Dr. Stephen Phinney on Nutritional Ketosis and Ketogenic Diets (Part 1)


– Hi, I’m Steve Phinney, and I am the chief medical officer of Virta Health. This is going to be the first of four talks I’m gonna be presenting on ketogenic diets and
how they are effective and safe in treatment
of various conditions. This first talk will be an introduction to nutritional ketosis. What led me to this field to begin with was that I’m a recreational cyclist. I like riding a bicycle long distances. I’ve been doing it for over 50 years. And very early on I discovered that if when riding a bike
for more than an hour or two if I didn’t eat when riding
I would hit the wall, which is what happens
when the body runs out of carbohydrates when it’s
carbohydrate-dependent. And you feel really lousy,
and your performance drops. So I very quickly became
a carbohydrate advocate. Interestingly, at this
time 40 or so years ago was when the Atkins diet
first became popular. And Atkins said, you
know, you don’t need carbs to feel well and function well. Well, I was a newly minted young doctor, and I was feeling my oats. And I was set out to
prove Bob Atkins wrong. And, guess what, proved myself wrong. Now, actually, it wasn’t quite that simple because if you go on a
ketogenic diet for a week, or two weeks, your performance does drop. My experience had been only in short-term restrictions in carbs. So we did a study that lasted six weeks, and by the third week
of the six week study people’s performance was coming back up. And by 6 to 12 weeks their performance was back to or above
where they’ve started. The body becomes capable of burning almost all of its energy from fat. In my research I actually make a habit, sometimes successfully, of
trying to prove myself wrong. And you say wait a minute, why wouldn’t you try to prove yourself right? If you prove yourself wrong that’s how medical advances are made. If you assume that something’s right, and you find out it’s
wrong, you can now change your understanding and
change medical knowledge. And that’s something that I, and my co-founder and collaborator
in this, Dr. Jeff Volek, have made a habit of doing
over the past multiple decades. In this process back
in 1980 I coined a term nutritional ketosis, and
another term, keto-adaptation. The first thing you have to consider when listening to someone talk about nutritional ketosis
or ketogenic diets is, how can you trust what they are saying? The reason is that they are a lot of self-appointed experts out there, but very few people in the medical arena have much training in nutrition. And most of them have
absolutely no training or research experience
in nutritional ketosis. That is most people get their expertise by reading what other people have done. Now, why should you trust me? I mean, I’m an MD, and I can
tell you I had no training in nutrition in medical school back when I went through that process. But after I completed my medical education curiosity drove me back to school, and I spent four years doing a PhD in nutritional biochemistry
because I realized there were a bunch of paradoxes
between what I was taught to believe and what the
evidence seemed to present. After completing that, my
PhD, I went on to do two years of formal training in clinical nutrition. Since then I published 80 papers, I’ve co-authored three books. I’ve been studying and prescribing ketogenic diets for 40 years. The first point I want to make is that nutritional ketosis
is a very powerful tool when properly done, but it’s not simple. It’s not just a matter
of cutting out carbs. And the other point is
that particularly in people that have medical conditions,
it’s not always safe. So my goal in presenting this information to you is to share the power
of nutritional ketosis, share the fact that it can reverse, and, or prevent very
significant medical diseases. Oftentimes taking
away the medications that are currently being
used for those conditions. With this power comes risk, particularly as it relates to having
being on medication because if you’ve reversed the disease, and you don’t take away the medication, you can have major side effects. The other important point is that this is much more complex
than just taking away sugars, bread, rice, pasta,
potatoes, and other things. For a ketogenic diet to be safe, it has to be much more scripted than that. Getting the diet right in terms of the other nutrients in the
diet is pretty complex. And it’s not something
that a simple slide, or even this simple talk
is gonna be adequate in order to do it safely. The other important point is there are some medical conditions where people should not do this type of diet. And I’ll mention those
briefly in this talk, and more completely in later talks. Let’s discuss what’s a ketone. It turns out that there are two compounds that the body makes from fat. And the body, meaning the liver, makes two compounds from
fat which are classified as, and I put this in air quotes, ketones. Now, I won’t get into the details of the technicalities of that. Now, these can either
be made from body fat, that is fat we’ve eaten before and stored, or fat that we eat, and that circulates through the blood after digestion. Fats that are eaten or
stored when they circulate through the blood are
difficult to transport. They’re in what are called
lipoprotein particles. And these are the things
that you were measuring when we measure cholesterol, and triglycerides, and things like that. And because doctors
worry about these things you might imagine that having
too much of them is a problem. Well, it turns out that
when fats in the liver are made into ketones you no longer have to worry about lipoproteins because these are water-soluble particles, and they float through the blood. They move into cells
easily, so it’s a much more efficient fuel for the body to use. Once it’s in the bloodstream
in adequate levels it can feed the brain,
it can feed your heart, and it can feed your muscles. And as we’ll mention in a few minutes it can do other important things as well. Now, how do we know it can feed the brain? Well, there are actually some, let’s say dangerous experiments done back in the 1960’s where patients
who’d been fasting for weeks, so they had quite high ketone levels, were then infused with insulin, which drove the blood sugar
down to an extremely low level, to the point where it should
cause people to pass out. And as long as there were ketones in the blood the brain
functioned just fine. So we know that ketones are a very efficient and effective brain fuel. We’ve discovered in the
last five years that ketones are a very potent signal
that talks to our genes. And some of the genes it’s talked to are the genes that
protect us from things that we call oxidative
stress, or free radicals. And this is really important because these are the root causes of
a number of diseases, including type 2 diabetes, heart disease, inflammatory bowel disease,
high blood pressure. Also, people with seizures
oftentimes have dramatic results when they get in a
well-formulated ketogenic diet. And it’s not so much about fuel as it is about reducing oxidative
stress and inflammation. This is a very, very important topic in terms of understanding how
