Using Ketosis to Lose Weight and Improve Your Health – Podcast #109

Using Ketosis to Lose Weight and Improve Your Health – Podcast #109

November 7, 2019 4 By William Morgan


Dr. Justin Marchegiani: Evan, it’s Dr. J!
It’s a Monday. How’re we doin’?
Evan Brand: Hey, I’m doin’ great. What’s
up with you?
Dr. Justin Marchegiani: Hey, it’s good that
you survived the weekend.
Evan Brand: Yeah, it was extremely exciting
weekend with the baby—getting a lot of trouble
with the baby.
Dr. Justin Marchegiani: Nice. What’d you
guys do?
Evan Brand: Just hanging out at the park,
hanging out outside.
Dr. Justin Marchegiani: Nice. That’s awesome.
Evan Brand: You get—you get stopped by a
lot of people when you have a baby.
Dr. Justin Marchegiani: Oh, I know. I just
a got a dog a month or two ago and I just—I’ve
never realized how many people are dog lovers,
but man, we get so much attention when we
have our dog. It’s crazy.
Evan Brand: Yeah, if you were single. That
would be the easiest way.
Dr. Justin Marchegiani: I told my wife that.
I said, if I ever—like if something ever
happened where I can go back in time—if
I were to do it all over again. I would’ve
got a dog like right off the bat, like just
a really cute, small dog but it’s all good.
I’m happy where I’m at.
Evan Brand: Yup, cool.
Dr. Justin Marchegiani: But I wanted to say,
we were talking pre-show there that I got
a crown today and I go see a holistic dentist
in Austin. Her name is Dr Joan Sefcik. I’m
gonna actually have her on the podcast real
soon. We’re gonna talk about root canals,
cavities, crowns, all those things, but I
had an issue with my tooth where I needed
a crown. About 16 years ago I split my tooth
in half when I was really young, just eating
a whole bunch of sugar, eating a whole bunch
of gluten. Hadn’t really got the message
back then about health. Split my tooth but
I was actually able to keep it together with
some cement, and obviously changed my diet
and never had anything like that happened
with my tooth again, but I had those—the
long-term consequence of that tooth being
unstable so we put a crown on it and we actually
did some testing, too, to figure out what
the best material was and we actually—I
think we ended on a cubic zirconia. So right
now I have an acrylic crown that’s a temporary
one and we got a cubic zirconia one coming
in. We had it muscle tested and we called
the lab. We—we chose the top 3 materials
that test the best based on blood chemistry
and then we muscle tested the top 3 and I
tested great for all of them which was great,
and then the doc said, “Well, you know,
this is the one I have the best success with,
and because you tested great with all three,
we’re gonna go with this one.”
Evan Brand: So I’m sure people wanna know
with holistic dentistry, that’s all cash
no insurance for that?
Dr. Justin Marchegiani: A little bit. I mean,
we have some dental but I—you know, I paid
that I think out of pocket. I think it ended
up costing me like a thousand bucks for the
crown–
Evan Brand: Yeah.
Dr. Justin Marchegiani: And if I didn’t
have insurance, it would have cost me $1500.
Something like that.
Evan Brand: Oh, okay. So insurance kinda works
for holistic dentistry.
Dr. Justin Marchegiani: A little bit. I mean,
the thing is what’s holistic is the material
we’re using, right? We’re not using the
standard-based crap. I think it’s nickel
a lot of times–
Evan Brand: Yeah, it’s horrible.
Dr. Justin Marchegiani: Which can screw up
with, you know, the conduction of nerves in
the body. So that’s the big thing and also
she used a lot of ozones as she go in there.
She’d use ozone and get in there, like a
lot of essential oils. So it was really targeted
to kill a lot of the bacteria and crap that
could be in there even though she—I actually
asked her, she said it was great, which is
good. It’s testament to you know, good,
clean—clean eating. So we’re gonna have
her on the show real soon to talk more about
healthy teeth and oral hygiene, so that that’ll
be fun.
Evan Brand: Awesome.
Dr. Justin Marchegiani: So I’m doin’ pretty
good. Not bad. I get to go get my cubic zirconia
tooth. My wife was texting me, it’s like,
“Is that gonna look like one of those fake
diamonds?”
Evan Brand: Is it?
Dr. Justin Marchegiani: In your mouth? No,
I don’t think so. I asked. It’s gonna
look, you know, it’s gonna look cosmetically
in sync with my other teeth. So it’ll be
alright.
Evan Brand: Awesome.
