Dr. Stephen Phinney on Problem Solving a Ketogenic Diet (Part 3)

Dr. Stephen Phinney on Problem Solving a Ketogenic Diet (Part 3)


– I wanna take a little bit of time to talk about troubleshooting problems that commonly occur on a ketogenic diet. The first problem that people have is that they just struggle with either having low energy after
a few weeks, or longer, so they should be through
the initial adaptation phase and they still don’t have energy or they can’t get their blood ketones up in a desirable range, that
it is above .5 millimolar. The most common cause of that if people are holding their
carbs in a restricted range is that they’re eating too much protein. Now why would people eat too much protein? Well, one thing is, many people refer to a
low carbohydrate diet as a high protein diet,
and that’s a mistake. People should think of this as a moderate protein, high
fat diet, and the second is, that people have been
taught to fear fat so much told that fat
causes heart disease, eating fat makes us fat, blah, blah, blah, that they just have a very hard time putting that much fat on
their plate and eating it. And besides, protein’s much
more expensive than fat and so environmentally and financially getting your protein dose right,
not too high, is important. So what is the right amount of protein? Well when we map this out on a graph where we show carbohydrates
on the vertical axis and protein on the horizontal axis if you look at the Standard American diet we eat about 50% of our
calories as carbohydrate then a minority of our calories are gonna be coming from fat. But when we switch to a
well-formulated ketogenic diet where the carbohydrate intake
is in the five to 10% range, if you hold protein in the
moderate range of about 15% then clearly the majority
of one’s calories have to come from fat. We cannot satisfy our need for energy by holding carbohydrates
low, holding fats slow, and then eating the rest as protein. Protein in moderation, and
the majority of calories, they need to come from fat. Easy to say, but for many
people, that’s hard to do. How would you do that in a practical way? Well this is a menu basically
of what somebody my age, a male my height and
weight would eat in a day. I’m a pretty high activity guy, my daily calorie need is in the range of 27 or 2,800 calories per day. For me, the majority of my calories, probably in the range of
75%, typically come from fat, and I do that by having, maybe, a high fat food for breakfast, some days it’s ham and
cheese, some days it’s eggs. On a typical day it might be
four modest size sausage links, that’s real sausage, not a processed meat that looks like sausage. For lunch I might have a couple cups of chopped green vegetables in a salad with six ounces of poultry,
or meat, in this case, it would be a six ounces
of water packed tuna. And again, we use water packed because we don’t want the fats that tuna is normally packed
in when they pack it in oil, that would be soybean
oil, we don’t want that, and we’ll come back to
that in a few minutes. And then to add the
fat, I add black olives, I may add some cheese, I’ll
typically make a dressing, in this case. it might
be a blue cheese dressing that has a lot of olive oil added to it. So it ends up being a high fat meal with very little carbohydrate. Snacks could be nuts in broth,
nuts being a high fat food, or it could be a couple ounces of cheese spread on some vegetables, and then dinner might
be a cream tomato soup made with homemade broth. A modest amount of
meat, it could be steak, or pork, or fish, and then
two servings of vegetables, both of which are cooked
or prepared with fats, like buttered green beans and mushrooms sauteed with
a little bit of garlic and olive oil. And when one’s in maintenance, that is, you’re trying to eat as many
calories as you’re burning, you can also add fat in the
form of high fat desserts and one can make really
delicious homemade ice cream with heavy cream and
non-table sugar sweeteners, and there are varieties of
those that could be used. And so this gives you the
idea of the range of food someone can have, this
looks like real meals, it’s all made with real food. The other point I make about this menu is it looks like there’s
a lot of protein in here but notice the portion sizes are quite modest for a male my size. But those could be replaced
with more dairy fat, with more eggs, if someone
is a lacto-ovo vegetarian, or they can be replaced
with tofu, nut butters, and other vegetable sources of protein if one wants to do this as a vegan. Doing this as a vegan is
a little more challenging but it’s not impossible,
and it certainly is healthy if in spite of having a
history of being a vegan if you’ve developed type two diabetes this is certainly a reasonable option to achieve metabolic health. The second problem that
is very common for people when they’re trying to make a well-formulated ketogenic diet work is they end up choosing
the wrong kinds of fat. Normal common sense assumption
that we’ve had for decades is that we should avoid saturated fats and eat healthy fats,
including polyunsaturates. That concept is turned upside down when you go on a
well-formulated ketogenic diet because the polyunsaturate fats that we get from vegetable oils that were thought to be good because they, quote, are essential fats, ignores the fact that when
you eat too much of them they can cause harm. You’ve probably heard of
both the Omega-3 fats, the so-called fish oil
fats, and Omega-6 fats. And it is true that we humans need a little bit of each of that category metabolically everyday to
help construct healthy cells but they don’t make good fuel, this is not fat that your
body likes to burn for energy. When you’re eating a high fat diet you naturally will get
enough of the Omega-6s even if you avoid the high Omega-6 oils. You get your Omega-3s by
having fish three times a week, or, if you don’t eat fish, then maybe supplementing
with a fish oil capsule. If you over eat the polyunsaturates, particularly Omega-6
fats, what happens is, that it upsets a person’s
stomach and digestive system and people just don’t
feel well after they eat and I’ve had so many people tell me, “I’ve been following your
diet for a couple months “but I can’t keep on it “because I just can’t tolerate
eating all those fats.” And I say, “Well, what
fats are you eating?” And they say, “The healthy ones, “I get the corn oil margarine, “and I get the soybean oil mayonnaise.” And I say, “No, no, that’s
not what you need to do “when you’re on a high fat diet.” You need to get most of your
fats from monounsaturates, and to some degree, from healthy
sources of saturated fats. Soybean, corn, the older versions of
safflower and sunflower, peanut oil, all are high in
the Omega-6 polyunsaturates and what you wanna do is have… Choose fat sources and oil sources where the great majority of calories come from monounsaturates and saturates. Probably the ideal source of fat for the the human diet is olive oil because that’s very
high in monounsaturates, has relatively little in
the polyunsaturate category. But even if you look at lard, which is relatively high in saturates, but also equally high in monosaturates, and has a low polyunsaturate
