Using ketosis to lose weight and improve your health – Podcast #109

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Dr. Justin Marchegiani and Evan Brand dive into an in-depth discussion about nutritional ketosis and what benefits you can reap from it. This is a podcast episode where you’ll get valuable information about a Ketogenic-Paleo diet, what to eat (and when!) to get the best results.

ketosis_1Learn why insulin needs to be kept low and the ketones high. Find out how you can keep your diet in check and avoid wasting money when you’re taking exogenous ketones. Discover why carbohydrates are better consumed during night time.

In this episode, topics include:

03:38 What is Ketosis? Who is it for?

08:35 Kinds of ketones

09:50 Ketone supplements

17:36 Using ketones beneficially

28:45 Ketoacidosis vs ketosis

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Dr. Justin Marchegiani:  Evan, it’s Dr. J! It’s a Monday. How’re we doin’?

Evan Brand:  Hey, I’m doin’ great. What’s up with you?

Dr. Justin Marchegiani:  Hey, it’s good that you survived the weekend.

Evan Brand:  Yeah, it was extremely exciting weekend with the baby—getting a lot of trouble with the baby.

Dr. Justin Marchegiani:  Nice. What’d you guys do?

Evan Brand:  Just hanging out at the park, hanging out outside.

Dr. Justin Marchegiani:  Nice. That’s awesome.

Evan Brand:  You get—you get stopped by a lot of people when you have a baby.

Dr. Justin Marchegiani:  Oh, I know. I just a got a dog a month or two ago and I just—I’ve never realized how many people are dog lovers, but man, we get so much attention when we have our dog. It’s crazy.

Evan Brand:  Yeah, if you were single. That would be the easiest way.

Dr. Justin Marchegiani:  I told my wife that. I said, if I ever—like if something ever happened where I can go back in time—if I were to do it all over again. I would’ve got a dog like right off the bat, like just a really cute, small dog but it’s all good. I’m happy where I’m at.

Evan Brand:  Yup, cool.

Dr. Justin Marchegiani:  But I wanted to say, we were talking pre-show there that I got a crown today and I go see a holistic dentist in Austin. Her name is Dr Joan Sefcik. I’m gonna actually have her on the podcast real soon. We’re gonna talk about root canals, cavities, crowns, all those things, but I had an issue with my tooth where I needed a crown. About 16 years ago I split my tooth in half when I was really young, just eating a whole bunch of sugar, eating a whole bunch of gluten. Hadn’t really got the message back then about health. Split my tooth but I was actually able to keep it together with some cement, and obviously changed my diet and never had anything like that happened with my tooth again, but I had those—the long-term consequence of that tooth being unstable so we put a crown on it and we actually did some testing, too, to figure out what the best material was and we actually—I think we ended on a cubic zirconia. So right now I have an acrylic crown that’s a temporary one and we got a cubic zirconia one coming in. We had it muscle tested and we called the lab. We—we chose the top 3 materials that test the best based on blood chemistry and then we muscle tested the top 3 and I tested great for all of them which was great, and then the doc said, “Well, you know, this is the one I have the best success with, and because you tested great with all three, we’re gonna go with this one.”

Evan Brand:  So I’m sure people wanna know with holistic dentistry, that’s all cash no insurance for that?

Dr. Justin Marchegiani:  A little bit. I mean, we have some dental but I—you know, I paid that I think out of pocket. I think it ended up costing me like a thousand bucks for the crown–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  And if I didn’t have insurance, it would have cost me $1500. Something like that.

Evan Brand:  Oh, okay. So insurance kinda works for holistic dentistry.

Dr. Justin Marchegiani:  A little bit. I mean, the thing is what’s holistic is the material we’re using, right? We’re not using the standard-based crap. I think it’s nickel a lot of times–

Evan Brand:  Yeah, it’s horrible.

Dr. Justin Marchegiani:  Which can screw up with, you know, the conduction of nerves in the body. So that’s the big thing and also she used a lot of ozones as she go in there. She’d use ozone and get in there, like a lot of essential oils. So it was really targeted to kill a lot of the bacteria and crap that could be in there even though she—I actually asked her, she said it was great, which is good. It’s testament to you know, good, clean—clean eating. So we’re gonna have her on the show real soon to talk more about healthy teeth and oral hygiene, so that that’ll be fun.

