Learning to Cook and My Go-To Recipes and Cooking Websites

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Cooking can be super intimidating. What does “sauté” mean? Blanch? Deglaze? Is a cube like a dice? What the heck is a pinch of salt? (it’s actually about 1/8 of a teaspoon so fill a 1/4 tsp half way)…

I remember when I was first learning to cook, how nervous I felt (my family is full of great cooks, so expectations run high). I burned, boiled-over, forgot, both under- and overcooked countless recipes, and every time I did, I learned.

How I learned to cook

When I teach cooking classes, I love to use the analogy of running: You (likely) wouldn't run a marathon by just thinking about it. You'd run a marathon by lacing up your shoes day-in and day-out to train, practice, and prepare yourself to cross the finish line.

It takes time, some discomfort and just plain work. 

Likewise, if you "can't" or "don't know how" or "didn't grow up learning how to" cook, then you probably aren't going to get any better by just thinking (*cough* dreading) it. 

How to get comfortable in the kitchen

Instead, here are some proactive ways to learn and prepare yourself to learn how to cook:

  • Look up how-tos (here’s one from Cook Smarts and one from Nourishing Meals). 

  • Find recipes online or pinterest. I’ll admit pinterest is one of my least favorite platforms because it overwhelms me, but they do have an endless number of recipes!

  • Set aside a day once a week or once a month to practice or try recipes.

  • Invite friends over to try out a couple recipes and send everyone home with meals for the week.

  • Also, whfoods.org have some very simple, basic healthy recipes and info about the health benefits of certain foods.

Here are come of my current go-to websites and blogs for recipes. I like these because I’ve cooked several of their recipes, and they work. Plus, they provide modifications for gluten-free, vegan, vegetarian, paleo, etc. You can often find what you need. I noted those that are strictly vegetarian recipes for anyone who’s already vegetarian to save you time:

What are some of your favorite, dependable recipes and websites? I’d love to hear them below in the comments!

My 5 Days on the Fasting Mimicking Diet

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So, I don’t know why I didn’t share my experience with the fasting mimicking diet (FMD) in real time on my Instagram stories, but I guess I’ll share a little bit of my hesitation before I get into sharing my experience with the plan.

As some of you know, I, like many nutritionists, haven’t always had the healthiest relationship with food (hello 5’9’’ 119 pounds). When I was at my worst, I would claim that I had “never followed a diet in my life” and “I ate whatever I wanted.” Well, when you’re obsessively thinking about every single bite you take throughout the day and mentally calculating your caloric intake, you may not be “on” South Beach or Weight Watchers or Atkins, but you’re not living your best life.  

I’ll spare you the journey between healing my relationship with food (if you’re curious, you can read about it here), but I was always hesitant with fasting and keto from the start.

My introduction to fasting

I remember about 5 or 6 years ago when my old boss and my nutritionist colleague (we were working in an integrative medicine clinic in an academic medical center) started discussing keto and the evidence for certain cancer populations (brain cancer, at that point). Also, there was emerging evidence about fasting for cancer patients before chemo treatments, and that fasting seemed to be helpful for side effects of chemotherapy. For example, there was less nausea, which I guess makes sense because you don’t have anything in your gut.

Knowing that any kind of diet and restrictive eating could be a trigger for disordered eating for me, I hesitated.

So, although I like to think of myself as an early adopter, based on my personal experience and, knowing the risk of a trigger, I decided to learn more about the fasting mimicking plan. After reading, listening and finally watching a documentary on Amazon Prime called “The Science of Fasting” where they interview Dr. Valter Longo PhD more about FMD, I thought about using it with a few clients. It seemed like it might be a great fit for their needs and their cardiometabolic (cardiovascular + prediabetic/inflammatory-type metabolic pattern) issues. I also had heard from some colleagues that they were having great experiences with the program.

But, before I put a client through the program, I needed to try it myself.

Trying out fasting mimicking

So, the week before Thanksgiving, I decided to do the 5-day “fast.” Of course, it isn’t actually a fast, and that’s why they call it the “fasting mimicking diet.”

You get the reported benefits of fasting, like turning on anti-inflammatory activity in the body, turning on your body’s clean up crew, and anti-aging gene activity, without actually having to fast.

Hooray!

Maybe I was inspired after I started noticing forehead lines that weren’t going away when I unfurrowed my brow or (gasp) my first gray hair. And, OK, I barely wash my face outside of the shower and only recently started using oil at night to prevent wrinkles. So, I’m not gonna pretend like I am excited for this whole aging thing.

Alright, I’ll spare any additional rambling and share how the fasting mimicking diet went for me:

Fasting Mimicking: Days 1-3 

The food and drink: It’s prepackaged food, but for prepackaged food, it’s pretty good. For breakfast you always eat a nut/granola-type bar. It’s good (but small).  They always give you tea to drink, and I didn’t read the instructions well enough to know whether I was supposed to drink coffee, so… of course I did.

