The good, bad and the ugly of low carb diets – Podcast #76

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Dr. Justin Marchegiani and Evan Brand break down everything you need to know about low carbohydrate diets. They talk about popular diets like Atkins, Paleo and Ketogenic, Zone, and Ornish. Discover how you can get satiated after a meal by adding in high quality fat and also not overdoing your proteins. 

Low carb dietsFind out what starchy and non-starchy vegetables are as well as net carbs versus total carbs in this podcast. Learn how you can customize your diet to to make it more suited for your individual needs because not everyone will feel the same about a particular diet. Dr. Justin mentions great points about the A to Z study and explains how some people feel good on some diets while others don't as well as some people doing okay either way.

In this episode, topics include:

3:30   Low carb diets

8:08   Going gluten-free and Paleo

12:34   Starchy & non-starchy vegetables

16:39   Net carbs and total carbs

21:07   Customizing your diet









Dr. Justin Marchegiani:  Evan, it’s Dr. J.  What’s going, man?

Evan Brand:  Happy Friday!  We’re–

Dr. Justin Marchegiani:   Happy Friday to you!

Evan Brand:  Rolling right along. Who knows what day this will go up, but it’s been a great week and ready to provide some more nuggets for people as they enter their weekend or their week start, wherever they are in the world listening at whatever time.

Dr. Justin Marchegiani:   Yeah, ooh, we got a dog in the background.

Evan Brand:   Uh-oh, it’s the mailman.

Dr. Justin Marchegiani:   Mailman, nice.  Well, I had a patient this morning–I got a few more this afternoon.  I try to keep my Fridays light; they’ve been a lot heavier than, you know, recent.  I’ve been seeing a full day of patients, you know, 12 patients a day on Friday.  I’m trying to keep it lighter, so we have more room for creativity with the YouTube videos and podcasts.

Evan Brand:   Yeah, I know.  It–it does–you have to balance it.

Dr. Justin Marchegiani:   Absolutely.  So anything on your radar screen, clinically, in the clinic that you wanted to mention?

Evan Brand:   The main thing is helping people to understand that emotions tie into your adrenal health–sorry, my mailman, I think he’s leaving now.  Emotions are huge.  I just had a lady this morning and she sent me basically a crisis email where she had an issue with some of her supplement programs and she was not feeling that good.  Alright, so she was having a struggle but everything didn’t add up.  The supplement she was taking, it didn’t add up to the symptoms that she was concerned about.  And so we started digging in a little bit better and found out that she had this huge ordeal with her brother during the holiday season and that had sort of left her in almost like a post-traumatic hypersensitive adrenal burnout state and once we got to work through some of that emotional trauma, she felt immediately better by the end of the call, and then we realized–okay, we’re still going to tweak the supplements a little bit but here’s an emotional thing that was the white elephant in the room and when you look at the symptoms and you look at the protocol, something didn’t add up and then we kinda dug deeper.  So I guess, I don’t know, maybe the clinical nugget there is don’t assume that everything you see in the surface is all that matters when it comes to your health.  Those deeper things totally affect you and tie in to your overall health and vitality and you being able to stick to your program.

Dr. Justin Marchegiani:   I like that.  One of the biggest couple of themes in the clinic this week is being able to digest protein is essential.  If you can’t break down protein or you’re stressed and you’re breaking down your structural protein, i.e. muscle, that can cause a big problem, because the more catabolic you are, the more you’re taking from your muscle, the more you’re taking from your brain neurotransmitters because those are all made from protein.  So being able to digest protein and being able to supplement specific free form amino acids can make a big difference in people that are stressed.

Evan Brand:   Oh, yeah, we can probably do a whole podcast and we probably should on just that specific topic, protein digestion.

Dr. Justin Marchegiani:   I know, it’s getting to the point where, you know, I’ve over 250 videos and almost a hundred podcast.  I know you have hundreds of podcasts, too, and it’s like, “Well, I feel like I’ve talked about everything.”  But I guess you can look at different topics, maybe the same topic with a different nuisance or angle, and it kinda changes it a bit.

Evan Brand:   Yeah, I mean, I–I’ve had this feeling way back maybe like when I hit 100 episodes of the podcast.  I’m like, “Oh, my God, there is nothing left to talk about.”  But I’m still amazed at how much info you can put out there but it’s never been presented in a way that someone’s gonna comprehend and how that relates to them.  So I think that’s what we’ll continue to do.  We’ll have content for 50 years.

