The Carnivore Diet, Ketosis, & Diet Variation


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Katie: Hello, and welcome to “The Wellness Mama Podcast.” I’m Katie from wellnessmama.com. And this episode is going to answer all of the questions I’ve been getting from you guys about the Keto diet. Because I am here with Dr. Gustin Gustin, who’s a board-certified sports physician, a functional medicine practitioner, and an overall food and fitness skeptic like I am. His focus recently has shifted from private practice to creating products that improve the accessibility of whole food nutrition and ketosis, with his company’s Perfect Keto and Equip.

And in addition to publishing his own health reports on his website, he has dranthonygustin.com, that will be linked in the show notes. And we’re gonna jump into everything keto today, so Dr. Gustin welcome and thanks for being here.

Dr. Gustin: Katie, thank you for having me.

Katie: Like I said, this is obviously a popular topic right now. I know so many people, even just neighbors and friends who are trying out the keto diet, and it’s super popular right now. So I’d love to hear first and foremost why do you think we’re seeing such a rise in the popularity of the keto diet?

Dr. Gustin: It’s hot right now isn’t it? It’s pretty crazy. And we’ve seen that in our business too, and just kind of the message we’re trying to put out is we can’t keep up, you know, we post like five to seven articles a week, people seem to want to know more, and more, and more. I think that one of the biggest things is that just people are getting results with it, and so whenever your results…I think something like this that can become kind of trend worthy. Just like when paleo started to hit you know, five, eight years ago, you saw a lot of people climbing towards because it was working so well.

I think that we’re seeing a lot of the same thing in a ketogenic diet as well, people are getting results whether that be from weight loss, from mental performance, from physical performance, from treating chronic diseases. The whole spectrum of people are really getting a lot of awesome results, so I think that’s kind of what’s driving it forward so rapidly right now.

Katie: Got it, I also feel like there are probably like 100 different versions of the keto diet online depending on who you ask, and who people are following. So I’d love if we could start with the very basics. First of all, what actually is a keto diet? Is it measurable? And then also what does that look like as far as the food you’re actually eating? Because I know some people take it to mean a bacon and cheese diet which I have some concerns about, so I’d love to hear your take.

Dr Anthony: Some of the biggest gripes that I have with the ketogenic diet is that, you know, in a paleo diet we set a lot of great parameters about what to eat, and in a keto diet we kind of set a lot of parameters on how much to eat, and so people really focus on macronutrients. And so to be in a state of ketosis, which is essentially just using your own body fat or dietary fat as fuel source instead of carbohydrates, you need to restrict carbohydrates first of all, and then moderate to medium amounts of protein, and then fat is gonna fill in the rest to fill in the void of energy that your body needs to function at a basic level.

And so from restricting carbohydrates, a lot people start measuring macronutrients, and when people start measuring just macronutrients, they kind of forget about the…

… A whole food diet first, and then a ketogenic diet second. And so I think that food quality is very, very important. And I think that the main mistake that a lot people make is that they try to do a diet like this just to raise their ketone levels. But just raising your ketone levels, unless you have some chronic illness like you know, maybe cancer or seizures or things like that, the ketone levels really don’t matter that much. And so the levels of ketones are measured either in the urine, or the breath, or the blood, this is saying that this is how many ketones are floating around and available for use. It doesn’t say how much are being used in your cells, and then when we start measuring that, we try to think that more is better and that’s not always the case.

And so I think that just thinking about, you know, from a fundamental level, what is your goal for nutrition? I think that a lot of nutrition when you dial it down into after whole foods you know, whether it be a ketogenic diet or a carnivore diet, or gluten-free, or vegan, or whatever, I think that you’re looking at how to use nutrition as a tool to get a job done. And ketosis is just one of those things, more ketones doesn’t necessarily mean better, and I think that that’s one of the things that people should be aware of here.

Katie: Do you feel like keto is another fad diet at least the way it’s done currently, or do you feel like it’s rooted in history and something we’re coming back to, kind of like the idea behind the paleo diet?

Dr. Gustin: That’s a great question. I think that it has not been in popularity from anybody who’s pretty much alive right now due to a lot of the demonization of fat. You know 40, 50, 60 years ago, and I think that it is now going to be accepted as we move this trend forward. Not necessarily keto as a name, I don’t know or really even care if that is something that resonates in 10 years from now. What I care about is that people start embracing fat as a healthy component of nutrition. And so this is something where I think that we missed out for the last like I said 40, 50, 60 years on fat and it’s an essential macronutrient.

And so when you do break down things like protein, fat, and carbohydrate, you can look at those very essentially. Protein is for sure needed, fat is for sure needed, and carbohydrates are not needed and if you’re looking at essential macronutrients for human health and just for performance and everything that you need as a human. And so I think that when we restrict fat for so long and add the carbohydrates in, we see a lot of the problems we do see right now. I don’t think carbohydrate are evil, I don’t think they should be avoided at all costs, but I think that for sure minimizing a lot of them and starting to incorporate some healthy fat back in the diet is a really good move.

And I think that we’re gonna see this massive macro shift from this low-fat diet that we’ve been fed for the last few decades, back to a more normal… what we’ve had throughout human history is just a super high fat or at least moderate fat diet that pushes things forward. I mean if you look at fat, for example, makes up a lot of our hormones, it makes up most nerve in the nervous system, it makes up all cell and cell lining. So like it is an essential thing that we need to thrive as a human being. So having an adequate amount is super important.

