucose predominantly directly for fuel, blood glucose that you’re ingesting in the form of carbohydrates. So when you switch your macronutrient intake, in other words, instead of taking in a lot of carbohydrates and a lot of protein and a little fat, you go to a lot of fat, moderate amounts of protein, and very few carbohydrates, like less than 50 grams or 20 grams a day, which is really hard to do. Your body starts to shift to, instead of relying on glucose in the diet for fuel, it relies on fat. It then creates these ketone bodies, that’s where the term ketogenic diet comes from, so the blood levels of these ketones start to rise. You can test this by peeing on a ketone strip that’ll turn black if you have a certain level of ketones in your blood, or you can do a finger stick, very similar to diabetics checking glucose, with special ketone strips that work in a regular glucometer as well, they’re more expensive, and you can check your blood hydroxybutyrate levels, that’s one of the ketones, and that’s a more accurate measure. Now, these ketones, when we talk about diabetics, when we talk about things like that, we talk about ketosis being terrible, oh, he came in in diabetic ketoacidosis, well it turns out, that type of ketosis is very different. In that type of ketosis, the body makes no insulin, no effective insulin, and as a result, it cannot use circulating blood glucose, so it turns to burning fat as a way to generate its fuel needs. The problem is it’s unregulated fat burning, so you end up getting high levels of these keto acids, and it causes the blood to actually get acidic, your blood pH to drop, and terrible, terrible, terrible metabolic derangements to happen that get you hospitalized and can be fatal. You cannot do this from a ketogenic diet, assuming you’re not a diabetic. You cannot do this from a ketogenic diet. So having ketone bodies from ketosis from a diet is not the same as diabetic ketoacidosis, so let’s get that out of the way. So why do people say this diet is a better way to lose weight, to eat, and to fight metabolic disease like cancer, diabetes, et cetera? Well, the theory that they propose is that, insulin is a problem, so when humans started shifting to eating more carbohydrates, and there’s controversy about this, the paleo people will say, well cavemen ate mostly meat, and fat, and berries that were low in carbohydrates, and therefore they were the original, sort of, you know, low-carb guys, but there’s debate because a lot of them ate nuts and acorns that have a lot of carbohydrates, so it’s unclear what our ancestors actually ate. That aside, insulin, which is secreted in response to carbohydrates in the diet including sugar, including complex carbohydrates, in itself as a hormone can cause problems at high concentrations. It can cause resistance to insulin where the tissues become resistant, and you have to get higher and higher levels of insulin, and that’s a problem because insulin itself is a growth hormone. It can cause tissue growth, there’s a debate as to whether it causes plaque and atherosclerosis in blood vessels, and whether it promotes the development of tumors, cancerous tumors. It also has bad metabolic effects. So the proposal is, with the ketogenic diet, is that you actually lower circulating levels of insulin because you’re relying more on fat, there’s less sugar and carbohydrates that you’re eating, so your insulin levels are suppressed, which allows you now to burn fat that’s also, you have effectively unlimited stores of, right, whereas you only have a limited amount of glucose in storage in the form of liver glycogen, muscle glycogen, that you can burn through really quickly. Here’s a good example, if you have something sugary, and then you go and do, try to run a marathon, you’ll hit what they call the wall in just a few miles, where suddenly you feel like you’re so hungry, and you’re dying because your blood sugar has crashed, because you’ve burned through your glycogen, you’ve secreted insulin, you’ve put all the sugar in your cells, and now you’re trying to pull it out, whereas on a ketogenic diet, your actual glucose levels stay a little more constant because you’re not getting these swings in insulin. So the theory is that insulin is a problem, by limiting insulin, changing our metabolism to focusing on fat burning, it’s more beneficial for weight loss and for metabolic health, preventing diabetes, preventing cancer, and other metabolic illnesses. Now, Tom, what did the documentary say about this in general?

– Listen, you threw a lot of science at me there, Z. And what I’m looking for, as a regular person, is just for you to sort of confirm my biases, because I’m on the ketogenic diet right now, and I feel great, so tell me that it cures all the cancers, please.