Evan Brand:  Awesome.

Dr. Justin Marchegiani:  So I’m doin’ pretty good. Not bad. I get to go get my cubic zirconia tooth. My wife was texting me, it’s like, “Is that gonna look like one of those fake diamonds?”

Evan Brand:  Is it?

Dr. Justin Marchegiani:  In your mouth? No, I don’t think so. I asked. It’s gonna look, you know, it’s gonna look cosmetically in sync with my other teeth. So it’ll be alright.

Evan Brand:  Awesome.

Dr. Justin Marchegiani:  Yeah. So we talked about doing something on ketosis. I’ve had Jimmy Moore on the podcast. I’ve spoken on Livin’ La Vida Low Carb Cruise. We did a podcast a few months ago on Keto OS which is a synthetic ketone supplements and look forward to digging in a little bit more on ketosis.

Evan Brand:  Yeah, there’s a lot of benefits. Ketosis in my opinion is not for everyone at every point in their life. It has a lot of incredible benefits for weight loss but if you have adrenal issues in my experience, some people feel worse. Maybe there is that adjustment period but I find that if people are just they’re afraid of carbs, they can tank out even more. What’s—what’s your experience with adrenal issues and—and ketosis?

Dr. Justin Marchegiani:  So I think ketosis is phenomenal for most people that are out there, especially if you’re dealing with metabolic syndrome, meaning there’s a level of insulin resistance and you’re body is having a difficult time tapping into fat for fuel, ketosis is phenomenal because what you’re doing is imagine fat is like this big branch and we’re trying to throw that branch into the wood chipper and then out of that wood chipper comes these things called ketones, and these ketones can be used by different tissue in the body and the thing is, glucose actually burns dirty. Right? It’s like a diesel fuel. You kinda sm—it’s smells. It’s stinky. If you ever drive by in a diesel car, at least the older ones. But ketones they burn really clean and when I say burn really clean, you don’t get a lot of reactive oxygen species or free radicals afterwards. So it burns really clean like that and also you don’t get the effects of glycation, which is basically all the proteins or tissue in your body gets sugar-coated and that creates basically a m—a magnet for free radicals. So we like ketones because of the stability they give people, right? With sugar, we get this up and down reactive hypoglycemic effect with a lot of people that are doing refined sugar or just higher glycemic foods, meaning they get into your bloodstream really fast. We don’t quite get that with ketones. So the big issue is most people who have metabolic syndrome, big waist, high blood pressure, lots of inflammation, lots of insulin and blood sugar, they can’t get the sugar into their cells and utilize it for fuel optimally. So they can’t—their cells are—are very resistant so they start—one, they get reliant on sugar to burn but two, their cells don’t wanna take it in a lot and actually burn it so they get very tired and a lot of that that gets put in gets stored as fat. So it’s a double edged sword. They’re tired. They don’t wanna exercise. They get cravings. They create more sugar and then when your insulin levels are high, it basically blocks fat from being burned so you’re primarily burning sugar but you can’t get a lot of it to the cells so you’re tired.

Evan Brand:  Right. I’ve heard recently which I’ve read. I can’t remember what I was reading. There’s this kind of—there’s kind of a myth that’s perpetuated where people who are only a fat burner or only a sugar burner and that’s not the case. It seems that most people have the ability to do both and if you wanted to survive in primal times then you would have, you better have that ability to be able to burn glucose or ketones to survive. But I think the goal of that is you just wanna be primarily a fat burner, not primarily a sugar burner which is what would you say, 90% of the population is probably primarily glucose—glucose driven?

