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115: What the Heck is Ketosis?

Sep 27, 2022

If the ads are to be believed, it seems like everyone is doing some sort of low-carb or "keto" diet. Is it just a fad diet of the moment or does ketosis actually promote weight loss? Nutritionist Thunder Jalili, PhD, joins the guys to discuss the science behind ketosis, whether he would recommend it, and the potential dangers and benefits of a strict no carb diet.

Episode Transcript

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Mitch: So maybe you've heard about it on some ads or a TV show, or maybe you got a friend who's getting really into it. It's ketosis or the keto diet. And I just have a lot of questions about whether or not it really is as magic as everyone seems to make it sound. So we're going to find out today.

This is "Who Cares About Men's Health," where we try to give you some information, some inspiration, and maybe a different interpretation about your health.

I'm Mitch, and joining us today is Scot. He is the master of BS, and manager of The Scope Radio. Hello, Scot.

Scot: I am looking forward to hearing about ketosis as well. I hear it's a state that's hard to get into, but you can burn some major fat, so I want to find out if that's true.

Mitch: And also joining us is the MD that gives us a little bit of validity. That is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Just a little bit. Don't overstate it.

Mitch: And to answer some of these questions, we have the wonderful nutritionist. Thunder Jalili is back with us to let us know about this particular process.

Thunder: Hi, Mitch. I'm happy to be part of the crew again.

Mitch: All right. So before we get into kind of ketosis itself, how about you guys? Have you ever tried out a low carb diet before?

Troy: Mitch, I'll just jump in right here and say no. I absolutely love carbs, so I can't . . .

Mitch: Carbs are the best.

Troy: Carbs rock.

Scot: Why would you do that to yourself? No, not really. I mean, the lowest I've ever had, I was on a diet called the Zone Diet, which I've heard is a low to moderate carbohydrate . . .

Troy: Carburetor?

Scot: Yeah. I've known people who've tried low carb diets, and they're not nice to be around. That's not just a cliché. That's actual truth.

Thunder: And I have tried a low carbohydrate diet. Very, very short-term for just a couple of days just to see what it was like, what it's like to follow this. Not for any weight loss reason, just more of an experiment.

Scot: Thunder, how did it go for you? What did you learn?

Troy: Yeah, were you super grumpy? I was going to ask that.

Thunder: No, not really. I mean, I still ate a lot of vegetables. Those were my carbohydrate sources. So I probably didn't have the classically super low carbohydrate diet. I mean, I don't think I was any lower than 30%, to be honest. So it was fine. I did it, and then after a couple days, I just wanted to have beans and some other stuff, so I just stopped. But it was mostly just an exercise to see how hard is it to do this? How limited am I from a practical sense?

Troy: And did you feel limited?

Thunder: Yeah, a little bit, I did feel limited. I don't mind eating salads and vegetables, but I don't like passing up fruit. You guys know how I love my smoothies. So I don't like trying to decide, "Oh, I can't put this fruit in the smoothie," and things like that. So, yeah, I felt limited in that sense.

I don't necessarily miss rice or pasta. But it's just when you start cutting the different fruits and beans and things, that's where it starts to get tough for me.

Mitch: So why don't we start the discussion here with what is ketosis itself? For someone who has never taken a physiology course, who doesn't have a degree in nutrition, Thunder, what exactly is ketosis and what does it do to the body?

Thunder: So ketosis is the metabolic state where your body is using fat for fuel. Basically, your liver has this ability to make ketones, which is kind of like a metabolic energy substrate in the liver, makes it in the liver. It can actually do this from fatty acids. To some degree, it can also do it from amino acids, which are the building blocks of proteins.

So your liver makes these ketone bodies, and it puts it into the bloodstream. And then those ketones can be used as a fuel for all the other cell types in your body.

There are a couple of particular types of cells that really need to use glucose, and if they don't have glucose, the next best bet for them is ketones. So it's important to have that. Your muscles can use ketones for energy, as an example.

So any time you're burning some degree of fat or you're using amino acids for energy, you're producing some of these ketones.

And then the last thing is "ketosis" is thrown around so much. Really, there's a window of ketone bodies, the level you can measure in the blood. And if the amount of ketone bodies circulating in your blood falls within this window, you're said to be in ketosis.

