Erythritol: Dangerous, but not why you think

Check out the video on Erythritol: Dangerous, but not why you think.
To Tuesday thank you for telling me about the sound tonight we are talking about ketogenic sweeteners especially erythritol which has been in the news recently due to the study that suggests it's linked to heart attacks and strokes so tonight I am going to discuss why you must be careful about those ketogenic sweeteners and why does it matter I.

Think you're going to be surprised at what my recommendation is we are going to start with tradition which is saying thank you for all being my sound check uh it was one little thing that I didn't do but when you've made the mistake this many times I knew exactly what to do so I am starting with the Traditions.

That show you what I do which is on this channel I am all about the numbers and the science and not that science but the real science not the one that makes the politics but the one that truly keeps uh on giving in a way that keeps us all on our toes I am going to start with checking my ketones and my glucose and I'll tell you my fast wasn't as perfect.

As I like it to be yesterday my husband kidnapped me and said lady you need to slow down um and still no sound no sound is good yeah you guys are all catching up um so ketones uh at 0.5 I expected that and glucose of 72. that even though I got in the sauna yesterday and I did sauna on Sunday and I did not eat.

Anything yesterday but I went to the beach with my husband had my bubble water and then I had a drink of his drink which had some sugar in it and I'll just tell you it's amazing how that does set back my numbers when I do any sort of cheat that is uh is in my fast so insulin resistance keeps teaching me I.

Have to check my numbers to keep it real as well so do not feel like you're alone when you say wow my ketones aren't doing what they're supposed to but I want to give a heads up for Karen who says yay for husband yes he is what keeps me really uh not not uh now it's a coming to the Pathology that lives within me which is oh there's always something.

More to do at the office um so he stole me sent me to the beach we had a great afternoon and I only did a little bit of work on the beach thank you we are going to talk tonight about uh some sweeteners and some of the science behind the sweeteners because if you're following this at all if you've looked at any of these news stories.

Which have swept the headlines I think you've gotten past the highlights um we're going to talk about that and then we're going to dive into what I think you should be focusing on and I will I will Loop you into that before we get into that I have a couple of uh easy announcements first of all I'm really happy to tell folks that inside our.

Store at bosmt.com we do have raspberry back in the house we are fully supplied and that's saying something because um I was not planning on being out of that as long I thought it would be a lot quicker turn around but under products if you click over you will find our our the first product I ever made which was the raspberry lemonade it is the highest.

Concentration of ketones in my supplements outside of pucker up and um and you can tell whenever I check my numbers on on the show and I use that I don't even have any for me so um I I have kept a secret stash of pucker up around though and um really uh I'll be using that a little bit tonight.

Not because I need to and but because I do like to show that when you use a supplement that works um it changes the numbers so we're going to check at the beginning and the end but that's not the most important thing I wanted to talk to you about um for those of you that do watch my Instagram one of the things I did on the.

Um on the beach yesterday was I went I did a little reel uh because I have had I don't know maybe more more than my fair share of folks writing and saying hey Dr boss I have a question for you hey Dr boss I have a question for you and so I did a real yesterday saying all right come hang out with me that's how you're going to get your questions.

Answered in person and the fastest and I'll be at ketocon I have a um I'm a I'm a little bit competitive so when Robin asked me to uh to to dish out a promo code for getting folks to attend uh ketocon not only do I want you to come see my lecture which I will show you a sneak peek about here in a minute um uh type in ketocon and when you go to.

Buy your ticket you should use promo code drboz because I think only a couple dozen of you have used it and I just think there should be more of you coming to ketocon truly is uh one of the one of the places where not only am I debuting this year's speaking lecture which I I'm giving you a sneak peek of right now this has nothing to do with sweeteners.

It is absolutely just me flexing saying look at where we're at with this um my my folks that show up at the pin chasers to do our support group here locally got to see a tiny little sneak peek of this this morning where I was taking one of their lab results and going through it and showing them what what is that thing that's on the page.

Right there what is a vldl and why the 50 nanometers matter and what happens after when it gets in circulation and what are those little red things anyways we've I've been working on the animation to make the understanding of cholesterol easy I am not done yet I probably have a hundred hours into this lecture that will only be 40 minutes and you will not.

Find it anywhere else except ketocon so come join me I'm not going to give any away any more of what I'm what I'm looking at here um I will turn it to the other slide deck when I get to the lecture but that attendance at ketocon I'm a little competitive and I sure would like to see more people using that code so.

Um and I'd like to meet you not honestly it's really fun um to see everyone's name in the in there and for those of you that have taken my courses I always love when the names that have been on the screen on Tuesday nights show up in a class and I get to I get to put a real person to who you are so if um if ketoka if Austin.