Dr. Justin Marchegiani:   I like it.  Well, pre-show we talked about us going into the good, bad, and the ugly of low carb diets.

Evan Brand:   Yes.

Dr. Justin Marchegiani:   I like this topic.  I spoke on the low carb cruise this year, with Jimmy Moore last year.  It’s 2016 now.  So 2015 and I’m a big fan of low carb diets, with a couple of caveats that will go into today.  I’m a big fan of Jimmy Moore.  I think low carb diets can be great.  I mean, if you follow any of Gary Taubes’s work.  Good calories, bad calories.  We know that low carbohydrate diets for the most part, you’re just excluding a lot of processed food.  It’s hard to eat a bunch of sugar.  It’s hard to eat a bunch of starch.  It’s even hard to eat a bunch of fruit on a low carb diet.  So what’s typically left when you eat lower carbohydrate is going to be vegetables and meat and ideally, lots of high quality fats.  Again, depending on how low carb you wanna go.  If you’re Ketogenic low carb, that is gonna be no fruit at all.  If you’re research low carb–and research low carb being typically a lot of low carb studies say 150 grams which may not even be low carb for most people, that’s why low carb diets may be a little skewed based on the research, it’s because low carb may not be what the real low carb is in the research, is you may be able to have some fruit and some starch.  But typically if you’re going on a low carbohydrate diet, you’re eating vegetables, primarily your green veggies, you’re eating high quality fat and high quality protein and you gotta be careful especially if you’re trying to be Ketogenic not going too high on the protein because protein can be gluconeogenic.  Meaning we can take that protein, those amino acids, and we can shuttle them downstream into glucose.  And we can sometimes, if we’re eating too much protein, increase our glucose via protein, but again anyone that’s having problems with glucose because of protein, well, you’re gonna have a hell of a problem with glucose from actual carbohydrate because it’s way easier for your body to get sugar out of carbohydrate because it’s a much faster conversion than getting sugar or glucose out of protein.

Evan Brand:   Right.

Dr. Justin Marchegiani:   That’s a couple of things there.

Evan Brand:   Right, which doesn‘t give you the green light and I just–that was funny you bring that up.  I was just talking to a guy this morning and he was saying how he’ll go and he’ll eat say a 16-oz piece of meat and he’s worried that he’s overdoing it with protein but he’ll leave the dinner table not satiated.  I’m like, “Well, just cut that down.  You can probably get away with an 8-oz steak and just add in some more fats, more butter or coconut oil or something, or some avocado oil or good olive oil.  Add in the extra fat, you’re gonna feel way better and you’re not gonna have to worry about overdoing it with that–what is it–the mTOR pathway.

Dr. Justin Marchegiani:   Yeah, M target of mammalian–M target of mammalian rapamycin, I think.  It’s a–

Evan Brand:   Yup.

Dr. Justin Marchegiani:   It’s kind of a long one.

Evan Brand:   It’s a weird one.

Dr. Justin Marchegiani:   And it’s a weird one, but regarding steaks, like the biggest thing is people are just doing super lean cuts of protein.  I guarantee you he wasn’t eating a fillet or rib eye or you know–

Evan Brand:   Don’t think he knows–

Dr. Justin Marchegiani:   He was probably eating maybe a sirloin or–or even a flank steak, right?  Something like that that’s probably more lean.  If you’re getting the fats in the meats, if you’re–if you’re eating, you know, more full fat cuts of meat, you’re gonna do so much better than doing the extra super lean cuts of meat, and I guarantee you it was a lean cut.

Evan Brand:  Yeah.  Now this is question for you.  If you get say a type of a rib eye or some other type of strip steak or you have that strip of fat, are you gonna eat that if that’s a good organic grass fed source?

Dr. Justin Marchegiani:   Yeah, if it’s good organic and grass-fed, I’m definitely eating that strip of fat without a dime.

Evan Brand:   Uh-hmm.

