Mediterranean Keto – My Involvement on a Breakthrough Study (full interview)
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Mediterranean keto I have been talking about it for close to a year now and now we’ve got a little bit of a research okay we’re starting to push this over the goal line a little bit so this video is going to be interesting I’m gonna bring on someone that I’ve worked with a lot dick nor Wits and we’re gonna talk about a particular paper that was just released in frontiers in medicine really cool stuff because we talked specifically about the ketogenic diet and Mediterranean cents now this is a study that I was a part of and I’m proud to be a part of one the reasons why I’m bringing it in front of you now I will note it goes on for about an hour and it’s fairly dense in some pieces so I don’t expect you to fully just be in front of the computer screen the whole time if you don’t want to be but maybe turn this on and listen to it like a podcast listen to it while you’re cooking while you’re stuck at home whatever okay because it’s very very very enlightening we talked about lipids we talked about how Mediterranean keto can affect inflammation in a lot of ways but more so how it’s affecting cholesterol why you might see your cholesterol go up why you might see some changes anyhow really interesting stuff I do ask if you haven’t already please hit that red subscribe button and then hit that little bell icon to turn on notifications and also like to give a big shout out to thrive market they’re an online-based membership grocery store so you can click on the link down below after this video and check out thrive market they have a lot of good Mediterranean keto options so I have like keto bundles and everything like that so you can get what Thomas would typically get at the grocery store anyway after you listen to this or watch this please do check them out down below in the description you’re not gonna want to miss it out so now I’m gonna go ahead and I’m gonna bring on Nick noir wits and we’re going to talk about this frontiers in medicine paper so hang on a second let me go ahead and grab all right so I’ve got my good friend and colleague Nick Norbit so Nick is a Oxford ketone PhD researcher as well as a Harvard med student but the cool thing is he’s the lead author on this paper so he and I have worked together in a lot of different things but this is a really cool study because it talks about the Mediterranean keto diet in such a positive light and so many things that I’ve talked about on my channel so Nick it’s so good to have you on the channel man thanks man so here the beer yeah well let’s just go ahead and jump right in because I know everyone is you know their time is precious and we want to be able to just get this information out there so give us kind of the overarching view of what this research was about what was this was this paper all about and then we can dive into the nitty-gritty so the purpose of doing this paper kind of is I feel a lot of people go to their doctor they’re on a ketogenic diet they’ve had great results for whatever maybe it’s wait maybe it’s irritable bowel syndrome whatever it is but they notice an adverse change in their lipids or a superficially adverse change of the lipids their GP freaks out they say get off the diet go on a statin or at least they suggest that and people don’t know then how to respond it’s like you’re caught between a rock and a hard place you’re obviously concerned about your heart health but this seems to be working for you so the question arises you know we’re learning more and more about Cardiology lipid ology are these changes we are seeing in blood lipids you know the increase in LDL and some people Dave Feldman calls in the lean mass hyper responders I’m one of those my cholesterol shot up when I started keto is that actually a bad change or is it not and I think we need to delve into that a little bit more deeply get into a little bit more of the nuance than most people appreciate so ensure this is kind of a paper for people to have in hand to bring to their GP if they have you know negative changes negative changes in their blood lipids so that their their doctor can look at and say oh this is interesting maybe I should order these tests to get a little bit more informed about what’s going on in your metabolism to see if this is good for you this ketogenic diet or maybe you should change it up yeah and this is gonna be cool this is really gonna give a little bit more of a practical application for the you know it’s you you look at research you don’t typically have a way to say okay well how can I take this and show my doctor how can I take this and you know like get something out of it so because of the same kind of thing first two years that I was doing the ketogenic diet you know nine ten years ago my cholesterol was extraordinarily high and then eventually it did balance out but will those wildin which we’ll talk about a little bit more as you know my inflammatory markers were significantly down so you know obviously we’ll talk about that so it’s like the combination seem to be down although cholesterol is higher and this study just you just go to write any of it so yeah most piece is totally integrating the basics the basic tests we do and you get a standard lipid panel the doctor will just order like total cholesterol HDL LDL triglycerides and that’s it and you don’t really get to see you know the breakdown in germ types of particles and how inflammation oxidative stress tie-in and so what’s kind of exciting about this paper if I will pat myself on the back a little bit is that and kind of an unprecedented manner it delves into the nuances of lipid ology not just the superficial level and so you know changes that look the same if you have an increase in cholesterol say eating a terrible McDonald’s diet versus eating a clean Mediterranean keto diet they’re obviously very different metabolically one would expect but you don’t see those changes on the lipid panels and the type of lipid panels we do you actually see the changes very interesting yeah and that’s obviously why I wanted to be a big part of this study you know say the Mediterranean keto keys like I promised it to my audience I said if I get when we started releasing content surrounding the world of Mediterranean keto which you know you and I have teamed up a lot on you know said hey we’re gonna do everything we can to be able to feed the research with this so you know I was honored to be a part of this study as well so thank you for letting me be a part of it’ll tell you very much followed up on your promise to your viewers I made sure that the last two words I think except for the references at the end are Thomas stole out everybody can go click on the paper and see that yeah by the way like we’ll talk about the the nitty-gritty of this paper but building the link below down the description so anyone that wants to you know fully read the paper you don’t just have to take our word for it you