Keto Resources

Dr. Stephen Phinney – ‘The Case For Nutritional Ketosis’

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dr. Gerber asked if he should introduce me no but if you do just call me the oldest heretic in the room and for those who didn't hear the presentations yesterday I've been at this for a long time and found myself orthogonal to the mainstream for most of that time and just in my background how I got into this was in medical school I dealt with this stress of medical school by writing trying to ride bicycles over mountains and this was back in the 1960s and I didn't know about carbohydrate loading and the importance of carbohydrate for endurance and and vigorous physical performance and I probably bonked or hit the wall 30 times trying to go over the same mountain you know you think eventually you get to might finally realize if I eat enough carbs I could go over the mountain and ride back and do it you know go 100 miles and then you know it was amazing what you could do if you ate enough carbs and I became a you know dyed-in-the-wool carb advocate by own experience and when I got to my internship and residency not long into that experience in 1975 I got into a discussion with a hospice hospice attending physician named Ethan Allen Hitchcock Simpson if any of you know anything about the history of this country Ethan Allen and the Green Mountain Boys from Vermont sold a bunch of cannons from the British and changed the course of the battle around Boston and Ethan was of that lineage and Ethan and this is 75-72 was bought when Bob Atkins published his first book and her a lot of people doing the Atkins diet and I said you know this is complete crap you know you're going to be completely debilitated if you don't eat carbs in Easton said well I know some people are on this diet and they don't seem debilitated I said well your Diels can't be true he said well let's do a research project you know if I if I hadn't done this or had done a better job at that research I wouldn't have been The Heretic so let me share with you a little bit of my perspective on low carb diets and some about physical performance you've heard some of that from Peter Defty and Peter duck dr.

Peter Bruckner yesterday and I'll try not to bore you too much with that but let's sort of go through this Odyssey so working with my good friend collaborator and co-author Jeff Bullock over the last 12 years we've tried to bring together a lot of the pieces of what's gone before and we have attempted to define nutritional ketosis as something which is unique metabolically from the fed state where carbohydrate fed state where ketone values are very low and we define that as under 0.5 milli molar on the left side there so when you get above 0.5 millimolar beta-hydroxybutyrate in the plasma becomes a significant substrate to feed the brain and as you go from 0.5 up to 3 milli molar that is a range in which beta hydroxy butyrate increasingly becomes a important contributor to fuel flow in the body so what we show you on the vertical axis there is improvement in fuel flow stemming from fat ox you know stored body fat or from dietary fat it's only when you get above 3 to 5 some people post exercise because exercise in many people stimulates ketone production and you might get as high as 5 post exercise 5 to 7 is really an area of starving ketosis and ketoacidosis doesn't begin till you get about 10 millimolar but endocrinology will tell you that if a patient comes into the emergency room a type 1 diabetic comes into the ER with a blood sugar over 150 and a beta-hydroxybutyrate level of point or 3 milli molar that they're in ketoacidosis that's predictive of them developing ketoacidosis but they're not acid emic till they get above 10 so anything up to 10 will do you no harm as long as you have significant beta cell reserve that is your pancreas beta cells can make enough insulin to moderate ketone production now we think of glucose being controlled by insulin but ketone levels are also controlled by insulin with a similar feedback inhibitory loop so ketones are a valuable fuel controlled and through an endocrine feedback loop involving insulin and you need insulin to control ketone levels in the same way you need insulin to control gucoff levels so it's a bimodal role for insulin so how does one you know make these ketones where do they come from and I again I've apologized for the size of the slide and it's old because this the the slide on the right is basically a deep cartoon by George Cahill from some absolutely elegant research that his group did in the 1960s where they defined starvation metabolism in humans and it's important because starvation metabolism in dogs is different starvation metabolism in rats as different humans are quite unique because we have a very large brain that we have to feed and we feed that brain when we're not eating any carbs with a combination of ketones and glucose now the higher your ketones go up 2 3 4 5 millimolar the greater the proportion that can be fed from ketones and by the way K olds and group did a study that they tried not to have to publish because once I did that they realized it was unethical to have done it and what they did was they took people in starvation ketosis infused insulin into their into the vein and their arm to drive down glucose they drove glucose down to under 30 milligrams per deciliter under to 1.5 mil Amol er which in a non kit anemic person would cause coma and death and what they proved is that at one point five million molar glucose these patients remained lucid and asymptomatic so they proved that ketones are as good or better a fuel for the brain and glucose but they did it in 1972 or 73 it did the Treaty of Helsinki in 1975 defined human subject research and the need for IRB approved research and that you don't do any research would endanger your