Using the classic ketogenic diet, which was described over a hundred years ago now Mhmm. And it's very effective. There's many controlled trials now for children and adults. It's quite effective. Did you know the ketogenic diet has been used for decades as a powerful medical therapy?
It's been used in epilepsy, mental health conditions like depression and bipolar disorder, dementia to endocrine dysfunction, and even in cancer treatments. We're speaking today with guest Beth Zupec-Kania. She is a registered dietitian and nutritionist and owner of Ketogenic Therapies. She has had a prolific career prescribing a ketogenic diet for multiple medical conditions. She's trained over 300 medical centers and co designed a mastery therapeutics course for medical practitioners to use keto.
If you've ever wondered if keto is just another diet trend or if it could actually change lives, this is the episode for you. Let's get started. It is really much more than a diet. I like to always say ketogenic diet therapy because it's not just a diet. People get into trouble when they think it's just a diet. In fact, people that are coming to me now come to me because they're in trouble because they just went on a diet on their own.
Well, Beth, thank you for coming on today. I'm really excited to dive in and talk about this really interesting but nuanced conversation about a keto diet, the ketogenic diet. So thanks for coming on. Thanks for having me.
Well, I'd love to hear you started as a registered dietitian working in the classical field and then switched to keto at some point and training patients and clients on the ketogenic diet. Will you tell us just briefly about how you got into this space? What was it that kind of converted you, that brought you over to this new field?
Yeah. It's sort of, interesting and unplanned trajectory of happening. So I worked in a pediatric hospital for twenty years with children that had epilepsy. Oh, wow. Using the classic ketogenic diet, which was described over a hundred years ago now. Mhmm. And it's very effective. There's many controlled trials now for children and adults. It's quite effective, particularly for people that don't respond to medications, which is usually what the first trial is. So about thirty percent of people with epilepsy don't respond to medications. They keep having seizures or they're having bad effects from the meds. And those are the people that we put on keto.
And so then, I started getting a lot of requests to write and teach at other centers. And I'm like, I can't do this and my job and raise children and be a wife. You know? So yeah. I'm like, alright. Time out. I am going to leave the hospital, start my own business. And I went into private practice so I could do all those great things, which was really right up my alley. It just made me so happy to have this creative freedom to work on resources and training centers. I went to over 300 hospitals in about thirteen, fourteen years, and then COVID hit. I had to stop traveling to hospitals, and then I created a virtual platform with a colleague of mine, Denise Potter, and we shared those trainings. And now we've, you know, we're training more people because it's easier to get all of the world. Right? Yeah. So the training is one part.
And I, all along, have worked with private clients. I have people with genetic metabolic disorders, epilepsy. The main group of people that I have now have mood disorders Mhmm. Because keto is moving into that Mhmm. Diagnosis.
And there's almost 18 or I think there are 18 trials. I went back and counted it just a moment ago. There are 18 trials right now for bipolar disorder, eating disorders, Alzheimer's disease, anxiety disorders in different parts of the world, and I'm involved in three of them. Oh, wonderful. Yeah. So, and then I also work with pets. So, and that's just kinda…
That's amazing.
I know. Somebody just emailed me, like, I know you work with epilepsy, but my pet has epilepsy. Can you help me? Turns out pets are really easy. What's that? Yeah. You have one recipe that eats the same thing today, and it works. It just works. So I've got several pets right now.
Well, I am so eager to learn more about this. I think one of the first things that we should do is, if you'll just explain briefly, what is the ketogenic diet?
Yes. So it is really much more than a diet. I like to always say ketogenic diet therapy because it's not just a diet. People get into trouble when they think it's just a diet. In fact, people that are coming to me now come to me because they're in trouble because they just did a diet on their own, and they're suffering from constipation, kidney stones, feeling terrible, gaining weight, losing weight, all these things because they didn't get the therapy part. They didn't get that message because they learned you know, they're desperate. They went online, bless their hearts, trying to help themselves, and they're coming to me to get fixed, which so I'm fixer.
Yeah. So, and usually it's it's quite amazing when they're very hungry for information and very motivated. So that's really what that attracted me to this diet because people traditionally don't follow diets. They get excited. They follow them for two weeks and they stop.
But what attracted me about keto is that because it is has such a profound effect on people and then they realize if they stick with it to the best they can, that they're gonna get better. And so that's what brought me in. I I you know, people always show up for their appointments. I don't have no shows. And so it's so rewarding in that respect, and that's really why I stuck with this for now over thirty years.
I've been doing this. Yeah. So we think of keto as, like, we'll go eat bacon and eat butter and, you know, beef. What actually are you recommending as part of this ketogenic diet therapy? Yes.
So the diet part of the therapy is a distribution of macronutrients, and that's a big word, but it just means where you get your energy. We get our energy from protein, fat, and carbohydrate. We'll leave alcohol out of the equation because that's a whole another topic. So we're just gonna talk protein, fat, and carbs. And here's a little lesson here.
We know fats are essential to life. We know protein is essential to life. But guess what? Carbs are not essential. And that just blows people away when they hear that.
No. We eat them because we like them. And, yes, there's vitamins and there's nutrition in them, but we could survive without them. And and there are indigenous tribes who have survived and even to this day in certain parts of the remote parts of the world who are subsiding on little or no carb. They're mostly eating animal fat, animal meats.
So it's it's our dietary guidelines recognizes that carbohydrate isn't necessary. What do we get from carbohydrate? We get sugar, which is called glucose, which is our energy in our body. But you can also get glucose from fat, and you can also get glucose from protein. So that's where the, you know, the stopgap is is that, yeah, we can get glucose from all of our macros.
Mhmm. So that's why carb is not necessary. So you're going through and and creating or using whatever plan, teaching people how to eat according to a percentage of fat protein and then a smaller percentage of carbohydrates. What what percentage of carbohydrates constitutes a ketogenic diet? Yeah.
So there's wide variability. There's actually six ketogenic diets that we describe for epilepsy, and they've just kinda evolved because they work some work better for certain people. The classic ketogenic diet, which is what I was trained in, is so controlled that less than 3% of calories come from carbohydrate. Okay. But that's not what I use for most people.