can you actually read the science yourself and print it out take it to your doctor but you know Nick so tell us just about the subject what the situation was what we’re you accomplished and then we’ll dive in a little bit yeah so this particular subject a dot wasn’t gonna adopt a ketogenic diet this was about eight months ago nine months ago seven months Oh anyway about eight or nine months ago and we predicted like we thought this might happen that you might have because Dave Feldman’s characterized these lean mass hyper responders he was of the phenotype so we thought okay there might be these weird changes in his blood lipid so let’s do this baseline test let’s do a in-depth lipid profile like never before so that we can follow him up over time let’s do it in it was a seven month follow-up and to see you know how things actually change we made this hypothesis which turned out to be correct and we’ll talk about that and a little bit of depth just to give a little bit more background the reason this individual was starting a ketogenic diet was for ulcerative colitis and irritable bowel syndrome the reason I mentioned that well it’s mentioned in the paper but that’s another condition just as an aside that clinicians report on widely that the patients who go on ketogenic diets for XYZ reasons have improvement in irritable bowel syndrome or colitis or Crohn’s it’s not actually reported on much but we report on this paper that this patient goes into complete remission comes up on medications and remains in remission and the inflammatory markers like dropped to non readable the HS CRP which is a common inflammatory marker that follow-up was less than 0.03 couldn’t actually register so inflammation went down well yeah any kind of you know ulcerative colitis or any kind of inflammatory condition like that is of course at the very root inflammation so and we’ve seen you know as far as nuclear factor Kappa B as been as far as nlrp3 with ketones we the research is pretty pretty clear as day right so so that’s no real surprise but I think when you get down to the gut level there’s probably even more that’s he hasn’t even been discovered yet realistically yeah that’s an understatement when it comes to the microbiome yeah for sure okay so you’ve got it so you’ve got a 23 24-year old individual who’s suffered from ulcerative colitis we adopted a ketogenic diet what kind of ketogenic diet did you adopt it was a Mediterranean style now this was more or less inadvertent it’s the style I know you and I practiced we think it’s kind of optimal we talked about it it’s like a perpendicular diet you know Mediterranean is all about the best types of foods Kito’s about your macro so you find the intersection and that’s a awesome diet at least it’s a start this individual just happens to really like that kind of food he was already eating a Mediterranean style diet ish it just included a like lots of fruit for example or higher carb vegetables starchy vegetables sweet potato and stuff so very healthy diet it wasn’t let and this is important because in some cases when people go from diet ex to diet why if they’re starting at a terrible baseline then it’s an unfair comparison totally I know we talked about the game-changers before and sigkill we went on a vegetarian diet and it was awesome but then he didn’t like he was eating KFC chicken nuggets for his protein before so if that’s your comparison it’s not fair in this case the subject creating a very clean diet all Whole Foods it wasn’t keto it was Mediterranean s but it wasn’t keto so he went on to a Mediterranean style ketogenic diet lots of fish olive oil avocados lots of monounsaturated fat sources tons of olive oil like a cup a day which talked about the nuance of that at the end because while things improve for the subject I would argue there were some things that didn’t and we can talk about olive oil hormesis later yeah yeah back up for one second because you said something you people all really have to realize you know keto is not a ketones aren’t necessarily a macronutrient I mean although they are kind of the fourth macronutrient you’re nailing it right here by showing that someone that was eating a clean diet and then going to just a just a ketogenic version of that clean diet suddenly starts to see all these benefits and all the you know all sort of colitis going into remission I mean that’s just kind of I want to say prove because we don’t want to say that a scientific community but it’s demonstrating in at least a ketone has an additional property outside of just being a macro-nutrients you’ve got to clean diets one that is glucose driven and one that is more ketone driven and you’re seeing results of the ketone driven one yeah absolutely I mean just kind of shameless plug again to myself and but also we you did a video earlier very generously on one of my papers talking about ketones is not just the fourth macronutrient people think about that but that really doesn’t appreciate what they are they’re also a very potent signaling molecule and in inflammatory disease they that can be talking about the two big controllers of inflammation people hear about NF Kappa B and the NRL p3 inflammasome ketones inhibit both of those plus a ketogenic diet has other anti-inflammatory effects even Justin they got for example the release of bile acids there were two papers I think they were in sell in nature very recently 2019 showing that you know eating fats released well eating fats we know releases bile acids which actually decreases inflammation further in the gut so that’s at least three ways it’s true ketones in kid Jack diet or reducing inflammation anyway not very interesting well now we could go on and on about that so let’s let’s keep let’s keep going on so so you adopted the Mediterranean style ketogenic diet and and what happened so I’m gonna just look at the numbers to make sure I get them proper but what happened first is let’s talk a total cholesterol because that’s kind of a number people people think about his total cholesterol started at 160 milligrams per deciliter now based on the basically when you get a look at the panel the doctor doesn’t really need to put much work into interpreting it because the high risk moderate and then optimal zones are predetermined and at some point maybe we can pull up the the data and it’ll show you like oh it’s optimal it’s like pretty green and it’s all safe and then if something is out of the range it’ll be in red and like an alert so a lot of the data are pre digested already this is another problem in the just data output so in this originally his total cholesterol was 160 milligrams per deciliter which was considered optimal optimal in this test was less than 200 milligrams per deciliter it almost tripled to 450 milligrams per deciliter Wow wedding like Oh more than twice high risk the high-risk special that would know would freak out any any person but yeah so that was quite alarming and then the question next is okay we we know you know people are about total