Katie: You’re right, and we saw such a policy for so long that demonized fat, and this was coming out of even governmental regulations. My listeners are pretty educated, so they probably already have a pretty good idea of why that policy we’re now seeing such big problems with it. But for anybody who’s not as familiar with that, can you kind of give us the high level of what’s changed and why we now understand that fat is not the enemy, and why they used to think it was the enemy?

Dr Anthony: I mean, anyone who wants a deeper dive into this, I would recommend Nina Teicholz book “The Big Fat Surprise,” she does the best job of anybody else that I’ve seen digging into all the details about, you know, why we demonize fat in general, how we got through this whole thing and where we’re at today. And she’s done a great work as far as trying to get the standards in the governmental recommendations for food change, so it is a moderate to high-fat diet. But really again, if you look at it, it kind of stems, like most awful things, from one kind of phase shift in the industry of government recommendations.

And this came from Ancel Keys who did a study trying to show that saturated fat causes heart disease and cholesterol as an enemy, and all this different stuff. And so packaging it up and saying that these things are bad for heart disease, you know, we had a lot of different things happen at that point, the president had a heart attack, we were trying to answer that really quick. We wanted an answer as far as what to eat, there was a lot of changes in the food system. And so we kind of had this perfect storm for recommending a low-fat diet. When that happened, a lot of things changed.

And so if you look at the data around incidence of diabetes, incidence of heart disease, incidence of obesity so on and so forth, all that spiked essentially when we went to a low-fat recommendation. And Nina does a really great job of explaining you know, all the information that she puts out that generally, American population does a really, really good job at shifting to what is expected from them from the government. And so we follow recommendations, and so when the government says “Stop eating fat eat low fat, stop eating meat, meat causes cancer,” we do these things across the board.

The really bad part here is that these things actually promote a lot of deficiencies in the diet and a lot of problems moving forward. And so what’s happened is that we’ve now gone a bunch of decades with a lot of these health problems looming and a lot of questions as far as how to really solve this, and what is going on with human health. I tend to think that usually comes back to nutrition, and so a lot of people who are smarter than me, who are doing a lot of research on this have shown that limiting fat and increasing carbohydrates is the crux of some of these problems you know.

So we’re looking at heart disease, looking at inflammation, diabetes, autoimmunity, obesity, a lot of these are tied back to overconsumption of simple carbohydrates, not getting enough fat. Obviously, a really inflammatory diet is not great so again going back to what I was saying earlier about having real food is super important. And Gary Taube’s is another one who does a lot of work in this, and he kind of as neat as a champion for fat, he’s kind of the guy who is talking about what is bad with carbohydrate. And so they kind of painted a complimentary picture to one another.

But, it’s a crazy thing and the fact, like I said, anyone alive today you know, just accepts that fat… you know, if you’re over the age of 20, 25 is unhealthy, you know, meat is unhealthy. And anyone older than 50, 60, 70, or beyond that, anyone, you know, who would have been 100 plus today would think that’s insane. And that you know, cooking with animal fat and eating animal products is just a normal day and a necessity as far as nutrition goes.

And so we’ve come a long way in the last 30, 40, 50 years, and I think that switching it over and seeing magazines like “Time” go from demonizing fat to now accepting it. And, I mean, it’s a fascinating thing, how fast things can switch over the course of human history and kind of where we’re at now, kind of accepting these things as ancestral norms and getting them back into our diet now.

Katie: And some of the weird things that came with it, like when everybody got rid of butter and adopted margarine which is this chemically created, essentially plasticized fat that the body has no idea what to do with, instead of butter or animal fat for cooking, or even Olive oil. There are so many better options and that was a thing that stuck around for a long time, and I feel people are now starting to get that there’s a problem with it.

But you I feel like you’re in a sense kind of a rare unicorn because you’re a board-certified physician, but you also understand functional medicine, and you also understand nutrition. So just to make sure we’re clear, from what you’re saying as a doctor, and as someone who understands nutrition, that fat does not cause cardiovascular diseases, is that your understanding?

Dr. Gustin: There’s just no evidence that points to that, and usually with people that I’ve seen… and of course is a very multi-factorial thing. That, one… again the biggest thing that I see is that people when they eat real food they normalize a lot of stuff. But you know, low fat versus high fat, there’s not even a comparison. People who limit fat you know, they’ve shown us in research that things do not go well for people who limit fat over the long term. And, it is something that demonizing the… like I don’t think that everybody needs to be on a ketogenic diet. I think it’s a useful tool like I was mentioning before. But I think that, you know, eliminating it entirely from the diet is a really bad move.

Katie: Exactly. So I wanna get back to you in minute to the keto diet and go deeper on that. But first, because you mentioned protein and you mentioned the carnivore diet, I have to get your take on this. Because I know this is another one that’s come on the scene that’s getting a lot more popular, and I’m getting questions about. And my background in nutrition and also just being a woman, I definitely have some concerns when I hear of women doing a carnivore diet, but I’m really curious, your take on it, and just any advice you have there.

Dr. Gustin: I was concerned about it for a while too when I was looking into it, and again, just like with a ketogenic diet, a lot of people were getting results with it. And so when you look at positive anecdotes, overwhelming amount of them saying that “Keto didn’t work for me, paleo didn’t work for me, you know, autoimmune diet didn’t work for me. But this, the carnivore diet works for me above all else.” And I just saw cropping up over and over and over again, I was a little skeptical, as I try to be when it comes to that.

I don’t like to deny or recommend anything without doing it myself, so I did five and a half weeks of a carnivore diet myself, just to see how it was. And looked into it and researched it, and kind of dug really, really deep into the topic. And I was shocked to find that there wasn’t really anything that kind of contraindicated the need for vegetables or the limits on meat. And I felt pretty incredible when I did my experiment. Now I don’t think that… and I don’t want to say that vegetables should be shunned entirely. I don’t think that… you know, for some people, it might make sense and I think there’s several reasons why… the normal person, that is not a great idea. We can dig into that a little bit further if you want.