Texas is in your area April 21st uh is when it starts it ends on the 23rd there's some other really great uh folks that I get that I know and I can't wait to see again there's Dr Sean Baker and I have a very similar journey and we keep ending up at the same uh speaking events um I think his audience and my audience have a very high overlap so um other.

Folks will that will be there are Dr Mindy Peltz and I think benazadi also again all folks that I really am thankful to be a part of uh in this keto space so we are going to talk about this study that was in the news this past week and there's a lot of folks that have already put out uh some hour-long talks on about.

The study and what's wrong with it and what's what is it uh what's good about it um I'm gonna hit the highlights on that um because I think there's a there is a section that folks are missing and that is when it comes to these sweeteners what um.

What is it about this one but also tell me more about why uh why people should be paying attention to a couple other parts of the science that that the sweeteners that we know about these sweeteners so let me um before I get into the little lesson let.

Me give you the the punch line of what I thought about that study number one the study that we're talking about will be in the show notes I also have um uh the study uh probably my favorite review article that I I looked at several of them but this is one of my favorites it just kind of goes through.

All of the science so if you like getting into the in the into the nitty gritty and want to hear it more in depth of what I would look at to get some of my answers um I would uh ask you to click on those uh those articles that are in the show notes all right um so the article that came out really.

Had um it had some flaws uh but I don't think that they were all wrong in studying erythritol as one of the sweeteners that they looked at um what what they were trying you know the headlines all said yes erythritol is linked to heart attacks and strokes through blood clotting in the body and.

They looked at it um uh with uh with a very interesting something I actually did not know is that we have erythritol it's it's actually an alcohol sugar a sugar that's got a little bit of chemistry shift to it um we make um we we put erythritol in our.

Supplements uh out there by fermenting sugar and it turns out as sugar spins through our Krebs cycle there is a component that is erythritol in our body and when you look at who makes more or less of this byproduct in our Krebs cycle it turns out that it is you'll have higher blood levels of erythritol like not consumed erythritol but.

Naturally made erythritol in your system when you have high blood glucose and when you have high oxidative stress these are two key factors that that cause heart disease and um so to say that hey that erythritol was higher in their blood um in fact it was really high when we gave these eight patients that we were.

They were looking to see what does erythritol do in their system uh it was still high over a day after they consumed erythritol and it linked to blood clots I So Not only was there a whole bunch of things that I think they they stepped over I actually do want to give credit to the people who did the study because of a few things they were.

Looking at and when they were looking at studying erythritol as opposed to looking at some of the other sweeteners so we have several studies out there that say yes erythritol is a um well it's a sweetener let me let me go over to my slides really quick and just walk through some of the basics for those of you that haven't looked into.

What I think folks should know about sweeteners these are the alternates of uh how do we get that sweet taste into our system how to you know what do you use to um powered my pen go well I might not get to write on my iPad today guys.

Must have fallen on the floor nope well um we're not going to be ready on that they're one of the sugar alternates they're one of the ways we sweeten our our food without uh getting um without adding sugar there are actually three categories to this uh one.

Is called non-nutritive sweeteners the next one's allulose and then the final one is the sugar alcohols I'm just going to list you a few of the non um the non-nutritive sweeteners these are the ones like if you if you're really old like me you remember tab that uh drink that was from the 1980s uh well.

That that has um it's called Ace K that's one of the non-nutritive sweeteners really old um approved in night like the 1980s aspartame also very early 80s when that came to and instantly my cheeks pucker when I think of these because I think.

They really tasted yucky um but that's what's in NutraSweet or an equal um they're they're very safe uh they've had several safety studies done even looking at how how much does it take to get toxic on them and it it really they really are safe uh so when when they throw out a headline that says it causes.

Blood clots or it's causing clotting it really is unsettling to to us that have said no no they're very safe um but again um stick around to figure out what I think you should be worried about saccharin is another one of those non-nutrient sweeteners uh super sweet like 300 times the sweetness of sugar.

Sucralose is another one that's what's in Splenda and um of course Stevia is the latest in this uh this generation this trend of non-nutritive sweeteners stevia's you know supposed to be all natural because it does come from a plant but um it is very sweet compared to Sugar like two to three hundred times as sweet.

But it is also um known for not impacting the glucose are not impacting the insulin all right so of all of those non-nutrient sweeteners by far Stevia wins uh definitely the easiest to taste and not not nearly as difficult so we're going to skip to allulose which is uh the latest on the.

Scene and then we're gonna end with uh the sugar alcohols because that's working this little throw time uh allulose is made from corn so I think of a South Dakota um corn Farmer's Daughter the next saying yeah at least it's not the corn and beans that grows in the.

Rows and rows and rows it is a um it actually is a sugar it's um it's not as sweet as as sucrose is it's about 70 percent as sweet um and it's actually when you look at it chemically it's just a mirror image of what sugar is so it's chemically just kind of inside out if you would from sugar but.