cholesterol but you have good cholesterol HDL and bad cholesterol LDL bad cholesterol um so it is HDL cholesterol digua it went from 48 which is already optimal optimal is above 40 in this case to 109 so we went up really high but if you actually think about what contribution that made to the overall jump that’s a you know 61 point jump and the jump was what 290 points most of it was LDL so the major contribution was LDL the LDL went up from 95 which is optimal optimal in this case being less than 102 321 and so higher than 129 is considered high-risk so this was dramatically higher than much more than two and a half times higher than the the higher threshold for you know what is high risk so 321 is quite high LDL and then his triglycerides were actually pretty stable so the amount of the fat in his blood LDL by the way just to clarify HDL and LDL they’re carriers for both cholesterol and for triglycerides so the total fat in his blood that carried in the LDL and HDL particle was stable but the cholesterol component did become what could one argue since this you know this individuals lead there was just less triglycerides to mobilize is that is that a hypothesis there – like if this head of someone that was overweight and had a higher degree of body fat would you potentially have seen triglycerides higher I think in that case triglycerides would have gone down probably yeah in this individual we we were actually trying to keep him weight stable or gaining weight whereas some people go on a ketogenic diet Andrew the losing weight a lot of the the diet the components of the triglyceride might have just been I mean yes it was at least a 12 hour fast before you know after the last meal we were measuring lipids but there was so much dietary fat relative to what this individual is normally consuming or relative to what any individual any normal American would be consuming I think that CA recommends like 50 to 65 grams of fat this individual is eating like over 300 their mother just been some residual dietary fat rather than fat being taken out from stored fat tissue okay so I would suspect in somebody who is if this was somebody a case – somebody losing weight it was previously obese we would have probably seen triglycerides go down that is actually quite common well you have different because you’re overweight and diabetic so this is a way stable individual so all these changes were in a weight stable context which is actually also important to mention you know somebody’s losing weight in their LDL Goes Down and their insulin resistance improves and all that might be a factor the weight loss not actually a change in the diet itself another kettle the other thing that I mean this might come up a little bit further down on us in the study as we talked about this but it’s interesting because you know it wouldn’t surprise me to see a large increase in LDL cholesterol if there was a lot of saturated fat coming in okay because we we’ve talked about before you know saturated fat can sort of decrease kind of the affinity for the LDL receptors in the liver so you know sometimes see more a higher level of LDL but this is unique because the subject wasn’t eating a high degree of saturated fat they were you know you largely mono and polyunsaturated fats and I think we will touch on this later but that’s what just captivated me it’s like okay wait a minute we still saw LDL increase there wasn’t a lot of saturated fat so it puts my mind at ease because I sit here worrying about people that do the ketogenic diet I worry for because I know they’re going to be worried about the saturated fat intake and this almost puts it at ease saying like hey it’s not necessarily the saturated fat it’s just this this shift in general which we can talk about more yeah I also don’t want to make separated fat on Mediterranean keto out to be the bad guy I think there’s a place for it and we can talk about that at the end because that came in with some of the recommendations we made to further optimize this patients lipids they included some new ways saturated fat intake for reasons that we can explain later but I guess the next step is then you know what what we would have seen is what I just described this individual goes on the ketogenic diet that’s the main change his cholesterol goes through the roof and his LDL cholesterol goes through the roof which would freak out most primary care physicians most cardiologists as well because those are the tests that are generally measured so what did you know we do differently as I think the next step to talk about what’s good let’s get into that so what was done different all right well actually before I do that the next second snack step I want to talk about just a little bit of background about why LDL could go up I think that’s relevant because that was the L can go up for different reasons and you were talking about LDL metabolism and how you know when LDL particles actually not by saturated fat but by glucose single occasion get oxidized on what’s called the Appleby protein they can’t be taken back up into the liver so what happens is you have the liver makes LDL it sends LDL out to bring you know fat and fuel to muscles or cholesterol the places it’s needed and they’re supposed to return to the liver and get taken back up correct so what can happen if you have a high carb diet or a westernized diet of sorts and this is why L this is what drives the association in Western rice culture between what’s thought to at least between lzo and cardiovascular disease is because when you have this westernized I at the LDL particles get damaged they can’t return to the liver they continue to just sit around in a blood stream they have been able to go and so they end up just like causing plaques the analogy would be you know the LTL boats are leaving the liver harbor to go dock somewhere else and then they’re supposed to return and be taken back up but they’re you know travel passport is damaged and so they just kind of sit around in the harbor they get further damage they break down they sink to the bottom and then they form a block never have an opportunity to properly dock its yeah and so they just accumulate and so that’s why all the air will go up now in the case of a low-carb keto diet what happens is you know your your your LDL boats are not getting damaged your boat economy is just way better you’re burning more fat therefore you need more LDLs and just travel through the bloodstream and so you have more boats going out and those more boats are then returning and so you just have more traffic but there’s a much faster turnover and so it’s a more efficient it’s a it’s a booming economic cruise ship company right it’s just it’s from you went from having let’s just hypothetically just small numbers say you’ve got ten cruise ships these ten cruise ships are going out and doing their job but then seven of them are getting damaged and ultimately lining the ocean floor with garbage and damage from the cruise ship or the other situation is you’ve