Dr. Justin Marchegiani: Yeah. So we talked
about doing something on ketosis. I’ve had
Jimmy Moore on the podcast. I’ve spoken
on Livin’ La Vida Low Carb Cruise. We did
a podcast a few months ago on Keto OS which
is a synthetic ketone supplements and look
forward to digging in a little bit more on
ketosis.
Evan Brand: Yeah, there’s a lot of benefits.
Ketosis in my opinion is not for everyone
at every point in their life. It has a lot
of incredible benefits for weight loss but
if you have adrenal issues in my experience,
some people feel worse. Maybe there is that
adjustment period but I find that if people
are just they’re afraid of carbs, they can
tank out even more. What’s—what’s your
experience with adrenal issues and—and ketosis?
Dr. Justin Marchegiani: So I think ketosis
is phenomenal for most people that are out
there, especially if you’re dealing with
metabolic syndrome, meaning there’s a level
of insulin resistance and you’re body is
having a difficult time tapping into fat for
fuel, ketosis is phenomenal because what you’re
doing is imagine fat is like this big branch
and we’re trying to throw that branch into
the wood chipper and then out of that wood
chipper comes these things called ketones,
and these ketones can be used by different
tissue in the body and the thing is, glucose
actually burns dirty. Right? It’s like a
diesel fuel. You kinda sm—it’s smells.
It’s stinky. If you ever drive by in a diesel
car, at least the older ones. But ketones
they burn really clean and when I say burn
really clean, you don’t get a lot of reactive
oxygen species or free radicals afterwards.
So it burns really clean like that and also
you don’t get the effects of glycation,
which is basically all the proteins or tissue
in your body gets sugar-coated and that creates
basically a m—a magnet for free radicals.
So we like ketones because of the stability
they give people, right? With sugar, we get
this up and down reactive hypoglycemic effect
with a lot of people that are doing refined
sugar or just higher glycemic foods, meaning
they get into your bloodstream really fast.
We don’t quite get that with ketones. So
the big issue is most people who have metabolic
syndrome, big waist, high blood pressure,
lots of inflammation, lots of insulin and
blood sugar, they can’t get the sugar into
their cells and utilize it for fuel optimally.
So they can’t—their cells are—are very
resistant so they start—one, they get reliant
on sugar to burn but two, their cells don’t
wanna take it in a lot and actually burn it
so they get very tired and a lot of that that
gets put in gets stored as fat. So it’s
a double edged sword. They’re tired. They
don’t wanna exercise. They get cravings.
They create more sugar and then when your
insulin levels are high, it basically blocks
fat from being burned so you’re primarily
burning sugar but you can’t get a lot of
it to the cells so you’re tired.
Evan Brand: Right. I’ve heard recently which
I’ve read. I can’t remember what I was
reading. There’s this kind of—there’s
kind of a myth that’s perpetuated where
people who are only a fat burner or only a
sugar burner and that’s not the case. It
seems that most people have the ability to
do both and if you wanted to survive in primal
times then you would have, you better have
that ability to be able to burn glucose or
ketones to survive. But I think the goal of
that is you just wanna be primarily a fat
burner, not primarily a sugar burner which
is what would you say, 90% of the population
is probably primarily glucose—glucose driven?
Dr. Justin Marchegiani: Yeah, I would say
at least 75%, and we talk in generalities,
right? We’re talking like, “Hey, you know,
you’re primarily burning sugar for fuel
or primarily burning fat for fuel.” That’s—that’s
the thing that we’re kinda get across there
and most people, you know, when we talk about
calorie partitioning, their partitioning,
right? You know, imagine you got a police
officer and his siphoning people through,
“Go that way. Go that way.” You got all
these calories that are going through and
the police officer is saying, “Hey, go this
way into the fat cell. Get stored as fat and
a small amount will actually get burned. So
we’re not shunting those calories. “Hey,
go to the mitochondria. Get burned. Create
energy.” While you’re creating energy,
you’re building muscle because you’re
doing something that’s creating resistance
in the body which builds muscle, whether it’s
the piezoelectric effect and you’re building
calcium into the bone or whether you’re
putting muscle into the muscle belly. So we
wanna essentially use that you know, traffic
policer officer or that you know, flight tower
attendant that’s telling the planes which
direction to go. We want tell those calories,
“Hey, go to the mitochondria. Get burned
versus get stored in the fat cell.” And
one the biggest ways we can do that especially
with people that have this insulin resistance
metabolic syndrome is getting into ketones
by cutting carbs.