– Alright, let’s back it up and talk about that, let’s go straight Muggle, and you and me talking about this diet. I did this diet, the ketogenic diet, high fat and low carbohydrates, for eight months, and this, I transitioned from doing intermittent fasting to the ketogenic diet. I lost about 10 or 15 pounds, which for me, I weigh at baseline about 150, and I’m about 5’5″, so I’m a short guy, I’m not a big guy, that’s a lot of weight. I got a six-pack for a minute, I lost a ton of body fat, and I felt generally pretty good. Downsides. My LDL cholesterol went from around 80, which was good, to about 170, which was not good. So I happen to be one of those hyper-responders where my lipid levels did not like the high amounts of saturated fat that I was eating. Now when I switched from saturated fat to monounsaturated fat, like olive oil, avocados, nuts, the LDL dropped, so that shouldn’t be an endpoint problem with a ketogenic diet. In other words, your lipids, most people, lipids actually might get better on a high fat diet, assuming you’re picking the right types of fats, and your genetics are appropriate for this, because there’s no one size fits all. So the other problem with that diet was I couldn’t sustain it because I couldn’t eat with my family, they’re big carbo, they’re carboholics, but they’re super thin, they have good genetics where they can just eat whatever they want, and it was starting to drive me crazy, so it wasn’t a sustainable pattern for me, and I worried about my lipids, and so as a result, I switched to a more Mediterranean diet. Now, here’s the truth. The ketogenic diet can work wonders for people, particularly with a tendency to metabolic syndromes like diabetes, and it can work really, really great, and I highly advocate it for people who it’s a fit for, which means you gotta do some trial and error, talk to your doctor, make sure it’s a fit, and give it a shot. If it works for you, wonderful. However, a vegan diet might work equally well, or it might only work for you with your type of genetics. Or any other number of diets that have these things in common. What is magical about the ketogenic diet, what is magical about a vegan diet, what is magical about diets that work and are sustainable like the Mediterranean diet? Number one, there is very little refined sugar in these diets. There just isn’t. Refined sugar by all sort of estimations seems to be, for most people, a toxin. It makes you hungrier, by secreting, causing insulin secretion, fructose itself is mostly processed in the liver, like a toxin. And I don’t use the word toxin lightly, because it’s overused by Goop and all these idiot celebrities, it is processed like a toxin in the liver, and high levels of it can lead to insulin resistance problems, obesity, and that’s partially, I think, the reason why we have an obesity epidemic is we shifted from a reasonably high fat diet to a reasonably high carbohydrate diet, particularly refined sugars in the form of sodas, and things like that, and that’s been a problem. So what do these diets have in common? Low refined sugars, real whole foods. The one major thing that happened when I went to a ketogenic diet is I started shopping in the stores with a deep understanding of getting real food that wasn’t processed, because all the processed food had high levels of sugar and crap in them that wasn’t compatible with a ketogenic diet. In that sense, the magical answer is, eat real food, don’t get a bunch of refined sugar, and understand nutrition, know what’s in your food. Understand that a can of Campbell’s soup may have a bunch of sugar added, it may have a bunch of salt added, and it is not necessarily, say, a healthy thing, it’s a processed food. Understand that a grass-fed steak may actually be healthier, particularly if you’re not charring the heck out of it on a grill and creating a bunch of potential carcinogens, but even that we don’t understand about, but a real piece of meat is probably healthier than going to McDonald’s and having a processed meat where they’ve added potentially fructose, and a bunch of salt, and a bun that’s refined white bread, that’s absorbed the same way sugar is and produces an insulin spike. So the bottom line is, no, there’s no magic pill, but there’s a magic way to eat, which is real food, not a lot of processing, not a lot of sugar added, and that spans everything from vegan to ketogenic.

– I have to mildly push back on you and the word refined sugar because people use this to mean only white sugar, as if something like agave nectar is not a refined sugar, or turbinado, or any of these, quote unquote, “healthy sugars”, you know what I mean? They’re the same as corn syrup, they’re the same as white sugar. All sugar is sugar.