Dr. Justin Marchegiani:   It has lots of good nutrients in those fats.  Again, toxins tends to accumulate in the fatty tissue, so if you’re doing a lot of conventional steaks, you really wanna be avoiding it.  Like if I go to a really good dry age, you know, steak restaurant like I mentioned in the past, they’re typically still good quality steaks, you know, maybe like, you know, hormone-free kinda thing, but they may not be grass-fed.  They may be corn-fed.  They may be grain-fed.  So it’s probably not the best, but I will still have it because it just tastes so damn good.  But in general though, I’m eating grass-fed steaks, you know, 90%+ of the time.  So I’m kinda in that 80-20, you know, Pareto principle where you’re doing it right 80% of the time, you can kinda cheat a bit.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:   So as long as you’re within that range, you’re probably okay.  And I’m not sick.  I’m in really good health, so I have a little bit of leeway with that.  So I’m always trying to choose higher quality of meat so that fat source, any of the–the higher fat portions of that meat won’t be as toxin dense if you will.

Evan Brand:   Yup.  Makes perfect sense.

Dr. Justin Marchegiani:   So if we look like your typical low carb diet, some of the really good things about it is for the most part you’re going default gluten-free.  Now the problem with people like, you know, the Atkins crew and–and the Ketogenic crew, is they kinda got the gluten-free right by accident.  Meaning just–what with the sheer nature of needing to cut out carbs, well, you kinda have to cut out the grains because they’re high in carbs.

Evan Brand:   Yeah.

Dr. Justin Marchegiani:   Now there wasn’t an emphasis on the inflammatory and autoimmune components of wheat and grains in general.  There wasn’t a component of leaky gut and the lectins and the phytates and the oxylates and the molecular mimicry and the autoimmune condition.  They–they got it right by accident.  So it’s good but we also wanna highlight.  That’s why where you talk about low carb, I always like talking about it with the Paleo template attached to it.  So it’s a low carb Paleo diet.  That’s important because well, if we don’t talk about the Paleo element, Paleo adds in the quality element.  It adds in the organic, the free range.  It adds in the element, hey we’re trying to avoid crappy protein sources.  We’re not gonna do the Atkins as far as the head soy protein.  We’re not gonna do a lot of the artificial sweeteners that may have been in a lot of these low carb products so if we talk about it with the Paleo template attached, then we can make sure we’re avoiding the trans fat.  We know why we’re avoiding the grains outside of just the fact that there’s carbs in there.  We’re avoiding the artificial sweeteners and maybe the MSG, any of the processed food diets because the quality portion matters and we’re really focusing on eating real food, and a lot of people get that by accident with the low carb.  It’s not it’s made focus, but we wanna shift that in there because there’s power in why.  If people know why they’re doing what they’re doing, when that new diet comes out or their friends like, “Hey, that’s silly,” or “That’s stupid,” or someone questions why you’re doing what you’re doing, you just don’t fold, because you understand the–the reason why you’re doing it and that creates sustainability.

Evan Brand:   Oh, yeah and the–the artificial sweeteners, that’s huge.  I mean somebody that I was talking to earlier this week, he was like, “Oh, man, I’ve been counting my calories and I’ve been doing a snack as Jell-O.”  I’m like, “How long have you been doing that?”  Like, “Where did that come up into your life?”  I said, “Are you home?”  He’s like, “Yeah.”  I was like, “Go look at the back of the ingredients.”  And we went through ingredient by ingredient of why that is just awful and it was sucralose, Splenda, neurotoxin and other garbage, and I’m glad you–you mentioned adding the Paleo on top of it because it’s really easy to be unhealthy and still be on a low carb diet.

Dr. Justin Marchegiani:   Yeah, I mean, you could be eating a whole bunch of steaks that are grain-fed all the time and are full of hormones.

Evan Brand:   Yeah, you’re low carb and zero fat–

Dr. Justin Marchegiani:   Yeah, I think–

Evan Brand:   Yoghurt.

Dr. Justin Marchegiani:   Yeah, I mean, and you–we could have a whole bunch of artificial sweetener in there, too, and you could be having your soy protein bars but when you add the Paleo element on there, it just creates a, you know, higher level–a higher level filter in which you are choosing your low carbohydrate foods from.

Evan Brand:   That’s the perfect way to phrase it.  Yup.

Dr. Justin Marchegiani:   Yeah, so when we look at that, how I apply it from a clinical perspective because we’re always trying to give you the clinical outcome.  Most people that talk about these topics, frankly they are–have not seen a patient in their life.

Evan Brand:   Yup.