But I’m curious actually as far as why you think for women in general or just what your take is and why it would not be beneficial. I wanna poke holes in it so I just wanna discuss you know, where people are coming from and why you think that.

Katie: Absolutely, for me, just mainly coming from the… I read a lot of research and have really delved into the microbiome lately, and I have concerns whenever any… like you mentioned, there’s not a need for carbohydrates necessarily, but there is a need for biodiversity in the gut. And different bacteria in the gut react differently to bacteria and prebiotic fiber that comes in. So my concern with the carnivore diet is you are essentially removing all of the prebiotic fiber that could potentially come in. And I wonder about long-term effects, if we’re gonna see reduction in the diversity in the gut, or potentially like changes in enzymes or things that we need for digestion. Is that something that you’ve run into at all or that you would be concerned about?

Dr. Gustin: Yeah, so I share a lot with Dr. Michael Ruscio on this topic, who is one of my go-to guys about gut health, and I mean we share a lot about gut health in general. So gut problems, what happens is generally the treatment protocol is to remove all fiber, not add more fiber in. And so that’s one of the reasons why I think short term carnivore diet works so well for people is that it’s essentially a gut reset program. And so you’re removing all fiber, and you’re correcting a lot of imbalances of the growth of bacteria that you have in your gut.

And so I think a lot of people… we have these ideals that biodiversity in the gut is good and all these different things, but we really do not know anything about the gut where we’re at right now. We’re still naming species and we’re still in a phase where we just generally don’t know that much. We know some stuff might be good, we don’t know in what proportion, we don’t know for what population. And so there’s something where I think that we put the cart ahead of the horse, and we don’t really know what we’re talking about yet.

And this is… you know, Dr. Ruscio is the same way, he knows how to deal with what he sees, he’s again the person I think has read the most research about this. And I think he’s had a book come up that is phenomenal dealing with this stuff. And, I think that fiber generally… and this might be controversial, but it’s a little overrated. And I think that you actually can get a lot of stuff from animal parts, so this is called proteoglycans in cartilage and skin that your body can actually use as prebiotic and probiotic fiber. And so that’s something too that can be incorporated to see what the microbiome… how it handles it.

I’ve just seen so many reports people long term 2, 3, 5, 10 years on this type of diet clear up digestive problems, clear up any kind of gut problems. And actually, thrive on this long term. That, you know, it’s not that I think that again it’s 100% necessary it just… you have to ask a question of is fiber really necessary to the degree that we think it is. And do we really know enough about the gut microbiome to say, you know, plants are the only ways to get this type of fiber, and the only way to balance a gut microbiome?

I mean, we’ve studied and the way we get the conclusion that, you know, more diversity is good or better is from people generally eating a standard American diet and not really even paleo diet let alone ketogenic diet or carnivore diet. So gut microbiome for somebody who eats only meat, maybe they need less because a lot of the meat actually gets absorbed in the small intestine, and you have no need for it in a large intestine anymore.

And so, there are a lot of studies showing that you need microbiome diversity for regulation of mood, and regulation of hunger, and all these hormones and stuff like that. But I mean the most important thing is that you have high mucosal integrity and high amounts of bacteria on top of that mucosa in the gut. And I think what happens is lots of people overeat fiber they actually… you know, with inflammatory foods especially is that they start breaking down that mucosal layer and getting into the gap lining of the actual gut and breaking that down. And more things get in your bloodstream than need to be. So I mean I think it’s a much bigger story than just you know, eat more fiber, more fiber equals more gut bacteria, and more gut bacteria equals more health.

And so I think it’s a way more complicated picture than we have to paint, and I think that we’re not even close to answering that question yet. So again, I remain skeptical, I don’t really know the answer, I don’t think anybody has the data to know the answer. But I think we’re really getting ahead of ourselves as far as gut health goes.

Katie: Interesting, it’s a great point and I think you’re right we’re only starting to barely touch the tip of the iceberg when it comes to gut health, and I’m really excited for what the next few decades hopefully will hold for research. But I am curious… so as a follow up to that, a), what about people who do this for an extended period of time and then do eventually reintroduce vegetables, do you think they could potentially lose the ability to digest that correctly? And also, I totally agree with you as far as I don’t think we need refined carbohydrates and certainly not sugar, and that most of these things are over consumed.

But it seems like even looking at the keto diet or the paleo diet especially, there is a strong historical prevalence of people eating vegetables usually green vegetables in small amounts, and like a large diversity of that, both for the micronutrients and then obviously that is a type of fiber as well. So I’m curious your take on those because like you said, it’s a controversial topic but I’m excited to go deep on this.

Dr. Gustin: Can you break those questions down for me, just kind of one by one so that we can tackle them?

Katie: Yes, so the first one let’s just tackle, do you think someone who’s done the carnivore diet for instance long term, will have trouble reintroducing vegetables at some point if they decide to?

Dr. Gustin: So just like with any type of nutrition, if you eliminate something entirely… which again, I’m not advocating for, and I don’t say that this is the best way to go about nutrition. I think again, carnivore diet might be a tool for some people for some reasons, and so that’s why I think it may be helpful. I’m not saying that everybody should be doing this, but even when you switch to ketogenic diet for the first time, you have certain receptors in your cells that use fats in a certain way and can show them into mitochondria that have basically been unused for your entire life, that starts getting turned on, that might take four to eight weeks to start using ketones as energy.