Lunch and dinners are always soups and sometimes olives and/or flax crackers. Then, at the end of a couple days you get some kind of weird chocolate thing with inulin in it, which I called the “fart bar.” The inulin is a “prebiotic” (fiber), which serves, functionally, to keep the digestive tract moving along, but bloated me something fierce.  

Sorry, Rob.

On days 2-5 they have you start drinking a proprietary electrolyte/glycerol concentrate that’s added to water. I put mine in the bottle they gave me and added the 2 tea bags of hibiscus tea to steep most of the day. I don’t fully understand what’s in the drink, but it was nice to sip on between meals.  

Supplements: They give you an omega 3 algae supplement (rather than fish) and some kind of multivitamin that I wouldn’t have designed that way, but it was only for 5 days. They were fine, and I took them no problem.

Energy/hunger: To ruin any anticipation or build up, I honestly felt great, especially days 1-4.

I couldn’t believe how well I transitioned into the “fast” (and maybe it’s because I’d done a short stint of a fast/shortened my eating window earlier this year), but I didn’t have any blood sugar “crashes” or “hangry” moments. However, Rob (my husband) might disagree (read on).

Mindset/food obsession: I was really busy on days 1 and 2. I saw clients all day each day and had some evening activities, so I didn’t have much time to think about it, which helped.

By end of day 2 and into day 3, Rob will tell you that I got more preoccupied with food. I was admiring his bowl of ice cream after dinner and even pining over the more typical meals he was eating.

Oh, one other random thing: I had some really vivid dreams and slept very deeply for the first 3 nights.

Fasting Mimicking: Days 4-5

The food/drink/supplements: Same bars, soup, crackers/olives. Some of these meals are even more sparse (just soup), and I would eat like 1/8 teaspoon at a time to draw out the meal longer than 90 seconds. Again, I really honestly enjoyed the food. Perhaps I was hungry enough?!

Hunger: I was talking and obsessing about food/eating. It was actually extremely interesting as I reflect back because I hadn’t been that obsessed with food since I was deep in my disordered eating. Rob would tell you that I was talking a lot about food and fast a lot of the time.  

After day 4 I was ready to quit and had been texting with my friend and colleague Amy about it (she’d done it a few times and had a good experience). I told her, “I think I’m good” and would maybe be finish a day early. She text-yelled at me (coached me) to keep going. She reminded me that the program was designed to mimic fasting and was an evidence-based approach to facilitate autophagy, which is basically the body cleaning up dead cells. So, thanks to Amy, I made it through day 5.

Energy/temperature: The final (5th) day I remember wearing an extra layer of clothes (it’s also been a cold late fall in Kansas City) and took the dog on an abbreviated walk because I was cold and didn’t have the energy to do our typical 3 mile route.

I was hungry.

Day 6 “Refeeding” Day: They tell you to start by drinking liquids (brothy soups, juices, etc.), so I had some apples that I blended in with some water and strained (too lazy to go to the grocery store, ok?!), and that honestly went really well. I tried some sweet potato and venison chili that Rob had made a couple days before for lunch, and had a teeny bit of gurgling in my stomach, which was likely just waking up after the several days. That evening I ate at my parent’s house (the night before Thanksgiving) and had some scallops and steamed broccoli (and maybe a glass of wine – hello right to my head).

This day went extremely smoothly, and I was pleasantly surprised that my body adapted back to food so smoothly. I think one key is taking the morning slowly and not eating any large amounts of foods or anything out of your typical norm of eating.

Thanksgiving: We didn’t have a normal thanksgiving meal on this day, but we did eat well. I felt just fine, and transitioned fully back to eating. As a general rule, I avoid (with my mom, brother and Rob) gluten, so that wasn’t hard because that’s built into our family.

Overall Reflections: To be honest, I would probably do it again. It’s 5 days, it’s laid out for me exactly what I had to eat and offers clear instructions. My only hesitation and caution I would give is to make sure you are mentally/emotionally fit for taking on something like this. It can easily trigger obsessive thoughts about food, disordered eating and could feed into further yo-yo dieting, if that’s something you’ve historically done.

The evidence for fasting is fascinating. I love the idea that it turns on anti-aging genes and allows our body to “clean itself up.” I also love the idea that throughout history, many cultures and religions have fasting built into their lives. Ancient wisdom is fascinating.

So, what else do you want to know? Comment below!

Ketogenic Diet: Interview with a Keto Expert

The ketogenic diet ("keto") has gained significant popularity. I sat down with my friend and colleague, Dr. Matt Taylor, to get his take on FAQs of keto (including his research on the ketogenic diet among patients with early stage alzheimer's disease!).