ketogenic diets can be used to markedly improve some chronic diseases. We understand not just what they do, but how they do it at the molecular level. And this is important in terms of moving this field forwards,
and making optimum use of this state we call nutritional ketosis. Where did nutritional ketosis come from, and why did we have to
define that as a term? Over a century ago doctors figured out that when people with what’s
called type 1 diabetes, the diabetes typically of younger folks where the pancreas stops
making any insulin at all, they can’t use glucose at all for fuel, and the body overproduces ketones. The ketones build up to very high levels, and that’s called ketoacidosis. When ketones build to very high levels you can actually smell them on a person. It’s like a (sniffs)
smell that these ketones, then say, ah, you know, this
is uncontrolled diabetes. And they realize that that
changes the acid levels in the blood, and that’s ketoacidosis. But these are vastly
elevated levels of ketones. So figure let’s say a number of 20 would be a extremely
high level of ketones. But if you’re eating a
well-formulated ketogenic diet your blood levels are not 20, your blood levels will
be in a range of .5 to 3. So it’s one-tenth that very high level. Yet if you eat say orange
juice and bagel for breakfast, after breakfast your ketone levels will not be .5 to 3, they’ll be .1 or .2. So one-tenth, 10 times higher
is nutritional ketosis. 10 times higher to that is ketoacidosis. So we define this state
of nutritional ketosis as being a safe blood level
where ketones function to feed vital organs in the body when you’re not eating a
whole lot of carbohydrate. You can see that in the green
zone between .5, and 3, or 4, that’s what we call the
optimum ketone zone. That’s when ketones have
beneficial effects in terms of feeding the brain and
other organs in the body. And as you can see, if you
were in total starvation, which we don’t recommend
because of negative effects on lean tissue and organ function, total starvation ketones
will go up as high as seven. And you don’t get anywhere near the risk of ketoacidosis until
the numbers are above 10. These are very distinct
states differentiating nutritional ketosis from
diabetic ketoacidosis. So by 1970 all of this
stuff was well-defined, and has been in the medical literature. And we kind of assumed that, you know, if we can just tell people that
ketones are good for heart, and muscle, and brain that
that would be a good thing. But really exciting things have happened in the last five years. The reason we know that
this is not a rumor, word of mouth, there were some
very solid scientific papers in the medical literature
now indicating not just that, gee, looks like
inflammation goes down, we actually know precisely how. The beta hydroxybutyrate,
this primary ketone we have in our blood, makes inflammation and oxidative stress go down,
and provides optimized control for some inflammatory diseases. Let’s kind of get to a little bit more practical information. How does one get into nutritional ketosis? People who have reason
to want to have benefit if they have type 2 diabetes, or they’re severely overweight, or have hypertension,
very often those people have what we call insulin resistance. That is their body has begun
to lose its responsiveness to this hormone, insulin,
which is the hormone that causes blood sugar to go into cells, and also manages body fat metabolism. So if you’re insulin-resistant
you probably have to get your daily total
carbohydrate intake down somewhere between 20 and 50
grams of carbohydrate per day. If you want to think about that in terms of macronutrients that’s less than 10%, and oftentimes less than 5% of your total daily energy
intake comes from carbs. So that’s very carb-restricted. And the more insulin-resistant the person is the lower they have
to go to initially get into a state of nutritional ketosis. In addition to restricting carbs, this is not a high protein diet. Protein, like carbohydrates,
stimulates insulin production, and exacerbates insulin resistance. So it has to be moderate in protein, enough protein to maintain
healthy function of our organs, but not so much that it
raises insulin levels. Then the other key point of a
well-formulated ketogenic diet is this is not a calorie-restricted, stop eating when you eat
x-number of calories per day. This is a diet when is done
right is eaten to satiety. That is when you finish a meal you should be satiated,
and you shouldn’t be hungry until it’s time for your next meal. And the way you do that if you’re eating very little carbohydrate
and moderate protein is the majority of your dietary calories have to come from fat. And we’ll come back to the
safety issues around, is it okay to eat that much fat if it’s
more than half my calories? And the answer is yes, and hopefully I can convince you of that later on. The other thing that is very important in a well-formulated ketogenic diet is getting enough vegetables,
provide enough minerals, maybe fiber to provide satiety. Rather than coming from pills it should come from fresh real food. So we suggest three to five servings of non-starchy vegetables per day. Now, realize this is just an overview, it’s not a prescription. Don’t just say, okay, I know how to do it, I’m gonna go do it. So this is something where you need to understand the serving sizes, that we adjust the protein
to the size and gender. So a small woman’s gonna need less protein than a very tall guy. There are variations in this
that require individualization. So this is not a cookie cutter
or one size fits all diet. I want to point out that there
are lots of low carbohydrate diet strategies out
there, but not all of them are either ketogenic or
involve keto-adaptation. For instance, a paleo
diet, or a primal diet, or a low carbohydrate, Mediterranean, and certainly not intermittent fasting. Those do not allow for keto-adaptation. Either they’re not sustained enough or they have too much protein. So if you look at this slide here where on the vertical
access it’s the amount of carbohydrates this percent per day, and the horizontal is protein. You can see that the
standard American diet, I think SAD, you know, sad
is a good term for that, which is high in carbohydrate,
moderate in protein, and relatively low in fat, is way above the low carbohydrate level. If you cut some carbs out of the diet, and add more fat, that would
be a Mediterranean diet, but it’s still not low carb. But as a general rule most people in the nutrition field will
call anything under 30% of calories as carbohydrate,
a low carb diet. So a paleo diet typically
is about 30% protein, about 20 to 30% carbohydrate,
and only 50% or less fat. So it’s not that high in fat. But the combination of the
carbohydrate and protein are enough that it prevents
the body from making ketones. So that doesn’t fall into
the ketogenic diet range. So you can see that to get to a well-formulated
ketogenic diet it’s kind of a small island of keeping
protein in moderation between roughly 10 to 20%,
keeping carbohydrates under 10%. So if you’re 20% protein and 10% carbs, and you’re holding your weight stable, that is after a period of time, you’re in weight maintenance, that means that 70% of your energy
has to come from fat. That can be pretty scary, but that’s how one does a ketogenic diet. And that can be done not