That's what I use for young children. Right? There I just reviewed a study on women with PCOS who were going through fertility treatment, and it is known with PCOS that insulin resistance can be the underlying cause. So these were women they that they studied. There were 12 women.
They all had PCOS. They all had one failed IVF. So they put them all on a very liberal ketogenic diet that had 50 grams of carbohydrate. They all got into mild ketosis, and they all got pregnant. Okay.
So tell us help us understand the details there. So fifty grams, I know that depends percentage on everything else, but you said before 3% was this really strict. How liberal is that compared to that 3%? Super liberal. Okay.
So most most people are walking around most adults are walking around eating between 203 grams of carb. Like, a a Starbucks beverage can have 40 grams of carb in it. Mhmm. Right? And again, you don't you don't need to get it from carb foods.
So the super restrictive ketogenic diet is 90% fat Mhmm. 7% protein, 3% carbs. And you don't have to remember that ever, I'm just telling you as a way to kinda blow your mind. It's like, this is like, sounds like crazy stuff, right? And it kinda is when you look at it on a plate.
But, here's the thing, We don't keep kids on this forever. They're on it for a short period of time. Maybe a year, maybe six months. And then we start to taper the fat and increase the protein, increase the carbs. So Mhmm.
We use it as a healing modality. Yeah. And then we we remove it and most children are only on it for two or three years who have epilepsy and they go back to eating whatever the heck they want. So And they're healed. They don't They're healed.
That's amazing. It is amazing. So so that's epilepsy. Now that's can be very different for different disorders. People that have glioblastoma brain tumors, which is a very lethal tumor.
You people usually die within a year and a half of that diagnosis. But I've worked with people that have lived for many years beyond that who follow keto. And they they are strict and they are very, very motivated to keep their carbs down and eat the fat that they need to eat and the protein that they're required to eat to have, you know, healthy body, healthy life. Those are the, like, the most motivated. Those people and then my mood disorder people are always also extremely motivated to follow this.
So the variations in keto are these variabilities in carb, protein, and fat. And we never really know what someone's gonna need till we get them going on it. We usually transition them gradually onto it over a period of, like, two weeks, and then let them settle in because it's a big lifestyle switch to go from having, you know, like breakfast cereal on a granola bar and a hot beverage with sweetener in it to eating eggs and and maybe bacon or sausage Mhmm. And heavy cream Mhmm. In your coffee and, you know, not milk.
It's a big switch. So I actually move people over in the transition one meal at that time. We just work on breakfast for a week. Mhmm. Everything else, keep the same.
And the next week, if you're ready, we'll do breakfast and lunch, and we'll do that for a week. So you see, for adults, we gotta do baby steps because it's a huge change in lifestyle and it's all, you know, just part of their life, part of their everyday life is even better. We got our systems down. Yeah. Yes.
So we graduate. And then once about two, three weeks in, when they kinda settle into a keto pattern of ketosis, which is generally low ketosis in the morning and it builds and it's higher in the middle of the day. And then we decide, how are you feeling? You need do you think you can handle stronger ketosis? Let's adjust this.
Let's maybe add some medium chain triglycerides into your diet. Or are the meds that you're taking, are they contributing some carb? I had a woman who was taking Tums, chewable Tums, three times a day, and that was a that's almost, like, 10 grams of carb. Wow. That was more than half of her carb in her diet.
So we discovered that and she It probably tasted amazing when she was on keto. It was like the only little sugar she was getting. This is candy. I'm not telling don't take this away. Yeah.
So the things like that. It's, you know, there's lots of changes, but they make a difference. Okay. So, so I have two questions now. One is I wanna hear more about those different variations of keto diet and and what makes the difference, and then what is the outcome that you're seeing?
Is it a tolerability that's determining, or are there different conditions that are associated with different, types of that ketogenic diet? And then I also wanna hear how you know if someone's in ketosis then. How closely are you monitoring that all day or once a week? Or tell us a little bit more about how you know if you're in that therapeutic range. Yes.
I wanna start with that because that will help answer the other question. So it is good to to, monitor degree of ketosis, and now there is portable machines that you can do this. It's a blood prick or urine strips, which is the crudest method. Or I have used the breath acetone meter in certain people, like children that freak out if you do a blood prick. I'll I'll see if they can do a a breath, analyzer, and and there's portable machines for that.
But the blood method is, regarded as the most accurate because, it's used in research. So we don't even know what degree of ketosis is ideal for epilepsy. Can you believe that? Because some people get improvement with low ketosis and some seem to need high. So it's a little bit of a guessing game, but the best thing to do is to monitor your degree of ketosis and then monitor the outcomes of what's happening, you know.
Yeah. I mean, the tricky part with epilepsy is you just have to wait for a seizure to see it's see if it's effective. Right? Whereas if you're using it for mental health, then you get a more continual, evidence there of if it's working or not. So that is really tricky.
Yes. Yes. And even with epilepsy, a lot of seizures are subclinical. People don't you don't know you're having them. You could have them in your sleep and never know when you wake up that you had them.
So it is a bit tricky. But generally, it's not just the seizure or just, you know, somebody's, bipolar event. It's all the stuff in between. Like their energy level, their quality of sleep, those are also signs that things are better, that you may be healing. Okay.
So that's what we look for. Even before I ask anything about seizures or anybody updates me on their seizure history, I I say, you know, how how's sleep going? Did you take any naps this week? You know, and and those are, to me, more important clues because for epilepsy and mood disorders, it can take three to four months before they even see an improvement. And that's that seems like, oh my gosh, it seems like forever when you're doing this.
Yeah. But I keep reminding people, your brain is healing. Right? Healing takes time. It's not like a cut that heals in three days, but kinda think of it like that.
Like, every all these cells are involved. Lots of mechanisms, and you just have to be patient. And in the meantime, let's enjoy the boost in energy, the not needing a 02:00 nap in the afternoon. By the way, that's something that a lot of people, no matter what they have, go on keto, know just they don't have to take a little nap in the afternoon. They don't feel like nodding off at work.
