Dr. Stephen Phinney on the Safety and Benefits of a Ketogenic Diet (Part 2)


– Nutritional ketosis
is a very powerful tool. And it can be used to achieve metabolic health and
well-being in people who have diseases associated with insulin
resistance or inflammation. Now, there are lots of
myths and misunderstandings about ketogenic diets and
about nutritional ketosis and I wanna really focus
on the scientific evidence around safety and efficacy of
this approach to nutrition. And I realize it’s hard
for people to commit to this kind of endeavor if
people around you are saying, “Oh, this is dangerous so
you shouldn’t be doing it.” So you need to be confident
that if you undertake this that you’re doing it in a
safe and efficacious way. In study after study,
not just ours but others, a well-formulated ketogenic
diet when compared to a standard calorie
restricted low fat diet has a greater effect on weight loss and particularly loss of
abdominal adipose tissue and it’s the adipose tissue or
a fat mass within the abdomen that is the most dangerous
fat that we carry in our body. For instance, a study that
I did with Dr. Jeff Volek and Dr. Cassandra Forsythe,
one of his graduate students, we compared a high carbohydrate low-fat calorie restricted diet
to a ketogenic diet that people followed
where their instruction was to eat to satiety,
that is not count calories and don’t restrict calories but eat enough to feel like they had had enough food and they weren’t hungry. And we ran the study for 12 weeks. And at the end of 12
weeks, the weight loss in the high carbohydrate
low-fat group was about half the weight loss in the
ketogenic diet group. Now, some critics will
say that well, when you go into ketogenic diet, a lot
of your weight loss is water. But we actually did careful
measurements of body fat and the water loss on the ketogenic diet was only about 1/5 of the difference so five kilograms on the
carbohydrate rich low-fat diet and 10 kilograms on the ketogenic diet and only about 1/5 of
that difference was water, the rest was body fat. More importantly, we used
the dual x-ray absorptiometry so called DEXA technique to
measure body fat content. There is a significantly greater reduction in abdominal fat, so
it’s not just total fat, it’s not fat from under the skin, but it’s some of the most dangerous fat is more rapidly mobilized
when someone gets the ketogenic diet right. The next most common effect is for people who have either slightly
or markedly elevated blood glucose levels, so
either prediabetes or diabetes, a prompt response of the ketogenic diet is a reduction in blood glucose. Now, that makes sense because
if you eat less carbohydrate in a diet, there’s
going to be less glucose produced by digestion and
the level of sugar coming into the blood is gonna be reduced, that’s what we commonly see. However, in Dr. Forsythe’s study… Now, these are people with prediabetes but their blood sugars are
still slightly elevated. We saw a marked reduction in blood glucose in the people on the ketogenic diet and no change in blood
glucose in the people who were on the high
carbohydrate low-fat diet. What’s more interesting
is that we also measured blood insulin levels. And insulin’s a hormone that
makes glucose go into cells, so if the blood sugar
came down, you’d think that the body was making more insulin to make it go into the cells. But it was the opposite of what we saw. And that is that insulin
level came down dramatically, blood glucose came down. And the only way you can
make sense out of that is that the ketogenic diet
improved insulin sensitivity, that is the body’s response
to any one molecule of insulin is markedly greater. And that’s a consistent finding we’ve seen across multiple studies and that’s the finding that
has let us to the concept that we can actually
reverse the root cause of Type 2 diabetes. Another effect of a
well-formulated ketogenic diet is to change the blood lipid values that are characteristic
of metabolic syndrome. And, by the way, metabolic
syndrome is also referred to as prediabetes. Typically we’d see with metabolic syndrome a reduced good cholesterol,
an increase in triglycerides and a greater proportion
of the small dense or bad LDL cholesterol. And when we looked at that in this cohort, we saw that triglycerides plummeted. Now, they went down in both groups but they went down more than twice as much in the patients on the ketogenic diet. And by they way, they
were eating more fat, and yet the blood fat levels dropped. HDL went up about 13% which is greater than any
HDL response we can get from any drugs that we have available, that we can write as a prescription. So this is a pretty much unique benefit to a well-formulated ketogenic diet. And then the small dense LDL which are the most dangerous didn’t go down. If anything they went
down slightly in the group who were eating the high carb low-fat diet and went down sharply in the group on the ketogenic diet. So again, all the lipid changes are going in the right direction in
favor of the ketogenic diet. So again, the concern about