got a hundred cruise ships and only two of them are getting oxidized in ninety eight of them are returning back to the station but after they returned back to the station they unload their passengers and it reload yeah but in the latter case reality of the hypothetical given the numbers used you gave would actually be much much higher even the both increased and so that’s the distinction we want to look I just to summarize in the one case westernized I you have damaged LDL it’s sinking to the bottom and causing plaques and in the other case you have you know healthy LDL but just more of it because you need more boats to traffic more passengers around the bloodstream so you have this booming metabolic economy I like that we should coin that term anyway so yes that that is the theory and other people have speculated on that theory what’s nice is that we actually have a way to look at that and this is what because cool butts papers we did that in a clinical context not an in vitro model not in an animal model in a clinical context where you can look at LDL and there are you know different types of LDL particles now let’s talk about that so LDL when it’s produced well different types in that LDL when it’s produced it’s big and fluffy and if actually there’s some data to suggest that this is cardioprotective it’s healthy for the heart the big fluffy lvl so if you have more big puffy LDL at least it’s associated with lower heart disease what happens is when it gets damaged or when it’s been floating around in the blood and LDL turnover is low is it condenses down it gets oxidized it glides it gets small and dense and that’s when it sinks so you know you don’t care about the big fluffy and in fact you’d want more of it if anything what you care about is the meat the the small into a lesser extent the medium so excuse me there is a you know what you would want an ideal distribution is a small amount of small LDL and a small amount of medium LDL ton of big fluffy and what that would tell you is that you have a high LDL but it’s because this high LDL or is consistent with the theory that is high LDL is being trafficked out and then returning it doesn’t have time to get damaged and become small and sink down because it’s so efficiently doing you know it’s transport job and so you won’t have any deposition into arteries so you actually that would mean you have a high LDL but all of it is big and fluffy so what did we see in this patient this is what’s exciting is again his LDL jumped from what was 90 sorry is LDL jump from yeah 95 to 321 again which would terrify them with G’s because people would presume that small and medium and large are all going up but this didn’t happen the large skyrocketed but the small and medium actually went down they went down which is by like eight and ten percent each Christic well we don’t have more than one so we can’t do a statistic test but they went down which is completely consistent with his hypothesis is his metabolism shift to its fat based metabolism therefore he needed more LDL some more I went up with the turnover went down because he was having less oxidation less inflammation so although the overall LDL went up it was just the big fluffy in the small and dense which are actually that bad types went down which is which was I mean that was I think the most exciting thing that we found because it’s just the most glaring obvious and the kind of thing that GP look again I said they want this to be a tool that people can bring to the review piece is the kind of thing that GPS can go look oh wow look at that like if you go on keto then the small dense medium don’t all go up it might just be the big which is good maybe what does this mean so that was exciting it’s interesting because you know a similar situation with me you know been keto for so long but after five six years they’re doing keto you know took a look at a fractionated you know healthy I’ll test and the interesting thing is my overall LDL levels did come down from the time that I initially had started keto mine were not as high as the subjects but mine my LDL went close to 300 and then it came down to a little bit above 200 after being on keto for five years however the ratio of fluffy LDL to dense LDL was even better so it was interesting because that you see okay not only am i I’m just everything is getting more efficient right everything is getting more efficient to the point where my body doesn’t even have to have as many cruise ships I guess the analogy there could be the booming economic economy started out with a hundred cruise ships and they said wait a minute we’ve determined how to run this leaner rather than having a hundred cruise ships let’s have 75 larger cruise ships and they make this even more efficient this is kind of interesting that’s at least somewhat of a hypothesis that I’ve had just based on what I’ve seen from this paper with my own personal kind of anecdotal stuff yeah I agree that right now it’s in the realm of speculation but you know before this paper there are other things there like I think that’s a great idea versus and I tend to agree and I’ve also seen similar trends in myself actually this patient where things time to just trickle to improvement as you stick with it so in this patient we did have some interventions but and this is not reported in the paper because we’re continuing to follow up but the LDL is dropped and the HDL which we can talk about next has actually gone up in the HDL P they just continue to trickle up and this is again the good cholesterol so there’s five different types of the good cholesterol ultimately right well there’s the thing with LDL is okay I said there were multiple types when I said there were multiple types I had pause and hesitated because I anticipated now saying this there’s actually only one type of LDL really your LDL into like one type produced by the liver the different types are that it then changes form you know well the individual LDL particle will evolve but it’ll struck down yes I mean one thing one could argue there’s like I mean at what stage of it’s shrinking down at what stage of it condensing is it actually measured one could argue that there’s a thousand types of LDL if you’re measuring at a small when I say once I mean the liver makes one type of LDL yeah delivered makes many types of HDL we haven’t actually classified all of them some people say three four or five it depends how you break them down there’s really different technologies you can use to break down LDL types but L sorry sorry I should have been saying it’s you break down HDL types there’s three four or five types of HDL as opposed to the one type of LDL produced by the liver and the different LDL morphologies the different sizes and densities probably correspond to different jobs so it’s it’s been thought that the small dense HDL c3 is the best at what’s called reverse cholesterol transport kind of taking this could be the rescue submarine going to take the damage out of the arteries that will be the