– Let’s talk about that. That’s actually a great point, Tom, thank you, so, sugar is mostly sugar. So honey, which is fructose and sucrose, pure table sugar, which is mostly sucrose, drinking glucose, like the glucola they give you for pregnancy challenging for oral glucose tests, these all end up in the body mostly being transformed into an insulin spike in sugar. Now the difference is with agave nectar, which is mostly fructose, since it’s processed as a toxin in the liver, it actually doesn’t lead to an immediate insulin spike, but there’s a lot of evidence, see Bob Lustig, et al, that it actually leads to a lot of metabolic derangements, potential fatty liver, and potentially diabetes, insulin resistance, et cetera. So sugar of any kind, especially added sugar, is not great. Now fructose is the predominant fruit sugar in fruit. Is it bad for you, if it’s a toxin? Well, when god creates a poison, he wraps it in the antidote naturally. So a fruit is full of fibrous matrix, which slows the absorption, which means, and this is why vegans really love fruits, because it’s actually absorbed very slowly, so you don’t get these spikes in insulin, you don’t overwhelm the liver’s processing ability for fructose, and you get the benefits of the vitamins, nutrients, and minerals that were in the natural fruit. Now what happens when people grind it up and juice it into a paste? You release all the fructose from its matrix, and that is not good. That is going to lead to an insulin spike in most people, and that may not be healthy. Some people in the comments are talking about the metabolic effects of the ketogenic diet, meaning, the effect on tumors and things. So the theory being that high insulin levels can be tumorigenic, they can promote the growth of tumors. Again, the jury is still out, we need more information, but eating a balanced, whole food diet, without a lot of processing, without a lot of sugar in it, is probably going to be a good thing from a cancer standpoint from all the, at least the anecdotal evidence we have so far.

– The other point I want you to expand on, Z, is the no one size fits all because now the diet has become the new religion, and vegans use it as moral movement to galvanize people. They will say things like, “How can it be that there are many different diets “for all different kinds of people “when animals, look at animals, “they all eat the same thing?” And it’s like, you idiots don’t realize that we all evolved in different geographic regions of the world, or what, because I’m confused.

– But let’s understand that food has cultural significance, it has religious significance, it has personal significance. There’s a lot of emotional energy tied up with food. This is why anything we talk about with food will get a bunch of angry comments, and a bunch of comments that are like, “Thank you, this is the word of god.” Because it’s such a deep cultural thing. If you look at cultures that have high carbohydrate intake, the Japanese with rice, certain parts of the Mediterranean, they still do really well. So telling people cut all the carbs is probably not the answer. It’s about a balanced sort of diet, and I think there are universal principles around that. There is no one size fits all for every genetics. Like, for example, the ketogenic diet, probably wouldn’t work for me because I small atherogenic particles of LDL. Now, I had no signs of inflammation, so one of the theories around the ketogenic diet is that it reduces inflammation because you’re not taking in high amounts of fructose and sugar, and other sort of wheat-based products. Now again, the jury’s still out on this. Books like Wheat Belly and Grain Brain, it’s still not clear that those are accurate in terms of wheat causing inflammation. Nobody really knows, and it may be different for me than it is for you. That’s why trial and error, eventually when our science gets better, we can look at your genetics and other things and say, by the way, right now one of the biggest scams out there is people saying that they’ll be able to test your genetics and tell you what you should eat, or what you’re allergic to. That is, so far, complete nonsense, right? Consumer genetic testing has its place, and we’ve done shows on it, but you’re not sophisticated enough yet to be able to do that. So there is yet no one size fits all. Anyone who tells you is trying to sell you something, or they have a religious belief, religious meaning some deep, elephant-based belief around how to eat, and you’re going against it.

– Jeanine says, “So a fresh fruit smoothie “is not good for me?” This is one the biggest lies in the culture is, like, that people, when they have that big glass of orange juice in the morning, they think they’re like really doing their body good, you know, like I’m being healthy. I might have two glasses of orange juice. It’s like, you might as well drink a Coca-Cola, you know what I mean?