And so, the same thing goes with all foods. So, if you eliminate carbohydrates entirely and you eliminate all fiber entirely, even if you eliminate meat entirely…so if you eliminate meat for a long period of time, your body stops producing certain acids in your stomach that help break down the meat. And so, your body doesn’t wanna waste energy dealing with stuff that it doesn’t deal with. And so if you do that, you might have a transition period adding stuff back in, you might need to take it a little slow. But it’s like your body loses the ability long-term or forever to be able to process these foods and use them as an energy source. Your body is very adaptable and it’s not like its going to just completely forget and have amnesia permanently about how to handle certain foods.

So I don’t think that this is a relevant concern. I think with anything when you go extreme, your body adapts to extreme, and it has to then adapt to moderation over a long period time as well. And I think that you see this an energy system, you see this in food choices, you see this across the board. So it’s not something I’m worried about. Can it happen? Yes, but I think that it’s less of a concern than people make it out to be.

Katie: Interesting, definitely, got it, and I know for me and my side of research I’ve come around especially in the last couple of years the idea that there’s obviously so many different dietary ideas and systems people use. And to some degree, I wonder if like what if we’re all right at least a little bit, like what if all of these things have their time and their place, but it’s finding out for all of us the thing that actually is going to work for us. And like you said, there’s genetic components, there’s personalization here, so no one recommendation is gonna work for everyone.

But back to the earlier point on vegetables, we do know just anthropologically there is a really long history of humans eating greens or different kinds of vegetables that were found in nature and easy to forage. So I’m curious, your take on those within the paradigm of a keto diet or a paleo diet?

Dr. Gustin: Oh,and this is… again, so your question of variance, I think you asked little bit about that as well. Like, we had a lot of variance, why would we skip on that? I totally agree with that point, I think that a lot of human nutrition and just human life in general, people have become healthier with variance. And so if anybody is curious more about this subject, read Nassim’s Taleb “Antifragile” to kind of dive really deep into the book about randomness. But I think that incorporating randomness is the most important thing, and so that’s why you know, when people look at fasting, for example, intermittent fasting every single day for eight years, it might not be a good idea, especially for women.

If they look at being vegan only for 10 years, probably not great, if they look at being a carnivore for a long-term, maybe we’ll find this as well. I don’t think that humans ever had a time where they were able to have the same nutrition day in and day out for years, and years, and years at a time. I think that mixing it up is a really good thing, And then that comes to fasting, that comes to food choice, that becomes the macronutrient ratio, that comes to metabolic flexibility. The whole spectrum, and I think that that includes having meat but also having vegetables as well.

And so when we look at kind of what vegetables are and how they provide nutrition to the body, it’s less that vegetables and plants in general, provide micronutrition or vitamins and minerals. Meat hands down, if you look at any kind of nutrition chart wins that hands down, whether that be organ meats is obviously at the top that spectrum, and then kind of second to that is just animal meat, and then way below that are spices and herbs, and below that are vegetables for example.

However, what they do provide that meat does not is a lot of hermetic stressors. And so for instance, everybody knows like justto give an example, turmeric, great anti-inflammatory, it’s because turmeric is a little bit of a stress to the body, so the body has to react to that in increasing a lot of immune system reaction. So that way your body you know, if it comes into more turmeric later, it does not become overwhelmed by it. And so the same thing with it, if you go out and do a bunch of squats and you become sore on it, that’s a stressor, you’re not adding to your body. Your body freaks out, it does not want to have that stress again, so it makes you stronger.

Plants work a lot in the same way, and that’s why I don’t think that anybody removing plants has it figured out totally. That’s like saying that, you know, work out make me sore, and I can get overtrained by running eight marathons a day, therefore, I’m never gonna move again. We still want a lot of stress in movement, we still want your body to move, we still want a lot of that baseline. And that vegetables and plants, in general, provide a lot of the same thing. And so if you look at books like, you know, “Plant Paradox,” and, like, people talking about plant toxins and all this stuff. Again, we don’t wanna put that in a bucket and go so extreme to say that you should never have that stuff, we should look at it and say okay, what is the utility of that.

And I think that just like working out, having a stressor for it and adapting to it is a really, really good thing. Does it makes sense to eat 15 salads a day? Probably not. If we’re getting those stressors on a cellular level over and over and over again, probably not a great idea. Do I think it would be good to eliminate entirely over the long term? I do not think so, I think that what you mentioned about variability and randomness is 100% how humans have probably adapted over the last couple million years, and probably how they should be approaching nutrition for the next couple million years. If that makes any sense, it was kind of a long example.

Katie: That’s such a good explanation and I think you’re so right. To me, what both history and current scientific data really back up is the idea that we do need, like you said, a ton of variation and different stressors at different times. And if you wanna look at just history alone, people didn’t always have the ability to eat all the time, so sometimes they had to fast by default. They certainly weren’t eating strawberries in the middle of winter, and, you know, they weren’t eating necessarily potatoes in the middle of summer, they only could eat what was available as certain times.

And now we do have complete availability of every food and every macronutrient at all times, but that isn’t what we’ve historically had the ability to do. So I’m curious, since we touched on a little bit and you mentioned intermittent fasting, I’d love to get your take on fasting both intermittent fasting and then water fasting and some of the other types of more extreme fasting?

Dr. Gustin: This is another thing that people don’t realize that fasting is a stress, and so, if you’re somebody who goes to work and you’re running at the door, and you’re grabbing lunch, and maybe not eating that day and you’re stressed about bills, and your kids are yelling at you, and all this stuff. And then you run to the gym afterwards and do a stressful CrossFit workout, and then rush home, and have no time before you go to bed, you should probably not be doing fasting.