The ketogenic diet ("keto") has gained significant popularity. I sat down with my friend and colleague, Dr. Matt Taylor, to get his take on FAQs of keto (including his research on the ketogenic diet among patients with early stage alzheimer's disease!).

I know I already wrote a blog post about why the ketogenic diet (keto) seems to be everywhere right now, but this article is going to give you tons more information from a ketogenic expert (Dr. Matthew Taylor has studied the ketogenic diet in people with Alzheimer’s disease). To catch you up on the basics of what’s going on with keto: the ketogenic diet is popular because a lot of people are finding it helpful for weight loss. In reality, it’s a new version of the Atkin’s diet, or at least the Atkin’s approach is based on the idea that our bodies will shift into burning fat when we deprive it of high amounts of carbohydrates. It’s an adaptive response our bodies have when we are faced with famine. It’s normal, natural, and generally safe… with a few asterisks, of course.

There was quite a bit of buzz around my blog post, so I wanted to follow up with some additional, in-depth background on the therapeutic use of the ketogenic diet.

So, I interviewed one of my former classmates and friend, Dr. Matt Taylor, who is a ketogenic diet expert and studied the diets (and did a keto diet intervention) among patients with Alzheimer’s disease (I’ll refer to as AD). His research used the ketogenic diet to see if it would improve cognitive symptom changes in patients with AD, and/or result in any measurable cognitive outcomes. Spoiler alert! Even though his study population was only 11 people, 10 of them had measurable improvements in their cognitive symptoms. That’s unheard of in comparison to AD medications. Typically AD meds will help with slowing the decline, but none of them actually result in improvement. Well, participants in Dr. Taylor’s study had actual improvement.

He's published a couple papers on the topic: the first found that a high glycemic (refined carbohydrate/likely processed food) diet was associated with higher burden of alzheimer's disease markers and the second study showed that putting people with mild (early) AD on a ketogenic diet was feasible

I sat down with Dr. Taylor a few weeks ago and picked his brain about many of the questions you have about the ketogenic diet, both related to cognitive health and AD, but I also asked him about who should and shouldn’t follow the diet.

Before I dive into the interview, a little background on the ketogenic diet. The keto diet is a very high fat (80-85% of calories), very low carb (5-10%), and moderate protein (~15%) diet. The idea behind it is that the body can shift, from burning primarily carbohydrates, into burning fat into what are called “ketones” or “ketone bodies.” Thus, the “ketogenic” diet.

Historically, the ketogenic diet has been used for epilepsy in kids when medications don’t work for them. Over time, the diet has been studied in brain cancer, and more recently there has been interest in its use for conditions involving cognition. Dr. Taylor’s study, as I already mentioned, is related to the ketogenic diet’s use in patients with Alzheimer’s Disease.

Here is my interview with Matt, condensed for readability and to avoid redundancy. I also made the more publicly relevant questions at the top and left the more science-heavy (nerdy) stuff at the bottom. Enjoy!

Leigh: So, why is keto so popular right now?

Dr. Taylor: Many researchers, physicians, practitioners, or people involved in the “keto movement” have seen improvement in weight or health conditions by following keto. Then, they encourage others to try it, and it spreads from there.

I think keto is most popular because of weight loss but I’ve also heard from many that follow the diet that they are following it because they believe it is best for their brain health. For weight loss, it’s a diet where you can eat and feel full most of the time – it consists mostly of fat, so it can be very satiating. Sometimes the diet causes people to eat fewer calories and feel satisfied. There is also evidence that some people can eat more calories and still lose weight. From a brain and focus perspective, ketones tend to give a sense of euphoria, so some people just like the way it feels and potentially feel like they have better focus.

Leigh: What are common misconceptions of the ketogenic diet?

Dr. Taylor: The biggest misconception is that this diet is a fix-all approach.

Also, there are many products touted to enhance ketosis, help with symptoms, or help with weight loss. Some of these may or may not actually work. The product consistently shown to be beneficial in this area is MCT (medium chain triglycerides). There is a lot of marketing for beta hydroxybutyrate (BHB) supplements, which research has shown that many don’t actually help raise ketones UNLESS given with MCT oil. With that said, a certain formulation of exogenous ketones has been effective at raising blood ketone levels after administration. I’ve seen posts on social media push products as “you have to be on these supplements follow the ketogenic diet properly” which is not true, some of it is gimmick.

Leigh: So what’s being portrayed in media that IS or ISN’T accurate?

Dr. Taylor: Once again, just the misconception that the keto diet is a panacea. Keeping focused on research, I try to stay away from what media is pushing out, but I do see what’s being marketed on social media. I’ve been asked to talk at conferences and seminars that companies have put on, but I haven’t taken those gigs, so can’t say for certain.