Evan Brand: Yup, so–
Dr. Justin Marchegiani: Typically down to
20-30g is a great starting point for most
people. Go ahead.
Evan Brand: Now, the people actually need
to count? I mean, I’m probably in ketosis
now at this point because I haven’t had
much today. I had some—I had a bison burger
and also I had some bison—or no, what did
I have for breakfast? Had some kinda meat
and—and I can feel that. I know because
you can feel your breath start to stink a
little bit more. That’s how you know. That’s
like the first sign of ketosis or one of the
first signs.
Dr. Justin Marchegiani: Well, yeah, you get
the acetone but I mean, if you’re only at
like .5 mmol, I mean that’s not a ton. So
maybe your breath gets a little bit fruity,
that’s the acetone. So there’s 3 kinds
of ketone. There’s acetone. There’s beta-hydroxybutyrate
and there’s acetate. So like if you look
at the breath meters. The breath meters are
really measuring the acetone in the breath
and then the blood is measuring the beta-hydroxybutyrate–
Evan Brand: Yeah.
Dr. Justin Marchegiani: In the blood.
Evan Brand: Okay.
Dr. Justin Marchegiani: Right? And then some
will actually measure the ketones in the urine,
not that efficient because if you’re burning
ketones, well, that means if you’re burning
them they may not end up in the urine, right?
So if you get someone who’s in ketosis,
they’re spitting out a whole bunch of ketones
but they’re burning them up efficiently
they may not pee a lot out. Does that make
sense?
Evan Brand: Yup.
Dr. Justin Marchegiani: So early on you get
a lot of people that are in ketosis but they’re
body’s not efficient at burning those ketones
so those ketones go in the urine to start.
Evan Brand: Well, let’s–
Dr. Justin Marchegiani: But then later on
as they get more efficient, you won’t see
them in the urine. That’s why I got my ketone
meter right here. I use the Abbott Precision
Xtra or Precision Xtra and it’s—I got
blood sugar on there as well as ketone strips,
too.
Evan Brand: Yeah, I’ve done the breath.
It was by Ketonix.
Dr. Justin Marchegiani: Yeah.
Evan Brand: I’ve done their breath one.
That one was pretty good. I find that I had
like a low level of ketones all of the time.
Let’s clear something up though. When people
hear about ketones, they’ve likely been
in the grocery store or Walgreen’s or somewhere
and they’ve seen the raspberry ketones as
a weight loss supplement. They became very
popular over the last probably 5 years. First
off, raspberry ketones, they’re not even
derived from raspberries when you see those.
Most of the time when I’ve looked at the
ingredients, a lot of times there’s synthetic
chemicals in there. There’s artificial colors,
sometimes artificial sweeteners in these raspberry
ketones. So I do not recommend them. I don’t
actually know enough about what’s actually
in there to know what’s actually going to
happen but generally just looking at some
of the ingredient list on ketones, it—it’s
garbage.
Dr. Justin Marchegiani: Yeah, raspberry ketones
aren’t necessarily ketones. I mean, if you
look at what’s in there, there are these
phenolic compounds that aren’t your typical
beta-hydroxybutyrate whether it’s calcium
or sodium beta-hydroxybutyrate salts. Like
if you look at a lot of the ketone products,
there’s Keto OS. There’s another one,
a Keto Sport I think, and they’re using
the beta-hydroxybutyrate salts, calcium or
sodium. Those are like the gold standard.
Now you can use precursors, right? Kinda like
how we use maybe pregnenolone for adrenal
support precursors. You can use precursors
like medium chain triglycerides which are
gonna be primarily C8 and C10. Like the, you
know, the brain—the brain ketones are more
C8, right? Octanoic acid or I think that’s
maybe caprylic, there’s two names. I like
the octanoic because it’s more descriptive.
The oct–, octo–, octagon, that’s 8—8
carbons. So typically we’ll do ketones that
are C8 and C10 because you get the brain effects
of ketones but you also get the metabolic
effects. So like typically in the morning
after I have either a good clean collagen
shake or some eggs and I do my butter coffee
with high quality MCT oil. I’ll get my ketones
up within an hour or 2 to—to .5, .6 mmol
and I feel great.
Evan Brand: Do you measure that?
Dr. Justin Marchegiani: I measure it, yeah.
Now the thing is with the Ketonix, it’s
more qualitative. So like that number like
let’s say you’re—you’re a different
color or light on that variant. That light
that you hit one day, you may hit it the next
day but your number may have been different
if you were measuring it in mmol of ketones.