Dr. Justin Marchegiani:   So when it comes to them applying it, they just have their own experience.  So we’re giving you a different perspective here.  So most people that I work with, depending on one, if they’re healthy already, and two, if–are they at a healthy weight.  If they’re at a healthy weight, right?  They’re at a healthy weight, then we don’t necessarily have to go low carb off the bat.  If they’re not at a healthy weight or if they’re inflamed or they have a lot of insulin resistant markers that are high, maybe higher fasting glucose or they have a functional glucose tolerance that’s off, meaning one hour after they eat a meal, they’re blood sugar is higher than 140 or two hours after a meal, it’s higher than 120.  That can be some good reference ranges.  They have fasting insulin greater than 7.  And these are–can be some good markers.  Anyone that’s just carrying a little bit of extra weight has a waist circumference greater than 40 inches for a male or 35 for a female around their waist, that’s a sign that they probably are gonna benefit from a lower carbohydrate Paleo type of diet at least initially.  And for me, I–I do that right, 50 grams of carbohydrate or less.  The reason why I do that, it gives just a little bit of room for some berries.  If you’re typically just doing non-starchy vegetables and we gotta break vegetables up into 2 categories.  We have starchy and non-starchy.  Our non-starchy are like the veggies that our parents said to eat, right?  Broccoli, cauliflower, kale, spinach, right?  All of those things.  And then we have our starchy veggies, which are gonna be our sweet potato, our plantain, our squash, our rudabega, our turnips, right?  Maybe our yuca or jimaca–jicama.  These are our starchy carbs.  So we have non-starchy, starchy.  So if you’re eating just starch–if you’re just–if you’re eating just non-starchy veggies, your carbohydrate typically won’t go higher than 20 or 30.  Won’t go higher than 20 or 30.  So you’re typically okay.  That’s gonna give you that Ketogenic diet and then most people they mess up on the Keto is they just do too much protein.  So if you keep the vegetable there, 20-30, if you do enough fat, pure fat, right?  Whether it’s butter, ghee, coconut oil, higher fat meats like bacon, rib eye, you’re–if you’re–eat chicken it’s gonna be skin on, chicken thigh.  If you’re eating fish, it’s full fat fish, may not be the super lean fish.  You’re just choosing fattier cuts of meat and you’re adding–gonna be adding additional fat, too.  Whether it’s coconut oil, avocado oil, actual avocados, maybe a handful of nuts, so we’re really emphasizing a lot of good fats.  We’re staying away from protein powders when we’re super, super Keto because that may create that extra carbohydrate in sugar from the protein going through gluconeogenis, which is taking that protein and converting it to glucose.  So as long as we do those things right, we can kinda stay in that Ketogenic range.  Most people are consuming 50-60 grams of protein a day when they’re going Keto to keep them in that place.  Any comments, Evan?

Evan Brand:   Well, the fat pieces–awesome, because protein–everyone knows about protein.  You’ll even see mainstream cereal companies now like Cheerios trying to promote like Cheerios plus protein, but you still don’t hear about fat in the mainstream.  So hear that message loud and clear, because you’re gonna get more calories so you’re gonna feel better, you’re gonna have those fatty acids that we talked about in the last podcast helping your brain, helping your hormones.  If you have trouble with sticking to a diet that is lower carb and you feel like you’re getting cravings or you’re feeling those low blood sugar symptoms or you’re just not feeling right, check out your fat intake.  Most of the time you’re gonna see that it’s not enough and sometimes I think Dr. Mercola I think he said he goes through like a pound a week of grass-fed butter.  I mean–

Dr. Justin Marchegiani:   Oh, yeah.

Evan Brand:   You can really go heavy with the fat and that guy stays ripped year-round.

Dr. Justin Marchegiani:   Absolutely.  So if you kinda looked at our carbohydrate curve.  We have that 0 to 50 range or more aptly that Keto range if we’re right around 20 or 30.  That’s gonna be an emphasis primarily on your non-starchy vegetables, virtually zero fructose because we’re not doing any fruit when we go to that type of Keto extreme and we’re primarily focusing on high quality fats and moderate protein.  Higher amounts of fat, moderate protein, probably adding additional fat to the meal just so we can get those extra ketones, get the satiety signaling from the ketones.  Ketones really knock our appetite down and getting just a little bit of protein in there but choosing high quality, organic, free range sources, and probably avoiding some of the protein powders, too.

Evan Brand:   Is that just for allergy or why do you mention the protein powders?

Dr. Justin Marchegiani:   Well, just because you’re gonna be getting a lot of extra protein without the fat.

Evan Brand:   Yeah, right.