It’s funny, I know several people who research the keto diet that are surprised to learn how many people are following it. Listening to people who are actually DOING it and articulate some of the benefits and obstacles can be helpful for scientific messaging. Sometimes there is good info in the keto communities, but not always.

Side note: here’s my (Leigh’s) previous post about keto that explains more.

Leigh: Who would benefit from following keto?

Dr. Taylor: We use the ketogenic diet very successfully in childhood epilepsy. Evidence has shown potential for people with adulthood epilepsy, Alzheimer’s disease and other neurological conditions, Diabetes, and even Polycystic Ovarian Syndrome (PCOS). There is emerging evidence around people with malignant tumors (specifically Glioblastoma – brain cancer) on keto with a potential shrinking effect and improvement in symptomatology. Individuals who have those types of conditions may benefit from keto. The ketone metabolism research shows us that many of these conditions are metabolic in nature, which we haven’t always known. Where we’re seeing an effect of the ketogenic diet is on conditions driven by metabolic changes impairing our body’s ability to use glucose for fuel. Once that condition has occurred, it doesn’t matter how much sugar you provide, there it seems there is a preference for ketones instead of glucose for fuel. Even in situations when glucose isn’t as usable anymore, such as in Alzheimer’s, ketone metabolism stays intact. Traumatic Brain Injury (TBI) is another condition that I’m researching with the keto diet. 

Leigh: Ok so this sounds like it has potential for a lot of different situations right?

Dr. Taylor: In science, we’re conservative about using approaches that are this extreme because we’re concerned about any possible negative outcomes. It’s interesting, many people have started this diet for many different conditions, and so we’re sort of letting the population do tests on themselves. Healthcare professionals can see the results from an anecdotal standpoint and we can then use this as rationale for future studies.

Leigh: Who shouldn’t follow keto?

Dr. Taylor: First, people with carnitine deficiency should not follow keto (you would have discovered/been diagnosed with this in childhood if this were an issue for you). This deficiency means that it’s harder to get fat into the cell for fuel, and you no longer are providing glucose as fuel either, so this could be a problem. There is some evidence that supplementing with carnitine may be helpful. Really, it comes down to personalizing the diet, because there are different ways to do keto, and it’s not for everyone.

Secondly, people with an APOE4 mutation may want to stay away from keto diet. These people don’t seem as able to handle high amounts of fat, especially saturated fat. This can be tested via genetic testing. It’s suggested that following the keto diet can have adverse cardiovascular effects like increase cholesterol levels and many with the ApoE4 gene don’t seem to have the same cognitive response in research studies.

If you’ve given it a try, consider how you feel. There is an adaptation phase to diet that many people experience, often called “Keto Flu”. The symptoms while adapting vary by individual, I’ve seen people go on the diet and feel great immediately, and other people go a handful of days and feel kind of bad, and others that feel horrible. For many, they adapt and feel good after a few days. Some never adapt at all and never feel good, once again it’s about individualizing the diet for each person. There is some really interesting evidence that feeling this way mostly comes down to low sodium intake to replete the high amount of sodium excreted by following the diet. I recently saw data from a study that put several hundred people on the diet. By ensuring that those individuals consumed plenty of sodium, they were able to attenuate many of the side effects associated with “keto flu.”

Another individual component to consider is insulin level before starting Keto. People with higher insulin levels may take longer to shift into ketosis and possibly feel bad. Also, what is your nutrient status coming in? Many people already lack electrolytes and hydration and this diet requires more hydration. Burning more fat makes you excrete more fluid, so people who aren’t hydrating or replenishing electrolytes will likely feel awful. The diet isn’t for everyone, if you follow this diet and feel awful on it (and continue to feel awful) more personalization may be necessary, or it just may not be right for you.

Side note: people with history of (or current) eating disorder should definitely consult with their healthcare provider and eating disorder recovery/healthcare team before taking on any dietary changes or restrictions.  

Leigh: On a basic level, can we get people to follow keto long term? Should that be the goal? Can we see changes, metabolically, with just macronutrient changes (without focusing on fruits and veggies)?

Dr. Taylor: After the study of metabolic change builds more evidence, then we can ask that more complex questions. We see overall improvement in condition, but what we also want to consider personal experience? I think diet quality could play a part, but that hasn’t been studied yet.

Leigh: What would you tell someone who is thinking about starting keto?

Dr. Taylor: Seek out advice from someone with experience or background in this area, like a Registered Dietitian Nutritionist (RDN). You may run into RDNs who are hesitant to comment or advise on this diet if they don’t have experience with it. However, those with experience would be more apt to provide objective help.

Leigh: What’s one thing you would tell someone to expect?

