Benefits and Myths of Ketogenic Diet

But what we find is that when he gets his patients to lose weight and go on a healthy ketogenic diet, low in seed oils, low in carbohydrates, about 30 to 50% of the patients who would have been booked in for surgery cancel. They no longer need the surgery. Is the arthritis reversed? Well, technically it's not reversed, but their pain's gone away. And that's pretty much the same thing. It's very important to not be confused between the difference between urea and uric acid. So eating a lot of protein absolutely will increase your urea, but that can absolutely be a good thing. Let me tell you about one of the major benefits of this. In no way do I consider an elevated urea to be problematic. You'll urinate a lot of it out. There's a study done, I think it was in 1963, that actually showed that the most important factor... in urine in terms of antibacterial activity was how much urea you had and there's been several studies that have then looked at some different diets a few of them were in dogs where they were trying to actually induce urinary tract infections and they found that they could give dogs who weren't eating much meat urine retract infections but when they fed the meat they couldn't because the urea in their urine was basically killing the bacteria before it could proliferate you So I would actually suggest that especially for females, this is a particular female issue, if you're worried about UTIs and have a problem with urine retract infections in a high protein diet, increasing your urea could certainly be a good thing. And for a little bit of extra bonus on top of that, I would supplement with a good mix of electrolytes, including sodium, potassium, and magnesium. because we also know that the combination of salts or electrolytes in the urine also exerts extra antibacterial activity. And I've had several patients who previously suffered from chronic UTIs. Some patients even have so many UTIs that they're on a daily antibiotic long-term permanently to try and reduce the risk of developing UTIs. And I've had patients who have been able to come off this, you know, antibiotics every day is not a good long-term solution. Much better to have a healthy diet, high protein diet with good electrolytes. Very natural way to do it and much more effective and no side effects. Uric acid is actually also often going up on a ketogenic diet, but that's something different. So uric acid is a breakdown product of purines. In some people, it can cause attacks of gout because it can crystallize. and form these needles. When we look at it under a microscope, it's what we call negatively birefringent crystals. When we do something called polarized light microscopy, that's just a fancy way of saying sharp needles that we can diagnose. And they cause terrible, terrible pain in a lot of people. So a lot of doctors get very concerned when they see a high uric acid level. A lot of doctors make the mistake where they assume that if you have higher uric acid levels, you must have gout. And that's absolutely incorrect. And a lot of... I wish people would stop making that mistake. It just increases the possibility. Having said that, most of the purines and most of the uric acid we get doesn't actually come from meat in the diet. It's a big myth that meat is actually what causes an increase in uric acid and increasing gout. You will get a transient increase in uric acid when you start a ketogenic diet because your body will start producing ketones. But the cellular machinery for your body to actually burn those ketones hasn't been upregulated yet. So the body says, oh, I've got too many ketones. What do I do? Well, we're going to urinate them out. They pass out through the kidneys and they share the same transporter that uric acid does. So if the ketones are leaving the body, they're actually making it harder for uric acid to leave the body. So you'll often get an increase in uric acid level for about a month or so after starting a ketogenic diet. The thing is this doesn't lead to a surplus of attacks of gout. I think I've only seen one patient who's had an attack of gout while they've been on this kind of diet. And I would say that the chances are that that probably would have happened anyway. That was almost certainly coincidental. I see a lot of people who have histories of gout. And even though the uric acid level may go up during that transient period of a ketogenic diet, their chances of having an attack of gout are actually down. And it's actually my job to usually reduce the medications that people take to try and suppress. their uric acid levels they usually take a drug called allopurinol which is what we call a xanthine oxidase inhibitor which xanthine oxidase is the enzyme that processes purines into uric acid and I'm very successful in a lot of patients who have had a chronic history of gout once they're stable on a diet and they've lost a lot of weight and they're metabolically healthy we say well let's stop the allopurinol and see what happens. 99% of the time I can't even actually recall a case where I've stopped olipurinol and they've had to go back on it. So uric acid related to protein is really not a valid concern. Urea related to protein might actually be beneficial. How did this myth arise that protein is bad for the bones? Well, it came over 100 years ago when we actually discovered that when people had high protein diets, there was higher levels of calcium in the urine. And people assumed. that that calcium must have been leached from the bones. In actual fact, that is not true because when you have a higher protein diet, you absorb more calcium from the diet. And if you absorb more calcium, then that means there's potential for more to then leave the body in urine, but it's not being lost from your bones. It's just being lost because you've just absorbed more. In actual fact, we have randomized controlled trial level of evidence that a high protein diet can assist in reversing osteoporosis. So there was a study done back in 2002, and they looked at supplementing with calcium and vitamin D, and they looked to see whether or not they could actually reverse osteoporosis. They followed people over three years and they did a bone density, a DEXA scan, dual energy x-ray every six months over that three years. And this was menopausal females and males over the age of 65, I think it was. And what they found that on average, they couldn't. slow bone the bone degrading by giving vitamin D and calcium, but they couldn't restore it. And then they did something smart. They said, what happens if we stratify the results based on how much protein people are consuming? And they found that the group that was consuming the most protein actually reversed osteoporosis in their hip bones, reversed osteoporosis. And this is really logical because bone is mineralized protein. It's protein strands that's got minerals embedded within it. So if you're trying to build more bone, you can't just give calcium because that's not the complete ingredients. You need all the ingredients. Bone has protein in it. 40% of the dry weight of bone is protein. So a high protein diet has been shown to be conditionally essential to actually reverse osteoporosis. Protein is good for the bone, full stop.

