Here are my notes of the seminar, which took place on September 1st 2014 at Sydney Uni. Due to complaints about the university organising such an *outrageous* event, the MC, Dr Kieron Rooney had to explicitly state the lack of affiliation of the university with the event and reminded the audience of the true nature of science with this quote: “There must be no barriers to freedom of inquiry… There is no place for dogma in science. The scientist is free, and must be free to ask any question, to doubt any assertion, to seek for any evidence, to correct any errors… And we know that as long as men [sic] are free to ask what they must, free to say what they think, free to think what they will, freedom can never be lost and science can never regress” J. Robert Oppenheimer
Dr Rooney (PhD, senior lecturer and member of the Exercise Physiology and Nutrition Research Team, The University of Sydney) left us with the big picture view of carbohydrate consumption. The spectrum of carbohydrate intake according to Feinman et al (2014, full article available here: http://www.sciencedirect.com/science/article/pii/S0899900714003323) is:
- 0 to 20-50 g/day: very low carbohydrate/ketogenic, 5-10% of daily intake
- 20-50 to 130 g/day: low carbohydrate, <26% of daily intake
- 130 to 250 g/day: moderate carbohydrate, 26-45% of daily intake
- 250 to 300 g/day: high carbohydrate, >45% of daily intake
The mean intake in Australians over 2 years old is 45%. Acccording to the Australian Dietary Guidelines of 2013 (National Health and Medical Research Council 2013, available here: http://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55_australian_dietary_guidelines.pdf) the recommended intake to reduce risk of chronic disease is 45-65%.
Dr Steve Phinney’s ketogenic protocol advocates < 50 g/day.
- Food can be medicine or poison.
- “The truth is that what we eat is a dialogue about what we believe we are to ourselves and to the world. More than often this dialogue reflects emotional issues – fears and insecurities we do not know how to deal with or overcome. We fall into eating habits developed in childhood that will over time effect our physiological health. There is, however a lot more to this than you might initially think.”
- Importance of animals getting a natural diet, of eating more organ meats (not just muscle meats), of building relationships with the people who produce our food.
- The first step toward change is spreading the word.
- We have to accept individualities.
- The message needs to be broader: sustainable and sensible.
- Importance of not eating processed foods, maximising nutrition (carbs = nutrient negligible), reducing toxic load (phytic acid, gluten), cooking (particularly slow cooking as a cost-effective and nutrient-preserving method), saving time and money, not “dieting” (counting calories, etc.)
Dr Steve Phinney
- Dr Frederick Schwatka studied aboriginals who had been living in the Canadian Arctic for ~4000 years. Their diet consisted mainly of animal products because there was no vegetation. They were nomads and didn’t have much capacity to carry food.
- The Masai of East Africa eat meat, milk and blood of sheep, cows, goats. The blood satisfied their salt requirements (hot environment, away from the ocean). When the Masai moved to the city and adopted an agricultural diet, the children became short (Orr and Gilks 1931).
- Native American warriors who ate buffalo were taller than those who didn’t (Richmond 1975).
- Professor Vilhjalmur Stefansson lived and travelled with the Inuit from 1905 to 1917. He ate what the Inuit ate: meat, fish, poultry, broth, organ meats. The macronutrient breakdown was: 115 g/day of protein (15-20% of energy intake), >200 g/day of fat (>80% of energy intake) and <10 g/day of carbohydrate (<2% of energy intake). Carbohydrate came from the glycogen in animal muscle. He did not get sick. (McClellan 1930)
- The brain requires~600 KCal/day. The brain can’t burn fat, but ketones (aka “toxic byproducts of fatty acid oxidation”). Ketones can become the predominant fuel for the brain.
- In a research study with 6 subjects locked up for 7 weeks the time to exercise (measure of fitness) went down, then up (i.e. the study didn’t prove the hypothesis, Phinney et al 1980, article available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC371554/?tool=pubmed)
- In a revised study, Phinney et al (1983, abstract available here: http://www.metabolismjournal.com/article/0026-0495(83)90105-1/abstract), used athletes as subjects. They were fed 15% protein, 80+% fat, and <2% carbohydrate (from glycogen) for 4 weeks. There was no loss of aerobic power and no difference in endurance, but a change in RQ (respiratory quotient) from 0.83 to 0.72, meaning that they were burning ketones instead of carbohydrate. They had reduced their dependence on muscle glycogen.
- The body energy stores of a 70g male athlete are distributed as follows:
- Liver glycogen: ~100g (2480 KCal)
- Adipose tissue triglyceride:12 kg (110,700 KCal)
- Muscle glycogen: ~500g
- Muscle triglyceride: ~300g
- Blood + extracellular glucose ~20g
- So fat stores are greater than carbohydrate stores. And an athlete hitting the wall is like a gas truck running out of fuel.
- Some endurance athletes like Tim Olson have learned to use ketones to their advantage.
- In a study with 40 subjects with metabolic syndrome, large waist circumference, and insulin resistance, low HDL and high triglycerides (TG), carbohydrate restriction:
- lowered LDL by 3% with change in particle size (less small dense, the dangerous kind)
- increased HDL, decreased TG
- decreased % of saturated fat in TG (because the body loves to burn sat fat for fuel, so it doesn’t accumulate. Forsythe et al 2008, abstract available here: http://link.springer.com/article/10.1007%2Fs11745-007-3132-7)
- Insulin resistance exists in a continuum that goes from carbohydrate intolerant (people with insulin resistance, type 2 diabetes, metabolic syndrome, obesity, expanding waistline) to carbohydrate tolerant (insulin sensitive people, athletes, normal BMI people). There is no perfect diet for everyone, it depends on where you fall in the continuum.