eating a high fat diet, eating maybe eggs and meat and dairy which contains cholesterol, the actual, the cholesterol in the blood and the blood lipids are
changing all in a beneficial way when one gets this diet right. If you’re eating low carbohydrate
and moderate protein, the majority of your dietary
calories come from fat. And a lot of the fats
that people eat typically come from animal products or from dairy and cocoa butter and things,
which are saturated fats. And so the question is is
eating a lot of saturated fat dangerous when you’re on a ketogenic diet? And the reason people
propose it as dangerous is that we know that when
you measure blood levels of saturated fat, that
the higher the blood level of saturated fat, the
greater the risk of diabetes, a heart attack and overall mortality. And so if you assume that
eating saturated makes makes the blood level go up, that would suggest this is dangerous. But people hadn’t ever
actually looked at what happens to the blood levels with saturated fat when they’re going to
ketogenic diet, so we did. And what we found was,
even though, the people on the high fat diet, the ketogenic diet were eating three times as
many grams of saturated fat per day, their blood
levels of saturated fat actually were lower than the group eating the lower saturated
fat intake high carb diet. And again, this is a head scratcher. It appears that we’ve disconnected intake from blood levels. And that violates the law
that all dietitians tell you that you are what you eat. In actuality, you are what
you save from what you eat. And the neat thing
about the ketogenic diet is it teaches your body to
burn fat more effectively. How effectively? Well, we did a study where we looked at highly trained athletes
some of whom were following a traditional high carbohydrate
loading diet regimen and the other half of them were following a well-formulated ketogenic diet. And these people had been
following these diets for at least six months or longer, which means that they
were fully keto-adapted for the ones on the low
carbohydrate or ketogenic diet. And when we looked at the resting rate of fat oxidation, it was about double as much on the low carbohydrate ketogenic diet as it was on the high carbohydrate diet. So again, highly trained
athletes, theoretically, their bodies are highly
conditioned to burn fat for fuel during exercise and yet,
just the difference of diet doubled the bodies’ ability
to burn fat for fuel. And then as they… We had them do greater and
greater levels of exercise, the people on the
ketogenic diet demonstrated remarkable ability to use fat for fuel. The athletes like that
because they can run on body fat stores much
better than trying to eat and load with carbohydrate which means that when you’re keto-adapted, your body has a capability of
getting rid of saturated fat and so the amount you
eat is not important, it’s how much your body
saves from what you eat. And clearly, the body
doesn’t save saturated fat when you’re keto-adapted, which means that saturated
fats are not harmful when consumed, if you’re keto-adapted. Another very important
area of current research is in the topic of
inflammation because we know that when we measure
biomarkers of inflammation, and there have been
some that we’ve measured over the last century,
like white blood cell count and some that are more
recent additions to our ways of measuring inflammation. That those levels predict
the later onset of diseases like heart disease, Type 2 diabetes, Alzheimer’s disease and many
of the common forms of cancer. And so in doing the study
with Dr. Volek and Forsythe, we actually measured every
biomarker we could think of and we came up with 14 different
biomarkers of inflammation. And when we compared them for the people in the high carb diet
versus people adapted to the low carb high fat diet, none of the levels of
inflammation went down more in the people who were on
the high carb low fat diet. In contrast, 7 of those 14
were significantly reduced for the people on the
well-formulated ketogenic diet. That is on average there
was a marked reduction in inflammation with the
ketogenic diet, indicating that this has a wide-ranging
antiinflammatory effect. Now, up until recently,
that’s been what we scientists call a phenomenon. We see it’s happening
but we don’t know why. And it turns out that
there is a particular gene, it’s kind of like a traffic cop gene, it regulates the flow of
traffic around inflammation. And this gene is targeted
directly by the ketone that we have circulating… A primary ketone in our blood which is called β-hydroxybutyrate, or BHB. And this is a place where
ketones talk to your genes and your genes turn down
the heat, if you will, through a regulated series of events to reduce inflammation of the body and that has the likelihood of
having very positive effects not just on reducing insulin resistance but also reducing other common
chronic diseases, as well. Now we not only know that
the inflammation goes down, but we know why it goes down
and why it is so effective and even modest levels
of ketones, the levels that you achieve just by