Well, technically it's not reversed, but their pain's gone away. And that's pretty much the same thing. It's very important to not be confused between the difference between urea and uric acid. So eating a lot of protein absolutely will increase your urea, but that can absolutely be a good thing.

Let me tell you about one of the major benefits of this. In no way do I consider an elevated urea to be problematic. You'll urinate a lot of it out.

There's a study done, I think it was in 1963, that actually showed that the most important factor... in urine in terms of antibacterial activity was how much urea you had and there's been several studies that have then looked at some different diets a few of them were in dogs where they were trying to actually induce urinary tract infections and they found that they could give dogs who weren't eating much meat urine retract infections but when they fed the meat they couldn't because the urea in their urine was basically killing the bacteria before it could proliferate you So I would actually suggest that especially for females, this is a particular female issue, if you're worried about UTIs and have a problem with urine retract infections in a high protein diet, increasing your urea could certainly be a good thing. And for a little bit of extra bonus on top of that, I would supplement with a good mix of electrolytes, including sodium, potassium, and magnesium.

because we also know that the combination of salts or electrolytes in the urine also exerts extra antibacterial activity. And I've had several patients who previously suffered from chronic UTIs. Some patients even have so many UTIs that they're on a daily antibiotic long-term permanently to try and reduce the risk of developing UTIs. And I've had patients who have been able to come off this, you know, antibiotics every day is not a good long-term solution.

Much better to have a healthy diet, high protein diet with good electrolytes. Very natural way to do it and much more effective and no side effects. Uric acid is actually also often going up on a ketogenic diet, but that's something different. So uric acid is a breakdown product of purines. In some people, it can cause attacks of gout because it can crystallize.

and form these needles. When we look at it under a microscope, it's what we call negatively birefringent crystals. When we do something called polarized light microscopy, that's just a fancy way of saying sharp needles that we can diagnose. And they cause terrible, terrible pain in a lot of people.

So a lot of doctors get very concerned when they see a high uric acid level. A lot of doctors make the mistake where they assume that if you have higher uric acid levels, you must have gout. And that's absolutely incorrect. And a lot of... I wish people would stop making that mistake.

It just increases the possibility. Having said that, most of the purines and most of the uric acid we get doesn't actually come from meat in the diet. It's a big myth that meat is actually what causes an increase in uric acid and increasing gout.

You will get a transient increase in uric acid when you start a ketogenic diet because your body will start producing ketones. But the cellular machinery for your body to actually burn those ketones hasn't been upregulated yet. So the body says, oh, I've got too many ketones. What do I do?

Well, we're going to urinate them out. They pass out through the kidneys and they share the same transporter that uric acid does. So if the ketones are leaving the body, they're actually making it harder for uric acid to leave the body.

So you'll often get an increase in uric acid level for about a month or so after starting a ketogenic diet. The thing is this doesn't lead to a surplus of attacks of gout. I think I've only seen one patient who's had an attack of gout while they've been on this kind of diet.

And I would say that the chances are that that probably would have happened anyway. That was almost certainly coincidental. I see a lot of people who have histories of gout.

And even though the uric acid level may go up during that transient period of a ketogenic diet, their chances of having an attack of gout are actually down. And it's actually my job to usually reduce the medications that people take to try and suppress. their uric acid levels they usually take a drug called allopurinol which is what we call a xanthine oxidase inhibitor which xanthine oxidase is the enzyme that processes purines into uric acid and I'm very successful in a lot of patients who have had a chronic history of gout once they're stable on a diet and they've lost a lot of weight and they're metabolically healthy we say well let's stop the allopurinol and see what happens. 99% of the time I can't even actually recall a case where I've stopped olipurinol and they've had to go back on it.

So uric acid related to protein is really not a valid concern. Urea related to protein might actually be beneficial. How did this myth arise that protein is bad for the bones? Well, it came over 100 years ago when we actually discovered that when people had high protein diets, there was higher levels of calcium in the urine.

And people assumed. that that calcium must have been leached from the bones. In actual fact, that is not true because when you have a higher protein diet, you absorb more calcium from the diet. And if you absorb more calcium, then that means there's potential for more to then leave the body in urine, but it's not being lost from your bones.

It's just being lost because you've just absorbed more. In actual fact, we have randomized controlled trial level of evidence that a high protein diet can assist in reversing osteoporosis. So there was a study done back in 2002, and they looked at supplementing with calcium and vitamin D, and they looked to see whether or not they could actually reverse osteoporosis. They followed people over three years and they did a bone density, a DEXA scan, dual energy x-ray every six months over that three years.

And this was menopausal females and males over the age of 65, I think it was. And what they found that on average, they couldn't. slow bone the bone degrading by giving vitamin D and calcium, but they couldn't restore it.

And then they did something smart. They said, what happens if we stratify the results based on how much protein people are consuming? And they found that the group that was consuming the most protein actually reversed osteoporosis in their hip bones, reversed osteoporosis. And this is really logical because bone is mineralized protein.

It's protein strands that's got minerals embedded within it. So if you're trying to build more bone, you can't just give calcium because that's not the complete ingredients. You need all the ingredients.

Bone has protein in it. 40% of the dry weight of bone is protein. So a high protein diet has been shown to be conditionally essential to actually reverse osteoporosis. Protein is good for the bone, full stop.

Transcript for:Benefits and Myths of Ketogenic Diet

Transcript for:
Benefits and Myths of Ketogenic Diet