Dr. Justin Marchegiani:   So if you’re really trying to get it, that may throw someone out because of that gluconeogenesis.  Now I like to be in the 50-100 range.  For me that works because I want the extra bit of protein, because I–I wanna be able to, you know, be able to work out and get a little bit of extra protein in there.  I want the freedom of having a little bit of low sugar fruit and/or maybe a little bit of safe starch.  So I want that freedom of that, so if I get just my veggies throughout the day, I’m probably sitting at around 20-30 grams of carbohydrate.  Maybe I have a quarter of sweet potato with some grass-fed butter and cinnamon, and maybe a handful of blueberries.  Great!  Now I’m at 60 or 70 grams of carbohydrate.

Evan Brand:   Yummy.

Dr. Justin Marchegiani:   So I think you’re okay with that.  A lot of people say, well, net carbs, you know, you can’t count your total–you can’t count net carbs, you have to count total carbs.  And–and net carbs are basically subtracting the–the fiber from the carbohydrate.  Now I think you’re okay doing net carbs if you’re just doing vegetables like your non-starchy you’re gonna be pretty okay with that.  You start getting a little bit off when you do it with fruit because of the fructose.  There’s more fructose in there so you can start getting a little bit out of control there with the sugar if you’re just counting net carbs on fruit.  And then also, you can get out of control if you’re doing a lot of Xylitol-based products.  So a lot of sugar alcohol-based products because we don’t count those net carbs.  So if you’re just doing veggies, you’re probably okay.  When you start doing it with fruit and other low carb products that have a lot of sugar alcohols in it, I think you can probably derail yourself from that.

Evan Brand:   Oh, yeah.

Dr. Justin Marchegiani:   So with the 50-100 range, you have your choice of good quality proteins.  You can use a little bit of protein powder, collagen protein powder, either grass-fed whey or pea or beef, like the–the True Paleo one that I have and the–and the True Beef, those are great ones that we carry in the–our store, and then from there, we can add in a little bit of low sugar fruit, maybe 1-2 servings a day whether it’s berries or lemon or lime or grapefruit or green apples.  I try to put cinnamon on those, too, because it helps with insulin sensitivity and then you can choose abundant amounts of good, organic, clean vegetables; high quality fats whether it’s coconut oil, grass-fed butter, or if you can’t tolerate butter, ghee may be better; avocado oil, I use the Marks Primal Mayo for my mayonnaise because it’s really good mayo with grass-fed eggs and avocado oil versus all the soy in canola; and then you high quality meat.  So you kinda have that Keto and now we have our–our moderate to low carb Paleo which is kinda where I like to live.  I feel the best in that and most people, we start them, if they’re overweight and inflamed and have that large waist size, we start them at the less than 50 level and we dial up to 50-100 later, and some people feel good at that lower level like Jimmy Moore may do better at a Keto level, whereas some people may do better at that 1 level up, that 50-100 where I feel do better at.  So kinda tweaking it and–and adjusting it to your needs works best and if you’re doing a bunch of exercise, you’re gonna probably have to tweak up that carbs a bit, because if you’re just relying on small amount of carbs, your body may have to do more gluconeogenesis which is cortisol-dependent, which means you’re gonna be stimulating your adrenals to get more sugar from that protein and that’s adrenal stimulation.  So if you’re doing more exercise, more CrossFit, more workout–well, workout, you should probably have to get a little more carbs in throughout the day from those safe starchy sources and you’ll definitely wanna do it post-workout to help blunt that cortisol response by upping the insulin.  Insulin can have a really nice effect to knocking cortisol down especially post-workout and if you add some protein with it, that insulin will just suck that protein in and bring it right into the muscles.

Evan Brand:   Great point.  I’m glad you were going there because a lot of people they read books about like Ketogenic athletes and things like that, and for me, a lot of people just don’t seem ready for that because they do have that adrenal stress already and then you add in that super low carb and then you try to do intense exercise and a lot of times, they just get tanked out and they don’t ever know why.  It’s safe.  You’re not gonna–you’re not just gonna ruin everything and blow up like a doughnut if you just start adding in a little bit more carbs.

Dr. Justin Marchegiani:   Yeah, and Keto is kind of relative when it comes to exercise, too.  I had Ben Greenfield in my podcast a few years back and he talked about, you know, being in ketosis with some of his endurance work and he is doing 200 carbs a day.  So, I mean, he was still spitting out ketones with 200 carbs.

Evan Brand:   Wow.