Dr. Justin Marchegiani:  Yeah, I would say at least 75%, and we talk in generalities, right? We’re talking like, “Hey, you know, you’re primarily burning sugar for fuel or primarily burning fat for fuel.” That’s—that’s the thing that we’re kinda get across there and most people, you know, when we talk about calorie partitioning, their partitioning, right? You know, imagine you got a police officer and his siphoning people through, “Go that way. Go that way.” You got all these calories that are going through and the police officer is saying, “Hey, go this way into the fat cell. Get stored as fat and a small amount will actually get burned. So we’re not shunting those calories. “Hey, go to the mitochondria. Get burned. Create energy.” While you’re creating energy, you’re building muscle because you’re doing something that’s creating resistance in the body which builds muscle, whether it’s the piezoelectric effect and you’re building calcium into the bone or whether you’re putting muscle into the muscle belly. So we wanna essentially use that you know, traffic policer officer or that you know, flight tower attendant that’s telling the planes which direction to go. We want tell those calories, “Hey, go to the mitochondria. Get burned versus get stored in the fat cell.” And one the biggest ways we can do that especially with people that have this insulin resistance metabolic syndrome is getting into ketones by cutting carbs.

Evan Brand:  Yup, so–

Dr. Justin Marchegiani:  Typically down to 20-30g is a great starting point for most people. Go ahead.

Evan Brand:  Now, the people actually need to count? I mean, I’m probably in ketosis now at this point because I haven’t had much today. I had some—I had a bison burger and also I had some bison—or no, what did I have for breakfast? Had some kinda meat and—and I can feel that. I know because you can feel your breath start to stink a little bit more. That’s how you know. That’s like the first sign of ketosis or one of the first signs.

Dr. Justin Marchegiani:  Well, yeah, you get the acetone but I mean, if you’re only at like .5 mmol, I mean that’s not a ton. So maybe your breath gets a little bit fruity, that’s the acetone. So there’s 3 kinds of ketone. There’s acetone. There’s beta-hydroxybutyrate and there’s acetate. So like if you look at the breath meters. The breath meters are really measuring the acetone in the breath and then the blood is measuring the beta-hydroxybutyrate–

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  In the blood.

Evan Brand:  Okay.

Dr. Justin Marchegiani:  Right? And then some will actually measure the ketones in the urine, not that efficient because if you’re burning ketones, well, that means if you’re burning them they may not end up in the urine, right? So if you get someone who’s in ketosis, they’re spitting out a whole bunch of ketones but they’re burning them up efficiently they may not pee a lot out. Does that make sense?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  So early on you get a lot of people that are in ketosis but they’re body’s not efficient at burning those ketones so those ketones go in the urine to start.

Evan Brand:  Well, let’s–

Dr. Justin Marchegiani:  But then later on as they get more efficient, you won’t see them in the urine. That’s why I got my ketone meter right here. I use the Abbott Precision Xtra or Precision Xtra and it’s—I got blood sugar on there as well as ketone strips, too.

Evan Brand:  Yeah, I’ve done the breath. It was by Ketonix.

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  I’ve done their breath one. That one was pretty good. I find that I had like a low level of ketones all of the time. Let’s clear something up though. When people hear about ketones, they’ve likely been in the grocery store or Walgreen’s or somewhere and they’ve seen the raspberry ketones as a weight loss supplement. They became very popular over the last probably 5 years. First off, raspberry ketones, they’re not even derived from raspberries when you see those. Most of the time when I’ve looked at the ingredients, a lot of times there’s synthetic chemicals in there. There’s artificial colors, sometimes artificial sweeteners in these raspberry ketones. So I do not recommend them. I don’t actually know enough about what’s actually in there to know what’s actually going to happen but generally just looking at some of the ingredient list on ketones, it—it’s garbage.

Dr. Justin Marchegiani:  Yeah, raspberry ketones aren’t necessarily ketones. I mean, if you look at what’s in there, there are these phenolic compounds that aren’t your typical beta-hydroxybutyrate whether it’s calcium or sodium beta-hydroxybutyrate salts. Like if you look at a lot of the ketone products, there’s Keto OS. There’s another one, a Keto Sport I think, and they’re using the beta-hydroxybutyrate salts, calcium or sodium. Those are like the gold standard. Now you can use precursors, right? Kinda like how we use maybe pregnenolone for adrenal support precursors. You can use precursors like medium chain triglycerides which are gonna be primarily C8 and C10. Like the, you know, the brain—the brain ketones are more C8, right? Octanoic acid or I think that’s maybe caprylic, there’s two names. I like the octanoic because it’s more descriptive. The oct–, octo–, octagon, that’s 8—8 carbons. So typically we’ll do ketones that are C8 and C10 because you get the brain effects of ketones but you also get the metabolic effects. So like typically in the morning after I have either a good clean collagen shake or some eggs and I do my butter coffee with high quality MCT oil. I’ll get my ketones up within an hour or 2 to—to .5, .6 mmol and I feel great.