You know? Maybe they're at a computer, and they usually take a little nod off for a few minutes. They just don't feel like that. They feel, you know, really good brain energy for the whole day, and then they tend to sleep at night. So those are the things I look forward everybody no matter what they have because I see it, across the board with children and adults as well.
So if you're not getting those those reactions, then you're gonna drive them into a little deeper ketosis. Yes. Yes. Or find out. Sometimes they're not getting that because their medication is interfering.
Mhmm. So that's a tricky road to go down because the doctor doesn't wanna change anything because we don't know if it's working yet. Right? Right. But I I've been pretty good at convincing docs that, you know, perhaps the medication is acting stronger in a state of ketosis because there's some evidence for that.
And I and I've been, effective in getting some doctors, like, okay. We'll reduce by 20%. And then sure enough, the person perks up. And Yeah. DAPA code is one medication used in epilepsy.
Also, mental health disorders that I've seen to have you know, one of the adverse effects is sleepiness. And, you know, a person can be not have that effect until they get into ketosis. All of a sudden, they're feeling sleepy. Well, that's not part of the keto. Mhmm.
You know, that's the medication interacting with their new brain chemistry. Mhmm. So that that's just a little bit tricky in there. I don't wanna get too deep into meds because that's a whole deep conversation we could go into. But back to answering, like, the variations in ketogenic diet therapies, this is why it's a therapy, and this is why it needs to be individualized because we can't just hand out you know a menu plan to somebody and say well here's the keto diet, go home and try this out, you know we'll see you in three months.
Right. It's it's not gonna work. You have to individualize it. And I have most of my patients don't even eat bacon. Most of them will eat butter or ghee, coconut oil, olive oil.
I'm big on pushing olive oil, extra virgin olive oil because of its polyphenol content, which can help with digestion and and regularity, bowel regularity. So we're we all know about fiber. Mhmm. But the the research is saying, actually, it's polyphenols have a lot to do with this too. Because I know people are not not getting 30 grams of fiber a day on their 10 or 20 or 30 gram carb keto diet.
Yeah. But they're getting boatloads of polyphenols from olive oil and avocado and their deep green vegetables and green tea and chia seeds. So, you know, those are the superfoods that are really making it healthy that most of them most people don't eat those regularly. They might say, I'm gonna have healthy salad in a week. But I'm having people eat these things daily so that their microbiome is healthy.
And this is where a lot of neurotransmitters are made, right, in the in your gut. So that's how I convince them, listen, we gotta fix the gut first. Mhmm. And then the neurotransmitters are going to stem from that and you'll get your brain health. Okay.
Well, I I have some follow-up questions about the the polyphenols and everything you were just saying. But before we go on, I wanna kind of lay the foundation for people listening. Who is keto beneficial for? Who should not try keto? And what are what are the conditions that we have the most data to support a ketogenic diet as as supportive to these conditions?
Yes. So let's start there because that's really the objective information that you want. We know it's good for treatment resistant epilepsy. Right? Many controlled trials on treatment resistant epilepsy.
We know it's good for slowing progression or putting multiple sclerosis into into remission. There's a very good controlled study on this. We know it's really good for early onset Alzheimer's. There's data, good quality data on this. And, we know it's good for endocrine disorders.
There is a an organization called Virta Health. And, they are a virtual health platform. And they have published, long term results of thousands of their clients. So these are people that paid, or their insurance company paid for them to go through their program. And they had support from psychiatry, dietitians, coaches to do a liberal ketogenic diet Mhmm.
That got them into a mild state of ketosis. So, like, I think the average degree of ketosis was like point three, zero point three, which is really, really low. You're not degree of ketosis starts at 0.1. So zero is no ketosis. 0.1, really light ketosis.
0.3, mild. I get people up over one point zero for mental health. So you know, 0.3 is just a whiff of ketones. But that study, and now this organization is a national, part of national health organizations, most people can give it through their HMOs. It works.
It reverses insulin resistance. People can get, reverse their diabetes, get off of their meds. And now it's being, tried in type one diabetes Oh, wow. Which is amazing. Right?
Mhmm. But diet what is diabetes? It's a disease of I mean, it's a disorder of carbohydrate metabolism. Like, we never talked about it like that. Mhmm.
We talked about the pancreas fails and we gotta replace what the pancreas did. Well, what the pancreas is responding to how much carbohydrate you you take in, and if you don't give it a lot of carbohydrate to work on, then it can rest a little bit more, right, and recover. Mhmm. So it's quite amazing, the research there. Those are the biggies.
There's there's case reports, of course, in other areas. I'm involved in, a trial with three women with treatment resistant anorexia nervosa. And that trial has helped stem a, broader controlled trial that's going on at the University of California, San Diego. I saw that in your in your profile and was just kind of blown away because you take someone with anorexia and and adjust their diet. You you think the opposite approach is, you know, it just don't worry about what you eat.
Eat eat whatever you need to. But so many nutrient deficiencies I know are associated with anorexia and and also I think of brain inflammation in general when I think about mental health and mental health and and it's really fascinating. Yeah. So the ketogenic diet has great anti inflammatory effects when it's well planned. You know, I'm I'm I'm gonna say not every ketogenic diet because there's something called dirty keto Mhmm.
That I learned on the Internet. And that's just going out and buying processed food that's Mhmm. Keto friendly. Yeah. It has non nutritive sweeteners in it, which Mhmm.
Are are not good. And I've had I don't recommend them, but I have clients who have tried them and then checked their glucose and their ketones afterwards and said, my ketones went down and my glucose went up. So you know, okay, this isn't true. And I and save your money because all that stuff is expensive. Yeah.
We're talking about real food and and taking this back to when the classic ketogenic diet originated, they didn't have processed foods. It was all whole natural food, and that's what it was based on. Yeah. Mhmm. So you mentioned a lot of those conditions.
I I don't think I heard you mentioned cancer. Is that are you seeing I think there is some data, but do you know? Yes. The strongest data is in brain tumor. And Okay.