just for weeks or months, that can be done for years and decades. And the best way to measure it is to, you know, be tough, prick
your finger like people with type 2 diabetes, or
diabetes to measure blood sugar. And there are special strips for ketone meters that
can actually measure your blood ketones, and
they’re very accurate. And you don’t need to do that forever, you need to do that long
enough just to know what level you get to if you’re eating
a certain range of foods. One of the keys to success here is you have to be sure that this is safe. If you do this, and do it
in a way that’s not safe, then you’re not gonna be successful. You’re either not gonna feel well, or it’s gonna make you ill, or actually carry significant risk. So as a general rule, even
if you’re otherwise healthy, and you just want to lose some weight, or improve your energy level, you should let your doctor
know what you’re doing. If you have type 1
diabetes, which is a case where the body is not able
to make enough insulin, you’ll need specialized medical support. There are some people who advocate using this type of diet
with type 1 diabetes. But it takes a specially trained physician who knows how to do this to guide you. And this is something that has to be done with very close supervision. The same is true with type 2 diabetes, but oftentimes with type 2
diabetes we can get people off of some, or most of their medications. And, again, that has to
be done by a physician, but then the supervision doesn’t have to be quite so close because
you’re no longer taking the medications that carry risk. The third situation where you would need careful medical support, and have your doctor be directly involved in what you’re doing, is if you have high blood pressure and
you’re on medication. Because, again, oftentimes we need to withdraw those medications. If you have a heart condition, or if you have significant liver or kidney disease that needs
to have careful evaluation to see if you have enough function of those organs in order to be able to manage the adaptation
of this diet successfully. Most doctors aren’t taught how to do this. Some of them will read books, hopefully our books, and
understand how to do it. But beware of physicians who don’t have the experience in doing this. The final point about
safety is this is not, as I said, not just
about restricting carbs, and keeping protein moderate,
but getting adequate minerals. The important minerals include sodium. If you don’t have enough salt, or sodium, in your diet you’ll
have a bunch of symptoms, which include lightheadedness, dizziness, fatigue when exercising, and constipation. Those are not side effects
of nutritional ketosis. Those are side effects of
not having enough salt. It just so happens that when
you’re in nutritional ketosis your kidneys get much more
efficient at getting rid of salt. And you have to provide
it on a routine basis in order to maintain your well-being and function on this type of lifestyle. An additional mineral
that’s very important, particularly for heart and
muscle function, is potassium. And you get that from broth,
you get that from vegetables, and you get that from
eating unprocessed meats. We don’t normally have to supplement that. If you get the vegetables, meat, and hopefully make your own homemade broth in order to maintain
adequate potassium intake. A third mineral we deal with a lot, particularly in people
with diabetes is magnesium. This is a mineral that most
Americans don’t get enough of. And it seems that people with diabetes have a significant problem
maintaining adequate amounts. A major sign of magnesium depletion or deficiency is muscle cramps, whether after exercise
or occurring at night. And that’s easily managed if someone is knowledgeable on how
to replace magnesium. But don’t just accept cramps as a necessary effect of this. That’s easily managed by someone
who knows how to do this. Other minerals include
calcium, which is necessary for bones, and nerve, and muscle function. That’s maintained by adequate vegetables, dairy, and cheese, also,
from homemade broth. We rarely have to
supplement calcium people when they have the normal food intake that’s appropriate for
a well-formulated diet. And vitamins are sometimes a concern because people say, well,
I’m not eating fruit, or I’m not eating enough fruit, and where are my vitamins gonna come from. It turns out that vegetables
are an excellent source of the vitamins that you would
normally attribute to fruit. So we find that people don’t need additional vitamins with this. But if one wants to take
a standard multivitamin it’ll do no harm, but
probably not necessary. To wrap up, a well-formulated
ketogenic diet and nutritional ketosis is a
healthy normal metabolic state. This is not something that is abnormal. This is not something that
you should only do for a week or two at a time because longer is unsafe. No, this is something one can do for months, years, and decades. It’s achieved by reducing sugar, and refined carbohydrates,
and most starchy foods. But in the meantime
you’re eating real foods, and plenty of foods, and
eating those foods to satiety. This is as I mentioned a very effective disease reversing way of living. And if you have diseases
that can be reversed with this you need medical
supervision, particularly if you’re taking medications
for those diseases. Because the good news is
you have to take them away. The bad news is if you
don’t take them away it can have serious side effects. So it has to be monitored by
a knowledgeable physician. To do this right it results in improved well-being and function. And the neat thing is this is not a calorie-restricted approach. You don’t have to go away
from the table hungry, and you don’t have to count calories. You let your natural instincts
empower you to succeed when you do a well-formulated
ketogenic diet. This is a graphic that we
use when we try to explain to doctors all the emerging things that happen when one goes
into nutritional ketosis. Across the top on the left-hand side are fat cells where we store energy. That energy can be
released by the fat cells, circulate through the blood,
get taken up by the liver. Made into ketones, and the
ketones feed the brain. We didn’t put the heart on there. The other interesting thing, it appears to feed the digestive system, which is intriguing, and
reduces inflammation. And that appears to be why
inflammatory bowel disease oftentimes gets better on a
well-formulated ketogenic diet. Clearly, ketones and fats
can feed the muscles. But it also reduces inflammation, including many people with asthma notice that their symptoms get better. There’s emerging science, not on people, but in little worms grown in test tubes, and in mice grown in cages, that a well-formulated ketogenic diet actually improves longevity
by reducing oxidative stress. Then, many athletes now,
particularly endurance athletes who go beyond marathon distances, like triathlons, or
longer distance running, and more extreme duration sports, they’re turning to a ketogenic diet because the body can run mostly on fat. Then the person doesn’t run out of energy and doesn’t hit the wall. So, again, this has a multitude of effects, many of them beneficial. But I want to get across
the idea it always has to be done with adequate information and adequate supervision to be safe. Thank you.