Dr. Taylor: First, following a ketogenic diet is usually a big change from most people’s typical way of eating. It’s really counterintuitive for many to eat as much fat as is required to follow the ketogenic diet and carbohydrate restriction can be difficult for people who have carbohydrate food cravings. It’s also possible that you may feel crummy for a period of time while your body adjusts to a different type of fuel (shifting from carb-burning to fat-burning).

Leigh: How does one know if they’re just adapting to fat-fueling or that the ketogenic diet isn’t working for him/her?

Dr. Taylor: It could be either, but there are steps you can take in preparation for starting keto that can help you to know if it’s a feasible option before getting fully invested. It could be helpful to know your APOE status, personally I’m a proponent of genetic testing, but I realize that some people are hesitant to that for various reasons. It may be helpful to do blood work from a PCP or other physician who could look at APOE status because we’ve seen people with APOE4 who don’t respond as positively as others. If you don’t know your APOE status and go on this diet, it’s advisable to get your cholesterol checked periodically to make sure you aren’t doing more damage than good.

Another helpful tip is to be proactive with hydration and electrolytes like potassium, phosphorus, and sodium. Bone broth has been helpful for adaptation phase, patients have been using bone broth to feel better and it is becoming more widely available.  In my research, we provided participants a multivitamin and a potassium/phosphorus supplement. My current study in patients with traumatic brain injury (TBI) with a small sample size provides a multivitamin but not phosphorus/vitamin D. I’ve never used exogenous ketone supplements in my research.

Leigh: Is it bad to abrupty start or stop following a ketogenic diet?

No! Actually, with the research we’ve had some interesting findings. The researchers determine “compliance” as following keto about 70-80% of the time. This means that ¼ – ⅓ of the time not following keto, which is a way of cycling, whether it happens intentionally or organically. This indicates cycling or abrupt stopping would be ok. People who have stopped the diet can pick it back up and resume. Once you’ve started making ketones, there’s an idea (among keto experts) that ketone adaptation, where you switch over to ketone fuel metabolism, becomes easier. There isn’t really a concern unless you’re just generally yo-yo’ing (dieting) bouncing back and forth between ketogenic and Standard American Diet (SAD), which is not healthful. This is a lifestyle/behavior change that is so important, and moderation is also important. Extreme shifts may be problematic, but we don’t know because we don’t have the evidence. Variation is important, cycling with a plan is probably a good approach, but we still need evidence on this as well. All these assumptions are also focused on diet quality. If the shift is on keto I eat bacon, eggs, vegetable oil, cheese (not high quality) then shift to bacon, eggs, oil, cheese + carbs, this is a problem no matter what because in both cases the fats are unhealthy.

Another interesting area of research is in athletes and performance. If you wanted to look into it more, Jeff Volek has discussed the concept of cyclic ketosis, which is the idea that if you’re keto-adapted you can be a more efficient athlete because you’re good at using 2 different fuels whenever they’re available.

Leigh:  Are there actual benefits to being in ketosis or burning ketones?

Dr. Taylor: Ketones are not only providing energy but are also powerful messengers that are important for metabolism. A bunch of animal studies have also shown that ketones are anti-inflammatory. Inflammation is necessary for healing an acute injury, but long-term chronic inflammation is linked to chronic disease. So, ketones have been shown to suppress pro-inflammatory pathways over a long period of time.

Leigh: Tell me about your study/work for your dissertation or any of your other keto-related research? Summarize your findings (high level) any surprises? conclusions?

Dr. Taylor: My original exposure to this was a pilot research study with Alzheimer’s disease. One of the key findings in Alzheimer’s patients is that their brains refuse to use glucose as an energy source, so we’ve started to shift our thinking of AD as more of an energy crisis. Amyloid and tau proteins are involved, but it’s more that brain metabolism has changed. Most basic thought behind research was to provide the brain with alternative fuel source. One study he did put Alzheimer’s patients on keto for 3 months, there were 15 participants at the start and 10 of them completed the study. Of those 10, 8 of the patients had improvement in cognition and decreases in Alzheimer’s symptoms. One person worsened, but he had other variables with his health, so it’s difficult to know what was going on, or if it was related to the diet change. With our study, the ketogenic diet education focused a lot on diet quality. Actually, I’m currently writing a paper regarding the positive changes in nutrient density of this study’s ketogenic diet vs. the standard diet that participants were following. I’m convinced that this type of keto diet is very different from a diet that only focuses on macronutrient ratios.

I remember from the research, a story about a patient that would read the newspaper multiple times a day but wouldn’t retain any of that information. About 2 months into the diet/study, the study partner reported that the patient had started reading the paper only once per day and retained some of that information later in the day. This type of story gives me optimism that it might be helpful for Alzheimer’s patients.

Leigh: What surprised you from your studies?