Evan Brand:  Do you measure that?

Dr. Justin Marchegiani:  I measure it, yeah. Now the thing is with the Ketonix, it’s more qualitative. So like that number like let’s say you’re—you’re a different color or light on that variant. That light that you hit one day, you may hit it the next day but your number may have been different if you were measuring it in mmol of ketones. So it’s a good indicator to—to say if you’re in ketosis. It’s not a good quantitative indicator of what exactly were you.

Evan Brand:  Yeah, the other brand that I’ve seen before. I’m looking—trying to find the ingredients right now is Kegenix. So I’m trying to see what’s in here. It’s $200 for a 4-week supply.

Dr. Justin Marchegiani:  Yeah, they’re kind of expensive. My biggest thing off the bat is number one, get your diet dialed in. So you talked about carbs. So the first thing is as a macro percentage of nutrients is you wanna get your fat up. Most people screw up in ketosis because they go too high in protein. They’re eating like you know, 30-40% protein. It’s hard to do that much in protein unless you do two things wrong. Number one, you eat lots of lean meat and number two, you do excessive protein powders. So those are the 2 things. Now you can get away, going higher on protein if you’re doing a lot of resistance training, alright? But if you’re not doing a whole bunch of resistance training, you want your macros up around 60-70% fat as a pretty good starting point. So what I recommend is just throw your foods into a MyFitnessPal and if you’re using a Paleo template, so that means you’re gonna be getting most of your meats from animal products. Your carbohydrates, you’re gonna choose obviously more from a non-starchy vegetable sources. A really easy thing is you’ll typically be good around 20-30g and you can just throw in your carbohydrates, a cup of broccoli, a cup of spinach, a cup of kale, maybe you’re doing some asparagus, maybe you do another salad for dinner or lunch. Throw all the vegetables that you do in there, you’re probably find that you sit around 30g of carbohydrate once you factor out the—the fiber, 20-30 is pretty good unless you’re doing a ton of juicing or ton of veggies. You’ll probably be around 20-30 net carbs. That’s a pretty good place to be. So that’s a good starting point and then from there, depending on whether you wanna stay in ketosis—I like to—to keep myself around 40-70 carbs a day and I keep—I get my ketones up to .5 and I feel phenomenal–

Evan Brand:  So you’re—you’re–

Dr. Justin Marchegiani:  At around .5.

Evan Brand:  So you’re basically in some level of ketosis most days.

Dr. Justin Marchegiani:  Absolutely. Absolutely. And then like if you listen to guys like Jimmy Moore, Jimmy is around 1, maybe—maybe 1-2. And again, you don’t have to worry about ketoacidosis until you get to about 20. Ketacidosis is potentially what could happen to diabetics type 1 primarily and/or alcoholics that have cirrhosis, with that—they have messed up livers. Essentially ketoacidosis is when your insulin levels are high and your blood sugar’s high. Okay, that typically hard to do because when the insulin goes high, blood sugar goes low.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Alright, so insulin’s high. Blood sugar’s high in the bloodstream but what’s happening is we can’t get the—we can’t get the—the calories or the blood sugar into the cell so the cell’s starving and what happens is the body is trying to generate energy so it spits out a whole bunch of ketones.

Evan Brand:  Yeah, so–

Dr. Justin Marchegiani:  Does that make sense?

Evan Brand:  Yeah, so I was looking at the ingredients here. Basically what this is, it is the beta-hydroxybutyric acid, that’s literally what’s your supplement— supplementing with. That along with some medium train—medium chain triglycerides and then leucine, lysine and isoleucine. That’s it. And then erythritol, some Stevia, some color, things like that. So you’re literally just taking—you’re taking ketones. That’s what it is, right? The—the beta-hydroxybutyric is one type of ketone?

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Is that right?

Dr. Justin Marchegiani:  Correct. I wanna go back and correct myself. I misspoke. So regarding the ketoacidosis, it’s the insulin is low. Insulin’s low.

Evan Brand:  So you can’t deal with the blood sugar.