– Exactly, and again, I’m gonna back down from that a little and say, look, if you want a fresh fruit smoothie once in a while, that’s wonderful. You’ll get the vitamins, you’ll get the minerals out of it, but you will also get a big dose of sugar. And if you’re using it as a detox, which by the way is not a thing, if you’re using it as a detox from a bad diet, no, all you’re doing is adding sugar to injury. If you’re using it as part of a balanced diet, more power to you, and it’s a way to get some fruit intake and vitamins, again, especially for people who, our, our Western diet is sort of so deficient in particular vitamins that it’s good to be able to have that almost as a supplement. But really just eating a balanced food diet is probably enough. Now the other piece of that is, again, a lot of the commercial juicing places add a ton of sugar, and that makes it worse. Now someone asked a question, “What about exogenous ketones?” So there are people who sell packaged ketones that you could take. Well, the jury’s really out on that because if you’re not eating a balanced diet and taking in ketones, yeah, you’ll burn them, by the way, they taste like jet fuel, you’ll burn them, but what is that really doing for you, unless it’s part of a broader strategy you have, working with a dietician or a doctor, to do something interesting, like my friend Dr. Peter Attia does with people, and he’s tried those, and he said they basically taste like jet fuel.

– Z, let’s end on this one. This, for a regular person, is very confusing because you’re always hearing different stuff from the medical establishment, you’re hearing eggs are bad for you, then you’re hearing the yolk is bad for you, then you’re hearing eggs are good for you, then you’re hearing don’t eat bacon, then you’re hearing do eat bacon. What, how do regular people parse this? What are they supposed to do, how do you find a diet that works for you when all information seems to be conflicting and nobody seems to have the right answer at the moment?

– I think step one is stop watching the news about diet because anything you see on the news is suspect because it’s all correlation and not causation. We still do not have good ways to study nutritional effects in humans long term, period. If you see a study shows some correlation, that’s just what it is, a correlation. People who eat a bunch of fruit may happen to have an overall healthy lifestyle, or have a genetic predisposition to living longer and liking fruit. We have no idea that fruit is causal in that. So the bottom line is this, eat food, not too much, mostly plants. I would actually advocate and say actually say mostly whole, natural food, that’s unprocessed, without added sugar. Try to avoid like a lot of white breads and easily absorbed carbs like that. And just enjoy the food. That’s another key thing is you need to enjoy your diet, or else it’s gonna be unsustainable. Those are the main things that I would advocate, and whether it’s a ketogenic diet, whether it’s a vegan diet, whether it’s a Mediterranean diet, which is what I eat currently, and when I fall off the wagon, I gain weight really fast, and it’s usually when I eat ice cream and processed food, and sugar, and go out to eat a lot because you don’t know what’s in your food, it’s tough. So that’s my take-home, guys, I don’t know, what do you think, Tom Hinueber?

– You heard it here, guys, everything that’s white is negative. White bread, white sugar, white people, white privilege.

– I hate you so much, Tom Hinueber.

– [Tom] Snow, water chestnuts.

– Actually, you know what, you should do a diet book called I Ate You So Much, Tom Hinueber, The Tom Hinueber Approach to Eating.

– It’d be like, step one, get your McFlurry on, people, because they’re delicious.

– Step two, toppings for the McFlurry. I prefer Reese’s peanut butter cups, just broken and put on top.

– When they used to have the Rolo McFlurry, that was the best McFlurry, I’m just saying.

– They had a Rolo McFlurry?

– Oh, it was amazing, yeah. Go in there, get a Rolo McFlurry, McRib, pinnacle of a healthy diet, people.

– I love all that stuff so much, by the way that’s,

– By the way, this is how my food pyramid goes, Rolo McFlurry

– A great take-home point.

– McRib, vegetables, fruits.

– Take-home point, sugar is addictive. The way the McRib is set up, the way these McFlurrys are, is we evolved to crave sugar and sweet because it was so rare in nature, and if you found it, the goal was eat as much of it as you can to store it up. Unfortunately in our current society that’s a maladaptive evolutionary drive. So we get a little burst of dopamine when we eat something sweet, and believe me the processed food guys are designing the food in a way to trigger that in you, so if you don’t want to be manipulated by Big Food, eat real food, not too much, and enjoy it immensely. We out.