restricting carbohydrates to less than 5% of total calories
and keeping protein moderate. We’re doing a study with
Indiana University Health where we recruited over 260
people with Type 2 diabetes and put them on a
well-formulated ketogenic diet. This study will be going on for two years, but I want to show you just the early data from the first 10 weeks of the study. All these people had the
diagnosis of Type 2 diabetes. Some were poorly controlled, some were pretty well controlled, some were very tightly controlled. So we divided the biomarker
of diabetes control called hemoglobin A1c or HBA1c into high levels, intermediate levels and well controlled levels. And in all three cases, after 10 weeks, there was a reduction in
the level of hemoglobin A1c and this effect was greatest in the people who had the highest levels. So people who had the poorest
control of their diabetes got the greatest effect, but
all three groups had an effect. And the result was that over
half of these people moved from having hemoglobin A1c
levels in the diabetes range into the non-diabetes range. What’s really intriguing is normally in medical care diabetes, you
get better glucose control by giving people more drugs. In this case, we took
away most of the drugs from five of the seven classes
of diabetes medications. And the two most dangerous which are insulin and sulfonylurea, those are the two classes of drugs that are most likely to cause hypoglycemia which is probably the most
threatening side effect, short-term side effect
of in diabetes management that we either stopped or markedly reduced the majority of those
medicines in these patients. And so here, again, we have the paradox, less medication, better control. And the reason we can get better control with less medication is β-hydroxybutyrate in ketones, in general, speak to the genes and
change fundamentally how the body functions,
including changing how the body responds to insulin so the body
can get much greater benefit from far less insulin. And then as a side effect of this, again, we told people to eat to satiety. It limited carbs, protein in moderation, as much fat as they needed, and again, they can put butter on their meat, they can put butter or
dressing on their vegetables and dip with vegetables, things like that. And so they were eating to satiety, and yet 75% of these patients lost more than 5% of their body weight. And on average, the body weight loss was as a little bit over 7%. And that was just in the first 10 weeks. At six months in this cohort, the weight loss went from 7% to 12%. So this is not a short-term
quick loss and then regain, but it appears to be a
sustained long-term effect. Because, again, people who
are six months into our study are doing the same thing we
told them to do at the onset and that is limit carbohydrate,
protein in moderation, eat fat to satiety and that
gives the body permission to burn a lot of body fat
stores because the body has become so efficient
in burning fat for fuel. Just to mention other
conditions that we’ve seen that show improvement
with the ketogenic diet, just general muscle and
join aches and pains. Irritable bowel syndrome
typically gets better. Polycystic ovary syndrome in women. People with migraine, headaches mention that either their frequency is down, the intensity is down and some
people get complete remission of their migraines when they
get the ketogenic diet right. As we showed from the
study of Dr. Forsythe, metabolic syndrome or
prediabetes has improved along with that liver fat levels go down which is a side effect of
poorly controlled diabetes. And we see improvements in fluid retention and blood pressure, as well. This is a very powerful tool. It can have very beneficial effects on a number of chronic conditions, but when a person’s taking medicines for these chronic conditions, those beneficial effects usually mandate a sharp and rapid reduction in medication. And that can be dangerous,
unless you have the assistance of a physician who
understands this type of diet and understands how to
manage the medications. This cannot be done in a casual way, you can’t start a diet and go
back and see your physician six weeks later and say, “So
what do you think I should do with my diabetes medication?” Because typically we
have most of the changes in the first six days when
people get the diet right. The concern is finding a
doctor who understands this and that is sometimes difficult, but we see increasing
interest in physicians, so if you look carefully,
you can probably find someone who can help you, if you
need that kind of assistance when you’re following
this type of regimen. So again, for our conclusion is a well formulated diet is not only safe but it can be very effective
in reversing disease. These effects are so powerful. However, this has to be started
with careful monitoring. Stated in this directly,
you have to find a physician who can help you manage your medications in the proper way that this
be done where the benefits far outweigh any potential risks involving changes in medication use.