Dr. Justin Marchegiani:  Blood sugar is high so you can’t get it–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Remember insulin’s the lock or the key that goes into the lock. The—the keyhole is receptor site, whether it’s a GLUT4 key which is that’s allowing sugar into the muscle or whether it’s on the liver and an—various different GLUTs. So imagine the GLUT’s the lock and insulin’s the key. So you can’t use the key to get into the cell. So what happens is all the sugar accumulates in the bloodstream because insulin’s low. So everything I said before is correct except it’s because of low insulin. Think, right? Type 1 diabetics have an issue with low levels of insulin because their—their islets cells in their pancreas, the beta cells have been destroyed by autoimmune attack. So they can’t get that sugar in there, so the body’s freaking out. It’s saying, “Where the heck am I gonna get energy?” So it starts ramping out a whole bunch of ketones. Ketones have an acidic ash to it or an acidic foundation to it so it shifts the pH because of instead of being a nutritional ketosis at .5 mmol or 1 or maybe 2, they are 20-10 x higher and that shifts the pH down. When the pH goes down, they can go into a diabetic coma.

Evan Brand:  Wow. Yeah, I—you said that quickly otherwise, I probably would have caught that. That makes a lot more sense. So insulin’s low, sugar’s high. That’s when you don’t wanna do it and like the supplement says that you cannot use it with type 1 diabetics for that reason.

Dr. Justin Marchegiani:  And I—exactly. And I was listening to a lecture just yesterday talking on the topic and he did the same thing I just did and I—I got his bad habit from it. He said the exact thing I said the first time.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So I got the bad habit by osmosis, but we corrected it here. So think low insulin, high sugar, the cells are starving.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  The body freaks out and it tries to go and generate a whole bunch of ketones but shifts the pH. Now how do we use ketones beneficially? So we can use exogenous precursors like we mentioned, okay? Obviously the diet’s gonna be foundational. Now for some people, there’s a couple of ways of doing it. You can live in ketosis. That can be great for some people. If you have cancer, lot of great studies especially over at Boston College, Dr Veech, NIH guy. He went to school—he studied under Dr Hans Krebs, I mean the guy invented the Kreb cycle, alright? He discovered it, which is how the body generates you know, energy via NA—NADH and FADH redox—redox reactions which then generate ATP in the—in the Kreb cycle as well as the electron transport chain, but this is how our body generates energy and this guy studied with this doctor that created or discovered this stuff. So moral of the story is this is another way the body can generate energy and ketones are really important part of the Kreb cycle and they are really important part of starving out cancer cells. So cancer’s primarily—primary fuel if you look at Otto—Otto Warburg or Otto Van Warburg, a German scientist in the 30s and 40s who got 2 Nobel prizes discovering this physiology around cancer cell metabolism and he found that cancer cells primarily survive on glucose and if you can starve the cancer cells of that metabolic fuel—remember it burns dirty—if we can use ketones, we can essentially starve that type of cell.

Evan Brand:  Yeah, so—I mean, basically you and I both touch in to ketosis. Now I do do some sweet potatoes and things in the evening so I likely pull myself out of that so this is something that this is gonna depend on the person but you can touch in to ketosis—you do some carbs, don’t you? Do you do sweet potatoes with dinners?

Dr. Justin Marchegiani:  I cycle in and out. I cycle in and out. Typically at dinners, I’ll do after a dinner as a treat. I’ll do a handful of berries and maybe some cream.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Or I’ll do some high quality, 90% dark chocolate that’s you know, organic and you know, obviously gluten-free. So it depends. Like this week I did buy some sweet potatoes so at one night, I’ll have that. I mean, you get different diets out there like a cyclical ketogenic diet.

Evan Brand:  Right.

Dr. Justin Marchegiani:  There’s also Jason Seib’s stick on the AltShift Diet, which is I think a 3 days—I think it’s a 5-day low carb, 3-day high carb kinda stick as well. So there’s different things out there where you can cycle in and out and those I think tend to be really good for most people. If you’re more metabolically damaged, ketones, ketosis at that 20-30 induction phase can be pretty good. It depends. Some people I see if they’re in ketosis long-term will start to develop some of those hypothyroid symptoms, losing hair, hair loss, outer third eyebrow, cold hands, cold feet, mood stuff.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And then would just add in just a little bit carbs, small amount, and they’re doing better, so–

Evan Brand:  That’s what I had to do.