Um um pretty it you know doesn't cause a rise in your blood sugars and it come you know goes is processed through the body without any um without any alterations all right so uh let's see let's go here the last one we're going to talk about is sugar.

Alcohols which is where our erythritol ends up erythritol is one of the three uh sugar alcohols Xylitol being another one there's actually about 15 sugar alcohols um oh I did have I wasn't sure if I had slides for these yeah those are the three those are the a monk fruit was the.

Other non-sweetener I forgot that one um and then allulose again um it is actually a sugar um and it's not quite as sweet as sugar and it is a mirror image of fructose again all the things I wanted to say uh last but not least is our sugar alcohols and that's where erythritol lies.

Erythritol um is the the latest one of these sugar alcohols Xylitol and sorbitol are actually um they're a lot nastier on your gut um when it comes to erythritol of the sugar alcohols and again these are all fermented from sugar they're changed chemical the chemicals change it from.

Sugar and ferment it but um they're pretty efficient in the way they are absorbed as well as excreted um of all the sugar alcohols this one erythritol is the easiest on the gut I personally think they're all terrible on my gut um there is definitely nausea bloating in gas that happens when any of these.

Sugar alcohols get in the system they are very low calorie I mean they don't they aren't a zero calorie like the non-nutritive substances were those the previous slides um but they are very low calorie so um this is where I am going to come back to that scene and talk through what I think people should be focused on so I have.

Some notes over here and if um if you want the super details of what I'm what I am pointing out you can find it in those show notes but I think um when people are talking about uh using sugar substitutes in their um Improvement of their metabolic health I wrote about this in my book that there is an approach of.

Uh ripping the Band-Aid off quickly or harm reduction so the first time I ever heard harm reduction I was in medical school and I was learning about HIV harm reduction was when they were giving out uh IV needles to people that were infected with HIV and at least the clean the needles were clean since then harm reduction has been used in lots of.

Different ways about how do you change a behavior that is leading to a serious detriment or a serious handicap of their health what's the first few steps that you do to lower the um the abuse so we have lots of other places in medicine we do this when patients come in and they're on you know addicted to opiates or heroin we use.

Buprenorphine or Suboxone to dampen how their receptors and their brain are are working in an addictive State when it comes to alcohol there's actually several receptor things that are again harm reduction to get them to to back down on the alcohol before we say hey this isn't working we need to go to rip the Band-Aid off quit.

You need to quit having alcohol again having many years of advising people I have my personal opinions of different chemicals we're going to go through that the science of that here in just a second so uh here's some things that I think should be pointed out I have notes over here so let me use them uh number one.

Eating causes an amplification of dopamine meaning a ramp up of dopamine in your nucleus accumbens which is very similar to what happens to people with substance abuse so my forte in the last 25 years of taking care of patients is always how do you get Peak brain performance and when you look at some of the.

Addictive behaviors I actually don't think it's an accident that I spent all these years working with several other addictive substances before I landed on oh carbohydrates or the love for sugar so when they when you ingest foods that are palatable foods that taste good it increases the dopamine production it is greater than in.

Standard Foods so when you take foods and you say here are what we would call foods that don't have a link to sweetness and then you add sweetness which is how it gets to be ranked on how palatable is it how easy it for is it for a um for a baby to like sweet allows the highest uptick of.

Dopamine it's easiest to like those Foods so we call them palatable so given that these palatable foods are they stimulate the same Pathways as drug addiction it has uh it is suggested that when you take in excessive sugar it can lead to this.

Addiction uh I don't need to have um uh a long list of um of examples to show patients exactly what I talk what I mean with this it only takes a few times in uh inside a ketogenic diet and then the relapses that happen um in as a consequence for those um.

Those times on a ketogenic diet they do really well and then one little bite lands them in a ditch and then the ditch gets full of mud and then they get stuck and then they're about six months before they ever say I gotta get back on track it's very real um especially in the I mean the number of times that patients have said yeah.

Doc I need to get sober and they step into that Arena of here's where here's the steps that we can help you to get sober um and as soon as they have one drink they we don't see them for six months so that same pathway in the nucleus accumbens that it leads to heightened production of dopamine with with addict.

With drug addiction is the same pathway that happens in people who have um they eat excessive palatable Foods so long-term consumption of sugar causes withdrawal symptoms that have been observed especially in animal models to be as addictive as morphine and nicotine dependence food addiction leads to this same.

Expression of dopamine receptors and I'm going to show you some of the some of the examples of that one in a slide here in a minute when we look at the images through functional MRI or other neural Imaging that looks at the dopamine sensitivity in that nucleus accumbens which is again this really important part for brains of addiction.

We see that there are dopamine receptors are decreased in how they listen how they're they take it takes more stimulus to get them to feel better and that's exactly the same pattern that happens in drug addiction we see that in people who eat palatable Foods over and over again that is sweets uh what's a sweet does to the.