57 Replies to “Dr. Stephen Phinney on the Safety and Benefits of a Ketogenic Diet (Part 2)

  1. hello,I.d be really grateful for advice,Ive a underactive thyroid,fatty liver and ,gallstones,after losing some weight on the usual carb diet, my liver had only slightly improved after eight months or so,I would really like to try the keto diet,but I'm a bit wary because of my conditions, otherwise I,m in reasonable health.

  2. Dr . Phinney, after reading your books and after 6 months now following your advice I can only confirm the benefits you are mentioning. I am 57, have done intensive sports all my life and I thought I had a healthy life style until you taught me differently. Now I feel much stronger, can go for hours on the racing bike without need for sugar, my problems with muscles joints disappeared and my blood pressure, that was a bit high, is now in normal levels ( and I have lost 10% of body weight, which is a nice to have). You have impacted my life (…and that of my wife and several colleagues that have been following my transformation) in a very positive way.

  3. I need help finding a physician to help me with this. I've been doing a ketogenic diet for about 8 weeks and do not know if I'm doing it right. I live north of Boston and close to NH border.

  4. Dr. Phinney, I have been on a Keto way of eating for about 8 months and have lost 40 lbs. My question is about lipomas. I have a lot of under the skin, not noticeable, but palpable, of my midriff. Is it possible that a Ketogenic way of eating can eliminate these lipomas or am I destined to have them no matter how much weight I lose? I also do Intermittent Fasting along with my Keto way of eating.

  5. I would disagree with canola oil always being a good source of fat, I'm sure a little won't hurt, but don't make it your main source. https://www.hsph.harvard.edu/nutritionsource/2015/04/13/ask-the-expert-concerns-about-canola-oil/

  6. FYI: In the video at 11:14 there is a URL for the research results (http://virta.com/research) (image: https://imgur.com/a/hhPhne4). Going to that URL seems to point to a different company. The correct URL is https://www.virtahealth.com/research

  7. What about a very thin person with type 2 diabetes.. that actually needs to gain weight and mussel ???? Can they do the ketogenic diet or way of eating?

  8. Keto diet lowers insulin level when? What happens when Keto dieters do an OGTT compared to someone who is on a "healthy" vegeterial and/or vegan diet that includes fats.

  9. This study is finally going to do it; it’s going to be far too difficult for the naysayers, both within and without the medical/academic community, to ignore the evidence that WFKT can cure diabetes. It may take quite a while for it to become standard of care simply because of the general stubbornness of many practitioners in nutrition, but it seems like this study is bound to tip the scales.

  10. Dr. Phinney, will one of the other videos address the affects of ketosis on kidney function and diseases?

  11. at 2:17 the slide is titled "Rethinking Sodium…." but the talk is about how much water plays a role in the weight loss

  12. 6:21 "[. . .] all dietitians tell you that you are what you eat". I'm a dietitian, and I was about to share this video until I heard that. Guess I won't now! I agree that dietitians haven't always been evidenced-based (following suit of MDs!), but there are some of us who are nutrition scientists that are trail blazing and making changes. Give us due credit.

  13. eating keto for a year has corrected all my issues but GERD. & I'm tapering off omeprazole now & hoping to quit it too.

