EP176 The One About Keto And Low Carb Diets


We’ve been talking about low carb diets in our clinic for over a decade. Low carb eating is the best way to fix high circulating insulin, which is the main cause of Type-2 Diabetes, heart disease, Alzheimer’s and Dementia.

But what does low carb even mean? How low do you have to go?

Ketogenic ‘keto’ diets are all the rage right now. Does everyone need to go keto?

How many carbs should you eat?

In this podcast we talk about low carb diets and why it’s a spectrum.

We discuss the three insulin roadblocks…

  • Eating Window
  • Eating Frequency
  • Carbohydrate Tolerance

TRANSCRIPT OF TODAY'S EPISODE

Dr. Martin Jr.: You’re listening to The Doctor Is In Podcast from martinclinic.com. Although we share a lot of practical and in our opinion awesome information, what you hear on this podcast is not intended to diagnose, cure, treat, or prevent any disease. It’s strictly for informational purposes. So enjoy.

Hello, I’m Dr. Martin Jr.

Dr. Martin Sr.: I’m Dr. Martin Senior.

Dr. Martin Jr.: And this is The Doctor Is In Podcast and this [00:00:30] is episode 176. Today we want to talk about all things low carb. It’s funny. You and I over the years, going back I don’t even know how many years ago, we’ve been talking about low carb, we’ve been talking about ketosis, ketogenic for a long time, and now I’d say for the last six months, seven months, keto has become a massive buzzword in the diet industry. The diet industry has embraced keto as a tool to help [00:01:00] people lose weight quite effectively for a lot of people. But most people now have heard the word keto. I mean it’s a buzzword. It’s used a ton. We’ve been talking about it for years. Now we’ve been talking about it not as much for weight loss, even though that definitely happens. You and I have talked about it for help with a lot of different conditions out there and for the health benefits of keto.

So what we want to do today specifically is kind of more or less do a [00:01:30] keto 101 or a low carb 101 type of episode where we just kind of talk about some of the basics, as we do get a lot of questions on ketosis and a lot of questions on low carb. That’s what we’ll do today.

Here’s the thing. When we talk, you and I, about going low carb, we always do it for a health reason. We deal a lot with people that have metabolic issues, diabetes, or blood sugar issues where insulin is the problem. So [00:02:00] we usually recommend as a result of that getting rid of carbs or sometimes cutting all carbs altogether, depending on what they’re there for.

I guess what we’ll do then is kind of just walk through, because remember, keto was a tool. Low carb is a tool. Moderate carb can be a tool as well, depending on the individuals. We don’t tell everybody that they have to go keto. It depends on what’s going on in their life, [00:02:30] what’s behind the scenes. If somebody wants to lose weight, they can go keto. But sometimes they don’t have to go keto to lose weight. They can cut down carbs. They can cut down … They can bring their carb … We’ll talk a little bit about that.

Dr. Martin Sr.: Yeah, I think just to refresh people’s brains, I like to do this in the office, and I always say, “Well, your body has two gas tanks. You’re either burning carbs or you’re burning fat.” The word [00:03:00] ketosis is you’re literally burning fat as a fuel. It’s gotten a bad rap for many, many years because people didn’t fully understand it first of all, and it seemed to go against the grain of nutrition, and that is we lived in a world for many, many, many years of a balanced diet, and it really wasn’t balanced, but they talked about a balanced diet with carbs-

Dr. Martin Jr.: Well, that’s [00:03:30] what they think. They about a balanced diet. Yet, if you broke down the diet, it’s like 60% carb, it’s 10-15% protein, and 10-15% whatever of fat.

Dr. Martin Sr.: So ketosis really is just if you keep your carbs down low enough, your body will literally change gas tanks and start burning fat. I mean it’s simple.

Dr. Martin Jr.: You’ve mentioned it. Ketosis is a normal metabolic process. It’s normal. And what happens when the body does not have enough glucose for energy, [00:04:00] which is where it gets carbs break down into … I mean everything breaks down into glucose, but carbs break down in glucose quickly. So when you don’t have enough glucose for energy, it starts to burn stored fats instead. When it does that, it results in a built up of acids called ketones in the body. Ketones are like a byproduct in a sense. That’s where the concept of ketosis comes from, because a lot of people when they’re eating [00:04:30] low, low carb, they check for the level of ketones in their …

Dr. Martin Sr.: In their urine.

Dr. Martin Jr.: In their urine. They’ll check for the level of ketones, and then they’ll be like, “Oh, I’m in ketosis now,” which means they got a build up of these acids called ketones. That’s a normal biological process. It’s not dangerous. For a while when the idea of ketosis was coming out, it was humorous but a lot of people kind of got that mixed up with ketoacidosis-

Dr. Martin Sr.: Yeah, which is completely different, [00:05:00] right?