intake, again, an excellent fuel source for humans. You can say the same for
beef fat, for butter, and for coconut oil, again,
they’re higher in saturated fats and that causes some anxiety in people. But as we mentioned in the previous video when you’re fully keto-adapted, your body more than doubles its
ability to burn fat for fuel and one of the first fats that
goes into that energy fire is saturated fats, they
don’t accumulate in the body, and they don’t cause harm. Now one of the questions
I get over and over, they say, “Well, Steve
Phinney, you’re a doctor, “you got a good income, and you
can buy that fancy olive oil “but it’s too expensive, “most people can’t afford olive oil.” And I would like to give
you a little simple example of why that’s not true, and that is, if you go do your big box grocery store where they sell stuff in big quantities you can buy olive oil
in a big jug like this and this is good quality olive oil, I’m not gonna tell you
which company it comes from so I’m not showing you this side, but this is true olive oil,
it’s not the extra virgin stuff which has very intense flavor, this is a more mild flavor stuff. And you wanna guess how much
1,000 calories of this costs? 53 cents. That if you pour out
1,000 calories of this and you mix it in, make it
into dressings and stuff, that 1,000 calories in
your diet, in one day, cost 53 cents, where
else in the grocery store can you buy 1,000 calories for 53 cents? I mean this is really good
energy at a very low price. The other point is, people say, “Well that amount would last me 10 years.” No, if I eat 500 calories of this a day this bottle is going to last
me a little over a month. So, it’s not an expensive
source of energy. I have this little bottle,
and in this bottle, I can put 700 calories, and
if I have a salad for lunch, and the dressing is suspect, I don’t know what fat
they put in the dressing, I just squeeze in some lemon juice, pour some of this over
the top, take it home, fill it up the next day. And then the other thing is, if you wanna use fat for frying, and fried foods are really good, as long as you don’t batter dip them, a good source of frying fat
is a high monounsaturate oil and again, you have to be sure
this is a safflower based oil but you have to read the
label, and look down here, and if it says mostly… If the… mostly unsaturates, relatively
few polyunsaturates. This is both a good food
for cooking, you know, ingredients in food, but
also a good oil for frying, or you can use coconut oil for frying, and it’s not expensive, as
long as you buy it wisely, strategically, in bulk. The next problem is, maybe,
the most common difficulty that people have when they’re trying to deal with getting the pieces of a well-formulated ketogenic diet right and that is they feel
light-headed, they feel dizzy, they have a headache,
they try to exercise, and they feel just really
bad and they stop exercising. And, frequently, they have constipation. If you go on the web and look this up it’ll tell you that you have the keto flu. Now I don’t like that
name because it’s not flu, it’s not an infection. This
is just a group of symptoms that occur when people are on a well-formulated ketogenic diet that they’re not eating enough salt. The reason why salt becomes a
problem with a ketogenic diet is that ketosis causes the kidneys to accelerate their excretion of salt. Now if you have… Retain salt, so you’re swollen, or if you have high blood pressure, and you get rid of that extra
salt, that’s a good thing, but if you get rid of too much of it, it impairs your circulation, and you have this group of symptoms. If it inhibits exercise,
and you feel lousy, you’re not gonna continue
to follow the diet. And so adding enough
salt is the key to having a basically a symptom-free experience. So the next question is, how much salt? And again, with the
caveat, if you don’t have problems with high blood pressure or congestive heart failure where you have to take
medicines for those problems, that number turns out to be
five grams of sodium per day, that’s not five grams of salt,
that’s five grams of sodium. And the distinction is, salt
has chloride as well as sodium and only 40% of the weight
of the salt is sodium. So five grams of sodium per day translates to 12 grams of salt and that means about 2.5
level teaspoons of salt. Now do you have to spoon out almost… Yeah, 2.5 level tea spoons,
and eat that everyday? No, because, most people, when they eat a real food diet to satiety will eat about three
grams of sodium per day. Places where that creeps into
the diet in concentrated form is in dill pickles, in olives, in bacon, and other salty foods. So don’t avoid those, you can include them in
moderation in your diet, and you’ll probably get about
three grams of sodium per day from your diet. And then the way to get to our
target of five grams per day is to add two cups of broth or bouillon. Don’t get the low sodium
bouillon, get the regular one, this is about a gram. And if you make your own homemade broth and you add the proper amount
of salt per the recipe, again, you’ll get about one gram per cup, and that’s not super salty,
and it’s delicious, it’s… You can have it with cheese,
or nuts, or something like that so it fits into your diet as a real food. So the question, then, is, you know, if that avoids all these symptoms but it makes you die
early from heart disease now what’s the rationale in that? You know, how can that be safe? In a study that was
published a couple years ago at a highly reputable medical journal by a really good research team they looked at the salt
intake and salt excretion from over 100,000 people
from 17 different countries and then they followed
them for almost four years to see how their health was
maintained over the four years. In particular, they looked at whether they had a heart attack
or whether people died, so the question is, at what level of sodium intake for these 17 different countries, at what level of sodium intake did they see the lowest mortality? The lowest point in the
mortality curve here is at five grams of sodium per day. If you go down to the point of 2.3 grams, which is where the U.S. government says
we should be eating sodium actually for that… those populations over in
many different countries and different cultures, there’s
a 50% increase in mortality if we were to follow those
government guidelines. If you go the other direction you go much higher than five grams per day mortality goes up, but much more slowly. Now these are people who live in cultures where they typically eat
a lot of carbohydrate. If anything we would benefit
from more rather than less but we find that five grams per day is plenty for most people
to avoid all these symptoms but if they stay at three or go under that they’re gonna have severe
symptoms of fatigue, dizziness, constipation,
things that we’d like to avoid and as a related some problem in that, again, if you go on the web, and you look at people’s complaints
about the ketogenic diet you can find many, many
bloggers who will tell you that if you stay on the
ketogenic diet too long you will develop something