So it’s a good indicator to—to say if
you’re in ketosis. It’s not a good quantitative
indicator of what exactly were you.
Evan Brand: Yeah, the other brand that I’ve
seen before. I’m looking—trying to find
the ingredients right now is Kegenix. So I’m
trying to see what’s in here. It’s $200
for a 4-week supply.
Dr. Justin Marchegiani: Yeah, they’re kind
of expensive. My biggest thing off the bat
is number one, get your diet dialed in. So
you talked about carbs. So the first thing
is as a macro percentage of nutrients is you
wanna get your fat up. Most people screw up
in ketosis because they go too high in protein.
They’re eating like you know, 30-40% protein.
It’s hard to do that much in protein unless
you do two things wrong. Number one, you eat
lots of lean meat and number two, you do excessive
protein powders. So those are the 2 things.
Now you can get away, going higher on protein
if you’re doing a lot of resistance training,
alright? But if you’re not doing a whole
bunch of resistance training, you want your
macros up around 60-70% fat as a pretty good
starting point. So what I recommend is just
throw your foods into a MyFitnessPal and if
you’re using a Paleo template, so that means
you’re gonna be getting most of your meats
from animal products. Your carbohydrates,
you’re gonna choose obviously more from
a non-starchy vegetable sources. A really
easy thing is you’ll typically be good around
20-30g and you can just throw in your carbohydrates,
a cup of broccoli, a cup of spinach, a cup
of kale, maybe you’re doing some asparagus,
maybe you do another salad for dinner or lunch.
Throw all the vegetables that you do in there,
you’re probably find that you sit around
30g of carbohydrate once you factor out the—the
fiber, 20-30 is pretty good unless you’re
doing a ton of juicing or ton of veggies.
You’ll probably be around 20-30 net carbs.
That’s a pretty good place to be. So that’s
a good starting point and then from there,
depending on whether you wanna stay in ketosis—I
like to—to keep myself around 40-70 carbs
a day and I keep—I get my ketones up to
.5 and I feel phenomenal–
Evan Brand: So you’re—you’re–
Dr. Justin Marchegiani: At around .5.
Evan Brand: So you’re basically in some
level of ketosis most days.
Dr. Justin Marchegiani: Absolutely. Absolutely.
And then like if you listen to guys like Jimmy
Moore, Jimmy is around 1, maybe—maybe 1-2.
And again, you don’t have to worry about
ketoacidosis until you get to about 20. Ketacidosis
is potentially what could happen to diabetics
type 1 primarily and/or alcoholics that have
cirrhosis, with that—they have messed up
livers. Essentially ketoacidosis is when your
insulin levels are high and your blood sugar’s
high. Okay, that typically hard to do because
when the insulin goes high, blood sugar goes
low.
Evan Brand: Yup.
Dr. Justin Marchegiani: Alright, so insulin’s
high. Blood sugar’s high in the bloodstream
but what’s happening is we can’t get the—we
can’t get the—the calories or the blood
sugar into the cell so the cell’s starving
and what happens is the body is trying to
generate energy so it spits out a whole bunch
of ketones.
Evan Brand: Yeah, so–
Dr. Justin Marchegiani: Does that make sense?
Evan Brand: Yeah, so I was looking at the
ingredients here. Basically what this is,
it is the beta-hydroxybutyric acid, that’s
literally what’s your supplement— supplementing
with. That along with some medium train—medium
chain triglycerides and then leucine, lysine
and isoleucine. That’s it. And then erythritol,
some Stevia, some color, things like that.
So you’re literally just taking—you’re
taking ketones. That’s what it is, right?
The—the beta-hydroxybutyric is one type
of ketone?
Dr. Justin Marchegiani: Yeah.
Evan Brand: Is that right?
Dr. Justin Marchegiani: Correct. I wanna go
back and correct myself. I misspoke. So regarding
the ketoacidosis, it’s the insulin is low.
Insulin’s low.
Evan Brand: So you can’t deal with the blood
sugar.
Dr. Justin Marchegiani: Blood sugar is high
so you can’t get it–
Evan Brand: Yup.
Dr. Justin Marchegiani: Remember insulin’s
the lock or the key that goes into the lock.
The—the keyhole is receptor site, whether
it’s a GLUT4 key which is that’s allowing
sugar into the muscle or whether it’s on
the liver and an—various different GLUTs.
So imagine the GLUT’s the lock and insulin’s
the key. So you can’t use the key to get
into the cell. So what happens is all the
sugar accumulates in the bloodstream because
insulin’s low. So everything I said before
is correct except it’s because of low insulin.