Gut what the sweet does to your blood sugar I'm not talking about that I'm talking about what it does to your brain so I think that it's very um um that it's inversely that the dopamine expression is inversely related to your body mass index in obese patients so as the body mass index goes up the.

Expression of the dopamine receptors gets lesser meaning it's they're just not listening very well they're very um um especially the the D2 receptor that's highly linked to that drug addiction what this suggests is that there is a chronic.

Um exposure that when you chronically expose people to sugar or those palatable Foods the sugar decreases um the decreases those those receptors and they are um it's like they get a dopamine deficiency.

As they the more they overeat the more they overeat the higher their body mass index the less pleasure they're getting and it's not just a theory there are less dopamine receptors in their brain the longer they stick to those high sugar foods those highly palatable Foods so when you look at the several areas of um when when people have chronic food.

Um um you know that excessive chronic sugar consumption um that there is there are modifications in both the metabolic side of their body as well as the the the the sensory or nerve side of their their body the metabolic stuff we've talked about on.

This channel that's where your um your insulin resistant your uh your insulin your insulin receptors are higher you've got uh they don't listen as well to the insulin you have higher fat cells they are less likely to put sugar in out of the bloodstream it gets stuck in the bloodstream those are all the metabolic sides but as that chronic addiction that.

Chronic consumption of Highly palatable foods and I keep using this word palatable because I don't want you to think it's just oh well that one has sugar in it if I have a sugar substitute it doesn't do the same thing yeah it does that's the whole point what I'm getting at um.

So so as you look at um the the The Chronic nature of uh someone who is um truly addicted to food I think I put this one in here um um they they have something called a.

Cephalic phase response and this uh is something I saw several blog articles just touch on and then hop right over I mean it is pretty interesting neuroscience and the studies on them are they're really well fleshed out in animal studies but not so much in human studies where we can see oh we can see it happening we just can't prove.

That it's the same thing that's in the animals where the cephalic response is when people say talk I can see uh I can see calories and put on weight I can see carbohydrates and put on weight uh well the truth is that there there is truth to that now not put on weight but put on that on that decreased pleasure Sensation that happens when they're.

Chronically addicted to palatable Foods all right so um let me see the com I'm gonna read this part because it's really the combination of learned responses with metabolic and sensory signals is a specific pattern of food intake it responds to sensory inputs such as the taste texture site of.

Food including the consecutive pre-absorptive physiologic response that's what happens during this thing called the cephalic phase response meaning they see the food they anticipate or the food and when somebody has been chronically eating sugar the changes in their brain start to happen the hunger for the addiction they.

Cannot just stop at one bite that's not just an accident that is actually physiologically happening because of the way their brain has changed over the course of eating highly palatable food again and again and again um all right so then here here's okay I'm actually going to read the rest or go through the rest of this after I show.

You these next couple of slides because I think these slides will show you what am I exactly talking about is it you know can it be um said that let's see if I can turn this in here all right so we are going to I really wish I had my PIN um so I want you to notice the word dopamine over there okay big highlighted dopamine uh I'm gonna show you we're not.

Gonna go through all of them but I'm going to show you several of these neurotransmitters that happen inside a brain and of course when I start to talk about this I'm not going to talk about food I'm going to talk about what is very well known to most of you just look one more time for my PIN I bet I'm.

I don't know where it is I'm gonna get done with the show and it's gonna be sitting right in front of me all right so let's just keep going so here is uh what happens when um you see that the purple arm that's coming down from the top there it is yeah Al Gaba comes binds in that receptor it sends a message Downstream.

And that little shiny light was the stimulus of dopamine and Gaba is one of the many things that makes us feel pleasure it makes us feel happy um um when you look at mimicking drugs such as alcohol it goes to that same receptor it parks in the same spot that the Gaba did and I don't know if you noticed that.

It was even more sparkly that sparkly happened um because uh it's parking there a long time when it parks there chronically uh again the your body's gonna say well hey you can use my Gaba right but it goes to try and park there and it doesn't have there's no place for it to park so the amount of Gaba that it produces is less.

And less and less um a similar thing happens when you use benzodiazepines they look like gaba2 but benzodiazepines are made to mimic alcohol they are if you want the alcohol to last for five days we call it Librium if you want the alcohol effect to last for three days we call it valium two days we call it Klonopin one day we call.

It Ativan but all of them are parking in that exact same parking spot where alcohol did and where our Gaba did when it perks they're that long for five days your body's like forget it we do not need to make any of this what's supposed to happen is a recycling process and but that that circuit gets burned when.

Um when when the parking spot is filled with a chemical such as alcohol here's just another prettier way to show that so these are this is supposed to be a nerve where the signal is coming from the top and shooting to the the nerve that's at the bottom so we have one uh one place.