called adrenal fatigue. Now that sounds like a medical diagnosis but nowhere in a medical textbook and nowhere in high quality
scientific literature will you find this problem of
adrenal fatigue as a diagnosis or as a problem of a ketogenic diet. What this adrenal fatigue refers to is the increasing symptoms that occur if people have this keto flu
for weeks or months at a time. So if you follow a low carb diet and you stalwartly limit your salt intake you will have increasing fatigue and maybe even a drop in
blood potassium levels and most of the bloggers will tell you the way to make it go away is eat carbs. Well yeah, that’ll work, just, you know, you make the body stop excreting salt. The simple way is, give
the body just enough sodium that it doesn’t have this
problem with impaired circulation and that’s the secret to
this, it’s not eating carbs, it’s avoiding sodium inadequacy. And again, salt is cheap, it’s harmless, if you don’t have hypertension
or congestive heart failure. And the other important point is it has to be taken consistently. The salt you ate yesterday
or the salt you ate last week isn’t gonna help you today because the body doesn’t
have big reserves of salt, you have to be consistent, so think of salt a little
bit like you think of oxygen or breathing, you know, to have the right amount today,
you gotta consume it today, you can’t rely on what you had yesterday. The next problem is a
little bit more complex and that is, how do you manage the diet composition as you go from starting
on a ketogenic diet where, frequently, people
want to lose weight to progressing through the
phases of a ketogenic diet till they get to long term maintenance? And many people ask me, “Well, so, what should my macros
be when I’m on your diet?” Well, macros means, how
much of the macronutrients, what percent of carbohydrate,
protein, and fat should I be eating? And I say, we don’t wanna deal with macros because they’re gonna change over the course of your progression on a well-formulated ketogenic diet. So when I started on a
ketogenic diet and I was… Had gotten to a point where
I had a fair amount of weight and a problem of high
blood pressure to lose. And I ate to satiety, getting
the right amount of protein, I was only eating about
14 or 1,500 calories a day but my body was burning twice that. And the other half of those
calories were coming from here but that didn’t show up
on the macros on my plate. So my point is, the amount of protein
you need from day to day doesn’t change, whether
you’re in the initiation phase or when you’re in the maintenance phase or anything in between, and that should be in
the range of 10 to 15%, at most 20%, of your
daily energy expenditure. You wanna keep carbohydrates
at your personal level that keeps you in nutritional ketosis and that could be in
the range of five to 10% and that probably won’t change much although when people lose a lot of weight and get rid of diabetes their tolerance for carbs may go up a bit, they can add a broader range of food, but not a lot of carbs. And what changes as you go from the adaptation phase to maintenance phase is to get to maintenance, eventually, you’re gonna be eating a lot
more your calories as fat so the macros will change but the protein and carb
intake stays pretty constant and all you do is you
adjust your fat intake just by your perceived
need to achieve satiety, you adjust your fat intake
to the point that you’re going away from your meals satiated and not feeling hungry until
the next time it comes around to meal time. The last problem I wanna talk about is one that has cropped
up in the last year or two and that is, it seems that on the web that people interested
in the ketogenic diet are having a love affair with fasting and that fasting might be
quote intermittent fasting or it might be prolonged
periods of fasting and some people will recommend that if you wanna lose weight
and get your ketones high you might fast for a week or even a month. Now the human body is very well adapted to fasting from an evolutionary
perspective as when… You know, people ran out of food and had to wait a week, or two, or a month till the next harvest, or
the next successful hunt, being able to get by on body
energy stores is a good idea. But the misunderstanding here is that when humans fast beyond one day they don’t just live on body fat they also break down muscle. And sometimes… And some people misrepresent
the muscle loss as being minor but in reality, in the first
month of total fasting, and even in the first
week of total fasting, at least half of the weight loss that you see on the scale
isn’t coming from body fat, it’s coming from lean tissue. This is not new information. There’s been really
top notch research done even 50 years ago that looked at the composition
of weight loss with fasting. And this has been demonstrated
over and over again this is not controversial information, there’s not solid data on the
other side of the argument, but, for whatever reason,
you know, people say, “Well fasting’s cheap and it’s easy, “so why don’t we just do it?” But the issue then is
you lose lean tissue, and as we learned from
The Biggest Loser Study, you know, the group of people
that went on that TV show and did radical amounts of
caloric restriction and exercise, attempting to lose huge amounts of weight, is when they came back and
studied them five years later that extreme combination
of exercise and fasting resulted in a permanent reduction
in resting metabolic rate. So not only did they turn
their thermostat down during the time of privation, years later, even after many of them have regained much of all their weight, they still have a depressed
resting metabolism. So, the solution for this,
from our perspective, is don’t go for short-term
quick weight loss. Nutritional ketosis is by… In and of itself, an
extremely powerful tool, and if you get the
composition of your diet right with moderate protein, low carb, and eating fat to satiety, and you get into nutritional ketosis, and you maintain that consistently so your body is not alarmed
by a famine, you know, being caused by fasting, then that will give you
the greatest benefit over a long period of time
and that’s much more likely to be sustainable in the long term. The other reason not to go
through prolonged fasting is pretty much anybody who’s done it for an extended period of time when they’re told,
“Okay, you can eat now,” there is a very strong propensity
to binge on carbohydrates. And carbohydrate binging after
fasting leads to, oftentimes, major episodes of fluid retention if you shut off the
kidney’s salt excretion, and in some cases, it can
lead to something called Refeeding Syndrome, which
can be fatal, and therefore, is something that we would advise people to be very careful to avoid. Again I want o emphasize that
this is not just my opinion but this is data from
many well-done studies, some of them going back
as far as 50 years, and study after study
demonstrates that, yes, weight loss was fasting as rapid, but, the cost in terms of losing lean tissue is too great for this to become something which is scientifically
or medically defensible. I hope those answer some
questions you might have and helps you avoid problems
going forwards, thank you.