Dr. Justin Marchegiani:   So that may be relative, so if you’re like trying to do ketosis with that 20-30 carb model, that may be way extreme if you’re doing a lot of exercise where you may even be at 100 or 150, but because you’re burning all that sugar up with that activity, you may still be in ketosis or spitting out ketones even with the higher carb level.  So I see a lot of–because me and you have the ability to see all these people that are doing CrossFit and doing these sports, you know, even professional athletes that we see that are coming in at a high level and bunking or really derailing their health with the exercise and their carbs being too low.  So some people will up their carbs, they’ll still be in a decent ketosis but they‘ll perform better than if they were in that traditional 20-30 carbs a day ketosis.

Evan Brand:   Yup, absolutely.

Dr. Justin Marchegiani:   So in the end, we have these general templates, but then we gotta customize it.  That’s kind of the big thing and, you know, there’s some research with low carbohydrate diets potentially affecting thyroid hormone conversion and I’ve seen that clinically where some patients go super low carb, we get their thyroid hormone better whether it’s through herbs and/or thyroid support.  We measure their temperature.  We measure thyroid hormone levels, T4, T3, and all the other co-factors there, but we’ll see some thyroid symptoms start to creep in whether it’s hair loss on the head or eyebrows or cold fingers or hands or brain fog or constipation and we’ll up the carbs just a touch and we start to see some of these symptoms go away.  And that’s kind of the nice thing about it is we know that that’s improving so we can add that customization level to it, so we have these general templates but then we customize as we go deeper with that patient.

Evan Brand:  Yeah, that’s what–that’s where the magic really happens because a lot of this stuff that you read online, it’s all theory and very cookie cutter and if you‘re trying to take a cookie cutter approach and apply that to yourself and it’s not working, well, that’s why; it’s because it’s cookie cutter and that’s not specifically tuned to you.  I think there’s always gonna be a demand for specialized nutrition programs, specialized supplements, things like that.  I can’t tell you how many times people come in and it’s like, “Here’s the 25 supplements that I’m taking,” and you dig in–I know you see this, too.  It’s like, “Well, why are you taking this?”  Like a random supplement, you know, that doesn’t even–that doesn’t even approach their symptoms, and “Oh, well, I heard it somewhere,” or “I read it on this blog,” or whatever, and then you got all these people that’s confused and I think what happens is you get decision fatigue and then you get an overindulgenece of information and you just really need to zoom out and focus on yourself and not focus about on–on what–what’s working for everyone else.  You gotta focus on you at the end of the day.

Dr. Justin Marchegiani:   Yeah, and one thing to kind of talk about, because this kinda bugs me a lot.  A lot of people are like, “Oh, Atkins screws everyone up.”  Well, if we look at Atkins from a perspective of, you know, a Paleo Atkins or if we just call it a Paleo Ketogenic, you’re gonna do great with that.  The thing that people mess up on Atkins is they look at the induction period of Atkins which is like the 20 carbs a day thing, where he’s trying to get people into ketosis, and they extrapolate that as that’s Atkins and it’s not.  There’s three phases to Atkins.  There’s the phase 1 which is the induction.  That’s kind of the ketosis type of phase.  And then there’s phase 2 which is the OWL phase.  It’s gone on–Ongoing Weight Loss.  It’s the balancing phase where you add 5 grams of carbohydrate and it does net carbs, so I’m find with net carbs as long as you’re not doing all the things I mentioned before.  Increased 5 carbs per week and as long as you’re weight loss isn’t dropping or you’re not gaining weight, then you can continue to increase 5 carbs per week up to about 80 grams of carbohydrate.  So wait a minute, Atkins isn’t, you know, a total low carb diet because you can go up to 80 carbohydrates per day.  So that’s the difference.  You can add customization with Atkins or a low carb Paleo.  Many people don’t know about it.  They bastardize it.  They totally ignore that phase 2 where you add 5 carbs per week, typically when you’re within 10 lbs of weight loss or so or your goal weight, you up it.  So you can kind of find your threshold even through Atkins.  So I’ve read this 10 years ago and it always perplex me how no one talked about it.  It always bugged me.  So I’m using this as my soak tool to kinda get it out but there’s customization even with Atkins and we just add that higher level of Paleo Atkins or low carb Paleo and we can up that 5 carbs per week and figure out what works.  And that way for that thyroid patient that’s having those symptoms of low thyroid, we can up the carbs a little bit and see if that starts to improve.  So we have this ability in functional medicine and functional nutrition to customize and not be dogmatic about what we’re doing.  Just make sure the quality is there and the macronutrients, the protein, the fat and the carbs, we’re totally agnostic about.  Our goal is to find what level works best for you.