  14. Does somebody know with facts, how much grams of protein per pound of weight do you need in order to get muscle growth into ketogenic diet?

  15. I had almost all of those conditions last year when I put myself on a Ketogenic Diet. Ten months later I now have none of them. I'm also 60 pounds lighter. This diet is effortless, I never feel hungry and meals are actually enjoyable instead of grueling.

  16. I have been following the KETO diet with 16/8 IF for a month now. Down 11 lbs, clothes getting loose, good energy, not sluggish after meals, not hungry during fast, and basically feel great. Normally only eat 2 meals between noon and 6ish. Yesterday did 23/1 with only one meal. For the last 4 to 5 days I have noticed that about 4 hours after the last meal I feel almost like I have a buzz from drinking alcohol. Is that normal?

  17. Dr. Phinney, what are your cholesterol and LDL numbers? Just wondering. Dr. phinney, I’m a fitness instructor. 38 years, now. My blood work was terrible on a keto diet. I now have RA and Hashimotos. I was drinking minerals in my water just not to cramp. That is not normal. My heart rate during a cycle workout 85% of my max was 172-176. When I would get into ketosis, my heart rate would rise to 181 for a few days. . Now I’m eating plant based whole food to reduce inflammation from all the healthy fat I ate for 2 years. I’m doing the same workouts and my heart rate peaks at 163-166. So my heart loves plants. I’m hoping to be pain free from eating fruit, veggie, legumes and grains. I feel great. Sleeping deeper. Weight is the same. Feel healthier. Why do keto people focuse on macros? I now just eat real food, but plants only.

  18. My migraines went into complete remission! 7 months no migraine! This is drastic as I experienced 1 per week and had to have FMLA in order to miss work as my migraines were severe and lasted 8 to 12 hours.

  19. To Virta Health, do you guys have any of the studies cited in these videos linked on your website? If so, that would make it easier for those wanting to go over the studies.

  20. I am a 52 y/o woman who had a complete hysterectomy when I was 33 but never took hormones to the date and so far no "menopause symptoms"..knock on wood… but I am caseine and lactose intolerant so how and what foods do I get my fats from since I see you push a lot of dairy products as the primary fat sorce?

  21. A must watch for any doctor concerned about eating a ketogenic diet, saturated fat. They often believe eating saturated fat is dangerous but those were also eating high carbohydrates. Great presentation of the science/ studies.
    Jeff McDaniel MD

  22. On a few of his videos, Dr. Phinney mentions guys really liking protein and meat, as if women do not. From my observations, a lot of women enjoy meat, and many enjoy a lot of it. Especially the juicy, flavorful meats from heritage breeds raised naturally on pasture.

    Some women have swallowed the vegetarian propoganda, like Lierre Smith, who wrote 'The Vegetarian Myth', and Nina Teicholtz, who wrote 'Big Fat Surprise'.

    Others have been told that carbs, even sugar, is better for them than meat.

    Most are unaware that there is a lot ore total far and saturated fat in the oily fish species we are encouraged to eat than there is in an equal amount of steak. https://www.youtube.com/watch?v=lntwufwQwoQ
    https://www.youtube.com/watch?v=wdznfiWvGq0

  23. Been on keto diet for just over 4 years I have moments were I have cold chills makes me want to stop the diet when that happens . Just feels like my bodies trying to tell me something is not right . Notice my blood pressure runs higher then before diet . I have played around with myself amounts and it doesn't seem to change blood pressure much.