subjects and they said crap we can't publish this and so it was hidden in the book chapter if anyone wants to chapter I've got a PDF and I'd be happy to give it to you so what they defined in terms of ketone metabolism that is within five to seven days of starvation ketone levels come up and stabilize that most of the brain's energy comes from ketones but still a minor component comes from glucose and when the body runs out of glycogen stored in liver or muscles after a few days then that glucose has to come from gluconeogenesis and that gluconeogenic glucose basically comes most of almost all of it comes from muscle protein and so if you look at the little muscle shaped thing on the lower right hand side over here even in prolonged starvation there is an egress of net egress of amino acids out of here going to deliver for gluconeogenesis and that then is a minor component of the brain fuel most of it comes from beta ox you butyrate and so your liver is feeding most of your brain but in starvation your muscles are broken down and even after a month of total starvation no protein coming in you're losing 4 ounces of lean body mass per day so think of even in the most adapted human starvation ketosis is robbing you of a quarter pounder every day and that's coming from lean body mass is coming from functional tissue now we're different than the sleeping black bear Ralph Nelson and Minnesota did some amazing research climbed into the dens of bears written during their winter sleep and drew blood sweeping back the hairs it takes them a while to warm up so if you're quick on the phlebotomy you can be out of there before the claws and then migrating gray whales that feed in the arctic and calves in and mate and calves in what used to be called the Sandwich Islands we now call Hawaii they know they travel five thousand miles and they don't eat for five thousand miles of travel and they don't lose lean body mass and the sleeping black bear does not lose lean body mass we humans have a much bigger brain relative to the size of our body and we can't do that so there is a requirement for protein on a daily basis if any but let us say if you go more than 24 hours without any food intake you will have loss of lean body mass it accelerates to its maximum about the third day of starvation and then your body slowly adapts and then it tapers down but you never get down below a quarter pounder a day and what I'm saying is they've been different than what dr.

Fung told you yesterday and where did we differ in terms of where we draw our data but you know maybe my data is old and antiquated but it's it has never been refuted so how do you how do you manage to get in nutritional ketosis but give people enough nutrients that you preserve main body mass and function so Jeff Bullock made this slide he any slides I have they're good were made by Jeff he's really phenomenal in terms of visuals he said well let's lay out the difference between some of the what people call the standard dies typical diets so in the upper left hand corner in the the yellow orange there is the Ornish diet and the Ornish diet is a plant based almost vegetarian diet that is very high in carbohydrate very low in fat and very very relevant low in protein and this works in some people as a very effective tool but I can show you data that it doesn't work in a lot of people and so there's no one perfect diet this is good for some people but it's at the quote extreme of reduced fat intake under that comes what we call the stay American diet I love the acronym for that is sad as you come down in carbohydrate on the vertical axis you come to the Mediterranean diet you can see it's a pretty big bulb there because as people said yes I you know that Mediterranean diet is in the eye of the beholder in terms of what it really entails but typically a Mediterranean diet is 30 to 40 percent of energy as carbs it's moderate in protein and it provides in the order of 40 percent of calories as fat and most people agree that in the Mediterranean most of those calories as fat came from monounsaturated fat typically olive oil then again the diet that has a somewhat broader definition but using loren cordain's definition of of the Paleo diet this tip is getting around 30% of energy's protein and it has a floor of 20% of the energy and this is not intake this is energy expenditure by the way and there's a difference in that we can talk about that and the question is to people period people want to want to understand why I say that but typically it's between 20 and 30 percent of energy is carbohydrates 30% is protein and although that is in the class of low carbohydrate diets it is not a ketogenic diet in other words people who eat 30% of their daily energy requirement is protein in a minimum of 20% as carbs will not have a ketone value after above 0.5 millimolar until unless or until they cross the finish line of a marathon so if you start a marathon having eaten a meta or a Mediterranean diet by the time you get to 26 mile you will have burned through enough of your carbs that you will actually be building ketone levels and that's called the Quartus Douglas effect and they were to South African scientists who define post exercise ketosis and so you can get to 0.5 at the shortly after you finish the marathon as the body is trying to figure out what's how to feed the brain when you've just depleted the body of almost all if not all of its glycogen to get into nutritional ketosis you have to keep protein moderate so this is not a high-protein diet it's typically in the range of 10 to 20 percent of energy protein the the top the highest carbohydrate you can take in that range of protein intake is 10% and still get above 0.5 millimolar for most people there may be some exceptions but the more Pro to because protein stimulates insulin release to some degree similar to carbohydrate