Think, right? Type 1 diabetics have an issue
with low levels of insulin because their—their
islets cells in their pancreas, the beta cells
have been destroyed by autoimmune attack.
So they can’t get that sugar in there, so
the body’s freaking out. It’s saying,
“Where the heck am I gonna get energy?”
So it starts ramping out a whole bunch of
ketones. Ketones have an acidic ash to it
or an acidic foundation to it so it shifts
the pH because of instead of being a nutritional
ketosis at .5 mmol or 1 or maybe 2, they are
20-10 x higher and that shifts the pH down.
When the pH goes down, they can go into a
diabetic coma.
Evan Brand: Wow. Yeah, I—you said that quickly
otherwise, I probably would have caught that.
That makes a lot more sense. So insulin’s
low, sugar’s high. That’s when you don’t
wanna do it and like the supplement says that
you cannot use it with type 1 diabetics for
that reason.
Dr. Justin Marchegiani: And I—exactly. And
I was listening to a lecture just yesterday
talking on the topic and he did the same thing
I just did and I—I got his bad habit from
it. He said the exact thing I said the first
time.
Evan Brand: Yeah.
Dr. Justin Marchegiani: So I got the bad habit
by osmosis, but we corrected it here. So think
low insulin, high sugar, the cells are starving.
Evan Brand: Yup.
Dr. Justin Marchegiani: The body freaks out
and it tries to go and generate a whole bunch
of ketones but shifts the pH. Now how do we
use ketones beneficially? So we can use exogenous
precursors like we mentioned, okay? Obviously
the diet’s gonna be foundational. Now for
some people, there’s a couple of ways of
doing it. You can live in ketosis. That can
be great for some people. If you have cancer,
lot of great studies especially over at Boston
College, Dr Veech, NIH guy. He went to school—he
studied under Dr Hans Krebs, I mean the guy
invented the Kreb cycle, alright? He discovered
it, which is how the body generates you know,
energy via NA—NADH and FADH redox—redox
reactions which then generate ATP in the—in
the Kreb cycle as well as the electron transport
chain, but this is how our body generates
energy and this guy studied with this doctor
that created or discovered this stuff. So
moral of the story is this is another way
the body can generate energy and ketones are
really important part of the Kreb cycle and
they are really important part of starving
out cancer cells. So cancer’s primarily—primary
fuel if you look at Otto—Otto Warburg or
Otto Van Warburg, a German scientist in the
30s and 40s who got 2 Nobel prizes discovering
this physiology around cancer cell metabolism
and he found that cancer cells primarily survive
on glucose and if you can starve the cancer
cells of that metabolic fuel—remember it
burns dirty—if we can use ketones, we can
essentially starve that type of cell.
Evan Brand: Yeah, so—I mean, basically you
and I both touch in to ketosis. Now I do do
some sweet potatoes and things in the evening
so I likely pull myself out of that so this
is something that this is gonna depend on
the person but you can touch in to ketosis—you
do some carbs, don’t you? Do you do sweet
potatoes with dinners?
Dr. Justin Marchegiani: I cycle in and out.
I cycle in and out. Typically at dinners,
I’ll do after a dinner as a treat. I’ll
do a handful of berries and maybe some cream.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Or I’ll do some
high quality, 90% dark chocolate that’s
you know, organic and you know, obviously
gluten-free. So it depends. Like this week
I did buy some sweet potatoes so at one night,
I’ll have that. I mean, you get different
diets out there like a cyclical ketogenic
diet.
Evan Brand: Right.
Dr. Justin Marchegiani: There’s also Jason
Seib’s stick on the AltShift Diet, which
is I think a 3 days—I think it’s a 5-day
low carb, 3-day high carb kinda stick as well.
So there’s different things out there where
you can cycle in and out and those I think
tend to be really good for most people. If
you’re more metabolically damaged, ketones,
ketosis at that 20-30 induction phase can
be pretty good. It depends. Some people I
see if they’re in ketosis long-term will
start to develop some of those hypothyroid
symptoms, losing hair, hair loss, outer third
eyebrow, cold hands, cold feet, mood stuff.
Evan Brand: Yup.
Dr. Justin Marchegiani: And then would just
add in just a little bit carbs, small amount,
and they’re doing better, so–
Evan Brand: That’s what I had to do.
Dr. Justin Marchegiani: Yeah, so some people–
Evan Brand: I crashed.