100 Comments

  1. ketones are muscle sparring. Fasting would slow down the metabolic state but why would we burn protein for fuel? We have glycerol for gluconeogenesis and ketones for more than 50% of energy. Can you please cite research where WFKD has shown to lose half the weight in lean tissue mass?

  2. WRT fasting and loss of lean muscle mass Dr. Jason Fung’s research says otherwise (I believe given that you don’t fast beyond your available body fat).

  3. He is wrong about fasting and loosing muscle on fasting, he refers to “ big looser” but participants of big looser were not on fasting but on low calories diet, ,! Big difference !

  4. What about time restricted eating, so you only eat in a 9-12hr window during the day to allow body process to Aline with our circadian rhythm. The fasting time is less than 16hrs a day so would that still affect muscle loss? This is the one where on mice it helped build lean muscle, obviously we aren’t mice but is interesting

  5. Phinney states that nutritional ketosis can be done as a vegan, though it would be more difficult. Ketosis or no, vegan diets are not sustainable, due to the lack of essential nutrients that are only available from animal source foods. Either the nutrients are not there, or they are not the same, or they are not available to human digestion.

    It's understandable that neither Phinney or Virta Health would want to confront the vegan 'religion' head on, but when keto vegans fail, it will probably be blamed on the keto aspects of the diet- instead of the fact that humans evolved to eat high-fat animal-source foods. Work done at te Max Plank Inst. shows early humans were 'super carnivores'. Anthropologists know that human height, dental development, and health declines when humans began cultivating grains, and legumes. Average brain size also shrank about 11%.

    In addition to the B vitamins, the Omega-3s from plant sources (primarily flax seed) are not equivalent to Omega-3 fatty acids from animal sources. Plant proteins are not available to human digestion, even those from legumes, like beans and peas- but those plants (and many other commonly eaten plants)do contain anti-nutrients and toxins. Most, perhaps all, of the calcium in kale, almonds, spinach, etc is locked up in calcium oxalates, and cannot be digested. Oxalates can build up in body tissues, however, and cause problems, the most well known being kidney stones.