Dr. Justin Marchegiani:  Yeah, so some people–

Evan Brand:  I crashed.

Dr. Justin Marchegiani:  Do better so I’m not dogmatic at all. There are people out there that do great on that diet and because they’re not clinically oriented, meaning they’re not working with patients that we are, they—they just think well, because they did good on it, the other person out there that’s having a bad response or not as good response must not be doing it wrong.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  I’m sorry, must not be doing it right.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Because they’re doing it wrong essentially. So we always just make sure the fat macros are up, the protein macros aren’t too high, and then just make sure the carbs are there and that’s a pretty good sign off the bat and then we can always measure it. Get to a .5 to 1. 1 is pretty good. Cut off. So we can customize it and then we can figure out. Okay, you’re at ketosis. You’ve been there for 2-3 weeks. You’re stabilized now. Okay, you’re already at a healthy weight. You’re feeling good. Your markers look good. Let’s just taper up some of those carbohydrates a little bit, just a little bit. And this is where it’s cool that you can play around with these exogenous ketones, the beta-hydroxybutyrate salts like the calcium and the sodium. This is great to try. Be careful though. Don’t make the mistake of adding these synthetic ketones and eating a whole bunch of sugar. The body is programmed when insulin goes up, typically ketones never should be there, right? Because think about it, right? Insulin has to be low for ketones to be high. Because if high insulin’s present, the body will block fatty acid synthesis. What are fatty acids? That’s the tree branch going into the tree chopper. Out comes the ketones, right? So we wanna keep insulin low so if we eat a whole bunch of sugar, take some exogenous ketones, insulin’s high, guess where those ketones are going, you know?

Evan Brand:  Well, hopefully it’s gonna help go into the mitochondria.

Dr. Justin Marchegiani:  Well, if insulin’s high and sugar’s high, you’ll actually pee it out. So if you use exogenous ketones, you wanna keep the insulin low still.

Evan Brand:  So if you—so if you’re eating high sugar or you’re eating high carb and then you take ketones, you’re saying waste of money.

Dr. Justin Marchegiani:  Waste of money. And again a lot of the marketings out there because frankly, a lot of these ketone companies, they don’t care if you do it right or wrong.

Evan Brand:  Right.

Dr. Justin Marchegiani:  Because they’re getting—they’re getting paid either way.

Evan Brand:  Exactly.

Dr. Justin Marchegiani:  Not saying that’s bad. There’s education that comes into play. So if you’re using exogenous ketones which I think can be great from a performance, neurological standpoint especially if you have issues with Alzheimer’s, things like that. That can be phenomenal because then if you have the right diet in place and then you add some ketones, it’s like bada-bing! You’re there. You know, we call it therapeutic ketone therapy. You know?

Evan Brand:  So basically, don’t waste your money. If you’re gonna do this thing then get the diet straightened out always but then get the—get the cyclical Ketogenic Diet or experiment with that first before you buy ketones.

Dr. Justin Marchegiani:  Experiment.

Evan Brand:  That—that’s expensive. That’s $200 and that’s a—a way to waste it.

Dr. Justin Marchegiani:  And you may not have to be you know, full out ketosis. You know, I sit around .5 to 1 and that feels pretty good. I think just spit out some ketones.

Evan Brand:  Okay.

Dr. Justin Marchegiani:  Get to a pretty good place. See if you can test it. Get down to .5 or 1. See how you feel. Stabilize and then taper in some carbs. You know, start off with a little bit of lower sugar, lower fructose fruit, and handful of berries. It’s a pretty good place and then you can always try adding in a little bit of safe starch, sweet potatoes, squash, yams, plantains. Do it at night. Because your body doesn’t need the extra sugar during the day because cortisol’s already there, mobilizing and conducting sugar out of the—out of the glycogen, out of the muscle tissue, or out of the liver. So the glucose is already going where it needs to go because of the high cortisol. Do your carbs at night where that cortisol isn’t as present.

Evan Brand:  This is fun.

Dr. Justin Marchegiani:  Yeah, you having a good time here?

Evan Brand:  Yeah, this is fun.

Dr. Justin Marchegiani:  Awesome.