Dr. Taylor:  I was surprised that older adults would follow it! To be honest, it was a challenge because these people have grown up through a low fat marketing era, and people are hesitant to increase fats to the level they needed on the study. Throughout, I had several shifts in perception. I had gone into it thinking it wouldn’t be too big of a challenge, but as I got feedback I realized how ingrained the low fat messaging was for these people. Also, I had no anticipation for the type of cognitive results that we saw. We saw improvements in patients that really compete with, or surpass some of the most successful Alzheimer’s research in the past. In Alzheimer’s research, a drug is considered to be successful if cognition decline is slowed, whereas in this study there was actually cognition improvement.

Leigh: What about the ketogenic diet for non-brain cancers such as Prostate and bladder cancers?

Dr. Taylor: There is some real interest in using it in these conditions, but there is currently not enough research to draw a conclusion. Based on results of other research it wouldn’t surprise me if it might help.

Leigh: Weight loss?

Dr. Taylor: Keto is one of the ways to do it. From experience of putting individuals on the diet, people have been able to eat a higher caloric amount and still lose weight. It has a thermogenic effect in that it boosts fat metabolism, which makes it effective for losing weight. After weight loss, like most other diets, you can’t go back to eating haphazardly because you’ll regain the weight. Surprisingly, it takes a lot of work for our bodies to store the fat that we eat as fat. Eating fat does not make you fat. (mic drop)

Leigh: So, would people with diabetes benefit?

Dr. Taylor: There is evidence that supports the use of keto in diabetes. Ketones are safe; it’s ketoacidosis that is dangerous.

Leigh: How can one be safe as a diabetic on a ketogenic diet?

Dr. Taylor: First, we should talk about the difference between type 1 and type 2 diabetes. Briefly, type 1 diabetes is an autoimmune disorder where the beta cells (cells that make insulin) in the pancreas have significant impairment or completely stop making insulin in response to sugar in the blood. Type 2 diabetes is when the cells of the body become resistant to insulin, meaning that the pancreas must produce much more insulin in response rises in blood sugar in order to transport it into the cell.

There is a very serious condition that can occur in uncontrolled type 1 diabetics known as ketoacidosis. Because of this condition, ketones are commonly thought of as bad or dangerous, but there is a big difference between ketosis and ketoacidosis. As we’ve discussed, our cells can burn either glucose (sugar/carbohydrates) or fat (in the form of ketones) for energy. Ketoacidosis is dangerous in uncontrolled type 1 diabetes in which blood levels of both glucose AND ketones are well above normal. This is a dangerous, potentially lethal, combination as high levels of glucose and ketones overwhelm the body’s ability to keep pH levels in a normal range. Ketoacidosis in type 1 diabetes is induced by the following:

  1. Ingestion of carbohydrates elevates blood glucose (sugar) levels.
  2. The pancreas does not produce insulin to drive the glucose into the cells, causing the body to think it is in a starved state.
  3. To compensate for the body’s perceived starved state, fatty acids are converted to ketones to use as an energy source.
  4. Because glucose is high and ketones are also being produced, the signal to shut down ketone production is severely impaired, resulting in extremely high production of ketones (~20+ mmol/L) and an overly acidic blood environment.

On the other hand, ketosis from following a ketogenic diet (without having type 1 diabetes) involves an elevation of ketones from what is normally ~0.1 mmol/L to anywhere between 0.3 to 1.5 mmol/L in the blood. The ketogenic diet provides a substrate that our cells can use and doesn’t result in the perceived energy crisis seen in DKA. Because ingestion of carbohydrates is low, glucose levels remain mostly normal while the brain and other tissue happily use the ketone bodies for energy. Ketones are more acidic than glucose, but that is okay at these levels since we are generally good at buffering the blood to normal pH levels.

It appears that the ketogenic diet may be safe and helpful in both type 1 and type 2 diabetes. First, a case study published a few years ago reported successfully treating type 1 diabetes in a 19-year-old male (Tóth & Clemens. Int J Case Rep Images. 2014). The patient previously utilized an insulin injection regimen and short-acting insulin for sporadic high glucose. Through 6.5 months on a vegetable-rich ketogenic diet, this participant maintained very tight glucose control and was able to incrementally reduce insulin usage until he came off of his insulin injections. (that’s insane, and unheard of) There were no adverse events reported. Interestingly, he also improved C-peptide production, which suggests that his pancreas regained some ability to naturally produce insulin. Similar findings have recently been published in a cohort of 11 type 1 diabetes patients (Leow. Diabetic Medicine. 2018). Disclaimer: This was all under STRICT supervision by a medical team. It is very important for an insulin-dependent diabetic to follow the recommended carbohydrate intake for their insulin dosage. Changes in eating patterns can affect insulin needs; therefore, making dietary changes like this must be done with a medical professional.