Dr. Martin Jr.: It’s a different thing altogether and that can … Type 1 diabetics can run into ketoacidosis. But because it sounds familiar a lot of people would share their concerns, but they were confusing ketoacidosis with ketosis. I mean, it sounds similar enough so you can’t blame them, but they just didn’t do a Google search at all between the difference because one’s a normal process and the other one is an abnormal process and has nothing to do with … I mean, they’re two completely different things.

Again, at the end of the [00:05:30] day, so here’s the thing. When you’re going into ketosis, it means you don’t have enough exogenous or available glucose. So here’s what happens. Your fat cells will release fat. Then that fat will go to the liver and it’s basically converted into ketones which your body will burn off as energy. You’re either burning, as you’ve mentioned carbs, or you’re burning glucose for energy, or you’re burning fat for energy.

[00:06:00] To be honest, a healthy person should be going back and forth between the two of them. They have that metabolic flexibility. They can go back and forth when necessary. They can efficiently burn glucose as energy and they can efficiently burn ketones as energy, and they have that metabolic flexibility between the two of them, and that’s an ideal world. But the problem is that’s not usually what happens.

There’s something else I like to just kind of remind people. [00:06:30] You can go into ketosis without eating anything fat at all. Some people associate, and I’ll give you the different way. For example, if you eat nothing at all, you eventually run out of glycogen. Now glycogen is just a fancy word for stored glucose. When you eat carbs or you eat sugar or you eat food, it’s broken down into glucose.

Dr. Martin Sr.: Protein.

Dr. Martin Jr.: And you and I have said this so many times that glucose is [00:07:00] toxic. Your body has to regulate your blood sugar so tightly that any amount of extra glucose your body gets rid of it, that you either burn it off as energy or you put it into storage, and you store it, glucose is turned into glycogen. Just think of glycogen as suitcase full of glucose. It’s just like a packed stored glucose. It’s all it is.

When you eat no food and you run out of glycogen, so right from your muscle glycogen, [00:07:30] the stored glucose there is stored in the liver, you go into ketosis. The average person, if they have a long enough fast over night, they stopped eating around 7:00 at night and they don’t eat until 9:00 in the morning, they’re in a little bit of ketosis. That’s why-

Dr. Martin Sr.: Just naturally.

Dr. Martin Jr.: That’s why people are, “Oh, ketosis is dangerous.” They wake up in ketosis every day. It’s not … They have no idea what they’re talking about. That’s one way. Also, and this is something else you have to understand. If you [00:08:00] ate 100% carbs, 100%, but you’re eating at a starvation level of calories, you’ll be in ketosis. You’re just burning off more than you can store. You can eat a couple hundred calories a day of carbs, pure carbs.

Dr. Martin Sr.: Pure sugar.

Dr. Martin Jr.: Because you’re in that starvation level of calories, you’re going to be in ketosis. You’re going to be burning your fat off as energy. That’s one of the things with fasting.

This is another thing as well. People don’t understand that. If you did a ridiculous, I mean [00:08:30] ridiculous amount of exercise, you can eat what you want in a sense and you’ll still be in ketosis because you’re burning off … I mean you have to, the amount of exercise, you’ve got to be running a ton of … doing a ton of things, which isn’t good for you, the stress level and the cortisol and all that stuff, but that’s … that can …

Dr. Martin Sr.: Yeah, it can be another way of doing it.

Dr. Martin Jr.: Another way which we talk about which is eating protein and fat and very low carb and then you just, right? You run on ketones. Ketosis is a natural thing that your body does. It’s not the scary thing that [00:09:00] people associate because the word ketosis can mean a lot of different things to a lot of different people, but it’s not a bad thing. It’s a normal thing. It just means that you’re burning ketones for energy. How does the average person get into ketosis?

In terms of the ketosis that they read about, the ketosis that people talk about for dietary purpose as well, most people, and we’re saying most because some people it’s different, most men typically [00:09:30] around 50 grams of carbs a day and under, they tend to go into ketosis. Most women around 30 grams and under, they tend to go into ketosis. But if somebody has a real insulin problem and they’re insulin resistant, they tend to not handle carbs well, they tend to put a lot of insulin out there, they need less than that.

Sometimes some people will only go into ketosis when they get down under 30 and their 20. That’s the person. But as a rule of thumb, the average person can go [00:10:00] 15 under, they’re fine. And sometimes they’ve got go lower and then they end up in something called ketosis, which is something that we talked about a lot. That’s the idea of ketosis.