Dr. Justin Marchegiani: Do better so I’m
not dogmatic at all. There are people out
there that do great on that diet and because
they’re not clinically oriented, meaning
they’re not working with patients that we
are, they—they just think well, because
they did good on it, the other person out
there that’s having a bad response or not
as good response must not be doing it wrong.
Evan Brand: Yup.
Dr. Justin Marchegiani: I’m sorry, must
not be doing it right.
Evan Brand: Yup.
Dr. Justin Marchegiani: Because they’re
doing it wrong essentially. So we always just
make sure the fat macros are up, the protein
macros aren’t too high, and then just make
sure the carbs are there and that’s a pretty
good sign off the bat and then we can always
measure it. Get to a .5 to 1. 1 is pretty
good. Cut off. So we can customize it and
then we can figure out. Okay, you’re at
ketosis. You’ve been there for 2-3 weeks.
You’re stabilized now. Okay, you’re already
at a healthy weight. You’re feeling good.
Your markers look good. Let’s just taper
up some of those carbohydrates a little bit,
just a little bit. And this is where it’s
cool that you can play around with these exogenous
ketones, the beta-hydroxybutyrate salts like
the calcium and the sodium. This is great
to try. Be careful though. Don’t make the
mistake of adding these synthetic ketones
and eating a whole bunch of sugar. The body
is programmed when insulin goes up, typically
ketones never should be there, right? Because
think about it, right? Insulin has to be low
for ketones to be high. Because if high insulin’s
present, the body will block fatty acid synthesis.
What are fatty acids? That’s the tree branch
going into the tree chopper. Out comes the
ketones, right? So we wanna keep insulin low
so if we eat a whole bunch of sugar, take
some exogenous ketones, insulin’s high,
guess where those ketones are going, you know?
Evan Brand: Well, hopefully it’s gonna help
go into the mitochondria.
Dr. Justin Marchegiani: Well, if insulin’s
high and sugar’s high, you’ll actually
pee it out. So if you use exogenous ketones,
you wanna keep the insulin low still.
Evan Brand: So if you—so if you’re eating
high sugar or you’re eating high carb and
then you take ketones, you’re saying waste
of money.
Dr. Justin Marchegiani: Waste of money. And
again a lot of the marketings out there because
frankly, a lot of these ketone companies,
they don’t care if you do it right or wrong.
Evan Brand: Right.
Dr. Justin Marchegiani: Because they’re
getting—they’re getting paid either way.
Evan Brand: Exactly.
Dr. Justin Marchegiani: Not saying that’s
bad. There’s education that comes into play.
So if you’re using exogenous ketones which
I think can be great from a performance, neurological
standpoint especially if you have issues with
Alzheimer’s, things like that. That can
be phenomenal because then if you have the
right diet in place and then you add some
ketones, it’s like bada-bing! You’re there.
You know, we call it therapeutic ketone therapy.
You know?
Evan Brand: So basically, don’t waste your
money. If you’re gonna do this thing then
get the diet straightened out always but then
get the—get the cyclical Ketogenic Diet
or experiment with that first before you buy
ketones.
Dr. Justin Marchegiani: Experiment.
Evan Brand: That—that’s expensive. That’s
$200 and that’s a—a way to waste it.
Dr. Justin Marchegiani: And you may not have
to be you know, full out ketosis. You know,
I sit around .5 to 1 and that feels pretty
good. I think just spit out some ketones.
Evan Brand: Okay.
Dr. Justin Marchegiani: Get to a pretty good
place. See if you can test it. Get down to
.5 or 1. See how you feel. Stabilize and then
taper in some carbs. You know, start off with
a little bit of lower sugar, lower fructose
fruit, and handful of berries. It’s a pretty
good place and then you can always try adding
in a little bit of safe starch, sweet potatoes,
squash, yams, plantains. Do it at night. Because
your body doesn’t need the extra sugar during
the day because cortisol’s already there,
mobilizing and conducting sugar out of the—out
of the glycogen, out of the muscle tissue,
or out of the liver. So the glucose is already
going where it needs to go because of the
high cortisol. Do your carbs at night where
that cortisol isn’t as present.
Evan Brand: This is fun.
Dr. Justin Marchegiani: Yeah, you having a
good time here?
Evan Brand: Yeah, this is fun.
Dr. Justin Marchegiani: Awesome.
Evan Brand: Well, just because you know, there—there’s
so many different ways to go about this and
there’s never—I—I think when people
download these episodes, they think there’s
gonna be like a single and that’ll be all
answer, and that’s never going to exist
especially for this ketosis discussion here.