Particularly the glioblastoma that I mentioned at the start of this Mhmm. Which is the most lethal of cancers. And and, you know, people are so willing to do a restricted diet Sure. With this disorder. So we've learned a lot.
Tom Seyfried, who is a, researcher at, Boston College has written a huge book on this. But there's it's been well studied in animals, and and now there's some research in humans. What other cancers are responding? Breast cancer, endometrial cancer, even some blood cancers. There's some early research in animals and and case reports saying it can be effective.
And what what we are suspecting is going back to this very simplistic, if there's insulin resistance, there's inflammation in the body, if there's inflammation in the body, and we all have cancer cells, right? You're pissing them off and they're kinda go going berserk. But also, high glucose is just feeding tumors. In fact, the, PET scan that they use for identifying solid tumors is glucose Mhmm. Attached to the, color or whatever the color The radioactive yeah.
Marker. The dye. That's what I'm trying to think of, the dye. Because they know that the cancer tumors will suck up that glucose and the dye will go with it and it, you know, shines, it brightens. So, you know So the whole reason it works is because the the cancers are they like glucose.
They like to take up glucose. Yes. So so that's part of it. And then also the anti inflammatory effect of a well planned ketogenic diet is, you know, what you want when you have cancer. No matter what cancer you have.
You want you don't wanna inflame your autoimmune system. So that you want it to settle down and launch its recovery system. Because we know we can heal ourselves. Right? Okay.
So and what I don't think you mentioned you did mention insulin resistance, but weight loss. What are your feelings about using Obviously, that's where we've all heard the most about it. And I think that the really difficult thing is so many people are doing it probably poorly. Mhmm. But also then what?
I think it's the then what. So tell us about keto and weight loss. I don't wanna spend too much time here, but but it's obviously well known. Yes. It's it's well known for weight loss, and there have been some studies, and a lot of, you know, discussion about what's better, low fat, high fat.
And and there's been a study that's compared low fat to high fat keto and saying sustained weight loss is much more likely on a well planned keto diet than a low fat diet. The problem is long term maintenance for people. In fact, I just talked to a client who she did great on keto. She had insulin resistance. She wanted to lose a few pounds.
She felt so much better. And then I didn't hear about from her for a while, and then she came back to me last week. She fell back into her old habits and gained weight over the winter. Mhmm. And I think she has a massive vitamin d deficiency.
I'm trying to get her in for a level, but she doesn't go out in the sun because she gets a rash if she does. So I think over the winter she's probably developed a vitamin d deficiency, which as so many people do Mhmm. In the North where we live where I live here. And which just exacerbates every condition. Right?
Yeah. So she said to me, I need to go back to keto. And so I had to have this conversation with her like, okay you're coming back but are you gonna stay? Yeah. And this time we gotta talk about how to make this more lifestyle rather than thinking of it as a diet.
Mhmm. Because it infiltrates every part of your life. She's a grandma, she's a professional, She travels. Like all of those things. There is high carb everywhere.
Right. Yeah. How do you navigate that? So, you know, instead of being so technical with her about what she should eat and coming up with recipes, my conversation with her needs to switch. She knows all that.
It needs to switch to how do you manage this situation? How are you gonna manage when the kids come over on Sunday? And, her daughter is a total sugar addict, and self admitted sugar addict, and brings two or three desserts for their brunch. You know? And and the mom can't my client cannot say anything to this 30 year old daughter because the daughter doesn't wanna hear it.
So she has to dance around this. And so our conversation is, okay, let's get into the mindset so you go into your mode of I can do this, I could do this. I'm not gonna have any or I'm gonna have something else that I I'm gonna make here and I'll have while they're eating theirs. So that's, you know, that's my new strategy with her because she really wants to do this, and she really wants to feel better and heal herself and not go on meds that her doctor suggested, that she go on a goose on pick. So, yeah.
It's it is not easy in our culture and just about any culture to do this really. So do you think everyone should be on a keto diet? Do you think the benefits are there enough that that we all should be moving that direction? Obviously, then you have the other piece of it about it's just socially extremely difficult. Yeah.
But that part aside Yes. From a physical health standpoint, how obvious is it that, like, this is what we should be doing? Right. I no. I don't think everyone should go on a keto diet.
I do think people need to get their carbs in check because somebody did a study. Sorry. I'm not gonna be able to cite it, but saying that sixty five percent of Americans are are metabolically unhealthy. Yeah. Or more.
Yeah. Or more. Maybe it's even higher. But I mean, the it you know, that's like everyone but you and me. Right?
It's it's the people in the know that are aware of this and all of the ramifications of eating a high highly processed foods diet, which by now there's lots of research saying how bad that is for children. For, any kind of cognitive performance, it's bad. Just really bad. And and we need to change. And food companies, you know, every time you buy something, it's a vote for that food item.
So that's what food companies respond to. But, I do so I my point is I think people should do a check on Riela. How much carbohydrate am I eating in a day? Like, do they have any idea? It should be less than a hundred.
That's one place. I had a young teenager who was eating 500 grams. He had no clue that that was too much. But she has bipolar disorder, and one of our our first step goals was to get her down gradually to a hundred a day. Weeks and weeks of making these little changes to get her down.
The first thing to go were the sweet beverages because that's where she was getting over half of that. Mhmm. So 500 down to 100. And that's 500 I think is kinda typical for, any overweight teenager. Wow.
Yeah. So we just know our bodies aren't meant for that. You're like, when you're eating that much carb, you're constantly pressing the button on the pancreas. I think of it as like the washer fluid, you know, the old pump button in the car. I think they're different now, but you used to pump that button to make the windshield wiper fluid come up.
That's kinda like what happens with the pancreas. You're actually stimulating it to give out a shot of of insulin, in a burst. So if you keep pumping it, pumping it, pumping it, you're gonna break the pump. But it's not meant to be pumped all day long. Yeah.
Right? Same thing is happening. And so that that triggers insulin resistance. And insulin resistance is a huge inflammatory process. You're wearing down your pancreas, PCOS for women, irregular menstrual cycles.