Evan Brand:  Well, just because you know, there—there’s so many different ways to go about this and there’s never—I—I think when people download these episodes, they think there’s gonna be like a single and that’ll be all answer, and that’s never going to exist especially for this ketosis discussion here.

Dr. Justin Marchegiani:  Plus we’re clinicians, so if it were that easy, you know, every patient would be a home run, right?

Evan Brand:  Yeah, exactly.

Dr. Justin Marchegiani:  So we have to put on our clinician cap, you know, so to speak. And we look at the diet, we customize it. So if you’re an endomorph, right? Larger, bigger, you know, wider hips, bigger belly, you know, those type of things, you put on fat easier–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And it’s harder for you to burn, then you know, you’re gonna really benefit by starting out with a Ketogenic Diet and then customizing and then stack your carbs. When it’s time to stacking your carbs, stack your carbs on at night.

Evan Brand:  Here’s another thing I wanted to mention though, too, that we haven’t brought up yet. And you and I talked about Kalish’s talk I think a few weeks ago together, where if someone has a bigger waist and they have this excess body fat. Even if they go into a ketogenic approach, they may not lose weight because of those toxins that are stored in the fat cells could still disrupt the metabolism, right?

Dr. Justin Marchegiani:  Yeah, so the fat cells are a toxic reservoir for toxins essentially. A lot of our toxins go into the fat cell. They’re–

Evan Brand: So what do we do then if—if you’re going, you’re trying to go super low carb and yet you still just maintain your heavy weight, you cannot burn fat?

Dr. Justin Marchegiani:  Well, that’s where seeing a good functional medicine practitioner helps so we’d look at organic acids. We would look at how you’re detoxifying via pyroglutamate and sulfate and a lot of these organic acids that look at phase 1 and phase 2 liver detoxification. Phase 1 is taking fat-soluble toxins, right? It’s already there. They’re lipid-soluble. I mean, they’re in the fat cell. We’re liberating them and turning them into water-soluble toxins primarily via B vitamins, antioxidants, and then we facilitate the transfer of these water-soluble toxins out the urine, out the stool, out the breath or skin, right?

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And we do that with sulfur amino acids, right? We’re supporting methylation and—N-acetylation, hydroxylation ,right? Glucuronidation, glutathione, all of these pathways that are shooting it out. So phase 1 is more B vitamin and antioxidant induced. Phase 2 is more sulfur amino acid induced. And then also some people because amino acids make carnitine, carnitine’s a really important compounds that shuttles fat into the mitochondria. It’s literally called the carnitine shuttle. You can Google it. It’s shuttling fat in the mitochondria to be burned so some people will see low carnitine. We’ll see some mitochondrial defects and then we’ll see some detox issues. So that can be something that we–

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Incorporate into someone’s metabolic functional medicine program to help enhance it. So we get the diet dialed in non-dogmatically. Again, if you’re overweight, default to a Ketogenic Diet. That’s pretty safe. A Ketogenic Diet on a Paleo template. Right? Atkins create the—or Atkins made that ketogenic term famous except he used a lot of crappy foods, you know, didn’t differentiate with soy protein, added aspartame and artificial sweeteners. Didn’t care about grass-fed or chemicals or pesticides or Roundup so he kinda stumbled on it by accident–

Evan Brand:  Right.

Dr. Justin Marchegiani:  Because he was just looking at it from a sugar and carbohydrate standpoint. He didn’t look at it from the qualitative standpoint of phytonutrients and pesticides and chemicals and—and inflammatory foods and excitotoxins like MSG and aspartame. So we know more. So we kinda add like a—a Ketogenic-Paleo template on to it and then we have tools like the Precision Xtra by Abbott and get it on—I think get it on eBay and buy the strips on eBay. There’s a company out of Australia. You can get a much cheaper—they’re expensive. They’re like $1 or $2 a strip but if you buy them here, they’re like $2 to $3. So you can get them like 50% off. I bought like 100 strips and I just test my ketones a couple times a week to see where I’m at and I pretty much know where I’m at based on what I eat because I’ve tested so many meals. I see a pattern.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  So if I’m eating like good, clean eggs or a good clean collagen shake with some good fats, MCT and butter in the morning, I’m sitting around .5.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And I feel pretty damn good with that.