  24. I am 39, 5’ 3” and my top weight was 334lbs. I have only been over weight for about six years. I had a myocardial infarction from a virus causing pericarditis at age 26. I have autonomic neuropathy, causing gasteroparisis and neuropathy that effects my limbs and mobility impaired (using a wheel chair and crutches as I can). I have no feeling in my legs from the hips down to both knees and haven’t had for five years. The nerves dying was some of the worst pain I have had. I also have a genetic condition of arthritis in my spine which has caused a spinal stenosis. I have spasmodic colitis. I got on the keto diet one year ago. I had I am now 286.7lbs. I just had a heart exam and was told that I have the heart and blood pressure of a 20 year old. I exercise every other day (due to a needed extended recovery time to not injure my joints… I have lost muscle mass and damaged muscle tissue from the nerve issue). I have physical therapy. I do both cardio and strength training with weights. Though one leg and the opposite arm, does not appear to be capable of gaining muscle, the other two limbs are. The nerve pain has stopped and does not com back unless my sugar drops too low. It no longer ever gets too high. My A1C is now 5.8, only .1 away from not having diabetes. That’s down from a 7.3. I have regained some mobility (though not all). I have hope that I may reverse enough damage to get out of the wheel chair for good. My doctor checks my triglycerides and A1C often and I check my blood three or four times a day on the clock. My body inflammation is not gone, but has gone down. The increase in protein is causing some trouble as it slows digestion even more, but I am working with my doctor to improve that. I have metoclopromide (that may not be the correct spelling) and miralax as well as sapositories which are helping and he wants me to lower the protein and raise the fats as well as raw foods such as bok choi and carrot (minimally) for snack, in hopes that will help. The carrot makes me a bit nervous, but I’ll try it. Kinda high in sugar. I am not sick and in bed for days on end any more. I am not in extreme pain. I have IBS relief some what. I no longer seem to have GERD at all and that was a serious problem and night time choking risk for me. I am off of all heart meds except my beta blocker and that is half the dose (only because my heart races too fast during exercise on a stress test most likely from a tiny bit of scar tissue). All meds for pain are gone (I used CBDs). Nausea is down. Sleep apnea is gone. Intestinal spasms are increased but again I think that’s the protein. I am up moving around every day and I feel so much better. I feel, though I have not experienced a total cure in all areas (except perhaps the diabetes), that this is still a considerable level of recovery. I feel as my weight improves I will only continue to regain quality of life. For people like me, the message and information about the keto diet is a life saving one. Thank you. <3

  25. Eating to satiety doesn't give me enough calories to maintain my muscle mass. I have to count calories to make sure I get enough

  26. Great videos but could someone please fix the reversed chart labels at 1:13 and 1:40. The LFD and LCD labels are the wrong way round. Example screenshot here:
    https://www.dropbox.com/s/z3utnq11hlhiya8/lfdlcderror.jpg?dl=0

  27. What if you don’t have a gall bladder? I feel,ok, but I worry what I am doing to all my other organs with such a high fat diet.

  28. I Pray that my expression of Thankfully comes through this text on how very very grateful I am for you posting this YouTube of this valuable information about Ketosis in such a complete and understanding way that is so outstanding. Thanks ever so much. If
    You’ve written book or you know somebody that has this I DepT info please let me know.

  29. Here in Canada, one cannot just seek out a different physician, so we have to hope our current one is open to learning and working with us. My family physician is showing interest in "following" my journey into LCHF, intermittent fasting, and ketogenic lifestyle, and its effects on lowering my blood pressure, weight, and hopefully my blood sugar levels to normal, with the upcoming blood tests. Thank you for your ongoing work, Dr. Phinney.

  30. I am a relatively healthy 16 year old who still growing but I'm worried that a ketogenic diet may stunt my growth, so should I wait until I'm fully developed before starting a ketogenic diet?

  31. I have been researching keto for 3-4 months to see if it’s a fit. I find his videos very well done and trustworthy. One issue I have is Canola oil. I saw his blog on it but I don’t agree. The ratio of onega6 vs. omega3 is out of whack. The rest is great. thank you for sharing.

  32. Dr Phinney, thanks for the information. I am 54 years old male, just gone under angioplasty. I am also suffering from Trigeminal Neuralgia. How Keto diet will work on me? Is there any research done on Trigeminal Neuralgia? I am really suffering beause of TN. Please guide. Thanks and Regards

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