You don't have to be in ketosis to lose weight, but a lot of times, if you're doing something from a dietary standpoint or restricting calories, you are going to be in some degree of ketosis.

And you can actually have too much ketosis where the ketone bodies in your blood are so, so high, it can be dangerous, and it can cause an acidosis and potentially cause some harm, but that's pretty rare to be in that state.

Mitch: That's interesting, because one of the things I came across was what they call the keto flu. Have you ever heard of that?

Thunder: Yeah, so that's if you're just too hardcore about it and your ketones are just really high in the blood, and it just makes you kind of feel bad. It's not really the best thing physiologically. I would say that happens in people who really take the keto to the extreme.

Mitch: Bad breath, soreness, nausea, headaches, irritability. It doesn't sound super great to me, but what are some of the health benefits, I guess, of being in ketosis or using ketones? I guess even if you're not eating a strictly low-carb diet, does the body still go into ketosis? And is there any benefit from that?

Thunder: Yeah, you don't have to be in a low carb diet to have ketosis. If you just have a low-calorie diet, you would be tapping into your fat stores and producing ketone bodies that way, too.

There's not really any great benefit or great detriment of ketosis. It's just one of those natural metabolic states that we fall into from time-to-time. And it's just that in the modern context of people trying to lose weight, people will try to use that as a goal, to be in ketosis for an extended amount of time, with the idea that that means they are burning fat. But there's no specific benefit or detriment. It's just something that happens to us.

The only detriment would be if you go too extreme and you have such high ketone levels in your blood that it leads to keto flu, like you were talking about, or other similar bad effects.

Mitch: Would this be, say, maybe a dangerous thing for someone who's maybe diabetic? Or with how low the nutrients are or how many nutrients you might be missing out on from cutting carbs completely, could it potentially lead to vitamin deficiency problems and who knows what?

Thunder: So, in general, yes to a lot of the things you touched on. I'm also going to give Troy an opening here for the diabetes question if he wants to hop in, but for diabetes especially, diabetics can develop a dangerous condition called ketoacidosis, where basically there's just too much ketones, too much acidity in their blood, and it's very dangerous. They have to be careful with that. Troy, do you want to add anything to that?

Troy: Yeah. I was going to say for diabetics, they definitely would not want to do a ketosis type diet. And I'm sure anyone who's dependent on insulin, they know that. They know their carbs, they're tracking those things, and they're adjusting their insulin doses based on that. So to go to a very low-carb diet could be very dangerous.

Number one, unless they adjust their insulin, they could really drop their blood sugar low, which would be dangerous. But like you said, Thunder, one of the things I treat in the emergency department is diabetic ketoacidosis, where patients come in, their blood sugar levels are really high, but that blood sugar is not getting into the cells, so then their body is producing ketones. And exactly like you said, Thunder, they're acidotic. They're nauseous. They're vomiting. They're confused. It can be a life-threatening condition.

So certainly people with certain medical conditions, you would not want to do any sort of a low-carb diet or really be trying to achieve any kind of ketosis.

Thunder: Yeah. Correct. And the treatment for that is a lot of insulin.

Troy: Exactly. Yeah, that's how you treat it. We start them on insulin. We give them sometimes an insulin drip. Sometimes they go to the intensive care unit. It can be a very serious condition, and something I see on a regular basis.

Scot: I'm sorry. I might have just dozed off or something. I'm a little confused. I thought ketosis . . . People do like the Atkins diet or a very low-carb diet because that puts them in the state of ketosis, which helps them burn additional body fat. Is that not true? I'm kind of getting the feeling that that's not the case.

Thunder: No. One of the ways to encourage burning body fat is to do a lower carbohydrate diet, but a lot of times lower carbohydrate diets can also be lower calorie diets. You've got to get the energy from somewhere, so you mobilize your fat stores.

One of the ways of thinking about this weight loss, fat burning, and all these different diets, there are a lot of different ways to get around the same thing, trying to produce some calorie deficit. So, really, you're not comparing the merits of a keto diet to a high protein diet or whatever other diet you want to find. It's not so much that. It's what kind of diet advice can a person follow to produce the weight loss that they want? That's really the question. Not necessarily does it have to be exactly a keto type diet or whatever else kind of diet?