    Dr. Barry Groves 'What We Are Designed to Eat' https://www.youtube.com/watch?v=X2qdyKxU0YU covers the bioavailability of plan proteins to human digestion, among other topics related to human diets.

    Sally K. Norton covers oxalates in common food plants in 'The Loss of Seasonality and the Overconsumption of Plants' https://www.youtube.com/watch?v=i7ArmIYGH0s

    Dr. Georgia Ede presents why we should not assume that common food plants are benign: 'The Risks and Benefits of Eating Plants' https://www.youtube.com/watch?v=YdRBFiBWQZQ

  6. Environmentally, meat including the fat, and dairy products from 100% grasssfed beef, lamb and other animals, an pastured poultry and pork – these are sustainable, even regenerative. Especially if te meat is also properly 'finished', which means fattened. (The term 'finished' came into wider used after fat became a negative term.)

    Grass finishing requires good management of the relationship between livestock, the soil life, and the plant community within the pastures – one that mimics the natural movement of wild herds over the landscape. This increases biodiversity, both above and below the ground surface, eliminates erosion, sequesters carbon, restores the water cycle, and also supports increased wildlife populations – birds, mammals, and pollinators.

    The Savory Institute and Holistic Management International have both been restoring damaged lands, and documenting the restoration, through grazing for decades.

  7. Thank you the Dr Phinney for all the passion you put into your study and research for the betterment of the quality of life. What you are promoting is revolutionising mainstream medical practices from a static to dynamic level which takes time a mundane mindsets to accept. There are many naysayers because many are not willing to change. Please continue with your good works because many are appreciating and many more will come to their senses.

  8. A Russian doctor noticed that people who died in the bombing raids, during the  siege of Leningrad. Then  because of starvation diet their internal organs had no fat around liver heart pancreas etc. Living on poor quality bread horse dog and cat meat and fats and butter. one meal a day and fasting threw very cold weather from 1941/1944

  9. I'm enjoying your video series on the ketogenic diet, however, your information on fasting is out of date. Because of the old "starvation study" and the documented effects of calorie restriction, researchers had erroneously concluded that fasting would just result in more of the same thing. More recent studies show that calorie restriction and fasting affect the body in radically different ways because of hormonal effects. Calorie restriction will slow your metabolism, but fasting actually INCREASES your metabolism by dramatically increasing your body's production of human growth hormone. After fasting for about 48-72 hours your human growth hormone will increase by something like 300% or more. Fasting actually is LESS likely to result in muscle wasting. The needed protein doesn't come from muscles but through autophagy and "recycling" of old/damaged cells, loose skin, blood vessels that are no longer needed to service fat stores, etc. Nobel prize in 2016 was for work on autophagy.

  10. 2 things I disagree with. One as you get older you Do need more protein that's in a lot of literature. When you're young you can get away with 15 20%. Scarcopenia Is caused by muscle loss as we get older. The minimum to maintain muscle when you're over 65 is .85 g x your body weight. And I that is minimum and there a lot of doctors and scientists that work with geriatric patients let's say this. When he is talking about primitive people and hunting it would make no sense for the body to lose muscle when fasting. Considering that these people did not eat on a regular basis or schedule. When you're fasting your body will hold on to muscle and burn fat. Burning fat makes the key tones for the brain so you stay sharp and holding on to muscle keeps you strong for the hunt or the forage. So what hes saying makes no sense to me. And those people he talks about on biggest loser we're not on ketogenic diet were not in ketosis. They were burning calories. They were on the calories in versus calories out theory. Which Has been thoroughly disproven.

  11. If you live in a hot climate (like me), bone-broth might be the last thing in the world you feel like, except in the dead of winter and/or when the temperature drops below 35°C…

    So here's my Australian Outback equivalent (let's call it RooAde!):-
    * 1 tsp salt
    * 0.5 ~ 0.75 tsp of your prefered sweetener (assuming it's a 1:1 with sugar), adjusted to taste
    * 0.5 ~ 0.75 tbsp of lime juice, adjusted to taste
    * 1 tbsp of lemon juice
    * 1 tiny lemon off your own tree – skin, pips and all – sliced (or parts thereof from a store-bought lemon, to about a tbsp).
    * Soda water, to make 600 ml (NB: this is NOT what Americans call 'soda', it's just a lightly-carbonated spring-water, without sugar or anything else. It's H20 that has bubbles, that's it).

    Drink as needed (which might be by the gallon if your weather is like mine!). It's wonderfully tart, without being overly so, and very refreshing.