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100 thoughts on “Dr. Stephen Phinney on Nutritional Ketosis and Ketogenic Diets (Part 1)

  1. Here's the Facts Doc.One ,ketogic diet doesn't need much of a doctors time. Two, this will mean we don't really need Doctors but Surgeons. Last, there's not enough meat to heal or feed everyone. I really think natural paths will take over the medical fields. Drugs and pills and making things completed are what Doctors do. In the future doing blood test will go higher in price cause this will be the only really good way to tell what your body is lacking. I am sure natural paths would want to make money and have their patients go through test after test and would like to see them over and over. Only way to fix this is for the medical industry to change the pay scale to wear ,if you are sick?You stop paying! You pay a rate of healthcare on a percentage bases. If you make a ton of money ?Then you pay 5% what you make. If you get sick then you stop paying. 5% of your pay for a poor person that makes 1600 a month would only be 80 bucks a month. If you don't pay ? No testing for you. Testing will be key for everyone in this future. Food will be the medicine. Making sure all has good food would be another problem we would face but having 4 acres of land covered in grass wasting water would not work. Having churches becoming local farmers and system wear you get what you put in would be nice. Carnivore/keto will be changing the world now we have Youtube with N=1 home study's. Poor people might have to work a job and work on the side for their food. The rich will be paying the most but if you made a million a year? $50,000 would not hurt you much. Also think Rich would be put first. They would need to be healthy first cause they need to run that business. As of right now, You go to school for free. Then get a loan to go to collage that is way to high is cost and will put you in debt. Then you work your ass off and get a job that pays crap and live in a cheap place with a roommate. Working for 2 years to pay off that dept only to realize you need more school and more dept either to buy a house witch you want to do as fast as possible to pay it off before you are old and sick. After getting a loan for a house for 30 years and more schooling and a car, you end up always broke and poor but have things that are kinda yours. Then 10 years goes by and your in your mid 30's the economy goes under for a while like it always does every ten years and you loose your Job one time, and year goes by all of your friends are in that same boat looking for work while your packing up your stuff cause you just lost your home , car, dog, boat,etc… now with this stress sickness comes and you can't afford any doctors to look at you. Time to live with your parents or grandparents that are hurting anyways. You then wait 3 years economy goes back up you look for a job only to find they are all hiring younger people. Need more schooling sorry. 40 years old seeing these young couple buying your house that you paid 15 years of mortgage on. I wonder how many people see this shxt happening every year? Burn out the younger age 20 years to 30 years old , kids don't know their parents but they know everything about youtube and drugs and sex. Work all that overtime and burn yourself out , loose your wife, loose your kids. I wonder how bums are made?