Dr. Justin Marchegiani: Plus we’re clinicians,
so if it were that easy, you know, every patient
would be a home run, right?
Evan Brand: Yeah, exactly.
Dr. Justin Marchegiani: So we have to put
on our clinician cap, you know, so to speak.
And we look at the diet, we customize it.
So if you’re an endomorph, right? Larger,
bigger, you know, wider hips, bigger belly,
you know, those type of things, you put on
fat easier–
Evan Brand: Yup.
Dr. Justin Marchegiani: And it’s harder
for you to burn, then you know, you’re gonna
really benefit by starting out with a Ketogenic
Diet and then customizing and then stack your
carbs. When it’s time to stacking your carbs,
stack your carbs on at night.
Evan Brand: Here’s another thing I wanted
to mention though, too, that we haven’t
brought up yet. And you and I talked about
Kalish’s talk I think a few weeks ago together,
where if someone has a bigger waist and they
have this excess body fat. Even if they go
into a ketogenic approach, they may not lose
weight because of those toxins that are stored
in the fat cells could still disrupt the metabolism,
right?
Dr. Justin Marchegiani: Yeah, so the fat cells
are a toxic reservoir for toxins essentially.
A lot of our toxins go into the fat cell.
They’re–
Evan Brand: So what do we do then if—if
you’re going, you’re trying to go super
low carb and yet you still just maintain your
heavy weight, you cannot burn fat?
Dr. Justin Marchegiani: Well, that’s where
seeing a good functional medicine practitioner
helps so we’d look at organic acids. We
would look at how you’re detoxifying via
pyroglutamate and sulfate and a lot of these
organic acids that look at phase 1 and phase
2 liver detoxification. Phase 1 is taking
fat-soluble toxins, right? It’s already
there. They’re lipid-soluble. I mean, they’re
in the fat cell. We’re liberating them and
turning them into water-soluble toxins primarily
via B vitamins, antioxidants, and then we
facilitate the transfer of these water-soluble
toxins out the urine, out the stool, out the
breath or skin, right?
Evan Brand: Yup.
Dr. Justin Marchegiani: And we do that with
sulfur amino acids, right? We’re supporting
methylation and—N-acetylation, hydroxylation
,right? Glucuronidation, glutathione, all
of these pathways that are shooting it out.
So phase 1 is more B vitamin and antioxidant
induced. Phase 2 is more sulfur amino acid
induced. And then also some people because
amino acids make carnitine, carnitine’s
a really important compounds that shuttles
fat into the mitochondria. It’s literally
called the carnitine shuttle. You can Google
it. It’s shuttling fat in the mitochondria
to be burned so some people will see low carnitine.
We’ll see some mitochondrial defects and
then we’ll see some detox issues. So that
can be something that we–
Evan Brand: Yup.
Dr. Justin Marchegiani: Incorporate into someone’s
metabolic functional medicine program to help
enhance it. So we get the diet dialed in non-dogmatically.
Again, if you’re overweight, default to
a Ketogenic Diet. That’s pretty safe. A
Ketogenic Diet on a Paleo template. Right?
Atkins create the—or Atkins made that ketogenic
term famous except he used a lot of crappy
foods, you know, didn’t differentiate with
soy protein, added aspartame and artificial
sweeteners. Didn’t care about grass-fed
or chemicals or pesticides or Roundup so he
kinda stumbled on it by accident–
Evan Brand: Right.
Dr. Justin Marchegiani: Because he was just
looking at it from a sugar and carbohydrate
standpoint. He didn’t look at it from the
qualitative standpoint of phytonutrients and
pesticides and chemicals and—and inflammatory
foods and excitotoxins like MSG and aspartame.
So we know more. So we kinda add like a—a
Ketogenic-Paleo template on to it and then
we have tools like the Precision Xtra by Abbott
and get it on—I think get it on eBay and
buy the strips on eBay. There’s a company
out of Australia. You can get a much cheaper—they’re
expensive. They’re like $1 or $2 a strip
but if you buy them here, they’re like $2
to $3. So you can get them like 50% off. I
bought like 100 strips and I just test my
ketones a couple times a week to see where
I’m at and I pretty much know where I’m
at based on what I eat because I’ve tested
so many meals. I see a pattern.
Evan Brand: Yeah.
Dr. Justin Marchegiani: So if I’m eating
like good, clean eggs or a good clean collagen
shake with some good fats, MCT and butter
in the morning, I’m sitting around .5.
Evan Brand: Yup.