Where the vesicles of um of a neurotransmitter are being built and recycled and then we have a place where the they they they will swim across the synapse they do not cross into the other nerve they just stimulate the receptor and get recycled so here's what it looks like so if you take one of those little vesicles it'll it'll make.

Its way to the end and then it it releases that neurotransmitter into that synapse and it sends a message as it does that those little vacuoles empty in order to be efficient with our resources the human body um it recycles it up on the sides of that that top neuron so watch this um.

So it see that little that's a little vacuum so in fact when I give you Prozac or Prozac Paxil Zoloft Celexa Wellbutrin Effexor it's blocking those little vacuums it keeps that chemical in between the synapse because it blocks the reuptake it blocks the vacuum and indeed it does help people feel better but when we look at folks that.

Are let's go over to nicotine so nicotine is designed to look like acetylcholine acetylcholine usually goes across I don't know if you can see that pink one I was supposed to draw this with my pen but uh it would go across that synapse and bind um and that does its little thing until nicotine comes and binds in its place.

Which stimulates Downstream dopamine and it uh the more nicotine that's in that receptor the longer it hangs out eventually it decreases the signal for the body to make any of its own acetylcholine so when they stop those cigarettes and say well I'll just make my own they're super tired there's no.

Acetylcholine in there for their systems to um I mean it's all empty there has been no stimulus to make it so that's why the withdrawal symptom from when people give up alcohol they actually have depression for a long time because Gaba one of our hormones that's supposed to prevent the.

Stimulus of depression well you haven't been making it the signal to make it has been blocked and you've still made dopamine but over time notice what happens Downstream now where the word dopamine is Watch What Happens so that nicotine still stimulates it and at first you recycle it but because there is the constant whipping of the body to.

Try and make dopamine at a high at too high of a level uh the dopamine production also decreases and you now just don't have as many in the vesicles they can't stimulate it this same process happens in people who are chronically in taking palatable Foods palatable Foods include these sugar alcohols these sugar.

Substitutes that um phallic phase I'm going to go back over to my uh this side and finish with that so now that you've seen what I'm talking about that it's not just a um all right so the.

Um okay the final thing I wanted to go through was that when's once oh I did put this in here I'm gonna go back to my I said when sweeteners are not associated with calorie intake their ability to sense energy is forever.

Is altered until you reset those vesicles inside inside the neurons that I just pointed out it also um when sweeteners are not associated with calorie intake so that is what that is what erythritol is our ability.

To sense that energy was coming in becomes altered um and it eventually reduces the ability for uh us to use energy and suppress satiety so let me just unpack that a little bit more as you uncouple um sweet tastes.

From energy you know putting in sweet taste and let's just go back 300 years putting in sweet taste is supposed to be associated with a high amount of glucose intake but as we have evolved to have sweet tastes end up on our foods that have no energy they're low calorie it it weakens that condition of uh well how much pleasure are you going to get out.

Of this bite so now a super sweet taste that should give you plenty of joy and dopamine and pleasure is now muted so then they start to eat more just like the alcoholic just like the nicotine user that consumption of the outside stimulus for that receptor becomes well it's there all the time it's super humid it's super natural and as a result the.

Sweeteners um say oh you're taking in energy but it Alters our ability to to feel that energy so even I mean the worst way this decoupling happens actually is when they consume carbohydrates so if you wanna the the summary that I got to it by the time I was reading all all through these papers and looking through.

Several of these studies was well here's the best way to take in erythritol first of all I do not think the study links to heart attacks or Strokes the way they wanted it to I think there are plenty of safety uh parameters for using erythritol we know that it does help people lose weight in the short term what I think people are missing is what.

It does to the neurologic uh reward for eating High highly sweetened foods and the price that you pay is in The Chronic use of that um so when I got to the part that said the worst thing that happens is when you take those sweeteners and you put them with a bunch of carbohydrates or you put them with a bunch of small particles so.

You take a pastry and you say I'm going to make flour and I'm going to make a erythritol sweetened I don't know crepe or erythritol sweetened um croissant I mean just something that's filled with fine powder fine flour that would be the highest impact for suppressing the joy and the dopamine it.

Turns out the food that would be the best to put that on is fat or meat so I'm like I'm not sure how how palatable that would feel to say here's a piece of uh you know a chicken drummy let's put some let's put some sugar on it let's put some sweetener on it um maybe I guess you can make a barbecue.

Sauce that has a little sweetener in it and you can have it that way personally I have uh I've done this dance many times with patients and the harm reduction is real the beginning where they're trying to see how do you count a carbohydrate how do you decrease the amount of sweetness I let them run their course in.

Um in using the sweeteners at first but about the time they get to keto Continuum number five where we're using time restricted eating we're going to be hopping over to a 36 hour fast not too far after that I really start to say this this habit is got it you gotta you gotta look in the mirror and address this you're not getting the kind of.