small dents and now the bigger LDS are HDL keep on saying LDL the bigger HDL particles they might be better at antioxidant capacity that’s what they were thought of in terms of predictive value right now the best thing to look at it’s probably called an HDL P which is not hdl-c is HDL cholesterol HDL P is the particle count so you count the number of HDL particles floating around in this to spend the hdop actually even better is for some reason the HDL p large so I said the larger the antioxidant ones which is interesting because if you’ll see three is supposed to be the one that is the reverse cholesterol transport the typical function people think about when they think about HDL but the large HDL P is actually the best predictor of cardiovascular risk food for inflammation thought anyway we we track the large HDL P in this participant and it went from moderate which was five thousand six hundred ninety nine moderate being in the like five to six thousand range to optimal optimal being above above six thousand seven hundred twenty nine it went to twelve thousand eighty which is GP and myself and other doctor who is on this paper I’m not doctor yet but one day all said like we’ve never seen something this high and in fact we were talking about triple trickle up a couple months later to Susan in the paper although it was in review under that time it jumped from about 13,000 so this will be continuing to go off but just interesting if we had the resources to test every month for like a year that would be really cool but very interesting and so yeah there was a great increase in HDL which is also good on top of this increase in large LDL and a decrease in small and medium LDL particles and just just to point me making the paper that I’ll make now in case we show can we show the at this point the ion base mobility fractionation we’ll be looking at that now and the point to make is won’t one would speculate based on everything we’ve just talked about we said that large LDL is good small and medium LDL are bad and there’s many different types of HDL each with probably distinct functions based on their different morphologies and sizes but that large LD a large HDL might be it has the best predictive protection predictive it’s most correlated rather with protection cardiovascular disease all I’m saying is I could speculate off of the information we have from the models that an ideal cholesterol profile will be one with that is smooth with regards to LDL this is called type a it was a big peak in large LDL and a very little small and medium LDL and then multi-modal with respect to HDL because there’s different HDL particles with different functions and so you want a peak in each small medium and large zone because you want all these different functions because they cooperate together but maybe you’d want the biggest peak in the large HDL because large HDL P is the best predictor of cardiovascular protection of the HDL counts and so summarize you want a multi-modal distribution with HDL peak and small peaking medium and the biggest peak at large and then you want a smooth curve with LDL with very little small medium and then a lot of large and you you know you can pull up the figure that is precisely what we see in the follow up with this patient interesting so and then everything that you’ve seen so this this is interesting because it’s such a quick shift it’s such a quick adaptation that’s what is really just endearing I mean it’s just it’s a really quick adaptation and I’ve done a lot of videos talking about the different stages of how long it takes book to become fat adaptive you know there’s obviously you see some acute changes very quickly within a couple of weeks you see some mitochondrial biogenesis potentially occurring within you know a couple of months and then you kind of have this continued gluconeogenesis efficiency and all this other stuff that kind of changes and skew I guess it kind of skews the data a little bit because everyone’s gonna have a different rate there but this is really interesting to me because it’s almost as though this subject became very fat adapted very quickly now I don’t know if that could be the case for every subject but that’s that’s just fascinating to me because so much the keto world says okay it’s going to take you you know months and months and months to start to see some effect this is showing that pretty quick I think so I mean admittedly this individual is young and healthy otherwise and so it wouldn’t necessarily be as quick in somebody who’s older and insulin-resistant and overweight but if you think evolutionarily I mean we are omnivores you know people say oh we only ate meat some carnivores say that but no we are armed of course we ate ketogenic probably during certain months of the year when produce was scarce but that would suggest you know if it’s over the timeline a month we did a seven month follow-up you know you change between you know the seasons within three-month time frames or six months if you have two seasons so it would only make sense evolutionarily that you could adapt within you know windows of six months otherwise you know a couple months otherwise it wouldn’t make sense it’s like that’s very true that’s very poor to adapt you would just finish adapting and then you go on to the next season and then of useless yeah well you make yourself glucose intolerant for you know survival standpoint right especially if in some individuals you don’t see as efficient of a process of gluconeogenesis which of course can change depending on someone’s muscle mass can change on a lot of different factors so I’ve always been a firm believer from my own personal experience that as you know doing Aikido for a long period of time and then being able to have a periodic transition on and off of Kido to be able to be optimally dual fueled as I would call it so my body understands still had a metabolites glucose because it just seemed like the most maybe most sense from an evolutionary standpoint so anyway this is yeah very interesting that a healthy young individual could adapt so quick and yes like you said I mean it’s important for the you watching this video you know if you’re older if you’re over 40 if you’re battling some insulin resistance it might not happen quite as fast because your body’s gonna be a little bit more stubborn but it still happens okay so we’ve talked about what was optimal kind of a positive side of this but we have to be we have to take sort of an objective look at this and talk about things that may be more uncomfortable so what were some things that maybe saw within this with a subject that worked ideal I mean not everything is you know hunky-dory perfect there’s got to be something that wasn’t so great or something that you’d want to see some improvement on yeah because there was really one thing that popped up that concern me there were a couple markers that didn’t change ideally but this is the one that I think was at the root of it all and I’ll explain why in a minute and it’s