Dr. Justin Marchegiani: And I feel pretty
damn good with that.
Evan Brand: Yup, so I know we’re running
out of the time but some of the benefits you
can expect—I notice mental clarity goes
up if I’m pushing towards ketogenic. Weight
loss can happen which I don’t need to lose
any weight but I am less hungry. I’m able
to go little bit longer between meals. I don’t
feel like I’m crashing like I was when I
was doing more starch. There’s a few benefits
for me. Did you wanna say anything on that
part?
Dr. Justin Marchegiani: I think you touched
upon it really well. I think a lot of people
will hear this especially if they’re medically
oriented. People get confused between ketoacidosis
and ketosis. So I already kind of touched
upon the people that ketoacidosis happens
to and typically you’re looking at over
20 mmol/L is gonna be what happens in ketoacidosis
and ketosis, you’re gonna you know, .5,
1, that’s totally fine. Now there’s nutritional
ketosis which is what we’re focusing on,
right? We’re doing it by nutritionally eating
an adequate amount of calories because you
can go on ketosis by starving and fasting.
Evan Brand: Yeah.
Dr. Justin Marchegiani: Right? Because you
still drive down your insulin levels because
there’s no calories. If there’s no calories,
remember insulin’s the door that opens up
the cell for the calories to go in. Whether
it opens up the mitochondria or the muscle
or the fat cell, that’s dependent upon how
much insulin is coming in. But you can lower
insulin by just going low calorie. So you
can be in ketosis via starvation, too. The
difference is we’re doing it nutritionally,
meaning we’re actually eating foods. They’re
real whole foods and we’re getting enough
calories so you’re body’s not gonna be
eating away lean tissue.
Evan Brand: Yes.
Dr. Justin Marchegiani: Most people confuse
it and they think, “Oh, you’re gonna be
ripping up your body. You’re destroying
your muscle.” It’s like—well, my body’s
not stupid. It rather burn the nutrients that
are in it versus taking away lean tissue,
right?
Evan Brand: Yeah, so—so don’t starve.
This is not starvation–
Dr. Justin Marchegiani: They’re confusing
the physiology.
Evan Brand: Yeah, totally.
Dr. Justin Marchegiani: They’re confusing
it and that happens all the time.
Evan Brand: Yup.
Dr. Justin Marchegiani: And it drives me nuts
so people need to really understand ketoacidosis
and nutritional ketosis, and they need to
understand ketosis vs fasting vs ketosis vs
adequate calories and also ketosis at the
acidotic level because of cirrhosis or type
1 diabetes.
Evan Brand: Yup.
Dr. Justin Marchegiani: Well, I think that’s
pretty good there. If you would have sum it
up, what’s the take home, Evan?
Evan Brand: Well, take home. Try it out. Make
sure you’re eating enough food. It’s easy
to undereat if you’re basically cutting
out, not almost, not an entire food group
but essentially, so make sure you are getting
enough good fats, enough good proteins, your
coconut oils, your avocados, your avocado
oils, your good meats, your good veggies.
You know, your leafy greens are excellent.
Stay away from the chemicals. If you start
to crash, if you notice your outer one-third
eyebrows going away, if you notice hair loss,
if you feel like you’re a little bit more
sluggish, you feel like hands and feet are
getting cold like you alluded to, get some
tests run. You can get some blood panels run
for thyroid. You could get your adrenals tested
to see if you’re just tanked out. Maybe
you can’t go super ketogenic. Maybe that
puts an extra stress on the body and you’re—you’re
just not ready for that right now. So make
sure your adrenals are healthy. Make sure
your gut’s healthy and I think you’re
gonna be—you’re gonna be on your way to—to
weight loss if that’s a goal which is why
many people go to—to ketogenic approaches.
Dr. Justin Marchegiani: So who should do this?
Cancer patients, Alzheimer’s patients, anyone
with metabolic syndrome, right? Waist size
35 or bigger for a woman, 40 for a man. Blood
pressure, you know, in the 140s or up. Any
bit of inflammation, chronic pain, any of
those symptoms. A good therapeutic trial of
a Ketogenic Diet, Paleo style, Paleo template
is a great starting point and again if you
enjoyed this show and you’re applying the
information and loving it, sharing is caring.
Also give us a 5-star review. We appreciate
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help us out.
Evan Brand: Yup.
Dr. Justin Marchegiani: Evan, it’s been
real, brother.
Evan Brand: You, too. Take good care.
Dr. Justin Marchegiani: You, too. Bye!
Evan Brand: See ya! Bye!