  2. Dr. Phinney. Great video. I’m a truck driver, my truck runs on diesel and I run on fat. I’ve been on keto for about three years and I’ll not do it any other way. Thank you and I’ll recommend your video to friends.

  3. Dear Dr Phinney we know that hyperglycaemia favorises microbial growth, but do we have any scientific evidence that Lyme disease an coinfections can trigger or aggravate glucose intolerance and insuline resistance?

  4. As a physician recently introduced to the ketogenic diet, I have noticed a stagnation in weight loss when a patient takes antibiotics

    Could we suspect the intestinal flora as being one of the factors of weight loss in a ketogenic diet?

  5. With all the damaging and disease causing effects of the SAD diet, maybe MDs should be recommending doctor's supervision for THAT. I don't see why you would need doctor's supervision to stop eating garbage.

  6. I borrowed a Keto diet cookbook and it says to use SWERVE or some kind of sugar substitute. I thought sugar substitutes are bad for you. Is honey allowed at all?

  7. What research shows too much protein to be a problem for ketosis? This is a debate amongst people with some saying too much protein can inhibit ketosis and others saying that protein doesn't matter. Some suggest it's only an issue if protein is very high so most people shouldn't worry.

  8. I gained from 145 to 185 pounds at age 40. I was bike racing 12 miles a day with a big pot belly. At age 63 I lowered my carb intake. My weight dropped to 155 and at age 65 I broke all my previous racing records. I have had to buy skinny clothes. I am 67 and this year I switched from biking to hiking to avoid bike wrecks on slippery roads. My weight is still below 160.

  9. This man is humble, enough to admit he has made mistakes along the way, and that he is willing to listen to good science and admit if he has gotten it wrong. Cheers Dr Phinney.

  10. I have followed Dr Phinney since 2013 and read all his books and completely agree.
    I have been eating this way and prescribing it for my patients and it motivated me to become Board Certified in Obesity Medicine
    If you are having trouble finding a Doctor to help you with this look for Obesity Medicine doctors especially if you have Diabetes or Hypertension.
    The other thing I do personally is focus on what I CAN HAVE looking for new recipes etc and videos and info instead of focusing on what I can’t have
    Jeff McDaniel MD
    Atlanta GA

  11. Wow! Dr. Stephen Phinney. Thank you, that was knowledge bomb after knowledge bomb you were dropping, there. Really, truly appreciate it. Thank you again.

  12. I am on Keto now . …hoping to lose weight . ..nothing else has helped . ..my Brother is a doctor and he told me to do so in order to save my life …I lost 12 lbs in 3 weeks . ..and I have to lose 70 – 80 lbs more . …
    So this can change my life . …
    I do love animals . ..and feel sorry for them . ..and I hate animals being brutally treated by the food – industry. …
    But my body needs meat . ..I can't live without eating meat . ..and as you know by the bible . ..God allows that . ..

  13. Why complicate things? The quickest way to get into ketosis is drinking a lot of alcohol. Most fun too. If the state is so desirable, why not get there the most efficient way?

  14. As people who regularly test their blood glucose levels and have compared with others doing the same already know, individual responses to the same amount of a particular food can vary pretty significantly. This is also true for responses to protein. However, generally speaking, protein does not trigger insulin levels to the same degree that sugar, high-sugar fruits (like bananas), or refined starches (like pasta) does.

    Atkins was misunderstood as recommending a high protein diet. We forget, or never knew, how much more fat all the meats contained when he wrote his book! Skinless chicken was unheard of, and even pieces came with the bone. Pork was juice and had FAT. Beef was well-marbled, and the fat was not all trimmed off the steaks. Lamb was more commonly enjoyed, and lamb is a rich (fatty) meat, too.

  15. Fascinating talk. I have great regard for Dr Phinney and his work. Someone ought to send the link to this video to Jullian Michaels aka Jullian Arrogant-Ignoramous so she can stop embarrassing herself and learn something about what she is so against and obviously knows Jack sh*t about…or should that have been Juilian sh*t?

  16. So glad you were willing to be wrong. Fascinating to realise you were a champion so may years ago and the information had not reached the population until recently. I am following the many, many videos of Dr Eric Berg and they are "small chunk" ketogenic trainings that have helped me to do this in a healthy way. My motivation is because I was insulin resistent. This keto diet is being driven by regular people because the medical fraternity and even dieticians are still sitting back waiting for ???? I have never eaten so many low carb vegetables and the low protein and high fat has removed cravings and stabilised my energy and moods.