    (And if you're really having trouble getting enough sodium, just do what we do and add Vegemite to your diet — by the spoonful if you're a fair dinkum Aussie, or on toast for everyone else [on keto bread, of course. NB: full-almond meal makes a better bread than either skinned-almond- or coconut-flour for Vegemite toast], with lashings of butter; on it's own, or with sliced tomato, or with your egg, for breakkie — or all of the above. Breakfast of champions in Australia! And no 'keto flu'. And if you're keen on the idea, I don't blame you – we do eat 7000 tonnes of the stuff every year after all! – 1 tsp of Vegemite has 1.5 gm of protein, 200 mg of sodium, no sugar, no fat, and is loaded with B vitamins ~ there's half your daily thiamine and folate in 1 tsp. It also makes a great Bonox substitute in winter, now that they've adulterated Bonox with sugar; and don't forget to add it to any beef recipe to enhance the flavour, but don't add salt as well because you won't need it.

    Declarations: I actually don't work for Vegemite … I'm just a fan. But remember, fan is short for fanatic … and I admit it! 😉

  12. Dr. Phinney , could you recommend how much protein I should eat, I'm a 42 active woman, 6'2 at 177lbs. Unfortunately, I'm having trouble on keto with the protein, quite a bit of conflicting information. Any suggestions would be great. I have a thyroid problem, I take 1mcg if synthroid. The keto diet corrected my thyroid, as my medication was reduced significantly, even though my thyroid was treated with radiation when I was 15 years old.

  13. Hair loss? I have lost so much hair and hope that they will ever grow back…it's horrified to see myself in the mirror..gosh, where is all my hair?? What should I do?

  14. Dr. Phinney, in regards to fasting, have you looked at fasting and autophagy? My wife and I have been doing SLOW carbs ( 60 – 150 g's ) and HEALTHY fats 130 – 200 g's and 15% protein for 4 months now, and have lost over 90 lbs. between the 2 of us ( 279 to 222 lbs. and 179 to 143 lbs. ). We combine this with OMAD, using the 20 hours fasting, 4 hours eating supper and snacking. The hardest part of eating this way, is convincing your friends and doctor you are not going to have a heart attack. ( I am now off of my High Blood Pressure (HBP) and cholesterol pills. On the HBP pills, 140/95 . Now,, no HBP pills, and 118/76 ) I would be very interested in seeing what your research shows. in regards to autophagy. I am impressed with authophagy !!!

  15. With deep respect for Dr. Phinney, I must question the olive oil. Extra virgin olive oil comes from pressing ripe olives, mechanically extracting the oil., More oil may then be extracted from the pressed olives – but does the non-virgin olive oil he recommends come from a 2nd pressing, or is it extracted using chemical solvents? Maybe Virta could screen and offer olive oil tested for purity AND a lack of chemical contaminants. This is a major issue, as much of the olive oil sold today is either diluted with cheap seed oils, and/or contaminated with harmful chemicals.

  16. Psst! Wanna know a secret? Lard (from pork) or beef tallow are still the best fats to fry in!!! Beef tallow can be purchased cheaply from most grocery stores. It is the fat they trim from the meat they sell. Rendered lard and tallow are shelf stable, at least until the container is opened. Now available online, or from natural food co-ops, or Whole Foods and better supermarkets.

  17. What do you say about the 'scientists" who claim that women cannot sustain ketosis as long as men in the long term because women cannot handle long term ketosis because of their need for leptin?

    I didn't watch the biggest loser programs, but the fact is that the biggest losers probably went back to eating cereal grains, especially wheat, and the effect is much like the opioid effect or the effect of wheat in general, which will put the weight back on quickly and the biggest loser is caught back up in the opioid effect — back on what Dr. William Davis calls the addiction cycle. Doesn't have anything to do with nutritional ketosis but with the effect of the wheat, which scientists failed to test on humans 70 years ago or even now. Get the grains out of your diet and you will be saved and continue to be the biggest loser while maintaining ketosis. You will also be happier and healthier with nutritional ketosis and off the grain train forever.

    I think it is time you read Dr. Fung's books on fasting and the benefits, pros, and cons. Two physicians to read thoroughly are Dr. William Davis and Dr. Fung.

  18. Most olive oils are olive flavored seed oils , and sold as pure olive oi. and They then charge a fortune for cheep unhealthy products, through false advertising

  19. Couple this with reading, “Super Fuel”, by Dr. James Dinicolantonio and Dr. Joseph Mercola. There is also a YouTube by Dr. Dinicolantonio on the right fats to eat and why. Thank you, sir for these 3 videos.

  20. Great info, Doc. Years and years ago, I was a high school wrestler, and accustomed to fasting for long periods. Fifty years on, I am moving toward Intermittent Fasting (IF) of the 16:8 variety (fasting 16 hrs, eating window of 8 hours); and that, only about 3 times/week. I am also moving toward LC (50 gr carbs/day). Probably my biggest hurdle is fat – I grew up repulsed by it (not only dietary guidelines, but also the aesthetic/cosmetic appearance).

  21. What if a person has a lot of trouble digesting plant matter so they eat all meat and fat, but are still not eating so much meat that they get into more protein than they should for the keto diet?

  22. Hi,
    Interesting video. I did a straight cut into a Ketogenic diet and interimittently fasted at the same time. Its something I keep up with still, 4 months in now. I had the Keto flu mentioned, or low sodium levels. Very interesting to recognize the symptoms. I learned how to balance it after a while and it got better. Now my Meals are quite well balanced and Im seeing stable results. Being able to stick to a functional diet is such a boon.