explained in the paper but we we mentioned that his small and medium what lvl went down which is good and his large went up which is good he’s oxidized LDL did not it actually went up a bit which is not good we don’t want LDL oxidation it’s interesting that despite the oxidation which often goes with glycation and becoming small and dense and small and medium went down so that’s very reassuring but is oxidized LDL went up and as to why that might be like you said you know nothing’s ever ideal you’re always kind of asymptotically reaching for perfection but when you make a shift it can be an improvement it doesn’t mean it gets to that perfect point and so some changes that in in the subjects that that might not have been ideal were you know he removed a lot of antioxidant rich foods including vitamin C rich foods importance of vitamin C in a minute but and then he was also and I mentioned this earlier eating a ton of olive oil oh it was great quality olive oil I also crust a premium virgin 20:19 harvest we collected a ton of data well at least it’s 20 19 hours now but you know the good stuff still o Allaah voya liz 12 ish percent omega-6 its ton of you know great move up but there is some one mega six which are inflammatory now if you’re eating a standard die and having a tablespoon or two a day that’s not a big deal yeah but if you’re eating 16 tablespoon is in a cup a day multiply that by the 12% times the 14 grams of fat and you are getting loads of omega-6 fat from that I’m not doing the metal mouth right now my head but let’s round it to 10 let’s say he had just 10 tablespoons and it’s 10 percent then that’s 14 grams of the omega-6 just in the olive oil yeah he was eating some you know not all the nuts he was eating were macadamia which was only enough so I really don’t have a mega 6 so there were other nuts in there there walnuts he was eating quite a bit of a walnuts one ounce of 11 grams there oh my gosh X bombs so these these little tweaks which you know these changes could have increased inflammation and oxidative stress by and omega-6 load and by removing some antioxidants like vitamin C that’s swell and that’s super intriguing it’s an E me it’s funny cuz you look at walnuts right and walnuts technically also have a higher omega-3 content than a lot of nuts but the fact of the matter is is that it’s that ratio it’s that balance there right so it’s like one could market walnuts and say they’re high omega-3 well that’s true but it also doesn’t deny the fact if they’re high in omega-6 is that essentially counteracts that the other thing to note is of course whenever you’re looking at the omega-3s that are coming from a plant source I mean you’re looking at alpha linolenic acid which quite frankly is hard to convert and ferment into the usable you know EPA or whatever you need right so of course we have talked about the little hack of turmeric to increase that bioavailability but in the day it’s still negligible yeah so when it comes to nuts I always recommend and I think you Mecca men the same that the 3 to 6 ratio which people talk about is actually not that relevant because the meaningful Omega threes and a large amount of mega threes you’re not you’re not getting from nuts correct it’s only the omega-6 that actually matter so think about the 11 grams don’t think about what is 3/11 because then you go to macadamia nuts and it’s like there’s no omega-3s it’s very little Omega 6 but so there’s like point zero zero zero or whatever but then you look at the ratio and the macadamia ratio is worse so yeah it’s like it’s a it’s a think about the omega-6 not the ratio drop in the bucket for sure and well I think the most important thing for anyone watching this video if you’re watching this video that this is what this instills is that when you are on a ketogenic diet you get your diet become significantly more fat right a lot more fats coming in and that simply means that you have to pay a lot closer attention to that omega-6 ratio if you ordinarily would again hypothetically you said of you if you’re typically consuming you know let’s say 30 grams of fat throughout the course of the day well if your omega-6 ratio is off when those 30 grams of fat it’s it’s not great but it’s not the end of the world because the overall volume omega-6 is coming in isn’t super high then you look at the ketogenic diet or any even paleo where your fats are increased I mean just this obviously that becomes a larger proportion of your overall macronutrient breakdown which means that that will make a 6 profile could be a lot more threatening to you so you just have to pay a lot closer attention so this is that makes perfect sense yeah and you know you’re doing a good job of bringing up some the nuances that happen when you shift your macronutrient focus and something I said earlier was you know I don’t want to make such great if that’s that to this bad guy because you know you and I I’ve talked about this concept of the fat tone before how it’s not just like you know how your genome your microbiome it’s through your genetics or your gut bugs all interacting determine your health the dietary fats you eat especially when you’re on keto also interact and so you want to find the right balance and when you’re doing Mediterranean keto it might be optimized if you’re having a ton of ton of fat to balance it out with just a little bit of stable saturated fats like virgin coconut products in fact I’ll just divulge this we’re doing some follow-up studies we’re probably gonna try to make it a case series not a case study but on this individual some of the recommendations we made and the predictions we made were all right let’s you know try to swap out some of your you know olive oil for some coconut now the literature is gonna say there’s problems with the coconut literature you mostly they use for fine products which have lost 85% of their antioxidants so the literature is gonna say that would make is LDL worse and maybe contribute to oxidation whatever so we swapped in some virgin coconut butter raw coconut butter rather it’s called artisan is organics great brand I have no connections to them financially but I think it’s tasty and what we saw is actually a decrease in the oxidized LDL as predicted we also saw at 80 milligrams per deciliter drop in the LDL total which was impressive both in small and medium and decreases other things like LP little-a and other factors so just to kind of get the throw in this idea that you know balancing your fast a little bit when you’re doing Mediterranean keto maybe a little bit of ghee which has some butyrate as well maybe a little bit of virgin coconut oil aren’t a bad thing I’m not saying have a lot but maybe two to three tablespoons a day if you’re you know out of the ten tablespoons of olive oil you’re having and you’re still getting all those healthy monounsaturated fats but then you have these other fats that say the lower caste and the coconut is gonna burn faster and then you later have you know the MUFAs for helping with heart