  17. Thank you ..good information but I have Dr Berg and Dr Funk guide me to successful reversing all I means ALL my metabolic problems..
    Keto for life for me!

  18. Great video. Primal Health channel recommended your videos. My question is do we need to consume 75% of dietary fat if we are already vastly overweight? Primal Health mentioned that 75% dietary fat is recommended for weight maintenance. What do you recommend for those who are seeking fat loss and have say 70 pounds of fat to lose?

  19. I agree totally with Dr. Phinney, however I dispute the frequency of meals.  For 200,000 years, this is the diet humans had which he described, so during the hunter gatherer times, they did not have breakfast, lunch, and dinner.  I get results with two meals a day in a 5 to 6 hours period in between lunch and dinner.   I get 17 to 18 hours of no eating.

  20. Is it not true that Ketoacidosis is a condition resulting from dangerously high levels of ketones AND blood sugar? It's not just high levels of ketones but ketones AND blood sugar which is why Type 1 diebetics get it. You cannot have high levels of ketones AND Insulin at the same time so if your pancreas is functioning and you are making insulin you cannot have Ketoacidosis. That's how I understand it. People freak out when ketones reach 6 or 7 and quit fasting but if they never measured ketones they would not freak out.

  21. Im vegan and when my psoriosis comes out of remission the only thing that controls it is a ketogenic diet. I veganise it of course. I do for a three month period on and off. There are links between psoriosis and candida ketogenic seems to improve both. Trial and error worked for me. Thanks for this video. When im in ketosis i also find i need less food and stay fuller for longer

  22. Most honest doctor I have seen so far. No doctor will convince me not to keto. My type 2 diabetes is darn near cured on this. I am lucky. My doctor is on board.

  23. LOVE this, can’t believe I just found it. I’ve been low carb/ keto for over 3 years, and this finally found its way into my recommended videos. Thank you!

  24. https://www.diabetesriskalert.com/telehealth-reverse-diabetes-with-executive-cognitive-control-free-trial-in-texas/

  25. The last thing you want to do is follow the advice of a Dr. about nutrition . They blow of basic nutritional science 101 . Like how glucose is needed by every cell of the body and is derived from the breakdown of "carbs" not protein or fat . It's amazing people blindly follow along with whatever a Dr. advocates . You can tell if your eating right by your breath , if you keep eating meats especially animal  without carbs [ bread] your breath will smell acidic common sense tells you , not good .

  26. Doesn’t ketosis shift the body into a hyper-adrenaline/ cortisol state due to a lack of glucose reserves in the liver?
    I’m also under the impression that the bodies primary source of fuel is glucose, and that the conversion of fat and protein to glucose (Gluconeogenesis) is actually inefficient when compared to the kreb’s cycle and is a stress response

  27. Dr Steve
    Of all The Doctors that I seen on Keto, you are the most informative, to the point I unsubscribed from some of them. I have subscribed to your channel and will be my go to. Thank You ☺️. Question if you can reply, don’t understand why my whey protein isolate with 25 G protein, total 2carbs, 1g sugar will spike insulin levels.

  28. You can’t burn fat efficiently without carb in the Kreb cycle. Ketones can maintain you alive but they can’t provide energy for intense efforts. Very low carb diet will shorten your life significantly as more and more studies show.

  29. Let’s put it simply : there is zero evidence that a ketogenic will do anything good for you on the long run. Zero nada, in the blue zones like Okinawa people have 70 % of car in their diet yet they have the longest life expectancy in the world and no chronic disease . So it doesn’t fit to this theory that ketogenic diet is the holly grail of nutrition.

  30. Dr I have a question. My urine test está ketons 5. Does not say persentage. I asume it is just traits. Thank you por your answer.
    Very intetesting video .

  31. That was so informative and very well explained. Thank you so much! I loved it from start to bottom.

  32. Thank you Dr Phinney for your refreshingly straightforward explanation of what keto adaptation is. Your explanation of exercise and how that works post keto was most helpful. As a cyclist and fairly new keto adaptor, I have always had a back up carb snack lurking in back pocket just incase, I found your advice and knowledge very encouraging, thank you.

  33. Nutritional biochemistry sounds like a fantastic PhD. We need more people in this field since there is so much confusion and contradictory information around nutrition. I don't like how people think this diet is just for unhealthy people.

  34. I have a question, after doing KETO for a while till most of the body fat burned out, then what should we do? Should we keep eating fat or go back to normal food?

  35. Questions for Dr. Phinny (or any other expert on this subject): 1) What prevents you from going into ketoacidosis when you are increasing your ketones on a ketogenic diet? It's not really clear from this video nor any other I've watched. 2) What prevents your liver from just manufacturing more glucose via gluconeogenesis and releasing it into your bloodstream when you limit your carbs? Wouldn't that defeat the whole concept of a keto diet? 3) Why eat any carbs at all on this diet? I think that's all for now, and thank you in advance to anyone who can answer these questions – in laymen's terms! Annie

  36. If carbs were meant to be our energy source our body's would store it as carbs, not convert it to fat. If we weren't meant to use fat at energy then our body's would flush it out of our system instead of storing it on our body's. I don't know why I never thought about this before.