  23. "im not gonna show the brand" and then accidentally turns it to the side when putting it down showing that its kirkland signature olive oil

  24. Dr Phinney is another of my new found rockstars!! Amazing DATA! I am happy to say that could help some clients lose significant weight using a ketogenic diet (one of them lost 50 pounds in eight to nine weeks). Less than 25g of Carbs, 0.5 g of protein per pound of lean body mass, and Plenty of fat (clean fats like SatFat from Butter, Coco oil, some nuts, Olive Oil, Avocado oil).
    One side effect that I saw in two of them was constipation. Great that now I know how to adress it. Even for me. I have been ketogenic for close to 24 months, and I do feel amazing. And now with the "salt" wisdom, even better!

    Where can I send my resume? 😉

    kudos Virta!

  25. Maybe you should study Dr Jason Fung on his Fasting recommendations. Seems to be completely opposite of your analysis on benefits of fasting.

  26. I think Phinney should add a new video and give apologies to fasting researchers and the fasting community about his comments. Or, otherwise, present in a non-biased form what he understood about the studies he mentioned and what he understands about the evidence presented by Dr. Fung and Prof. Valter Longo. If Phinney is a decent person and researcher (which he seems to be) he has to clarify the point about fasting. Longo and Fung have presented so much evidence about its benefits that this deserves a clarification. So far, in the way this video is, I can only think of Phinney being biased to protect his own business of treating people with the keto diet. What a terrible way of doing it. He, Volek, D'agostino, Fung and Longo must clarify this point to the public. By the way, Longo is doing sort of the same and he does not recommend anything else but his own diet and saying that everything else in the long run is dangerous including keto. Dear researchers, you are doing a fantastic work, but please do not be biased by your own businesses and simply expose the truth with rock solid science.

  27. You are a "doctor". you studied biology. your hair is white. you will DIE soon. LEARN, eating CORPSE of MURDERED ANIMALS, is a CRIME. before you die, LEARN. this simple FACT. murdering animals to sustain your pathetic miserable useless demonic life is a CRIME. you WILL go to HELL. LEARN. Change. Teach this, to those pathetic miserable pest humans you misguiding now. Moses. Vegan-Religion.org

  28. you need to be careful about which olive oil brand you are buying….because there has been a rash of FRAUD olive oils (mixing olive oil w/ canola and other Omega (cheap) 6 oils)…making you think you are buying something you clearly are not.

  29. Very, very interesting videos. It took me the longest time to figure out on one of your charts how 77 grams of protein a day would add up to the calories you said it would. I finally realized I was counting the fat calories in the meat as well, not just protein calories. So I'm not over eating protein as I originally thought. Also, thank you for the link and the information on fasting. Much to my chagrin everyone is jumping on the fasting bandwagon, but I always felt Jason Fung was wrong in what he said based on all the medical research I've read in the past. It is nice to know that I'm correct and that information has not been proven wrong.

  30. The Dr. doesn't address time restricted eating or condemn 24 hr fasting but only brings up concerns of extended fasting. It would be interesting to see him and Fung discuss this together they may not be that far apart . Even in his promotion of keto Dr. Phinney constantly urges caution in getting it right and under supervision. Fung talks of muscle tissue being affected but being rebuilt because of rising levels of HGH. Both obviously brilliant men well worth listening to.

  31. i think there is really a lot of confusion regarding the muscle loss when on fasting. i think that a lot of these fasting studies are not done with a starting point of ketosis. with the water loss and more protein burning before the ketones are getting high and also when the body is not fat adapted this is a completely different story. i am sure there are a lot of interesting studies out there but i am also sure that they do not apply to fasting when someone is in ketosis and completely fat adapted. also protein turnover as a proxy does not automatically mean muscle loss. body fat has also about 5% of protein in it. so when you are in ketosis and autophagy destroys the whole cell then there is 5% protein released that other cells can use as fuel or for rebuilding.
    so the correct measurement and the right state is important to do when looking at these outcomes from fasting.

  32. Lol He compared the biggest loser style diet and its effect on metabolism to extend fasting. He needs to get with Jason Fung to get enlighten. Maybe he just wants to sell his protocol. I’m a bodybuilder who intermittent fasts who incorporates 5-7 day fasting every quarter or when I come back from vacation 🙂 and I do not suffer from a lower metabolism or muscle loss. I’ve never been more leaner.

  33. Great talk but totally disagree with your position on fasting. Supported by literature? Well there is lots of literature to support the pyramid diet and that is clearly wrong!

  34. Thank you Dr Phinney for another inspiring presentation

    I have a question in regards with a refeeding syndrome in case of emergency procedures for a person on a long term ketogenic diet.

    In case of an accident, the person can turn up at the ICU and have a glucose drip placed or undergo surgery.

    Is there a danger of seeing a refeeding syndrome in such a case? Should these individuals have a special introductory card on them warning the medical staff of the dangers of a refeeding syndrome?