Evan Brand:   Uh-hmm.  Great.

Dr. Justin Marchegiani:   So any comments on that–the OWL phase or that phase 2, that balancing phase?

Evan Brand:   No, that was a great rant.

Dr. Justin Marchegiani:   Okay, good.  I like that.  So looking at that again, if you look at some of these diets, Christopher Gardner did a great study where it’s called the A to Z study, and Christopher Gardner is out at Stanford and we actually were able–I was able to reach out to him at one point because I was living in Silicon Valley for many years and he was just down the road 5 minutes over at Stanford Medical.  And he did the A to Z study where he looked at the Ornish Diet, the Atkins Diet, the–I think your standard American Diet, I think the Zone. And he found that the Atkins really what it was was meat, vegetables and fats, right?  I mean, let’s just–let’s call it what it is, outperformed better in every single statistical category regarding cholesterol, HDL, LDL, blood pressure, hip to waist circumference, a whole bunch of markers, BMI–it improved every single person, you know, better in that group than each other group.  So the–that low carbohydrate group did so much better.  Now here’s the thing though, when we look at the groups in that study, here was the catch.  Everyone in that Atkins group improved, but there were still some people in the other groups that still did well.  Now here’s the catch.  When they controlled for some of the metabolic markers, they found whether the people that were in that low carb group or let’s say in the Zone or in the Ornish that had more carbohydrate, they found that whether they were in Zone or the Atkins, they did the same.  Like it didn’t really matter what diet they were eating when people had insulin levels higher than 7.  So fasting insulin higher than 7; that it didn’t really matter what diet they did.  They did good in both of those groups.  Now here was the catch.  When people had insulin levels less than 7, when they went into the higher carbohydrate groups, they did worse.

Evan Brand:   Yup.

Dr. Justin Marchegiani:   Alright, but they did better in the Atkins group.  So here’s the thing.  You have people that will do good in either one, alright, because they’re eating real food, they’re gonna do good in either one.  The people that are more insulin-resistant, they will do worse in the higher carb group.  So the people that are more insulin-resistant which is a significant portion of the population because of stress, inflammation, and refined carbohydrates and fructose, they do worse when they increase carbs.  So that’s why my default is always going on a lower carbohydrate approach because then we don’t let people slip through the cracks and let’s say someone will do better on higher carbs, well, great.  We’ll cycle them down through that lower carb and bring them up or if they’re already at a healthy weight, we’ll do the moderate carb, 50-100 and have them start to that.  So we can have that customization level, we have to know why would someone do good on low carb and not and why would someone do good on high carb and not, and it really comes down to insulin resistance for the people that gain weight and insulin sensitivity for the people that will do good in either group.

Evan Brand:   Yeah, here’s the 10-second test to tell if you’re insulin-resistant, you’re listening to this.  You look in the mirror, if you have excess weight especially around your hips, you’re likely insulin-resistant.

Dr. Justin Marchegiani:   Or if you–let’s say, you look good and you look healthy, but you know if you start upping carbs a bit, you start gaining weight and you know who you are because you’re–you know, that weight goes up on that scale and you know it, and you know that you do better when you keep the veggies in there versus the carbs and starch, you’re probably insulin-resistant but you’re modulating it with the low carb Paleo diet.

Evan Brand:   Uh-hmm.

Dr. Justin Marchegiani:   So how are you applying this to your patients, Evan, in your practice?

Evan Brand:   Mostly, starting out same thing, lower–I don’t usually say low–I say the same thing as you, lower carb in general to start people out.  I always–I have to harp on the fats.  I mean, you would think how much you and I talk about butter and coconut, that people would eat more fats, but it’s still a struggle to get them to add enough.  So that’s kind of the point that I hinge upon is adding that extra tablespoon of coconut oil if you’re gonna do like a beef protein shake or adding that extra tablespoon of butter on top of your steamed broccoli in your veggies.  To me that’s a game changer after the carbs get dialed in because that’s when they start to lose weight.  That’s when maybe their hair stops falling out as much.  Maybe that’s when their sex drive improves and it’s all due to those good quality fats.  I mean, smother everything with butter–

Dr. Justin Marchegiani:   Yeah.

Evan Brand:   I promise.

Dr. Justin Marchegiani:   Yeah.

Evan Brand:   It’s gonna help you.