There was also this really cool study published by Stephen Phinney and Jeff Volek this year (Hallberg. Diabetes Therapy. 2018). Out of 349 type 2 diabetes patients, 262 patients were treated via a continuous care model that included a vegetable-rich ketogenic diet and 87 received usual care for type 2 diabetes. The patients on the ketogenic diet produced a blood ketone range of 0.5-3.0 mmol/L, demonstrated better diabetic control, and had significant reduction in diabetes medications when compared to the usual care group. The overall care model was labor intensive for the practitioners and researchers, but this study showed some pretty cool results for potential use of the ketogenic diet in diabetes treatment. They also, really focused on diet quality, which makes me think that there is long-term feasibility for the style of diet that the patients followed.

Leigh: So if someone is concerned about ketoacidosis, is it important to monitor ketosis and shift more slowly? 

Dr. Taylor: I can’t say that I’m currently a proponent for keto in type 1 diabetes as I feel there much more need for research, but the ketogenic diet itself should not induce ketoacidosis. However, if people with insulin-dependent diabetes did want to pursue this as a potential treatment, it would be imperative that they do so through a medical professional with significant knowledge in the area. Following a ketogenic diet will require adjustments in insulin dosage and strict adherence to the diet protocol.

There’s a line of thinking that if you’ve become unable to use glucose (sugar) as a fuel, which is what diabetes IS, then the ketogenic diet may be an alternative. Think of it like this: why give your body more fuel that you can’t use? In type 1, perhaps keto could serve as a therapy that would alleviate the need for insulin injections. In type 2, it seems that it is effective in bringing abnormally high insulin levels down due to decrease in need. 

Leigh: Does the ketogenic diet contradict the idea that a calorie is a calorie?

Dr. Taylor: On keto, the machinery used for getting glucose metabolism are reduced because you start using more of the fat and ketone metabolism machinery. Therefore, everything that we know about metabolism when we are primarily using glucose is turned on its head. One of the effects of the diet could be that we increase the number of mitochondria available, which is where the body makes energy.

Leigh: Is there a thermogenic effect?

Dr. Taylor: Ingesting more fat for energy makes you more likely to burn more of your stored fat as energy. Think of it this way: fat burning machinery is at its peak, so stored fat in our bodies become available as an energy source.

Leigh: Why do ketones make us make more mitochondria?

We still aren’t exactly sure why. Some theories include that ketogenic diets cause less metabolic stress allowing for more mitochondrial biogenesis or perhaps that ketones themselves have a signaling effect. It’s very important to keep in mind that all of the research available has been done in humans/animals with health conditions, not those that are generally healthy.

Leigh: Is there any evidence about the quality of the diet and efficacy of keto or is it all about the macronutrient balance?

Dr. Taylor: Right now, research outcomes have all been about macronutrient balance. I’d really like to see research go toward diet quality, which is coming. From a clinical standpoint (non-research), I’ve observed it is more feasible when people focus on quality, especially when following long term. A keto diet based on high quality foods would include beneficial fats, vegetables, and generally more of a whole food approach. These people seem to tolerate the diet better. They likely could go long term and have success, but we still need to learn if it’s feasible to follow a strictly ketogenic diet long term.

Leigh: Is there any effect on the gut while doing keto?

Dr. Taylor: Interesting new research about gut flora modulation suggests that some benefits of the ketogenic diet may be mediated/modulated by gut flora changes.

Leigh: What are the changes in flora?

Dr. Taylor: I’m not sure how it may affect people with an “optimal flora” but if you take, for example, epilepsy, MS, etc. it is suggested that the gut flora may be altered. In epilepsy, those changes in gut flora have associations with changes in seizure control. There are some animal studies where changing the gut flora can help halt seizures. This poses an interesting question: does diet quality in the ketogenic diet matter? Now we have to ask: do the microbes change by the macronutrient distribution, or does the food type matter (e.g. do veggies/fruit matter)?

Misapplied Information is a Bigger Problem than Misinformation

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To be completely honest, there’s a ton of really good information available to us. Yes, there’s click bait and spammy junk. But, you can also access pubmed abstracts and sometimes even full articles. Many of the most well respected schools and institutions provide free training and information online (Stanford, Mayo Clinic, Cleveland Clinic and others).

And although there’s some training involved in navigating through the nuance of scientific studies, what I’m more concerned about is the misapplication of good information.

What I mean is this: We see others close to us (friends, family members, people we stalk on Instagram) make diet, exercise or other lifestyle changes. We think: well, I like them, trust them, admire them and I want their results. I SHOULD DO WHAT THEY’RE DOING!