Pleasure that you that you really wanted to get from your um from your food that um you know my my husband and I have a rule he's definitely allergic to all this stuff not just that you get diarrhea like Stevia he gets mouth a ulcers and.

Gets bloody diarrhea like he I I think I've told him the story before that when we were first figuring this out if I wanted to know if Stevia was in something I would say hey honey take a bite of this and if you got mouth Fosters I'm like oh there's Stevie in that one okay I don't do that too anymore it got.

Worse and worse and worse but we all we both learned that um I'm better off and again this is after I've lost most of the weight I you know every woman could lose a few more pounds but I've lost most the weight most of my metrics are pretty good um that if I'm gonna have a bite of.

Sugar it's going to be real sugar it's going to be a small amount and it shouldn't be more than once a month I mean it just shouldn't be that's what I when I'm having it more often than that I start to count down I start to Crave it I start to want it and I know that in the past where I've tried to say well I'm gonna try how's this new.

Sweetener do you know I think when alulose came on the market I thought oh I'm going to try that oh my goodness I was so sick I didn't do any anything lovely to my gut um and it really just triggered me to want a lot more sugar that whole addiction to sugar is something that I had hardwired into me for probably 20.

Years 15 years at least and and it wasn't until I got on the ketogenic diet and really said okay I've got to decrease my want for that sugar and by adding a sweetener that whole cycle that I would see in people with drug addiction man it would turn right back on I would turn right back on like oh I really I really want it I would.

Think about it I would dream about it I'm like that's nuts they call that a using dream when you're taking care of patients with addiction all right we are going to go over to your questions in just a minute I do want to just take a minute to uh look back through several of the folks writing in and say I it's always lovely.

To see so many of you um there was one person here that I wanted to make sure I said hello to um I can scroll back on the side over here oh Philip Hugh is here I just wanted to say hello to you Gail Johnson is another one I wanted to make sure to say hello to Deb from New York Karen Lee.

Edwards um and um right at the beginning was my uncle went back oh Jerry Cash that was one who showed up at the beginning yes yes nice to see all of you um I'm going to go over to your questions here again and answering your.

Questions is part of what I uh not only enjoy when I do a lecture like this I'm curious if it was something that you had any questions about where are the places where does this make sense um or is it something that um maybe maybe you already knew it um I've talked about addiction before but probably not to this level of.

Neurotransmitters so let's get over and take a look at your questions uh here we go all right so either I'm on the wrong page or there are no questions oh they're there I was on here we go holy mackerel we got questions okay so Bobby writes in and.

Says please uh discuss uh prolonged fasting for chronic kidney disease and retinopathy okay um let's I'll do that I see the next couple ones are about the sugar alcohols but let me answer Bobby's question first so prolonged fasting with chronic kidney disease so let me just start by saying.

Um if you want to see the most irritating thing I see in the ketogenic world that I have to really work to not reply to it's when people say oh my gosh fasting is bad for your kidneys I can't do that it's bad for my kidneys the first person I like to point you in the direction of is my my call excuse me.

My colleague um Jason Fung who takes care of kidneys that need to go on machines for dialysis and one of the first thing him and his partner Megan Ramos do is they have them fast for like seven days now in my program I do not fast for seven days I don't have patience fast for seven days mainly because I'm after the long game.

And I hope you're coming to me long before you need to see Dr Fong or Megan Ramos about a dialysis um they're great at it they also do a lot more supervision when they put folks on those fasts uh so I Bobby I answer your question in that to say some of the best experts in the world know that if you have chronic kidney disease.

Um one of one of the most destructive things that you can do to the kidney is keep a high blood sugar the um the reason someone would have chronic kidney disease with retinopathy or the destruction of the back of the eye is that the microvasculature the tiny little blood vessels at the back of the eye very similar in size to the tiny.

Little blood vessels in your kidney have been um well they've been sacrificed The Chronic blood sugar that's been elevated the chronic inflammation that's been elevated is your enemy so when I look at folks that have these problems um I make no guarantees because it.

Really depends on how long this has been going on but the only way out is to lower the blood sugar lower the insulin and in my in my success um I don't have them start out fasting but they definitely do get to the fasting part I'll tell you that most people with chronic kidney disease and.

The retinopathy they have several other health problems those if those are on the problem list um there's a whole bunch of other things that you know their brains probably not as sharp their metabolism is pretty slow their gut probably is not doing what it's supposed to it's not as sealed as.

It needs to be so they're probably deficient on several vitamins so they have a lot of things we need we need the long game we don't need the short game so anybody with chronic kidney disease I'm say I won't see you until you've got that workbook and you've got that figured out and I usually have had them I mean looking forward to how I don't.