And I don’t think anybody talks about this, I think that minimizing allostatic stress load is the overall stress component that a human has to deal with. If your other stress units are high, I think it is a very, very good idea. And so for example, for me, very personally, beginning of the year, I moved from one city to split time between two. I basically… my roles and my company are changing rapidly, the company was growing like crazy, I was hiring staff, I had a lot of personal things going on. My level of stress was insanely high. I was still trying to max it out doing crazy workouts, and fasting, all sort of stuff because I thought it would give me all this edges.

When I eliminated fasting I just ate like a normal human being and ate three times a day, I minimized my workouts, and I started doing more gymnastic stuff instead of with the hard intense strength training workouts, I felt incredible. I felt like I adapted extremely quick to my environment whether… if I was trying to push the stress level on the stuff, on and on and on, I think that it would have been a rough, rough year for me, and I probably won’t be able to have this conversation right now. So I think that looking at fasting is a stress, and if you can handle that, and you feel like you’re at kind of a good baseline level of nutrition and health, okay, now we can talk about adding fasting in.

I wanna get that out of the way where people do not understand that, you know, they may be eating like crap and they don’t really have, you know, any sleeping control, any meditation going on, no stress management going on, and they start adding in fasting. I just don’t think it’s a good tool to use at that point in time. However, if you have all that stuff dialed in, I think it can be an effective tool for a lot of reasons. I feel generally… and why I do it is that… so the way I approach intermittent fasting is I just generally do not eat when I’m not hungry, and I eat when I’m hungry. Because I’m on a ketogenic diet, that looks like one to two meals a day generally.

And so then I just… if I wake up and I’m not hungry, maybe I had a really fatty dinner the night before, I just do not eat until I’m hungry. A lot of that time is extended because I work really intensely, and I get kind of into the zone, and just kind of forget to eat, which is a side effect of a ketogenic diet as well. That’s how I approach it generally. As far as extended fasts, I try to get at least two to three five-to-seven day fasting per year. There’s too much evidence out there suggesting the benefits of long-term fasts regarding clearance of old cells, increase in mitochondria biogenesis. Just, you know, resetting hormones, all this different stuff.

And the downside to me is nothing, the downside is you don’t have mouth pleasure for five to seven days. You just miss out on food for five to seven days. If I had even potential benefits long-term from a downside of essentially nothing, I’m gonna take that risk a couple times a year and not flinch at it. I’ve done it a few times now it’s really not that big of a deal for me, and so that’s why I try to sneak that in.

When we look at intermittent fasting, which is generally people you know, eat less in one day and then they eat less the next day, you just don’t get the same amount of benefits if you were to restrict fasting for a long period time. And so I like to think about it instead of intermittent fasting and fasting, I like to think about it as time-restricted feeding or eating, versus fasting. So fasting I think is longer term, we actually start kicking on autophagy and you’re looking at maybe an extended 2, 3, 4, 5, 7 day fast rather than intermittent fasting, which I think should be just time-restricted eating, or time restricted feeding. Which a lot of great people are doing a lot of research on.

There’s still a lot of benefits there, but I don’t think it’s the same thing as actual fasting over a long period of time. And there’s something too where maybe I can rant about fasting for a long period time because I get so many questions about it. But one of the other larger issues that people ask is, “Okay, well what breaks my fast? Well, what’s breaking my fast? Can I have this, can I have that, can I have that?” Fasting is not eating, and if you eat anything, then you are breaking that fast. Like, sure there are some wildcards in it like, you can have non-caloric things like coffee and tea. There’s some evidence if you’re using fasting, for example…I just travel time zones a bunch, if I wanted to kind of reset my body with circadian rhythm fast then I would do that, and I would not have anything no matter what it is, and I would just do water only.

But as far as breaking a fast with coffee or tea or anything non-caloric, not a big deal. If you’re gonna use exogenous ketones, again I think not a big deal because if you are already in a fast, you’re gonna be using that as an energy source anyway, and it’s a bio-identical source as what you’re gonna be getting from your fat cells. And so I don’t think that’s an issue but pretty much anything else. If you’re over like 30 to 50 calories in an hour in a day then I don’t think that that’s fasting. And that’s something where I think people are getting really confused because they see you know, Bulletproof coffee over here, ketogenic this or that, and fat still increases insulin.

Fat is a macronutrient, and your body has to metabolize it, and it shifts a lot of the different hunger signals on and off. And so I think that if you’re having a big fat bomb and having a fat coffee and all the stuff that that is just not fasting. And so I think that if it’s a non-caloric thing or exogenous ketones you can bucket it over on one side and say okay, I continue to fast. I think the other side I would say that just don’t eat or consume anything else besides water or again non-caloric beverages. So maybe I kind of took that off tangent, but that’s kind of my 10,000-foot view on fasting.

Katie: I’m right there with you. My husband and I do a five or seven day fast pretty much every quarter. Just like you said, the research is so strong and undeniable, plus people have done this historically. Every major religion has fasting in some way, and people just couldn’t eat sometimes. And it’s really fascinating what the research is showing, and like you said, there’s very little downside unless you have obviously a medical condition that would prevent it or talk to your doctor, pregnant women should not fast, the logical things like that.

What about fasting mimicking diet? Because these have come on the scene. I know Dr. Valter Longo talks about this. And he’s incredibly smart I have a lot of respect for his work, but I also have doubts about fasting mimicking diets are actually as effective as fasting. Just because I’m with you, if I’m fasting, it’s water, if I’m time-restricted eating, I might drink black coffee once in a while, but if I’m pure fasting, it’s just water for me. So I’m curious have you run into any research on fasting mimicking diets and how those work?