But yeah, bottom line is any kind of low-calorie diet will produce some kind of ketosis because you've got to tap into your fat stores to provide the balance of energy that you're missing because you're not eating as much food. Does that make sense?

Troy: It does, yeah. And, Thunder, along the lines of weight loss, I've wondered how much weight loss . . . I know with a low-carb diet and pushing yourself toward ketosis, a lot of people do see some fairly quick results in terms of weight loss. But my understanding is that a lot of that is water weight and you get ketones in the blood.

And again, I see the extreme of this with diabetic ketoacidosis where they have these ketones in the blood that pulls fluid from the cells into the blood. That's why you often hear of people who, when they have diabetes or when they're first diagnosed with diabetes, are urinating a lot more frequently, because they're losing a lot of fluid.

And I've wondered with these low-carb diets, where you're pushing yourself toward ketosis, how much of that weight loss is truly long-term fat breakdown versus just pulling a whole lot of water out of your body and losing weight because of that water loss.

Thunder: Yeah, that's a great point. There have been feeding studies, clinical trials have been done comparing different diets over longer time periods, like a period of months, sometimes even up to a year. And a lot of times, you look at the graphs of weight loss, and they kind of look the same. There's an initial big drop in weight in the first few weeks, and then actually, the weight kind of comes up a little bit, and then it stabilizes.

So there's definitely an element of what you said, Troy, in there. You have some water loss initially, but obviously, if you stick with it for the long-term, you're going to be also losing some fat. It's just probably going to take a few weeks for it to stabilize at a certain level. You can't say what you lose in the first three days is going to be the trajectory because that's probably not accurate.

Troy: Interesting. And maybe that's kind of self-reinforcing. You say, "Wow, look at the weight I'm losing." But probably, like you said, you're not going to keep losing that amount of weight over the longer term. You're probably seeing a lot of water weight loss, and then eventually, you're going to kind of level out to where maybe it's more realistic.

Thunder: Yeah. You just kind of settle in on an amount of weight loss, and then you hit a point of diminishing returns where, in these studies, people don't necessarily lose any more weight. They just kind of stabilize at a certain level. And then if you want more weight loss to occur, you have to try something different.

Mitch: So I guess to wrap up that idea, is a keto diet worth it, or are there other ways to lose weight? Is it comparable? For me, at least, it just seems like such a lot . . . I mean, we were kind of joking, but I do love carbs. Carbs are delicious.

Thunder: Especially in the form of cookies.

Troy: Sure.

Mitch: Oh, cookies, whatever, sure. But is it worth that amount of . . . are the benefits, the increased potential for weight loss, etc., enough of a difference that would make cutting all those things out worth it, in your opinion?

Thunder: I think with any kind of change in food behavior, you have to land on something that you can stick with. So, yes, you can lose weight following this keto diet. But the question you have to ask yourself is, "Is this something you can stick with for the next 40 years or whatever?" Forty or 50 years. And if you can't, then it's going to be something you do temporarily, and then you're going to stop and then maybe fall back into old habits.

So I'm not a fan of extreme diets of any kind for exactly that reason, because I'm afraid that this is something that people just can't stick with long-term. It's like a short-term fix.

Troy: Yeah, I agree. And again, it's a theme that seems to come up again and again as we talk about diet and exercise and all that. In my mind, too, it's all about sustainability and not just that short-term fix and getting ready for swimsuit season or whatever it is. It's like, "Hey, can you do this for the next 40 years and enjoy it and have this lifestyle that's rewarding for you?"

And I guess if ketosis is, if a low-carb diet works for you, and you're good with that, you enjoy it, then great. If it's something you're doing just to try and lose the weight and looking at as a short-term fix, it just doesn't seem like a great approach.

Mitch: So why do you guys think that the keto diet is so popular, then? I mean, some of the numbers that I was able to kind of pull up were saying that in the last year, 24.5 million Google searches were trying to figure out whether or not keto was right for them. It continues to have more and more people being a part of it. Why keto? Why cutting out all carbs? Why is that the diet of the time?