I mean, this is whole Mhmm. Cascade of of events that are endocrine related. And I see this starting in younger and younger in women, sadly. Mhmm. So definitely aiming for lower carbohydrate, but but obviously with the difficulties, not necessarily aiming for ketosis for everyone.
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Click that five star button and let us know what you love about the podcast. Your support means the world to us. Now back to the show. How long does someone have to be in ketosis before you start that, healing phase, before you start seeing some of these benefits? I think, as soon as somebody says that they're they feel more energetic when they get up in the morning, that's the key right there.
Mhmm. It's it's clear that they're getting better energy to their brain. So lowering the carb is one thing. And remember I said fat is essential. Like, do do you have fat in your diet or are you eating low fat?
Everything. The women with anorexia nervosa that I worked with, in this trial, low fat yogurt, low fat cheese, low fat everything. They basically were eating mostly carb and a little bit of protein. Mhmm. And so it makes sense to me that giving them fat, which your brain is 65% fat.
Yeah. The brain really loves fat, and it can use ketones for energy more efficiently than it can use glucose. So think of a hybrid car. Electricity, right, that's the ketones, or gas, that's the glucose. Which one is more efficient?
We know the electricity is because it doesn't give off end products. Right? It's clean. Mhmm. So same thing same thing with ketones and glucose.
So when people start lowering their carbons, say, woah. Do I have can I replace it with something? Mhmm. Hey, you can. Put some fat, you know, or don't eat the low fat version of Okay.
Of, dairy. Like, if you love yogurt, eat the, Greek yogurt, which is high in fat. What you might have to look at the fat content. 4% milk fat is typical for yogurt. Some of them are a little bit higher than that.
So you want fat in the diet. Baby's first milk from mom is 60% fat. That's the colostrum. That's the first milk. And then breast milk is about 50% fat.
So we know babies need it for brain development. And and that's why you should never give a baby skim milk. They should get whole fat milk. Even toddlers, whole fat whole fat milk. So to follow that up, if I am getting started and I spend a couple weeks sort of slowly getting my carbs down and we're not necessarily measuring ketones at that point, we're just trying to train me of how to eat that way, and then we start doing some blood strips.
We're gonna test my we're gonna prick my finger. Is it once a day? Is it multiple times a day? Yeah. So let me back up a little bit Mhmm.
With the carb reduction. I would say one way to really make this even more effective and more motivating to follow because you see these results right away is to wear a continuous glucose monitor. And now you can get some over the counter. Mhmm. And they usually come in a thirty day limit.
Right? So it's a little sensor that you put on your arm and connect it to your app. You can see your glucose all day long. You eat something and within seconds, your glucose goes up. Mhmm.
My, client ate a bag, a one ounce little bag of potato chips. It's like six chips. Right? And her glucose went up to one fifty in minutes. And she thought she thought potato chips were low carb because there's no sugar at all.
Sugary. Right. And anything that's deep fried has a high glycemic index. Potato chips, french fries. Right?
It won't fry if it's not if it's not carbohydrate. Yeah. Right. So it's it's it's a highly processed food. Yes.
It has a high glycemic index. It goes into your bloodstream almost directly. So with a continuous glucose monitor, it's like your best friend. It's telling you, oops. Lots of glucose here.
Can we find something else? Or not eat as much. Right? Mhmm. So it is like instant feedback, and I have seen the most change in people that are willing to wear a continuous glucose monitor versus checking their glucose two or three times a day, which seems like a pain, right, to have to prick your finger three times a day.
So those now that they're out in the market, I tell all of my clients, I want you to do this first. I want you to just be aware of these peaks in your glucose. And and peaks actually are normal, but that glucose should come back down within, you know, half an hour. They should shouldn't be up there for an hour up popping up and down. Skinny peaks.
Skinny low peaks is what we're going for. Yeah. So, like I said, I've behaviorally, I've seen people respond more beautifully to that kind of therapeutic adjustment, you know, the behavior change Mhmm. Of being aware of what spikes their glucose. No matter what they read, it's what they're putting in their mouth and how much.
And I see them making the conversion over to real food that doesn't do that. That is, you know, vegetables that have fiber, fruit that has the skin on it that you're chewing and taking a long time to eat. You know, it takes a while to eat a whole pear versus drinking juice, which Mhmm. Goes in your bloodstream very quickly. So that that's when I start people on that come to me and say, I wanna do keto, but I'm not really sure.
And I'll find out, well, do you really need to be on keto? Or do you just need to fix what's going on? That's not gross. Yeah. So, I'll start with that and then, and take them from there.
And some people are like, you know, I am feeling better but I with how much I'm feeling better, if I could be even better than this, I'm willing to go keto. And that's what I'll say. I'll take you to the next step. Like, you're fully prepared for this. And also they don't have the keto flu because now their body's used to less carb.
Yeah. Yeah. Okay. So we've done we're decreasing carbs. We're watching on the CGM, the continuous glucose monitor, so we can get that positive reinforcement.
Now we're ready to go to ketosis if so. And then we start doing those the blood testing strips. Sorry. Is that is it every day? Is it multiple times a day, a few times a week?
When when we're getting going, it is good to do it, the glucose and ketones once a day. And and here's the thing, if your glucose is over a hundred, you probably don't have ketones. So I tell people, check your glucose first. If it's over a hundred, don't even bother wasting a strip because your ketones are gonna be either zero or very, very low. Now if your if your glucose is a hundred or below, go ahead and check your ketones because you're gonna have some.
So and then time of day, it's good to be consistent. As I mentioned, ketosis tends to be lower in the morning, which is also when your glucose is lowest. Right? You get up in the morning, if it's before sunrise, that's when it's the lowest. After sunrise, your cortisol level is punching your liver to release some glucose.
Right? Letting go some of that glycogen and your your glucose will go up all by itself just with the sun rising. That's part of our circadian rhythm. Right? So you'll see that when you do continuous glucose monitoring.
You'll be able to watch it like a clock. But anyway, so glucose is lowest in the morning as are ketones. And as you consume food through the day, both of those will rise. And the key is to not let that glucose rise too much, but let the ketones rise and that that's where the fat comes in. So fat with every meal, and what fat does is it slows your digestion too.