When we talk about low carb, we’re not always talking about ketosis, and that’s the thing. Ketosis is considered a very low carb, a VLC diet, very low carb diet because you’re under 50 grams or under 30 grams a day.

Dr. Martin Sr.: For most people.

Dr. Martin Jr.: For most people. [00:10:30] That’s one low carb. But low carb, you don’t have to eat that little of carb for it to be considered a low carb diet. Unfortunately there’s a lot of confusion. They’re like, “I’m not in ketosis,” but they’re still eating very low carb, but they’re just not in ketosis, they’re still going to get a ton of benefits.

Dr. Martin Sr.: Oh yeah, big benefits.

Dr. Martin Jr.: From that. And that’s the thing. You have to decide … Go head.

Dr. Martin Sr.: Well, just because I think in a practical way we’ve always encouraged [00:11:00] low carb eating. The reasons are legion. I mean they’re just so many good reasons to do it. Like you say, I think people are confused as to how difficult it is. It’s almost like they want a measuring stick to know whether they’re going into ketosis or not. But we’re trying to get them into a low carb lifestyle, and that’s a lifestyle eating. I mean this is because we know the benefits of it.

Of course, if you want [00:11:30] to lose weight and for most people they have to be pretty strict, they got to be very, very low carb. Especially women, they just don’t do well with carbohydrates. If they got hormonal issues and whatever, they got to be at least during their weight loss period, they’re pretty well into ketosis. They pretty well have to be. They have to be burning fat all the time. Whereas I try and get people to understand, look, I’m trying to teach you to eat [00:12:00] low carb all the time, and that is not no carb. Come on. I’m not into no carb-

Dr. Martin Jr.: And that’s what’s interesting-

Dr. Martin Sr.: … but I’m into lower carbs compared to the population that is … Like I read something yesterday that the average American or whatever is consuming 50 gallons, gallons of soda a year. You can’t have that and survive. You’re just, you know what I mean? You’ll never …

Dr. Martin Jr.: And I think to [00:12:30] help people to kind of further explain what you’re saying is that you and I, we’ve come up with, years ago again we wrote a book Serial Killers and we’ve turned into a program that we use for people, and it’s a program. In there we talk about the individual carb tolerance that a person has because the reality is there’s a lot of reasons why somebody else can handle more carbs than another person. There are a lot of factors that go in [00:13:00] there. The first big one is does that person have metabolic damage at all? Do they have metabolic syndrome? Do they have type 2 diabetes.

Dr. Martin Sr.: Insulin resistance.

Dr. Martin Jr.: Exactly. And that person there cannot tolerate a lot of carbohydrates. Whereas somebody who is lifting weights, who’s got a lot of muscle mass, who’s moving around quite a bit in the day time and they’re insulin sensitive, they can handle more carbs in a day.

The idea is first and foremost is figuring out where [00:13:30] you fall on that carbohydrate tolerance scale. As we’ve mentioned, if you’ve got metabolic syndrome, or you’ve got like heart disease, you got high blood pressure, or you have type 2 diabetes, well you’re going to be on the side of the scale that you have to bring your carbs down quite a bit, and if you’re type 2 diabetic you actually do very well when you’re on the far end of the scale which is ketogenic. We would say a diabetic, ketogenic as well, metabolic syndrome, they [00:14:00] do well on ketogenic diet as well. And then you can slide up a little bit for people with high blood pressure. You can be around that very low carb mark as well, but not necessarily always be in ketosis. That’s kind of the thing.

Now if you’re saying, “Hey, I metabolically I’m pretty good, I’d like to maybe lose a little bit of weight,” or, “I’d like to bring my carbs down,” well that’s different number. I always find it fascinating when I look at low carb research or I look at dietary [00:14:30] research and … Listen, there’s a lot of debate on a lot of things, but what I find interesting is that even when they’ll call a low carb diet 30% of calories from carbohydrates which is not … Anybody who uses low carb in practice would not consider 30% of your calories from carbs as a low carb diet, people still lost weight, their metabolic markers got better, they felt better. You could see there’s a wide range. That’s why we always say [00:15:00] low carb is a spectrum. Somebody says, “Should I go low carb?” We always say, “Well, what are you doing it for?” “Well, I’m diabetic.” “Okay, yeah.”

Dr. Martin Sr.: For sure.

Dr. Martin Jr.: You got to go on the tight range. I like to bring down some markers of health. Okay, you could bring your carbs down, but you don’t have to throw carbs completely. You can throw out processed carbs. You can throw out crappy carbs.

Dr. Martin Sr.: Which you should do anyways.