Dr. Justin Marchegiani:   Now, here’s where low carb diets fail.  Exactly what you said you don’t go high enough on the fats.  Number two is if you have a gut infection that is preventing you from breaking down protein and fats, oh my gosh, that’s primarily what you’re eating more of in these diets.  So if you can’t break it down, it makes sense.  These foods act like a brick in your stomach and may ferment and rot and rancidify and putrefy and create more inflammation.  So if you’re not doing well on it, you gotta look deeper at the gut for infection, SIBO, parasites, fungal overgrowth, and you have to have that looked at.  You may do better with–the time being–with hydrochloric acid and enzymes and/or extra bile salts especially if you don’t have a gallbladder.  So you gotta look at are you making the digestive secretions to break the food you’re eating down, if you’re not, well, that’s strike one.  If you have a gut infection that’s compounding that, that’s strike two.  And then if–if you’re in that fight or flight because your adrenals are really stressed out, that will turn off your digestion, too.  So you may have to look deeper at the adrenals and your stress response.

Evan Brand:   Absolutely.  So many people don’t eat in a relaxed state.  You’re wasting your hard-earned money on that food.  Chill out, get off the phone, relax, chew it, breathe, give yourself a couple minute buffer time before and after meals.  That’s what I always recommended.  Just sit there–ahh, okay–not finish that last bite as you’re merging on to the highway.  That’s not optimal digestion conducive.

Dr. Justin Marchegiani:   Exactly.  And one last thing.  I’ve alluded to on the–on the A to Z study, alluded about it regarding why people who are on the high carb group still felt good, well, again, a message to all you vegans or high carbers out there.  Don’t demonize people who are low carb just because you can do well on both.  Just because you can do well on high carb, don’t extrapolate that to, well, that’s how it should be for everyone because it’s not.  I see a lot of people say, “Well, I can do 300 or 400 carbs a day.”  Well, most of the time, you’re probably genetically lean anyway.  You probably also do a lot of exercise, because people that can handle a lot of carbs, carbs create energy in those people.  People that are insulin-resistant, carbs create fatigue because insulin drives lipogenesis in insulin-resistant people.  That means you’re making fat.  When you’re making fat, you’re taking calories and you’re storing it, not burning it.  Thus, so it creates fatigue in those people.  So be understanding.  Be compassionate.  People that have issues with lower carbs–I mean with higher carbs, they have to eat a diet that’s more insulin-sensitive so that it helps reduce their insulin resistance so they can basically do more metabolically by shifting their body to burn their calories by decreasing their insulin level.  So have a little compassion.  Just remember, you know, N equals 1.  Just because you can do it, it doesn’t mean it’s the same.  You may be the exception for the rule.  When I see a lot of people commenting on my videos saying this stuff, but you’re just the exception.  That’s it.

Evan Brand:  Absolutely. Well-said.

Dr. Justin Marchegiani:   Any last comments, Evan?

Evan Brand:   No, that’s it, man.  That was a great coverage and that was a good way to wrap it up.  I will restate that though for people that are dealing with insulin problems.  When you add carbs up, your energy drops.  And if your insulin is too high and you’re insulin-resistant, when you drop the carbs, you get more energy because your insulin’s coming down.  Did I re-state that accurately?

Dr. Justin Marchegiani:   Yes, exactly.  Well, a lot of people, too.  Even if they’re carbs, yes, if you’re–if you’re insulin-resistant, yes, that’s exactly how it’ll go.  The people that are insulin-sensitive, right?  Meaning they can–they don’t have that receptor site downregulation from the insulin response, it doesn’t matter either way.  And they’ll typically feel better with the higher carb.  Correct.

Evan Brand:   Got it. That’s great.

Dr. Justin Marchegiani:   Alright, well, this is a podcast that I think we gotta listen to a few times.  A lot of the things we talked about just clinically individualize yourself if you’re having a hard time with the diet piece, that’s where you reach out to Dr. J or Evan and then we can dig in and customize things, and if you’re having problems with the diet piece like the digestion component or the stress component or you’re not breaking things down appropriately, constipation, just your stools like they’re a mess, that’s where you gotta dig in and find a good functional medicine doctor to get to the root issue here.

Evan Brand:   Yup, absolutely.

Dr. Justin Marchegiani:   Alright, Evan, great talk.  Have a good weekend!

Evan Brand:   Take care, bye!

Dr. Justin Marchegiani:   Bye!

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