It slows how quickly you're absorbing any carbs or protein that you consume so you don't get a burst of glucose. It slows that down. So it has two functions. It slows down digestion and it, it's also satiating. That's three things.
Mhmm. And it and it's what makes ketones. And it's a good nutrient source, like you said earlier, for them. Yeah. Yeah.
So what are your favorite go to fats, when someone's in ketosis? Yeah. So, I olive oil, absolutely. Extra virgin olive oil, even better. It's a little more expensive, but the benefits are so worth it.
I also, like to say about half olive oil and half saturated fat. So saturated fat would be butter, ghee, or coconut oil, or MCT oil, which is a variation of coconut oil. And so this kind of mimics the composition of our body fat. So, this is a theory, but this is what I've used with people. It's like we wanna get about half and half because we need saturated fats and we need the mono and poly, which we would, you know, easily get from olive oil and olives and avocados.
Right? All of those are are excellent. And what about animal fat then from dairy or from meat product? Yes. So, well, butter is a dairy fat.
Right? So that's more saturated. But some of the, like, beef fat has is pretty high monounsaturated fat, so that's fine too. Chicken fat, that's fine. That's high also in monounsaturated and some saturates.
So animal fats are fine. The the only caveat with animal fats is I worry if they're not the quality meats, you know, because the the toxins tend to sit in the fat of the skin or just the fatty tissue. So you wanna make sure this is, no no antibiotic, preferably grass fed. I know that isn't it's expensive. Mhmm.
I personally have cut back on my beef consumption because how expensive it has gotten. Mhmm. And I've, you know, I've leaned more towards turkey and fish, which I find kinda typical for for a lot of women. But you wanna you try to want to get clean meats when you can because they can be a source of leaky toxins. Mhmm.
Well, that brings up one of the questions I really wanted to talk about is is ketosis in women? I think that one of the theories or one of the the recommendations that I hear thrown around that I've shared at some points, but I find it a little bit confusing is ketogenic diets in premenopausal or women of childbearing age, you know, of peri and menopause that we have a little more clear data. But it seems very confusing in this these earlier or these younger women to use a ketogenic diet. A lot of people say their periods go away because there's not enough carbohydrates to fuel the brain, to fuel the hormones. And yet I hear other people say that's not the carbohydrates, that's the quality of the ketosis.
So will you educate us about that? Yeah. So I've had, some experience with menstruating young women, not a lot. But I have my colleagues have and and I've talked and consulted with them. In my experience, the majority of the women, and these are mostly women with epilepsy, they actually get regulated really well.
Their menstrual cycles get regulated really well. And they're following good ketogenic diets because they wanna get rid of their seizures. And oftentimes for, menstruating women, their seizures occur around their menstrual cycle because that's when their estrogen levels are changing and, you know, things are off kilter. So I have seen mostly positive effects. Now here's a case where, like, maybe we don't need to go into ketosis, but maybe we just need to bring the carbs down even premenstrual.
And there used to be a premenstrual diet, like, twenty years ago was kind of floating around because it worked anecdotally for people to get rid of all sugar and cut back on processed carbs. And it kinda it makes sense. I mean, I I went to a talk on it. I'm like, gosh, these people are really convincing that this works. So I tried it, and I thought, this does work, but no one did a trial on it.
So that's why it's not out there. But so that's why I'm like, yeah. Of course. This makes sense that sugar's very inflammatory, and it causes your insulin to go up, and that messes up other hormones. So if you can do a seven day sugar free, whole foods diet Mhmm.
Prior to your menstrual cycle, you probably will have a much smoother course and and stick with that through. You'll probably have a more smoother course, and you don't need ketones. I don't think you don't need ketones, but we don't have good science on this. What about in the mental health field? Because I I I know, like, Chris Palmer, the psychiatrist out of Harvard, has really been a a vocal advocate of this.
And it's one of the questions that I've had is using, are they are they collecting data when they're doing these mental health studies? Are they looking at men versus women, to see other outcomes? I think the thinking is that a lot of people with mental health issues also have insulin resistance. And therefore therefore, it may not be an issue. But if you have someone who doesn't have insulin resistance, is there still benefit from ketosis for mental health?
And if so, then is it a risk of going too far then if they're not insulin resistant? Yeah. So I don't know if you know Matt Pazuki, but he is a patient of doctor Palmer, Chris Palmer's, who had very bad bipolar disorder, tried everything, did not have insulin resistance, did keto because they tried all the medications and combinations. And in four months, he was significantly better. Okay.
He's a guy though. Right? I think they Chris isn't doing research right now from what I understand. He's got a he's opening a clinic. But there are, as I told you, 18 trials.
And one of the trials I am they they are monitoring women Mhmm. And and surveying them about, you know, their menstrual cycles. And the women I've worked with in this in this study have reported better, regularity like clockwork menstruation. But these are not teenagers. These are older women.
So there may be a difference because teenagers are still growing. Their brains are still developing, and we don't know. And Yeah. Again, I haven't had a I I have had people say there was more blood loss. I have heard that.
But shorter menstruation days, you know, instead of four or five days, they're they're bleeding over three days. So yeah. So there's unclear data. I think one of the things that makes me think of, which leads to the next question, is this idea of quality of the ketogenic diet. Right?
If you are eating really poor quality foods that are that are just pure I mean, I won't say pure fat because the fat actually has some benefit as you're talking about. But if you have a low quality keto diet, then my question is, one of the concerns I have about a ketogenic diet is nutrient levels. You know, in functional medicine, we care so much. In medicine, we should care so much about nutrient levels. Right.
Vitamin d, you mentioned, which is not primarily through diet, but but what about b twelve and and, more so than antioxidants and the phytonutrients? So I would imagine there's a way to do that right and a way to do that wrong. Will you help us understand how you get these other nutrients and along those lines to gut health. Right? We we talk so much about fiber and, come back to what you were saying about the phytonutrients for gut health.