Dr. Martin Jr.: But you can eat whole food carbs in a sense and you’ll do fine. That’s the first thing, because [00:15:30] and I said this before and this is something that we’ve come up with. We talk about the idea that insulin is supposed to be, we call it imbalanced or we call it in harmony. Means that your body makes enough insulin, it doesn’t make too much insulin, it keeps your blood sugar levels in a healthy range. We call that the insulin glucose harmony. Everything’s going well.

But we found over the years basically there’s three things that can cause your insulin and your [00:16:00] glucose to be out of balance. We call them insulin roadblocks. We’ve talked about this before. We say there are three roadblocks in a sense that can get in the way and can affect that balance between insulin and glucose. One of them is that individual carb tolerance. Somebody is eating too many carbohydrates for their own tolerance, they end up with high insulin and their blood sugar levels spike and go to low and spike and go to low and they just end up with all these problems and eventually they end [00:16:30] up with type 2 diabetes or metabolic syndrome and all those things.

That’s why when we talk low carb, low carb we’re addressing one of those insulin roadblocks which is your carb tolerance, and then we always, like I said, so we approach it very simple. Diabetic says, “Ah, how should I eat?” Okay, their carb tolerance is terrible because you and I’ve said this before, but a type 2 diabetic for all intents and purpose is allergic to carbs, [00:17:00] their body can’t handle it anymore, just as if somebody who’s celiac can’t handle gluten. Their body is allergic. It overreacts. It can’t handle it. So it’s like, okay, until you fix that, until you bring that and go into remission, you reverse it, you should be cutting out the source of the problem, which is carbs, your body can’t handle it, and they do very well when they do that.

So we always say, “What are you doing it for?” Then we can kind of slide them on that carb scale. Where do you fit on that carb scale? [00:17:30] Do you got to go super low? Do you got to go low, or can you handle a little bit more? That’s the first thing.

Then we’ll always talk about their eating window because that’s another thing that can mess up your insulin. Insulin is a food hormone which means it’s present. As soon as you start eating and then after you eat, insulin is present to bring down your blood sugar levels. So if you’re not eating, you don’t have insulin, which is why a lot of people do well fasting.

Now here’s the thing. You can [00:18:00] eat low carb, which is a great way to lower insulin. But another great way to lower insulin is just not eating food, is to shorten your eating window. For some people, that’s a great tool as well. Some people combine their carb tolerance with shorting their eating window for a double whammy. So they’re shortening the amount of hours they eat in a day, and when they do eat, they’re eating low carb. So they’re getting almost double [00:18:30] benefits and they do fantastic.

Dr. Martin Sr.: Science has really shown that there’s many, many advantages to eating within a window of time because the old … If you look at old nutrition books, I’ve been around a long time-

Dr. Martin Jr.: What’s that new study that just came out?

Dr. Martin Sr.: One that very recently?

Dr. Martin Jr.: Yeah, on breakfast.

Dr. Martin Sr.: They always said that … brought to you by the cereal companies because you better [00:19:00] eat breakfast because if you don’t, you’re going to be come a diabetic. I can’t remember what …

Dr. Martin Jr.: Yeah, as you’re talking, I’m going to look it up.

Dr. Martin Sr.: Okay, well, yeah, and I …

Dr. Martin Jr.: I just saw a study …

Dr. Martin Sr.: Yeah, and I think it said that it increased your risk of diabetes if I’m not mistaken. But anyway, the point is who was it brought to you by, the cereal companies. It’s the old idea that you’ve got to eat frequently and you’re like a bear. If you don’t … You’re going to store fat if you go [00:19:30] on a fast, which is just the opposite really of what happens and it’s so good for you.

Now, we’ve often talked about fasting and intermittent fasting. You go back into episodes. We’ve spent episodes talking about the benefits of intermittent fasting. Some people do it differently. Diabetics ordinarily will do better eating in the morning, and then ending their day a little earlier food wise and then don’t snack at night and they can intermittent fast [00:20:00] and usually do very well. So what was the study now?

Dr. Martin Jr.: This study was done … So basically they looked at … It was an article written that looked at and showed that most evidence that eating breakfast leads to weight loss was actually funded by cereal companies, and in one case Quaker even designed a study and edited the manuscript. I mean they had a lot invested because cereal companies, I mean …

Dr. Martin Sr.: Can you imagine?