Dr. Gustin: The whole reason Valter is doing that stuff is to increase maintenance in compliance with fasting in general. And I think that the biggest thing you can do to increase compliance with fasting is to get somebody in a ketogenic state before they start fasting. I’ve done fasts before where I went from eating even moderate to low carbohydrate into fasting, and it was miserable. I’m talking like I was rolling around on the floor crying,close to at least, after a day or two. However, when I am in deep ketosis and I’m in that for like probably roughly a week beforehand, it’s really not that big of a deal because your body is so used to using your own body fat for fuel.

And so I think that just looking at that and saying okay, why are we doing fasting mimicking diets in the first place? If it’s to increase compliance, well are there any other ways to get there? And I think that using a ketogenic diet is a really, really good tool to do that. And so then I think that you look at again the other side of the coin, like well why are we doing a fast mimic diet? There’s no research that says eating a little bit of food is better than eating no food when it comes to fasting, like we have no evidence that says that.

I also I’m not a huge fan of his macro-nutrient ratio, and in general, his composition of his NewLong or whatever it’s called, his trade marker patented. A formula of bars and stuff like that, it’s just, again not real food. So if you’re gonna eat 500, to 700 calories of food which is the fasting mimicking diet, take a step back when people don’t… that might not know what it is, it’s just, you know, eating only 500 to 700 calories of food, and he has a very special ratio that he’s put out as far as micronutrients, he sells products based upon what he thinks that ratio is. And I’ve worked people who have done kind of modified fast before, I’ve done modified fast before, and I would not recommend not because it’s not really a ketogenic ratio.

Again, going to a fast without being in ketosis is miserable so why would you go through a fast not being in ketosis, it doesn’t make sense to me. And I think that if you’re gonna do a modified fast at all, I think it would be a protein-sparing modifying fast, where you basically only eating lean protein and only getting that as a macronutrient, as to save a lot of lean body mass. Just anecdotally again, this is n equals one, so a lot of people think that is a hard and fast rule, but for me, I’ve tried fasting you know and done the experiments myself where I’ve done a water fast, and I’ve done kind of a protein-sparing modified fast, and I’ve done a modified fast where I eat kind of whatever I want. And you know, eat like small salads, small avocado etc., 500, 700 calories a day.

On the water fast and the protein-sparing modified fast, my lean body mass stayed the same or either went up after a fast. And again, you’re gonna ask a question like why is that the case, you need food. Well, your body, again, it’s a stress to your body, so your body says okay, we gotta start eating our own protein, we have to start eating our own lean body mass, we do not wanna do that ever again. So let’s make it more resilient and so you need start… you kind of have a protein negative balance and so when your body eats protein, you start moving your body in certain ways, you send certain hormones to build up more muscle mass.

When I was eating kind of a general modified fast where I wasn’t doing high protein, I was just doing kind of whatever almost close to what Valter has showed, I had actually started getting a loss in lean body mass. And so that’s something that me personally, I wanted to preserve my lean body mass as much as humanly possible. And I have a lot of thoughts on the concept of the macronutrient ratios, and the timing and all that. And so I would say try… if you’re hesitant on trying a fast because you may think that your compliance would be low, I would do two things.

First, I would start with just trying a protein-sparing modified fast, so eating the same, you know, 500 to 700 calories of just protein only for a couple days so you get the idea. If you’ve done ketogenic before and you wanna do that, I would say switch into that, and then try doing a water fast for one or two days is one of these things that’s very reversible. So if you want to eat and you’re hungry and you feel like crap, then just do it. And so you can end it at any time, There’s very low risk of… you know, it’s not like one day you’ll be walking around feeling great, and then the next second because you’re fasting you’re gonna drop to the floor. You’re gonna have a transition period and your body’s gonna realize, okay this is not working for me, and let’s switch it over.

And so, I think that he has a lot of good research but I think that, you know, if his research were controlled against ketogenic diet first, and then a water fast, or a protein-sparing modified fast, that we might see some either same or better results. But again, that’s just my hypothesis at my end.

Katie: Interesting, and I think we’re gonna see more research on this too. And from my own personal anecdotal side, I’ve seen the same thing, I test labs and run labs all the time just to gauge the effect of things I try. And with water fasting, all of my labs have improved, did not lose lean body mass. And I will say at least from my experience, the first time seems to be the most difficult even if you are used to getting in and out of ketosis, but it seems to get easier the more your body does it, like anything, the body gets more used to it. And now if we water fast, I’m in pretty deep ketosis for sure by the second day.

So even if I’m not coming from a keto diet ahead of time, and I’m testing like blood levels and breath acetone. But that’s really interesting and you mentioned macros a couple times, so I’d love to get your take on that. Because that’s something that seems to go hand in hand with some of these different diets, especially the keto diet right now. So I’m curious do you think there’s any merit to that? And are there certain macros that you typically try to hit?

Dr. Gustin: I do not track macros and I never really have, and that’s something that I tried it once, it didn’t really get me to my goal faster, so I just stopped doing it. I think that with a ketogenic diet, people tend to under eat protein, I think that is one of the biggest things that is kind of a misconception about a ketogenic diet. Is that should be very low in carbohydrate, low in protein and very high in fat. And I just don’t think that’s the case. You’re just taking a lot of nutrient dense food away from your plate if you’re doing that, and I think that you can have a lot of problems.