What we don’t realize is that their metabolism, genetics, health, family and life histories, and myriad other things are different than ours. We’re AREN’T THEM! And--news flash--that’s a GOOD thing. So, I’d say if you try a new way of eating and it just doesn’t quite feel right, what your body tells you are hints to you that maybe something isn’t quite right.

So, although there’s unending good information available to us now, we should check in with ourselves and honor what your body and intuition tells us. Is this right for ME or someone else?  

What’s the Magic Health Pill?

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My take on What the Health and The Magic Pill, two popular food and health documentaries

Over the past year, I’ve had people from all seasons of my life reach out to me and ask me what the H I think about the “What the Health” and “The Magic Pill” documentaries.

I have to be honest… I hadn’t even watched them. Although I’m obviously pretty interested in nutrition, health, and what we can do to reverse chronic disease, I sometimes need to just watch a binge-worthy documentary on Netflix (um… Wild Wild Country and Evil Genius anyone?!). I just need to shut off from all of that. Plus, I get to the point where I only need to watch 5 minutes of a documentary, see which “experts” they’ve interviewed, and I can already predict the bent to the show.

So, I finally bit the bullet. 

I picked these 2 out because they’re 2 of the most popular/high impact (people are making big health/diet decisions based on watching these), and they were both published in 2017. Other food and health-related documentaries I could have talked about include Fat Sick and Nearly Dead, Food Inc, Fed Up, Forks Over Knives, Cowspiracy, King Corn, That Sugar Film, and honestly more than I realized existed before watching each of these.

I had an intern working with me the past couple weeks, and we sat down to watch them (lucky her, right? Your assignment is to relax on my couch and watch movies with me). Together, we put this table (below) to compare and contrast the two documentaries. If you’re unlikely to read through the table, let me summarize it briefly here for you:

Ok, first before I go any further, I want to acknowledge that this is a very high level summary of what I see as the main themes, similarities and differences between the two documentaries. This is by no means comprehensive, and there is definite nuance to each.

So, now that we have that out of the way, here we go:

What the Health summary

What the Health (WTH) claims that a vegan, plant-based diet is the best health approach to eating. You should eat zero animal foods, and any chronic disease that comes from poor eating comes from foods derived from an animal. Sugar doesn’t matter. Eat all you want. You can see in the table that WTH is most concerned about processed animal products without concern for processed or refined carbohydrates. WTH would say that there is also no difference between organic or conventionally-raised foods.

The Magic Pill summary

The Magic Pill (TMP) claims that an ancestral “paleo” or ketogenic-type diet is the most healthful. Get back to the way we’ve historically eaten and let our genes lead the way. TMP would care more about highly processed/refined foods, overall. Quality of food is the higher priority over whether foods are animal or plant-derived.

Both documentaries hold big ag and big industry (pharmaceuticals and food) responsible for the cultural drive for this way of eating. They also both emphasize minimizing highly refined or processed foods (whether meat or carb). They both tell compelling stories of individuals who have dramatically changed their diet to follow the purported “best” way to eat, and you watch these people share how the diets have transformed their lives, leading to lower pain, less medication, and an overall better quality of life. Both documentaries tell compelling stories, and that’s what we all love. I can see why people choose to change their diets after watching either!

My take away: each of them emphasizes the importance of plant foods. Although they don’t address it in either movie we need to be mindful of the idea that you can eat a “healthy” version of either of these “diets,” and you can eat a less-healthy version (soda & chips are vegan and bacon & cheese are keto). So, using some common sense with their application is always important.

Is there a magic health pill?

So, What is the Magic Health Pill? I'm sure you can guess what I'll say, but there's no short cut to wellness. Eating more plants and less processed foods is always going to be a good way to approach your diet. The evidence is consistent in the literature that eating more plant foods is associated with better health outcomes. So, if you've never eaten your veggies, it's never too late to start.

I would say that if you’re unsure of what to do, just take a look at what you’re eating on a weekly basis (maybe keep a weekly log), and also pay close attention to how you're feeling. Do you have good energy, focus, good digestion? If not, your lifestyle may be playing a role in how you're feeling. As far as how you're eating, if half or more of what you eat is coming out of packages or windows (drive-thrus), then maybe a change would be worth it? If you’re eating mostly whole, minimally processed/refined foods, then you likely have a solid foundation. My only word of caution for the dietary approaches from each documentary is that they can both leave us vulnerable (similar to a Standard American Diet) to nutritional deficiencies if left unmonitored over a long period of time. There's no "one size fits all" approach to lifestyle changes, especially when it comes to diet. Integrative and functional healthcare practitioners are best equipped for monitoring and evaluating your nutritional status and would be a great sounding board for your efforts.

I know a really good nutritionist, if you’re looking for one.

So, what did you think about the documentaries? Have you made any changes since watching either or both of them?