  37. no use being #1 diabetic & looking for a physician to 'closely supervise' your ketone diet – physicians don't learn about this in medical school and most will recommend old school stuff like low fat high carb in small meals through the day… remember that the cholesterol boogeyman still rules 🙂 – use HFLC with common sense and listen to your body!

  38. My first time listening to you. Great info. Ty so much. 3 sizes down in keto in 10 months. I’m in month 15!!

  39. I am not so sure about his suggestion that too much protein will simulate insulin release. Recent evidence suggests that protein gouconeogenesis is a demand driven process and so the body will only create as much glucose from protein that keeps your blood sugar from going dangerously low. So eating high protein does not stimulate insulin response in the body. See this video:
    https://www.youtube.com/watch?v=z3fO5aTD6JU

  40. Dr. Phinney – THANK YOU for this series explaining Ketogenic living – my husband and I, in our late 40s, were in search of just such a resource as this – we are grateful to have found our way to Virta Health, and are thrilled to have an informative resource to turn to and grow our understanding. Thank you, again!

  41. Dr. Phinney, thank you for taking the time to produce this video which is extremely informative and helpful. I'd like to add, after living a ketogenic lifestyle for the past six months and losing 30 lbs, any symptoms of arthritis and my IBS symptoms, is that avocados are an excellent source of the fats you reference. I also supplement my daily intake of fats with MCT oil if I find I'm short after dinner. And lastly, I find the Carb Manager app invaluable in calculating the fat/carb/protein components of the foods I eat. I struggled with keeping to the ratios you suggest before I found it.

  42. hmm… i don't have a disease, i just have a brain tumor lol. i would say the same thing if i had diabetes, i dont have a disease, i have a low functioning pancreas

  43. I'm a 38 year old female, and lost everything due to a rare anoxic brain injury which resulted in degenerative dystonia, parkinsonism, and extreme chronic fatigue. I used to be an outdoor adventurer and occupational therapist, and now I can't walk, have 24/7 rigidity, and am on ssdi (poverty). There's no more medical treatment left for me (that I can afford). I really feel ketosis would help my damaged brain, however, unfortunately, I can't afford to eat strictly grass fed meat and organics. Is it more harmful than good to do nutritional ketosis if I can't eat grass fed? Also, I'm not even sure that I can afford to test my blood ketones even with the keto mojo strips, which are 'only' $1 each. Due to my disabilities, I can't do much cardio, but I used to do light weight lifting before my chronic fatigue and dystonia worsened. My #1 goal is to increase energy and reduce my Parkinson's symptoms and depression. I used to do better when I was able to go to the gym 3-4/wk and ate paleo, but since I developed unrelated legal blindness (post lasik ectasia) ,I became severely depressed and sugar addicted.

  44. Just wanted to thank you for the incredibly informative lifestyle change. It is a long road, education is a huge part, this is fantastic. Thank you.

  45. Hold on… You're saying the Standard American Diet (SAD) is low in fat?? All the cheeseburgers, french fries, chicken strips, and tortilla chips are low in fat? Hell No. The common food choices Americans make are usually loaded with 50% fat or more. Don't know what you're trying to sell doc but recommending to eat more fat is not what our society needs, rather the opposite.

  46. Is it ok to do a keto diet 365 days a year year on year. And what do i do if i dont take any medication from doctors? do i still need supervision lol

  47. I’m so glad he was confident enough in saying one can eat this way for weeks months and decades. So great. Although I practice vegan keto, it’s still so superb

  48. There are some great trailblazing doctors out there that care about testable nutritional science and not “dogma”. You, sir, are among them. Thank you for continuing and improving upon the legacy that Dr. Atkins brought to the forefront of nutritional science.

  49. According to a growing number of prominent low carb Doctors the belief that high protein diets increase insulin production isn't supported by current scientific evidence and that high protein diets are often more beneficial than restricted protein diets.

  50. Too many compulsive air quotes. Compulsions show stupidity and narrow mindedness. But evidence suggests what he is telling is true.

  51. Hi Dr Phinner, my father is diabetic and takes insulin on a daily basis. Is ketogenic diet recommended for my father ? If yes, could you recommend an appropriate medical clinic or similar in India ?

  52. Wow! It just clicked in my head (duh!). Dr. Kinney said, when bicycling long distances, "I would hit the wall…" In response to this, he, "… became a carbohydrate advocate." I immediately thought, "Keto reserves are hundred-fold compared to carb reserves! He could have kept going WAY longer if he had been doing keto." Thank you, Dr. Kinney!! 😀

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  54. Dr. Stephen, thank you for the video. I have learned so much with you about the food to consume in KETO.
    A few weeks after I started KETO I got a bit concern due to the loss of strength at the gym lifting weights. I took as a side effect, but I was willing to part with strength in exchange for a healthy ripped physique. For my pleasant surprise after 10 weeks of KETE I am starting to improve in my lifts just a bit under where I was before KETO, but now I am ripped and 30 # lighter.