I think a lot of times women when they have problems with the ketogenic diet especially, they have plateaued, they have weight gain, they have hair loss, they have thyroid problems, I think is from, one, under eating and, two, under eating protein. And so I think that the way to look at it… and Luis Villasenor, Robb Wolf, a lot of these guys are doing really good work in this where you should look at it as protein is goal. So I think that people… you know, again this is all from Luis, but 0.8 grams per pound of lean body mass for protein is a minimum. And so you should not go below that, and people go below that, people are going like 0.2, to 0.4 grams for lean pound of body mass.

And I Instagram message all the time and some people are messaging me and saying that “I’m going over 23 grams of protein today, is that okay?” Yes, it’s okay and you should probably quadruple that amount. And so that’s something that, I think, hitting as a goal, and then, two, eliminating carbohydrates. And so as long as you just don’t eat carbohydrates, I mean… if you don’t know carbohydrate-containing food then just track your food for a while and you can see, you know, maybe you’re not used to it. And you know, you realize an apple or an avocado or whatever is more in carbs than you realize, so just track them for a while to see. And then after that adding in fat as… to whenever you’re full essentially. I think that that’s just a really basic way to do a ketogenic diet that I think people, they overcomplicate it.

And when it becomes a trend, and it becomes a super, like you said, maybe compartmentalize, people get into certain specifics about, “Oh, I’m following this macronutrient calculated into that one, and I need to hit specifically 67 grams of protein today, and if I go over by three, then its a bad thing.” Like I think people confuse it way too much. I think that again 100% I think that people should be focusing on is eating real food first and nothing else. Once you get that nailed, sure if you wanna start digging into macronutrients, that’s fine.

But the question I ask is why? Like are you tracking what you’re looking for? Are you just measuring macronutrients just because you think it’s something you should measure? And I think that people get pretty orthorexic about this type of stuff, and get a little intense about, you know, needing to hit certain macronutrients. I think that generally also people over eat fat in a ketogenic diet, I think that this is something that people again, you know, try to get fat bombs, like really crush you know, nutrient-poor fat sources over, and over, and over again to excess because they’re fat.

You know, people either told them that fat quantities don’t matter in a ketogenic diet or that they think they don’t matter, and they can eat 500 grams of fat in a day and be totally fine. That can actually lead to a to a lot of long-term problems. And so, I think that tracking macros is fine if that’s what keeps you honest, but I don’t think it’s necessary one bit at all.

Katie: Got it.

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Katie: Are there any specific considerations that you give for women, specifically with keto? Because I get that question quite a bit, and it seems that certain segment of women at least do run into a point you mentioned it a little bit where they don’t feel good on a keto diet. So are there special considerations for women, especially hormonal considerations when it comes to a keto diet?

Dr. Gustin: Yes, certainly. I think that the two things come from what I’ve said before, which are not eating enough and not enough protein. And so I think what happens a lot of times the ketogenic diet is that it’s so satiating that a lot of people under-eat vastly when they switch to it. And so somebody will go from eating 2,500 calories a day to 1,300 calories a day, and then they’ll switch their protein from 150 grams a day to 30 grams a day. That is not good for anyone’s metabolism let alone a woman’s metabolism.

So I think that actually undereating protein and under eating the amount of food total are two huge missteps that usually when women shore that up I haven’t seen any kind of long-term effects in a ketogenic diet. You know, it depends too what the other loads of stress look like in one’s life. And so again, it comes back to stress and so if no one… let’s say it’s a woman who is super stressed out, she again does something like trains really, really hard, does CrossFit and this type of stuff, but then switches to a ketogenic diet and then under eats protein, that is a recipe for disaster.

And I think that looking at switching diets is also a stress as well on your body. So if you switch from eating hard carb to low carb, your body is gonna figure out a lot about how it should be working now. And so that’s a huge stress, a huge demand on your body, and so again I would not recommend this to people who have a huge amount of stress at home or they’re doing really crazy workouts. Pull things back a little bit and get a baseline, and start kinda transitioning slowly and I think that’s the best way to go forward with that.

Katie: And I love that you keep bringing up stress, because I think that’s the easy-to-ignore but super important part of health that doesn’t get talked about enough. And I say that as a recovering perfectionist and super type A, that for so long I was just like I’ll just push through, I can work harder, I can do better. And at least for me that was a big key in figuring out my own health problems, was I had to learn how to sleep, and I had to learn how to address stress. Because even though mentally, I was great, I could push through and be fine, my body wasn’t feeling that.

And I think for women especially there are just typically a lot of stresses especially for moms that we deal with on a daily basis, so I love that you kept bringing that up first and foremost of like don’t give your body one more stressor if it’s already really, really stressed. And also to the pregnancy and breastfeeding side, obviously those are not times when any doctor would typically recommend that a woman be on a keto diet or certainly not a carnivore diet or anything like that. But I will say, having done a lot of research on this topic, that I don’t think you should specifically avoid anything other than maybe sugar while you’re pregnant.

But we do know that women who eat, like you said, more protein when they’re pregnant and get enough healthy fats but not extreme amounts, typically have better birth outcomes. Because you do need a ton of protein to grow an entire human being, so I like that you brought that point up about protein content. And I think that could be like a very big key for a lot of women is actually eating more food, because for so long, the diet industry has said eat less, move more, eat less, move more. And for women maybe it’s actually we need to eat more especially protein and move more. But what’s your take on that?

Dr. Gustin: I think you nailed that, it actually comes back to the point I was making before about total caloric load and total protein load. I don’t think that people generally need to like extreme overeat or anything like that, but I mean times of pregnancy, things like that are obviously extenuating circumstances where I think that nutrition should be like a little bit differently. Again it’s a tool, and I think the tool… like you want the tool to be building another human being. And so whatever that takes. And like you said, increasing the amount of food, increasing the amount of protein to have that buffer on that end is super important.