Evan Brand:  Yup, so I know we’re running out of the time but some of the benefits you can expect—I notice mental clarity goes up if I’m pushing towards ketogenic. Weight loss can happen which I don’t need to lose any weight but I am less hungry. I’m able to go little bit longer between meals. I don’t feel like I’m crashing like I was when I was doing more starch. There’s a few benefits for me. Did you wanna say anything on that part?

Dr. Justin Marchegiani:  I think you touched upon it really well. I think a lot of people will hear this especially if they’re medically oriented. People get confused between ketoacidosis and ketosis. So I already kind of touched upon the people that ketoacidosis happens to and typically you’re looking at over 20 mmol/L is gonna be what happens in ketoacidosis and ketosis, you’re gonna you know, .5, 1, that’s totally fine. Now there’s nutritional ketosis which is what we’re focusing on, right? We’re doing it by nutritionally eating an adequate amount of calories because you can go on ketosis by starving and fasting.

Evan Brand:  Yeah.

Dr. Justin Marchegiani:  Right? Because you still drive down your insulin levels because there’s no calories. If there’s no calories, remember insulin’s the door that opens up the cell for the calories to go in. Whether it opens up the mitochondria or the muscle or the fat cell, that’s dependent upon how much insulin is coming in. But you can lower insulin by just going low calorie. So you can be in ketosis via starvation, too. The difference is we’re doing it nutritionally, meaning we’re actually eating foods. They’re real whole foods and we’re getting enough calories so you’re body’s not gonna be eating away lean tissue.

Evan Brand:  Yes.

Dr. Justin Marchegiani:  Most people confuse it and they think, “Oh, you’re gonna be ripping up your body. You’re destroying your muscle.” It’s like—well, my body’s not stupid. It rather burn the nutrients that are in it versus taking away lean tissue, right?

Evan Brand:  Yeah, so—so don’t starve. This is not starvation–

Dr. Justin Marchegiani:  They’re confusing the physiology.

Evan Brand:  Yeah, totally.

Dr. Justin Marchegiani:  They’re confusing it and that happens all the time.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  And it drives me nuts so people need to really understand ketoacidosis and nutritional ketosis, and they need to understand ketosis vs fasting vs ketosis vs adequate calories and also ketosis at the acidotic level because of cirrhosis or type 1 diabetes.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Well, I think that’s pretty good there. If you would have sum it up, what’s the take home, Evan?

Evan Brand:  Well, take home. Try it out. Make sure you’re eating enough food. It’s easy to undereat if you’re basically cutting out, not almost, not an entire food group but essentially, so make sure you are getting enough good fats, enough good proteins, your coconut oils, your avocados, your avocado oils, your good meats, your good veggies. You know, your leafy greens are excellent. Stay away from the chemicals. If you start to crash, if you notice your outer one-third eyebrows going away, if you notice hair loss, if you feel like you’re a little bit more sluggish, you feel like hands and feet are getting cold like you alluded to, get some tests run. You can get some blood panels run for thyroid. You could get your adrenals tested to see if you’re just tanked out. Maybe you can’t go super ketogenic. Maybe that puts an extra stress on the body and you’re—you’re just not ready for that right now. So make sure your adrenals are healthy. Make sure your gut’s healthy and I think you’re gonna be—you’re gonna be on your way to—to weight loss if that’s a goal which is why many people go to—to ketogenic approaches.

Dr. Justin Marchegiani:  So who should do this? Cancer patients, Alzheimer’s patients, anyone with metabolic syndrome, right? Waist size 35 or bigger for a woman, 40 for a man. Blood pressure, you know, in the 140s or up. Any bit of inflammation, chronic pain, any of those symptoms. A good therapeutic trial of a Ketogenic Diet, Paleo style, Paleo template is a great starting point and again if you enjoyed this show and you’re applying the information and loving it, sharing is caring. Also give us a 5-star review. We appreciate it and click below this screen and you can help us out.

Evan Brand:  Yup.

Dr. Justin Marchegiani:  Evan, it’s been real, brother.

Evan Brand:  You, too. Take good care.

Dr. Justin Marchegiani:  You, too. Bye!

Evan Brand:  See ya! Bye!

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