  55. What is the long term effect of the brain switching from glucose as its primart source to ketones and are there any adverse effects? Are there any scientific studies on the long term effects of the ketone diet on the body? If you lose weight on this diet do you lose muscle or fat mass?

  56. Thank you Dr Stephen for your sharing!👍🏼👍🏼 so fortunate to have found your channel… very informative. Hope many more will find your channel. Subscribed!

  57. I was 🛌 bound at 620 pounds. I went more carnivore. I do eat some vegetables. I'm down to 486 near a year. In a standstill but I'm still fighting . I was swimming 6 days a week but I been having major symtoms with whizzing and chest pain on exertion. Did a heart ultrasound and a contrast ct scan. I past them both. Doing a stress test Oct 6 and another sleep test on the 13th. I have major sleep apnea breathing trouble at night even on 20 with cpap. I get medicare 2020. I need a better cardiologist. She is old school which is out dated. We don't see eye to eye. I wish this doctor would reach out. Watch all of his stuff. Not many MD's I would trust. He is the real deal

  58. I wonder how Pinney explains to his clients that the longest lived people on this planet don't eat Keto, or for that matter low carb. They are all high carb societies. In fact the small number of people on this planet that are near keto, or at least high fat have a life expectancy of 55 years?

  59. 4:10 – 'Dr. Stephen Phinney, This is much more complex than just taking away sugars, rice, bread, pasta, potatoes, and other things. For a ketogenic diet to be safe, it has to be much more scripted than that..' No argument, but for those who are not on medications, there is no downside to eliminating processed foods, sugars, and starches.

    For those on medications for diabetes or high blood pressure, the medications have to be lowered or eliminated as the sugars and starches (which are actually sugar) are removed from the diet. Dr. Eric Westman, who has been treating patients and doing clinical research on VLCHF 'No Sugar, No Starch' diets for decades, provides a lot of information on how to do this in his presentations. Those who are on meds may want to refer their physicians to Dr. Westman for information on how to do this.

    Dr. Eric Westman – 'Update on Ketogenic Diet for Obesity, Diabetes, and Metabolic Syndrome' https://www.youtube.com/watch?v=WendvONj5O0
    This presentation includes the diet the Westman has used with success with thousands of patients over many years. The need to reduce medications is included in the presentation. Dr. Westman invites physicians to contact him, and even to visit his clinic to learn the methods he has found to be successful with a wide range of people.

    Of course, Virta Health and the books of Phinney and Volek are also important resources.
    Thank you, sirs – and Virta Health!!!

  60. Hi, i have a question. I had some symptoms making my life a little difficult for uite some time, 20 years or so. Ive been experimenting with what I eat and been from doctor to doctor often being sent to psychologists, psychiatrists. All in all I am mentally healthy.
    I came across keto. I tried and went through fat adaptation and had positive results. My focus improved, my emotional stability, energy levels, positivity, brain and body speed. However I fell out, and now I can no longer function eating the way I used to, as in the bad symptoms returned but with stronger impact. After different tests I now discovered I have autoimmune reactions, and my symptoms and test results are leading me to believe I have hashimoto.
    I am curious why my symptoms and reactions are stronger after testing keto lifestyle?

  61. Do NOT fast? Come on DR Phinney!!!!
    I fasted for 5 days and I am healthier that ever, autophagy? Anti aging, etc benefits, are you saying they're wrong? I know I won't get an answer from you about it but you lost me there, and I'd like to hear your argument.

  62. I knew from the second you said you try proving yourself wrong that you're a real one. The MVP. Thank you for going at the ketogenic diet with an open mind and actually doing it yourself to see how it affects the body. I will be watching all 4 parts!

  63. I'm glad I found your channel. I was trying carnivore diet but not feeling the best & my bowels not working well either. Had lots of health issues since young.

  64. I've been on a Low Carb High Fat diet now for 7 days to lose my severe overweight. My mom is a diabetic type 1 and I tried using one of hers ketone blood "sticks" and it read 3.7, is this much too high? I have lost a lot of weight in just one week and my appetite has went down a lot to the point where I'm almost never hungry I am only eating 1-2 times per day. If i eat more I get nausea and disgusted by the food.

  65. Sorry Dr. Phinney – before I listen to your vids Are you perchance going to cover Type IIa hypercholesterolemia. Coz I DID go onto total keto diet and my LDL became normal for the first time since birth. BUT even among Keto proponents they tend to advise the likes of us to stay away from it. I did it for a full year and my family thought I would surely die but my bloodwork improved radically. I don't see ANY others of my ilk who have done this. If I did NOT have double digit blood cholesterol I would not even have looked at this diet. But I seem to have been the only one who did.

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