health XYZ it’s a complicated area I’m just trying to help introduce a little bit of a nuance into it so I wanted to mention that yeah well I think you started to touch on something by like introducing a just a bit more in the way of vitamin C rich foods you know having kind of an antioxidant aspect there because it’s easy let’s let’s take a look at just someone that’s starting a ketogenic diet that isn’t focusing on maybe a Mediterranean style in the first place I mean imagine someone that is jumping into keto and they’re going and they’re just there their kudos to them because they’re taking the right steps but they’re starting just with whatever they can get their hands on right there you know perhaps they’re eating just a bunch of burgers and cheese and things like that well okay you were eating Mediterranean keto which means you at least had some antioxidants coming in from the olive oil you know the hydroxy fluorine you had some of these other things right but when you look at what most people would be eating when they start ketogenic diet they’re probably very deficient in antioxidants and when you have to pay attention to the fact that there’s a difference between inflammation modulation from a ketone and oxidative stress right an oxidant of damage like there’s a difference just because you’re controlling or potentially controlling inflammation doesn’t necessarily mean that you aren’t having a higher degree of oxidation occurring at some level right so I would actually contend on that and inflammation and oxidative stress are highly interlinked what I would say is that if you’re eating dirty keto the way I would cast it is you’re counteracting some of the positive effects so you’re doing the right cutting out the carbs and you get the ketones coming in and you’re reducing inflammation but then you’re contributing to inflammation via just having a nutrient deficient and you know otherwise dirty diet and so you will be getting this positive effect but instead you’re gonna get this positive effect because you’ve just canceled out a bunch of it with literally diet yeah it’s very true you look at you know oxidative damage you look at kind of even the mitochondria being less efficient you have this reactive oxygen species that’s affecting that then of course that’s going to in effect you know trigger camp and trigger all kinds of different things damn by the way is you know damage associated basically this inflammatory response so yeah you can directly have this sort of constant cycle that’s occurring between reactive oxidant species and inflammation so I think exactly what you’re explaining is what I’m saying is you’re getting all the positive effects there yeah so if you’re bringing in foods that are going to be damaging if you’re bringing in foods that are unhealthy then yes modulating inflammation is still good but you could be essentially canceling it out in some ways yeah exactly the the analogy and this is a really important point because Quito gets a lot of crap for being nutrient poor I hear that all the time and I read it in like the Atlantic or whatever they’re like you know Quito you know you can lose weight but then you’re discouraged from eating fruits and vegetables and it’s nutrient poor so blah blah blah that is such an unfair argument that’s like saying and here’s my analogy that vegetarian diets are fundamentally unhealthy because if you only eat Oreos then you’re nutrient deficient like yes an Oreo diet is a vegetarian diet just like beef jerky and Cheez Whiz is a ketogenic diet but that’s not a fair comparison so so yes ketogenic diet can be nutrient deficient but it doesn’t need to be and so the issue is there’s people aren’t educated healthcare protect practitioners aren’t generally educated so they can’t support their patients in this shift so people tend to just have a easy rule I’m gonna cut out carbs and then it’s easiest to rely then on kind of dirty food so to do a well-balanced ketogenic diets what kind of stephanie says are well formulated that’s what you really need to get to end that’s on the fault of scientists nutritionists and you know physicians for you know they need to there needs to be support to teach people what to do to make a clean keto diet because you don’t want to be eating beef jerky and cheese it was just like you know you don’t want to be eating Oreos for your vegetarian diet thinking it salty correct correct and you know it’s a great spot to mention that a little bit of fruit on the ketogenic diet is not going to destroy it you know I’m a big fan of having you know even a few times per week I’ll have a quarter cup to a half a cup of strawberries you know low glycemic fruit great way to get some you know get some vitamin C in don’t be afraid to have a little bit of bell pepper or things like that and I know that in the papers specifically mentions those you don’t need fruit if you do that fruit like you said have berries but you don’t need food no people think like an orange is a great source of vitamin C it’s not a great source of lemon and C whatsoever you know a hundred grams of cauliflower has more vitamin C yeah Eenie has more vitamin C a head of cauliflower is eight times vitamin C even orange I think bell peppers you mentioned broccoli or they’re both great yeah obviously yeah going for the you know the lower carbohydrate versions of course are going to obviously be better I mean additionally you have to remember the vitamin C’s and glucose are gonna compete for absorption so you have to factor that into so you look at orange juice it’s probably not the best way to get your vitamin C in so you know broccolis gonna come with the other benefits a selfie or vein and everything like that to which is obviously good I also don’t know what the production of endogenous fight well humans don’t produce vitamin C like other animals but maybe our gut bacteria do they’ve genetically engineered bacteria to do so and so I only bring this up because I’ve been questioned by the carnival community on this so people do fine on carnivore I’m like I don’t know why that is some people seem to do well I don’t think it’s optimal for most people but if you do then maybe this is shifting your microbiome where you’re converting you know some glucose there and there is a coulis on a carnivore diet you can get glycogen and liver or whatever into vitamin C maybe your gut bacteria are producing it I don’t know I mean they’re so I got my own there are a lot of things a lot of variables so maybe I’m Kido you have a shift in your microbiome that improves vitamin C uptake efficiency or whatever dive into more but I’m not quite I’m in C the reason it’s particular than this paper the reason we mentioned it in addition to the antioxidant capacity is something that went up and this patients blood was something called LP little a which is not studied much it’s kind of like LDL but it has an extra little tail it’s job is this is a hypothesis by Linus Pauling the only person to ever win two Nobel Prizes and we can link to