Katie: Awesome, so another question I get a lot with the increasing popularity, you mentioned a little bit exogenous ketones, but also different types of oils and fats, MCTs. I’m curious your take on those and if they have a place in a keto diet and if so, how to integrate them?

Dr. Gustin: So, exogenous ketones first of all… I mean, obviously I’m biased, so full disclosure, I have a company that we offer exogenous ketones. A lot of people hate on me for promoting them when I have something like that. Like of course, I think that they’re appropriate that’s why I have them as a product, and that’s why I want them in the world. There’s just so much research coming out right now. I mean, most of it is showing that even with carbohydrates, exogenous ketones… so if you’re not in a state of ketosis but supplement with ketones, you have mental clarity boost, you have inflammation reduction, you have anxiety reduction, you have depression reduction, you have energy improvement, you have metabolism improvement, you have insulin sensitivity boosts.

Like, the amount of benefits that are not coming out are just astounding, and so this is something we’re like… again, you look at nutrition as a tool. I use a ketogenic diet as a way for me to be more mentally sharp. I do not use it for weight loss, I don’t use it for anything else. Essentially what I use it for is to keep… I was super overweight when I was younger, I think that I feel way better on a low carb diet in general. But I think that my mental performance is hands down much better on a ketogenic diet, and so that’s why I use it.

And so that’s one of the things where people can try them and see and get the feedback loop of, “Wow, a ketogenic diet might be right for me.” And it might spark some interest as far as what can a ketogenic diet feel like because people take it and they feel like for instance effortless energy. And that’s something that I think is super, super valuable. So I think that times use that, I just flew from New York to Paris a couple days ago, and I used it on the flight because I just fasted through it, and I felt 100% fine and my energy was super high. And in places when I switch time zones, I use it instead of coffee and things like that to keep energy super high.

I use it in the morning in addition or replacement of coffee to again have the mental energy up but for me, super, super high. For a lot of people when they’re switching into a ketogenic diet, your body doesn’t really know yet that it should be switching away from carbohydrates to using fat for fuel and so doesn’t really have the same pathways that somebody who is fully keto-adapted would, to start breaking down fat for ketones to be using your bloodstream. And so when you just shoot that up in your bloodstream, your body goes okay, I can start using this now? That sounds really good. And so it starts using up those ketones and switching to a ketogenic diet little bit faster, a little bit easier.

It can help subside cravings and hunger issues for people who have metabolic issues. I just think here’s tons of uses for it. Do I think it’s 100% necessary? Absolutely not, this is something that’s not real food, I think that things that are not real food are just not 100% necessary. But do I think that can be helpful? Yes, 100% it can be helpful. Same goes for MCT oils, things like that. And so, think about BHP, which is beta-hydroxybutyrate, which is a ketone body, that’s what you get from exogenous ketones. MCT oil, which is medium chain tri-glycerides are essentially the precursors to beta-hydroxybutyrate or ketones.

And so think about if you look at it on a graph, that exogenous ketones basically provide you with immediate and intense energy, huge spike. MCT oil and MCT oil powder, what that does is it provides you with more long lasting, kind of the same effect. And so you’re getting a lot of the same types of energy boost, you’re getting a lot of the same types of metabolic differences, and that’s where the benefit from that comes. Again do I think it’s 100% necessary? No, I think that real food hands down is what is necessary and 100% required.

I think that these are things… again, look at what they say on the package, they are a supplement. They should be supplementing a real food whole food diet, and not replacing anything. I don’t think they should be replacing anything, I don’t think they are 100% necessary, but I think they are extremely helpful and extremely additive. And so again, when we’re talking about, you know, the fast mimicking diet and what that does, it helps with compliance. I think that these products also drastically help with compliance of shifting somebody from a carbohydrate rich diet into a ketogenic state. And so I think that switching that over and maintaining energy status and feeling really, really great, they can be very, very helpful in that regard.

Katie: Got it, that was a great synopsis. And a question I’d love to ask as we get close to wrapping up. You’ve already mentioned several books and I’ve added them to my reading list. But I’d love to ask if there’s a book that has had a really big impact on you personally or that you’d like to recommend?

Dr. Gustin: I think that’s a tough question to answer because I think that a book like… I mean, I don’t know if you ever heard the quote, like, “You never read the same book twice.” I think that that is so personal and timing is really so relevant. I think that if I had never read “4-Hour Workweek” by Tim Ferriss when I first moved to San Francisco six years ago, I would have not been doing what I’m doing now. So I think as far as sheer influence, that is one of the main ones for me. I think that recently, I think that the last couple of years just as far as thinking about my place in life, “12 Rules for Life” by Jordan B. Peterson is probably high up there as a close second.

Katie: That is a good one. And lastly, if there’s a piece of advice that you could give to a lot of people, potentially to everyone listening, I know we talked about a lot of topics. But I’m curious if there’s advice that you can impart, what would it be and why?

Dr. Gustin: I mean if it isn’t clear already, I would say eat food that spoils, eat real food, eat stuff that grows locally and is in season. And I think that as long as you nail that, you’re nailing a lot in life.

Katie: I love it. Dr. Gustin, thank you so much for being here. I think you answered a lot of questions that I’ve been getting a lot recently, and hopefully helped a lot of people navigate the world of keto, and understanding all of these new types of diets, and when they have their place. So I really appreciate your time and being here especially with the time difference. I’m honored that you took the time.

Dr. Gustin: Thank you so much for having me.

Katie: And thanks, to all of you for listening, and I hope to see you again next time on “The Wellness Mama Podcast.”

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.



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