Dr. Martin Jr.: You’re eating cereal mostly in the morning. I mean they had a lot invested [00:20:30] in breakfast. If people started skipping breakfast, they would be in trouble. I mean all those studies, basically they’ve created this kind of myth around the first meal of the day, and what they’re finding out-

Dr. Martin Sr.: Eating the most important [inaudible 00:20:43]

Dr. Martin Jr.: Yeah. In fact, meta-analysis supports. Meta-analysis was kind of the gold standard, supports the idea that skipping breakfast leads to weight loss. So for a lot of people there’s a ton of info out there that shortening their eating window, [00:21:00] they do very well with that.

Then just to kind of quickly continue, we’re almost out of time here, the idea … We talked about you’re finding your individual carb tolerance. We talked about your eating window, and there’s a lot of different ways to fast. We’ve got episodes on fasting. There’s ways to shorten that eating window.

And then even the idea for people that have a problem with insulin, they got a problem with their blood sugar levels, there’s that idea that you got to eat [00:21:30] all day, you got to graze all day, or you have to snack six times a day six little meals a day. The problem again is if that insulin is present when you’re eating and you’re eating all day, that’s a problem.

Research, there was an interesting study done with diabetics and even on blood sugar, they do better eating three bigger meals than snacking six small times a day because you have to give everything a break. You have to give a time to rest [00:22:00] and digest. You have to … The idea again of eating a ton of food throughout the day, you can imagine where that most likely came from. People that do really well eating six times a day are generally metabolically healthy to begin with.

Dr. Martin Sr.: They can get away with it.

Dr. Martin Jr.: A woman or a man who has a metabolic disaster, they don’t do well eating all day, they don’t well because their insulin is high all day. They-

Dr. Martin Sr.: And not only that. I mean think [00:22:30] about it too, like just what we see practically. This is why I like to, you know me, I like to argue sometimes, but it’s just because you get guys, and I follow nutritionists and whatever online. Listen, in all due respect to them, I love them dearly, but when they’re dealing with healthy subjects all the time, I always tell them, “Look, clinically you’re talking about research.”

Dr. Martin Jr.: And they’ll always say when calories are equated. I understand [00:23:00] that, but who lives in a world where calories are equated? It doesn’t work that way.

Dr. Martin Sr.: No, because-

Dr. Martin Jr.: No, that’s not real life.

Dr. Martin Sr.: If you have a real disorder, and this is what we deal with every day and I’m sure a lot of our listeners know exactly what we’re talking about, if you have any kind of hormonal, we just talked in the last episode about the thyroid, and we talked in many episodes about estrogen and all the things, adrenals, cortisol, bla, bla, bla. Well, you know what? The guy that’s lifting [00:23:30] weights can lift 500 pounds in the gym and got muscles coming on both hands-

Dr. Martin Jr.: They can handle carbs.

Dr. Martin Sr.: I mean they can-

Dr. Martin Jr.: I know guys who can … that eat 350 to 500 grams of carbs a day and they got like 8% body fat. But that’s not the normal …

Dr. Martin Sr.: No, but come on. That’s Arnold Schwarzenegger. I mean, you know?

Dr. Martin Jr.: But that’s not the normal person who-

Dr. Martin Sr.: We’re not talking about real people here.

Dr. Martin Jr.: No, and they’re metabolically healthy. They’re really sensitive to insulin. They don’t make a ton of it.

Dr. Martin Sr.: No. We deal with this stuff [00:24:00] all the time. It’s what we see.

Dr. Martin Jr.: Yeah, we’re not dealing with somebody like that.

Dr. Martin Sr.: Right?

Dr. Martin Jr.: No, that’s right. It’s different. So that’s why, again, we’re out of time. I know we’ve gone over here. Not that there’s … I always say that. It’s not like we have an official time. It’s just that you and I get bored of hearing our own voices after a while, so we know the listeners are definitely bored as well. So when we say that, we just, we know that what’s going on.

But again, when it comes to low carb, always ask what are you doing it for? Are you metabolically healthy? If you’re unhealthy, then you’ve got to go on the low end of the carb scale. [00:24:30] Then you want to figure out your eating window. You want to also bring down the amount of times you eat in a daytime and that’s how you become metabolically healthy. That’s how you fix a lot of the issues nutritionally.

Dr. Martin Sr.: Yes, absolutely.

Dr. Martin Jr.: With food that the average person would have problems with. Again, we want to thank you for listening and have a great day.

Dr. Martin Sr.: Thanks for listening to The Doctor Is In Podcast from martinclinic.com. If you have any questions, you can reach us [00:25:00] at info@martinclinic.com. If you’re not a newsletter subscriber, you can head to our website and sign up for free.

We also have a private Facebook group that you can join. It’s a community of awesome people. Finally, I do a Facebook Live every Thursday morning at 8:30. Join us again next week for a new episode.