Yeah. So part of the therapy is supplementation. Okay. Because I have evaluated, technically evaluated through a computer system looking at what people are eating or what they're reporting they're eating and comparing it to the reference intake for the vitamins and minerals that they're supposed to have on a daily basis. And I've identified, you know, some of the B vitamins, certainly vitamin D, even selenium, like a whole bunch of nutrients are deficient.
Mhmm. I've also evaluated diets of people who are eating highly processed foods and I've come out with many more nutrients Absolutely. That are missing. So the problem is also that the nutrients that we are using in our database might not be the exact nutrients that were this carrot has grown in ex farm. Right?
So it's a little bit of a guess. So what is key is that we supplement to ensure that they're getting some quality micronutrients to supplement what they may or may not be getting in their diet. So I definitely believe in quality supplements and and not just say go take a multivitamin because that's it's like saying, you know, go eat whatever drug you need to eat to get better. No. There's huge differences between them.
Yeah. Mhmm. So what does what does a good quality ketogenic diet look like then? What are what are people eating in in these programs that you're running? Yeah.
So what I do before I start working with somebody is I have them give me a, like, a three day food guide or record to so I can get a handle on their food style, which may be affected by culture and their age and all that. So then I look at that and I come back with, we're gonna do a transition and you pick the meal that we're gonna work on, and it's usually breakfast people, because the first meal of the day, they're all excited to do this. And so I look at what they're eating over over a typical three days, and usually people will report cereal or, you know, they'll eat hard boiled eggs or take them to work or take eggs to school of some nature. And so I'll try to match that with something keto. So, for example, I had somebody the other day that is like, I really miss pancakes.
I just want pancakes. I'm like, you can have them on keto. You know what what the ingredients are? It's so simple. It's two eggs and a quarter cup of pecans that you blend together, and it's a batter that you fry in butter.
It looks just like pancakes. It actually tastes just like pancakes. And then what do you put on it? You put butter and cinnamon and maybe heavy cream that you've whipped and maybe some berries. Right?
So we can come up with things that look and taste very similar to what people are eating. And and the best way for me to personalize that is to find out what they're eating and try to match it. At least for this transition period where we're getting them going on keto, because that's that's just one less thing that they stress about is like, oh, I have to eat this keto food. No. I'm gonna eat I'm gonna have pancakes this morning.
And if I really like pancakes, I'll make a bunch so that we can freeze them, and then we don't have to make them in the morning. A lot of people are open to doing a smoothie for a meal. One or two meals a day, like, I have people that work fifty, sixty hours a week and they just don't wanna I don't cook. They tell me, Beth, I don't cook. K.
Can you blend? Because if you can blend, we can do a really good keto smoothie starting with a protein powder, two sources of fats. For example, like half of an avocado, some coconut cream. I use water. I don't use the nut milks because you can't taste them and save your money.
And, some kind of flavoring. Lemon, holy basil, or chia seeds, and we can put some, you know, those fun things in there. And, some kind of flavoring like chocolate. Cocoa is very, very, healthy if it's unsweet. And how do you sweeten it?
Well, in the beginning, you might might have to use some allulose. Once you get into ketosis, your taste for sweetness really declines. And that's how people get for weight loss, which we were, mentioning a little while ago. That's why one of the reasons it works so well for weight loss is people lose their sugar cravings, their carb cravings, because ketosis depresses that urge to eat something carby, and they have really good appetite control. So, anyways, a smoothie can be a complete meal.
And that's an easy way to get people going on on keto is because they just put it all in one in one meal, they drink it, they're done. You know, and it's high fat, low carb, moderate protein, and and they're getting all this good nutrition all at once. And this is another place to sneak in polyphenols and fiber. Right? The chia seeds, the avocado, which has magnesium and fiber.
So, a lot of people swear by it that they have to have that once a day to be regular. I even I even incorporate, green banana in, into smoothies for people that tell me that they really have constipation issues. I'm like, alright. For the first week, you're gonna get, you know, get some green bananas, cut them up, take the skin off, put them in a bag in the freezer, and then you're just gonna pull out a couple inches of it for your smoothie. And then, we're gonna get you going every day.
Right? So that's how adamant I am about fixing gut issues, that they really need to be regular before we get into ketosis because this is gonna just make ketosis so much easier to slide into without keto flu. And how many vegetables are they able to incorporate? You mentioned earlier, I think dark green leafy vegetables. Are there other vegetables generally that they're incorporating?
Yes. So I I like to think of it as all the above ground vegetables. Right? You can have. It's the underground vegetables, potatoes, root vegetables.
Sweet potatoes are so nutritious, but they're so high in carbs. So I I like to say you can still have them, but just like a little piece. Like, a little tiny piece. Radishes, excellent salad. If you just shave a bunch of radishes with a little mandolin.
Right? Vinegar and oil. For a salad, you just need at least one vegetable, but maybe two or three would make be more exciting. I have people shave brussels sprouts Mhmm. For salad or saute them with their eggs in the morning for a little bit.
That's a nice little crunch to have with fried eggs. So there's different ways to incorporate vegetables, and usually it's more vegetables that people have been eating. The super high nutrient dense vegetables that you can buy at the store, you can grow at home are sprouts. Mhmm. They're high protein.
They're super low carb, very nutrient dense. Throw them in your smoothie. You can't even taste them. Or, you know, if you've got kids, it's fun to to grow them. It's a it's a cool thing to to grow sprouts.
I used to do it with my kids and that was the coolest thing. Yeah. Yeah. Like Chia Pets, but with Yes. Yeah.
With broccoli sprouts. Yeah. Mhmm. Well, this is super helpful. I think there's an an OB GYN who's talked a lot about ketosis for women, Anna Quebeca, and she really talks about incorporating green vegetables and incorporating plants because a lot of women just don't tolerate the classic ketogenic, you know, like I said, bacon and and butter and and beef and, you know, these really high fat diets that that or high fat in that way that a lot of women just don't feel that good.
But that's helpful to hear because when we do think keto, you don't think vegetables. And I think that's probably one of the flaws is that people just think that it's all animal, you know, and Yeah. Yeah. And butter. Yeah.