Have it all figured out how my Clinic's going to work here in in Tampa but um most people don't need to see me they do need an intense course they need to be shown how is it that I use this in in the world of repairing people and that's what we teach in that 21 day course where you don't need me you need a real example of how a support group works and.

How intense this can be but um Bobby it's a long answer because it really means a lot to me my dad died of kidney disease his was probably from The Chronic use of of pesticides as a farmer but when his kidneys were failing the only thing that kept him functional and on the out of the hospital was that he was on a strict ketogenic diet he had my.

Mother to live with it um so let's move on let's go to um the other questions here we go Lisa writes in and says sugar alcohols can affect the gut health right aspartame can be addictive both of those are true I actually think that it's why when I.

Look at the the recommendations I have for sugar substitutes unless they just can't make it through um the only time I have them use it is when they're putting in ketones again I think ketones without any sugar substitute that tastes just fine but that wasn't how my palette started out I needed sweets I wanted sweets I craved.

Sweets um when I when I throw the dice out for cost versus palatableness on your gut uh Stevia one in when I was picking what sweetener to put into the um the ketones the Ketone powders the sugar alcohols they were more.

Expensive and oh they just trashed their gut um now I did that knowing my husband's allergic to it like he can't have those at all so he does do the ketone ketones in a capsule he actually was the one who encouraged me to do this I'm like um it was he he would he he chirps about the taste it's really it's called pucker.

Up because it tastes like a really sour lemon but there's nothing else in it just beta hydroxybutyric acid it is just liquid BHB liquid ketones and it raises ketones like you can't believe um so yes the reason I stay away from sugar alcohols is I will I will gas my husband.

Out of the bed if I do that it's just awful I think they just rip my gut up and it's not just me it's because it's really destructive to that um the lining of your of your um your slime layer lining your gut gut biome is the other name for it all right.

Um Fast Eddie's wife is there a trick to getting low glucose and high ketones you mentioned it in an old live like a 68 and 3.5 yeah there are tricks to it um the tricks are in all in the long game um so Eddie it it definitely matters at.

Where you're at on the Spectrum as far as your health if you're brand new to the ketogenic diet if you're in that time where ketones are just a flood you have a ton of ketones coming out of your system because you have lowered the insulin you've lowered that uh glucose or lowered that carbohydrate intake.

Um boy that chemistry shift is just amazing their ketones just rise up once you've had um uh that that ketogenic um adaption like they have that wave and.

Their body says okay we're not in the business of wasting energy we are trying to match the energy that you use and that flood of ketones is way too much energy your body's not using it all it's peeing it out and although it's great because it'll Bridge you that you don't die of starvation when the resources are low what it will do is it will lower the.

Production of ketones to what your metabolism is and that's where we need to start boosting metabolisms as well as feeding it in a way that um that really is helpful um I'm going to show you something over here on um um so there's a couple of uh places that I uh let's go over here.

Okay so on our page if you go to the front home page and you scroll all the way to the bottom there are several videos that people have uploaded um and I I meant to tell you that earlier but the reason I'm bringing it up now is there is one woman who put a 30 minute I should put the link to her uh thing in my.

Um so here are these uh videos where I ask people who've taken the 21 Day course saying put in a video and tell people about what you thought and man I was looking at them I was watching them and then reading several of them just delighted to see what this did for patients so I encourage you to look at that because you're gonna a hear a lot.

About what patients thought about um the course but there's specifically one person who did the hack that you're asking about and she recorded it um I think she's called the keto woman uh keto woman podcast uh not that's not quite right um uh I wish I could think of her name uh.

So I watched it last night it's probably on my search history here on my YouTube channel um where she did the Sardine challenge So Fast Eddie's wife uh one of the key things is to do a true sardine challenge we do this with everybody in the 21 day and we we lower glucose and we Spike ketones it is truly a metabolic.

Challenge where again we are we are really lowering the amount of carbohydrates we are putting in um portion control because when you're eating only sardines and that sardine fast does not start until the first sardine hits your mouth as it does that you can start the timer for 72 hours the only thing they get to eat for three.

Days for 72 hours is sardines well this gal um uh she she put uh her experience online and I just sat there and watched it with a big smile on my face uh and really saw that she Not only was she way better at cooking sardines and figuring out how to make them taste good than I am but her.

Experience of how she um about how she handled it about some of the things that were very stressful like to give up to have I mean it is no carbohydrates it is only cans of sardines for three days but if you want to see your glucose go down and your ketones go up 72 hours the final hour of.

That 72 hour fast you have to eat another can of sardines the first hour you don't start until the first bite you do not start the timer till the first bite uh once you've had the first bite that can and now you I encourage you to at least have three cans a day it should be three to five you can have as many as you want you can have as many as you.

Want anytime you want anytime you're hungry there's no eating window there's no eating hour you just 72 hours of as many sardines as you want and Watch What Happens that's that's the that's the secret okay let's keep going um all right Sarah writes in and says um new to keto.