- Inflammation underlies heart disease, diabetes, Alzheimer’s disease, etc., and is therefore a major target for inflammation.
- The ketone β-hydroxybutyrate inhibits histone deacetylases, enzymes that remove acetyl residues from the proteins that pack DNA (histones). This inhibition leads to expression of genes that confer protection against oxidative stress. (Shimazu et al 2012, full article available here: http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23223453/)
Safety of KD during pregnancy?
We don’t know because we can’t study that due to ethical issue.
Is hypoglycaemia safe?
Since you’re not using much glucose your blood glucose is much more stable
Low carb paleo but not keto adapted. Is there any harm in going in and out of ketosis? What about cyclic keto-refeeds?
Everyone has to find their place in the continuum. If you feel/function well, continue doing what you’re doing.
If you’re keto-adapted, your muscles need more glycogen. If you eat carbohydrate, almost all will go to muscle.
How did cyclists feel in Dr Phinney’s studies?
The first 2 weeks they felt like crap.
Generally athletes need 3-4 months before getting completely get keto-adapted.
Ketosis + resistance training?
Dr Jeff Volek (Dr Phinney’s coauthor) is a competitive powerlifter. Enough said.
Is ketosis required for weight loss? Is saturated fat required for ketosis? Can you cheat with medium-chain triglycerides (MCTs)?
It’s not requirede but the more insulin the individual requires, the more likely to benefit. The A to Z study (Gardner et al, 2007, abstract available here: http://jama.jamanetwork.com/article.aspx?articleid=205916) suggests that insulin sensitive + Ornish diet might work but not insulin resistant + Ornish diet.
MCTs can’t be stored, therefore they are good way to boost ketosis but there are no studies.
Is there any benefit in trying to increase animal fat for people who don’t eat (a lot of) meat?
It’s recommended to increase omega-3 fat intake (from omega-3 enriched eggs, fish, etc.), avoid seed oils (full of omega-6 fatty acids).
What about Lipitor, does it counteract a high fat diet?
In a study, males on Lipitor were put on a ketogenic diet (KD), increased their HDL and lowered their TG. Lipitor and a KD are compatible and additive. This doesn’t mean you can’t off the meds eventually.
Where do I get my fibre from?
5+ servings of vegetables a day, some berries. There’s something about nutritional ketosis that makes you not need that much fibre.
When adopting a KD, cholesterol goes up. Is it temporary?
Cholesterol goes up when people lose weight rapidly. We store cholesterol in adipose tissue, therefore losing weight mobilises cholesterol. After 2-3 months it should normalise.
Strategies for travelling?
- Pete Evans: Be prepared, do the best that you can and don’t beat yourself over bad choices. Carry jerky, coconut oil, hard-boiled eggs, etc.
- Dr Phinney: Carry nuts, olive oil, sugar-free chocolate.
What about Bulletproof coffee?
- Pete Evans: Coffee is a stimulant. Why do you need it? Something is out of balance.
- Dr Phinney: Coffee is inverseley correlated with type 2 diabetes. It’s a personal choice. He has chicken broth with Kerrygold butter when he needs an stimulant.
Links and extra resources
Dr Kieron Rooney
Dr Steve Phinney
Tom Naughton: Diet, Health and the Wisdom of Crowds
Allan Savory: How to fight desertification and reverse climate change
Martha Herbert: The Autism Revolution
Dr Natasha Campbell-McBride: GAPS diet
Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frasetto L, McFarlane S, Nielsen JV, Krarup T, Gower BA, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti H, and Wood RJ (2014) Dietary carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Nutrition (in press).
Forsythe CE, Phinney SD, Fernandez ML, Quann EE, Wood RJ, Bibus DM (2008) Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids, 43(1), 65-77.
Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, and King AC (2007). Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA, 297(9), 969-977.
Orr JB and Gilks JL (1931) Studies of nutrition. The physique and health of two African tribes. London, H. M. Stationery off.
McClellan WS, DuBois EF (1930). Clinical calorimetry XLV: Prolonged meat diets with a study of kidney function and ketosis. J Biol Chem, 87, 651-668.
National Health and Medical Research Council (2013) Australian Dietary Guidelines. Canberra: National Health and Medical Research Council.
Phinney SD, Horton ES, Sims EAH, Hanson J, Danforth E Jr, and Lagrange BM (1980). Capacity for moderate exercise in obese subjects after adaptation to a hypocaloric ketogenic diet. J Clin Invest, 66, 1152-1161.
Phinney SD, Bistrian BR, Wolfe RR, and Blackburn GL (1983). The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metabolism, 32,757-768.
Richmond RW (1975) Letters and Notes on the Manners, Customs, and Conditions of North American Indians. American Indian Quarterly, 2(2), 146-148.
Saslow LR, Kim S, Daubenmier JJ, Moskowitz JT, Phinney SD, Goldman V, Murphy EJ, Cox RM, Moran P, and Hecht FM (2014). A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One, 9(4), e91027.
Shimazu T, Hirschey MD, Newman J, He W, Shirakawa K, Le Moan N, Grueter CA, Lim H, Saunders LR, Stevens RD, Newgard CB, Farese RV Jr, de Cabo R,Ulrich S, Akassoglou K, and Verdin E (2013) Suppression of oxidative stress by β-hydroxybutyrate, an endogenous histone deacetylase inhibitor. Science, 339(6116), 211-214.
Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, and Feinman RD (2008). Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids, 44(4), 297-309.
Westman EC, Feinman RD, Mavropoulos JC, Vernon MC, Volek JS, Wortman JA, Yancy WS, and Phinney SD (2007) Low-carbohydrate nutrition and metabolism. Am J Clin Nutr, 86(2), 276-284.
NB: Not all the references are mentioned in these notes.