I had someone who who I'm starting up right now. We're into her second week of start up, and she texted me and said, I'm used to eating a lot more fruit and vegetables. Everything seems so heavy. You know? And I'm like, what do you mean by heavy?
Well, she was getting meals delivered. These are it's part of a study, and the the meals have these cheesy kinds of sauces. And I'm like, leave out the cheesy sauce. I'm gonna give you an olive oil dressing that you could put on everything. It's basically olive oil and basil leaves and a little bit of apple cider vinegar and making a dressing out of it.
And it's lovely, and it makes you know, it's just a taste this beautiful taste that you can put on meat, fish, poultry, and even vegetables and get your excellent fat that way. So, yeah, you don't have to it's not animal heavy by any means. In fact, people are surprised to see the small amount of protein, like, the size of a deck of cards is a typical serving of of meat that someone would have at a meal. I think that actually sounds more sustainable to me, you know, to be able to have the diversity of foods too that goes go with other plants and and incorporating other things. You mentioned before that for for epilepsy that there's actually a reparative mechanism so that they can then come off of the ketogenic diet at some point.
Is are there other conditions where that's the case, or most other conditions it's lifelong? If you're gonna get the benefit, you're gonna stay on in ketosis. Yeah. So this might be the difference between children and adults. So for for children with epilepsy where it's one to three years, they're off.
For adults with epilepsy, I haven't seen any that haven't actually been able to come completely off. Yeah. And I think it's because their brain is done growing. And children, their brains aren't growing till they're, you know, 19, 20, 20 one, 20 two sometimes. And that's why they can do surgery all the way up to that age.
They can do brain surgery and not lose any function because there's another area of the brain that will just take over. Yeah. Because it's their brains are that, you know, they're developing, right, very adaptive. So, so that that's probably the same point for other conditions that, you know, a full grown adult might have to consider doing this long term. And and, you know, people are willing to do it if they get benefit from it.
They're willing to invest, and and and it's important to have that conversation with them. It's like Mhmm. One of the first things people ask me is, how long do I have to do this? And I'm like, okay, we're gonna have a talk about that this is a therapy and it's a lifestyle therapy and you might have to do it forever in some form. It might not have to be as strict after several months when your body heals.
But, you know, are you in for that? And and usually they tell me yes in the beginning. Yeah. Right. Right.
Because they're so excited. Mhmm. And then when they start going through a year of holidays and vacations and trips, that changes them a little bit. But I I have a lot of I have a lot of repeat visitors that come back to me, like the woman I mentioned, like Yeah. I can't Okay.
Let me start over. Yeah. I'm sorry. I went off. You know, I got off, and I really wanna come back.
And that's, you know, that's just humans. Right? That's Well, for sure. And with the social pressure, I I it's it'd be really, really hard. Will you as we're wrapping up here, will you share is there anything we haven't covered or anything you want to reemphasize or emphasize to our listeners that that would be helpful for them to know at this point?
Yeah. I'm hoping people don't say, oh, I got this. I think I'm gonna I'm gonna try doing keto. I don't that's not my message. In fact, I encourage you not to do that because I've seen some horrible things.
And when I carried a pager working at the hospital for twenty years, I would get calls on the weekend from the ER doc saying we have so and so here, who put themselves on keto. Or or I put them on keto and they ended up in the ER with a kidney stone or something like that. Because in my early days, I didn't know all these aspects of the therapy. I kinda learned through the school of hard knocks. People need to drink sufficient fluids.
So everything goes through their body safely and doesn't end up sitting in the bladder for a long time because you can get very dehydrated when you're in a state of ketosis. It's just a function of how your kidneys are handling the fluid. And Mhmm. Carbohydrate's like a sponge, it holds on to fluid and when you're not taking all that carb, there's no sponge. It just goes through you much quicker and you dehydrate quicker.
So fluid is part of the therapy. Supplements are part of the therapy. Blood work is part of the therapy before you go on it, and then this monitoring of ketones and glucose while you're on it. So those are the biggies. And then there's some people that need, an amino acid called carnitine supplementation.
It Mhmm. Particular meds kinda eat that up and they need to be supplemented. So if you're one of those people, you wanna know about that before you start keto. So, yeah, I I don't encourage anybody to do that. I encourage people to have a conversation with their their provider to see if this is something that they should consider, and they might be even educating their provider.
But there's a lot of information. There's a lot of really good articles. There's going to be consensus, guidelines very soon for keto for mental health disorders that's coming out this year sometime. And there's other, you know, there's other good resources. Metabolic Mind is an excellent website.
Charliefoundation.org is a, nonprofit that I consult for. We have a lot of diet information, not so much on the specific disorders, health disorders, but a lot of the diet itself, recipes and you know information about cooking techniques and things like that. So that's easy and a a nice resource at charliefoundation.org. Well, thank you so much for sharing your wealth of knowledge. This is just so interesting.
And, you know, we wish we had the magic bullet that was easy, and that's not this one. But, man, I'm grateful it exists, and I'm grateful for the people who are researching it and able to have more tools in our tool belt for when people have medical conditions that are resistant and we're not able to make the progress. If we have to ask them to do something hard like a ketogenic diet, but they get big wins out of it, that's that's worth knowing. You know? It's worth having as an option for that therapy.
So I'm grateful for all you do and all you've done throughout your career and are continuing to do because it's it's such a value to people. So thank you for coming on, and thank you for everything you do. Oh, you're so welcome. It it was a pleasure to talk with you and to share. Thank you.
Mhmm. Thank you. Will you tell people where they can find you, where they can learn more about working with you? Yes. So my website is my name, that's dupekania.com, and there is a contact us form.
I also have a colleague that I mentioned I do the virtual training, and the virtual training is really for health professionals. It's mostly nutritionists, but we do have nurses and doctors taking our courses. And sometimes we have patients that are just like, I wanna learn about this too, and we let them go ahead and take it. So that's another place that you can connect with me. And, and charlie foundation dot org, again, that that's you know, I I help populate that website with lots of information that's that's helpful to people that are seeking, you know, the introductory knowledge.
So there you have it. Wonderful. Thanks so much, Beth. It was so nice talking. Alright.
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