  35. Hello dr! According with your best knowledge, for someone who wants fasting, which Is the maximum Time a person can fasting without significant decrease in lean mass?

  36. I just jumped on board Dr. Fung's IF bandwagon and now am wondering if it really works or if there is lean muscle loss. I've only tried IF for less then 16 hours a day so I think according to Dr. Phinney that's fine but now I'm confused. Dr. Phinney seems to back his thought process about prolonged fasting up with studies, according to the video. Full disclosure-my knowledge on IF and Keto has mostly come from the good Dr.s vids. Haven't read the studies or their books yet. Alot of people like to combine the two techniques, but are they losing muscle with the fat? Wondering if there is more concrete proof out there.

  37. Canola Oil??? Well, that's a shocker!!! I always believed we should steer clear from that stuff. Someone please enlighten me 😔

  38. Please know that xylitol is extremely toxic to dogs so be extremely careful if you have pets in your home if you choose xylitol as artificial sugar

  39. I am just curious about canola oil why is that being showed together with olive oil and coconut oil basically implicating that its an approved oil ( just around 6 min mark or so )- I have been told that it's also in the bad oil category with vegetable and soy oil ?

  40. 7 books about keto for 37$

    7 books that changed my life in a few months!

    Even if you don't wanna buy, check it out and read it:

    https://bit.ly/2I3WX7u

    Be strong guys! Peace!

  41. Great video, Doc. Thank you for your honest and generous sharing of this important health knowledge! Blessing to you, Sir!

  42. If you do some extended fasts, just don't carb load or overeat in general when breaking the fast. Ease into it. Maybe eat a steak with butter. No big deal.

  43. Keto is beautiful. I lost 60 pounds this way. Now I'm fat adapted I can even add some carbs back. Currently 130 grams per day for 1 year and staying constant!

  44. Just another comment on fasting: when I fast, now usually 3 days at a time, about once a month, I lift weights 2 of those days. I don't lose strength… I think my body know it would be stupid to use muscle for energy when there's fat available, and probably muscle is needed to get the next meal. Dr. Phinney doesn't mention whether these studies of fasting required the fasters to perform heavy lifting… I'll bet not.

  45. I had massive heart palpitations when I tried keto I felt awful despite drinking salty water. I want to try again though. I have no underlying medical conditions that I am aware of. Do you have any advice for my second attempt. I'm not fit but my resting heart rate is around 54-59 which sounds low and my blood pressure is normally quite low. Could this be related to my issues? Thanks.

  46. These 3 videos have been the most informative and best keto for health I have seen yet!. Really enjoyed them!👍

  47. I also have to disagree on the fasting. There is even a Youtuber who just completed a 150 DAY fast and is doing very well and feeling fine.

    I believe that you misrepresented fasting and I would love to see your data that shows this massive loss in lean muscle mass. Additionally if a person loses 15 percent of their body weight would it not stand to reason that their body would lose an equal amount of muscle mass as our bodies are prime to forego tissues that are no longer used.

  48. Cholesterol readings? Doesn't it terrify heart doctors to see high cholesterol readings? My docs panic, but my heart is calcium free and I passed the treadmill test with flying colors

  49. From all videos on yt (and I probably watched hundreds of them) those 3 parts by doctor Phinney are by far the most scientific, authentic and informative. (MD myself)

    Thanks Vitra Health

  50. Enjoyed the three videos and it shine a light to what nutritional ketosis really is everything online just says it’s another diet 😑. I learned something new everyday 😊

  51. I have an inquiry if I am a runner but for long distances up to marathon, does the keto will improve my performance and how in case of 5km race I usually run this distance without running out of energy? So please explain how is that could happen?

  52. The best source of fat I have found is beef trimmings (grass feed), it's cheap, it's unprocessed and not heated so it's less oxidized, it tastes good unlike many oils, it has a good nutritional value unlike oils, it's most similar to what we would have eaten in the past unlike oils.

  53. A lot of the keto police on YouTube are huge advocates of intermittent fasting for glucose and insulin stability. I personally can't do it and I don't like it. I'm about 17% body fat and highly active. Am I missing something?

  54. Thanks for the awesome video. My question is where can I get the keto diet plan that has been approved by experts like you? You mentioned some keto diet plan that you follow but if you have an extensive diet plan, please share it in this channel.

  55. Tuna in olive oil is quite easy to find in local grocery stores (at least here in CA) or Trader Joe's. Or you can order from Amazon. But it is true that the common big brands of tuna in oil are the unhealthy oils. Wild Planet brand, available at Costco, is tuna canned only in the natural fish juices. It is a bit more expensive, but is a big solid slab of meat, not the mushy "cat food" from cheap brands. Just don't throw away the good oil and juices! Mix with vinegar and use as a dressing on your salad.

  56. If carbs should be 5 to 10% of calories and potassium should be 10 to 20% of the calories. How do we figure out what that is if we don’t count fat calories or total calories?

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