Thunder: That's a complex question to answer, but I think maybe some of the themes that are involved there are people are looking for some sort of program that they can easily follow that has noticeable quick results.

People are looking for any kind of crutch or help. A lot of times, if an individual is overweight and wants to lose weight, they don't feel great about it and they may be approaching it from a place of desperation. So if they can latch on to something that they see has worked for other people, and they're like, "Oh, all I have to do is cut out carbs. I can do that," I think that has a pretty powerful element.

And then there's also the element of marketing. I mean, not that there's a specific company marketing keto, but there are a lot of lifestyle-, nutrition-, exercise-based websites that market keto is the way to go. So you have also that marketing that's out there in the ethos that is always promoting keto. So that gets people to try it.

And then the last thing I'll say to that is keto diets have definitely been studied. Low-carb diets have definitely been studied in clinical trials. And the general conclusion is they don't work really any better for weight loss than any other diet. But a lot of times, people will see medical research like that and they will rationalize and say, "Well, that's the averages, but I think it'll work for me." And then they're willing to take the plunge that way anyway because they figure there's no harm in trying.

So that's my personal take of some of the things that are involved in keeping keto popular and really any other kind of fad diet or supplement that comes around.

Scot: Hey, Troy, what about the medical benefits of keto diets? I remember on one time we did an interview with a doctor that said there was some evidence that showed that for young children that had epileptic seizures, some of them responded really well to low carbohydrate diets that put them in that state, that ketogenic state.

Are there other health benefits that you're aware of? I mean, you'll see it on the web. People will claim diabetes, cancer, epilepsy, Alzheimer's disease. What do you know about that?

Troy: I'll say, in my opinion, and this is purely my opinion, I think the detrimental effects of a low-carb diet are probably greater than the health benefits. And the reason I say that is because I think a lot of low-carb diets lead to higher meat consumption, and primarily a lot of red meat consumption. So, right there, you have the detrimental effects there.

When we talked about that before, there are those rare exceptions where being in a state of ketosis does help maybe some children with seizure disorders.

Certainly, if you have weight loss, and it's a decent amount of weight loss, and you're able to maintain that that's going to help with potentially reversing diabetes, like a type 2 diabetes, and potentially helping with some of those long-term effects of being overweight. But again, in my mind, the sustainability of a low-carb diet I think is just a challenging thing for probably most of us.

And again, I think probably a lot of the protein intake in the form of meat . . . At least a lot of people I know who are on low-carb diets, they tell me they are eating a lot of meat. It's often a lot of red meat. And I think the health effects of that there, you're talking about increased risk of colon cancer, other types of cancers, certainly increased risk of heart disease, vascular disease, leading to risk of stroke, all those sorts of things. So I think it's kind of a mixed bag, quite honestly.

Thunder: Yeah. And if I could just add on to what Troy was saying, too, I think there are certain medical conditions, like you mentioned epilepsy, where this type of very high-fat, ketogenic-type diet may be required. Sometimes people have inborn errors of metabolism and they have to do kind of crazy special diets. Sometimes these patients are backed into a corner, so to speak, because they just may have to do that to move on.

But for most of us who are not in that camp of medical conditions that require it, then I would agree with Troy that the risks are probably outweighing the short-term weight loss benefits.

Troy: Yeah. And I will say anytime anyone asks me, "What kind of diet should I do?" and we say this again and again, I say the Mediterranean diet. The reason I say it is because there are so many good studies out there looking at long-term health effect impacts on heart disease risk, cancer risk, stroke risk, weight loss, and it does the trick.

And certainly, I don't consider it a fad diet. It's a very, I think, manageable, sustainable long-term diet. And it's certainly not a low-carb diet either.

So, in terms of just scientific evidence, that's the one diet that just seems again and again to come up over many years, lots of really good studies published in very strong reputable journals that really show beneficial health effects.

Thunder: Yeah, 100% agree with Troy. And also it's more of a moderate carb diet, and it's delicious because you get to eat a lot of delicious foods.

Troy: Yeah, exactly.

Mitch: Well, thank you so much for joining us, Thunder, and kind of enlightening us a little bit about keto and what it can and cannot do. I guess keto isn't really magic. So thank you so much, Thunder, and thank you for caring about men's health.

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