Um my hands and feet are swelling I think it's because of higher sodium suggestions okay so this is a great um segue I actually just did another video on this that'll be coming out I think in a week or two but yeah you're gonna need salt for this diet but when you first get on this you have to decrease the sugar while you increase.

The salt and when you're doing that transition if you're not watching things it can be well you can hurt yourself people on high blood pressure medications they can see it really Spike if they're not doing it right I I walk you through it very carefully in that workbook right there keto Continuum uh you can get it on.

Amazon you can get on my website either way that um those steps of how you do that is especially if you've had um years of not doing well years of being too metabolically sick which is high blood pressure being overweight especially around the middle and then if you've got swelling in your lower.

Extremities that's another really important sign that you're probably struggling More Than You Think You Are um oh I love this next question uh vo says can a thickened gallbladder be reversed or is it the only way to fix it to take it out well it's been a few years since I've done a gallbladder one.

Um I mean I think I think I have an official gallbladder video out there because everybody asks about it but some of my favorite stories about the ketogenic diet are because or through the gallbladder those are the first ones where I had the ultrasound I had it in their chart that they had gallstones and we.

Put them on a ketogenic diet and I was worried about the gallstones like what's going to happen um let's remind you what the gallbladder does the gallbladder is there to hold bile bile is a secretion from your liver that um.

That you secrete out into your gut into the the area where your food is and it will emulsify the fats that you can absorb those fats especially longer fats um but specific fats need to be emulsified by bile so you have to have this around in order to produce um to absorb those fats and get them into your system so when people have a.

Thickened gallbladder it's almost always because they've had high sugars and low fat they haven't been using their gallbladder as much it's kind of stiff and out of shape so the first few times we ask you to squeeze it and it's thickened it's usually swollen and inflamed so if you go in and you only eat a KitchenAid diet you can sometimes.

You know get a really sore muscle and if if the soreness is because well there's a little Stone that's clogging one of the hoses well that can be actually a medical emergency that part you need a surgeon for but most the time it's not that um when you have you know that waves of.

Cramping pain that happen when you have a stiff gallbladder that's out of shape it's much like well if you've not done squats for a while do 50 air squats before you go to bed tonight and then tomorrow morning when you get up to go to the bathroom and you say oh my goodness why does that muscle hurt so bad.

That's because you haven't used it in a while and now you overused it when you first go on the ketogenic diet you you can have a very um strong workout for that gallbladder now for those of you that don't have a gallbladder your body learns to make the amount of bile that um that you need to emulsify the fat.

That you usually take in in fact during the Sardine challenge I tell patients that one of the reasons their ketones go up day after day after day is in part because your gallbladder gets or the production of bile if you don't have a gallbladder then it's the production of bile your gallbladder and the production of bile get more and they produce the.

Amount of bile based on the history of how much fat you've been eating so when they go on a ketogenic diet they level up their amount of fat that they've been taking and their gallbladder says oh we got a new formula we got to keep up with this new way of eating it doesn't do it on the first day and so sometimes they have more diarrhea than they should.

Because they can't absorb the fat it's just they didn't make enough bile the next day they make a little more by the third day they're doing a good job of secreting um the amount of bile for the fat that they're swallowing it matches better and that absolutely is part of why a their satiety Is So High by day three because.

Gallbladders and satiety really do work together um and it's it's not without um their own limitations of are they able to keep eating those sardines all the way through that final day of um that our final hour of that 72 hour fast um.

Uh it's why I marked the Sardine challenge by the first bite um not like you do fasting where you say okay I just got done eating now I'm gonna start fasting no that's not how it works you don't start the Sardine challenge until the first bite of sardines um all right I'm gonna check my numbers.

Again here again um even though I did a good job of not eating um that little bitty um teas from husbands uh drink yesterday totally did it totally did it I'm totally gonna blame husband.

I don't regret the beach 64 is my glucose and oh my gosh Ketone is 7.4 I must have ketones on my fingers I'm gonna check it again that can't be right but if you touch that pucker up you can make your numbers look really high I'm just gonna look one more time here it's not the right color I can eat this one.

Ketones is 7.4 that I mean would be great if that's how high it might up Made It Go I mean I knew I was on the rise because it's been I mean two and a half days about 68 hours since I've eaten but okay let's try again here all right one more time on the ketones glucose is 64. ketones.

For those of you watching this on replay I do have a really good very well edited oh 3.2 that's more normal uh that I believe um a really well edited um video on sugar substitutes when we did the documentary with uh Michelle one of the episodes was all on sugar.

Substitutes and she asked all the right questions and we answered them for you it's a lot better edited than what I did tonight as far as uh the specifics about the different types of sweeteners I hope you like this I would love to know in the comments I will see you next week and if you like this we'll keep doing more.

Um I love talking

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