a lay article about it in the show notes but the hypothesis is that LP little a acts as a surrogate for vitamin C so most animals produce their own vitamin C animals that don’t tend to produce this little LP little a particle now what vitamin C does in addition to being an antioxidant with regards to cardiovascular health specifically is it’s important in repairing art artery walls when they get damaged you need the vitamin C to rebuild it to rebuild the collagen so probe the holder exhalation etc whatever multiple steps and you get rebuilding the artery walls but if you can’t have it rebuilt if your vitamin C deficient what you need to do is put up barriers kind of cordon it off generate a cloth so you don’t get excess bleeding and a clot is a plaque and so LP the delay does that job it binds where vitamin C would help repair and prevents this clotting factor plasminogen from becoming activated so then you you know get the clot you get the plaque so that’s why I hope you’d the delay is associated with cardiovascular disease or the spongebob but again it’s a surrogate for vitamin C so if your vitamin C deficient you have an increase in the LP the delay yeah you add in vitamin C them they’ll peel it away comes down and you don’t get the quarter you don’t get the plaque yeah I also will mention because this is relevant to the paper you know to get a paper published like this you need it’s really helpful to have a functional measure of cardiovascular plaque buildup and so one thing you can do is called the coronary REM calcium scan we actually look at the plaque buildup and so that’s kind of the most important thing you know that’s the proof is in the pudding and so we did a CAC score on this patient and it was zero even with an LDL of 321 a total cholesterol of 450 there was no noticeable plaque accumulation admittedly this individual is young and his 20s so you know that could be a contributing factor but it was something important to include you know being good scientist we want to try to disprove our hypothesis if we saw all these changes and look at parameters but there was this jump in plaque that’s terrible the fact this or zero is no doesn’t prove anything but it’s reassuring if nothing else of plaque buildup and there was a CAC score of complete zero so we’ll continue to follow up and I will definitely let you know if it increases you can let everybody else know but I don’t think it will well that’s awesome this is I mean this is everything that we need to start getting the Mediterranean keto diet out there any other Mediterranean keto diet wasn’t the emphasis of this study and it wasn’t you know designed to be that way but it was taking a look at okay let’s see some true case studies in the world of Mediterranean keto because this I can say for my own personal opinion my own experience this is not your words this is not any research words but I think the Mediterranean keto diet is kind of the future of the keto diet and I’m excited to see where this can go and the biggest piece for me with Mediterranean keto diet again speaking just from my heart is it drops a barrier for people that might be concerned about just some of the I don’t know kind of nefarious foods that are out there in the ketogenic world you know foods that might just seem a little bit daunting and seem like it’s just overall unhealthy right people start feeling like I don’t want to eat just like you said Cheez Whiz and beef jerky all the time this opens up a new realm of it hey here’s keto but look how bright colorful it is and look how healthy it is and I think it’s going to allow a lot of the mainstream to really see it in a different light and I think it’s gonna do the ketogenic community just a huge service to be able to help promote the matter so I’m really excited about this paper for that reason that’s why I wanted to be involved in it and Nick you know it’s a pleasure and that’s all we can appreciate all your help everything that you helped us do with this channel and bring your good research and I’m happy to have him in front of the audience and hopefully we can do this a heck of a lot more to ya know thank you so much I think that’s an excellent point to conclude on I do on adjusting because it would work me as a responsible scientist not to say this is I don’t mean this paper to be conclusive it is an N equals one it has its limitations it’s in a 24 year old I mean you know this would we can’t idealize clinical cases it was just taking advantage of an opportunity we saw so that people look one thing that well people will have tools than to bring or a tool to bring to their physicians but just to inspire other people to follow up on this research so we can actually do the real clinical trials so that people can get proper testing so they can get better information so I’m not saying this is perfect I can poke holes in it to no end but it’s an exciting next step and you know I would just more than anything I hope that this will help people argue to their GPS for better testing so that they can have more informed decisions and if their GP still wants to put them on the statin and get them off the cater diet they can have that discussion then but at least this is the next step something to argue there’s that that is great yeah there’s a couple links down below in the description didn’t mean to catch you out there and just want everyone to know that you know there’s there’s some links to just some highly recommended pieces but also a link to this study in particular so I highly highly highly recommend yes we did this in-depth video on it but read it for yourself download it for yourself I do want to mention that the way these things work in the research world with some of these published studies the more people that get to this study and look at it and read it and hit that website and actually look at the PDF it does raped algorithmically to some degree and it allows it to get pushed forward more in the medical community so more physicians will see it more researchers will see it this is why actually I have a lot of I have a lot of publications that do come to me say hey can you help me by getting this out and obviously I don’t do that with everybody Nick’s a very good friend and I’m involved in this study so it played a big part but please if you want you can do your part by just just going to reading the study just checking it out it will make a big difference and let you be a part of pushing this along in the medical community a bit more yeah absolutely that’s a huge help thank you well Nick will do this again soon in and as always everyone keep it locked in here on the channel we’ll bring in more about its reading’ Aikido content throughout the summer and throughout the fall see everyone soon
This Post Was All About Mediterranean Keto – My Involvement on a Breakthrough Study (full interview).
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Nicholas Norwitz – Oxford PhD Researcher and Harvard Med Student:
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