the more protein you eat the less carb you have to eat and that's why that blue triangle there tapers off as you go up in protein so this has to be moderate in protein and low in carbohydrate we differ one from another and what are carbohydrate tolerances and the more insulin resistance a person is then the lower you have to come in carbs to stay in nutritional ketosis that is that 0.5 to 3 milli molar bitter drexler butyrate so it's tough to do well this is not a big target this is a small target we say this is like trying to fly an airplane from San Francisco to to Hawaii to Honolulu people say well where is it you say let's go that way well if you have a plane that has 2,500 miles worth of fuel and you go that way and you're off by 3 or 4 degrees on the compass you'll never see the day amount and you can have a long swim back home you really it does take a certain amount of coaching and guidance to get this right so if it's that tough why do it no I mean you can feed your brain with glucose all of us have done that for most if not most motive of all of our lives well again if you like to slide you've all made it so on the top you see adipose tissue that yellow blob on the left you see the liver in the middle and the brain on the right across the top and what I showed you from the work done by Cahill adipose tissue stores thousands tens of thousands of calories in your body your liver can utilize that under controlled endocrine li endocrine on islet ender can logically control mechanism to make enough ketones to feed your brain whether you're in nutritional ketosis in eating some carbs and protein or whether you're in total starvation your brain is going to stay alive the lights are going to stay on it's really elegant ok and that's what we thought this was good for up about three or four years ago and in December of 2012 a group of people I never heard of at the Gladstone Institute versity of San Francisco University California San Francisco published a paper in science and said guess what metrics you butyrate down regulates a group of enzymes called histone deacetylase inhibitor a histone deacetylases so beta or Expedia is a selective signal to turn down the activity of a certain enzymes and these enzymes are genes silenced the enzymes and this gets complex you're turning down enzymes which silence the genes that protect you from oxidative stress so it's complex but what it means is when you eat carbohydrate a whole system of defense against oxidative stress has evolved if you believe in evolution over a billion years those enzymes gets turned off which means you need to eat antioxidants when you eat carbohydrates because your God given a fizzy oxidant system is shut up by eating bread drinking grape juice whatever and I'd only get into religion but you know carbs are part of our religion our agricultural heritage and they turn off a system that protects us from oxidative stress and inflammation well what importance is that clinically well a number of subsequent papers show that upper airway inflammation and asthma are caused by down-regulating these enzymes that if you take a little nematode called C elegans and you grow that nematode in regular culture medium it lives typically for 20 days if you grow it in a culture medium that contains beta naught beta hydroxy butyrate it leaves 26% longer now the name of this nematode is a darling of the longevity research community because they only lose 20 days you if you do a study on humans you got to run it for at least 80 or 90 years do a study on monkeys 35 years do a study on mice it's three and a half years you can do a full study in 20 days so use this for screening compounds that of human they think are looking for calm house improve human longevity and if you got a drug that you could show is safe to use an extended human life extended the life of these these worms by 26% you'd have a billion dollar from ten billion dollar hundred billion our drug candidate and we've got it we make it in our liver it's called vena Drucker butyrate and by the way it doesn't it does decrease oxidative stress and inflammation but okay so it's reason to want to do this who knows how to do this I mean big where is it in the textbooks there's not much written in standard textbooks so let's call upon a panel of experts to figure out how to do this here are my first two experts these are two into it women photograph was taken around 1910 they knew more about how to prepare a ketogenic diet what mix of meat and fat how you fed it to your family how you fed it to your grandchildren to make them grow be strong and functional they knew more about this than I will ever know unfortunately they were not illiterate people very smart I mean they vented some amazing technology the igloo anybody here ever slept in an anglo yeah I mean compared to a tent in the winter igloo is the Hilton it's warm one candle lights the whole thing no wind quiet that they went don't get really smart people didn't write it down so we don't know what they a there were some Anglos who went among the into it and rather than bringing our culture to them some of them wrote down stuff about their culture and this guy fred rich SWAT co which was a US army of surgeon decided that he wanted to go into the arctic learning from the inuit how they lived in the arctic and then travel to the up to the islands in the canadian arctic to try to figure out what happened to a British expedition seeking the Northwest Passage which is called the Franklin expedition 129 men to ships went into the Arctic in 1843 disappeared and it became the quest of the late 1800s to determine the fate of the Franklin expedition and these guys wanted to be actually just fine fine foilage if they go on ashore and buried their log books Nick get a Karen to find out what happened to her and so they recruited to it families they travel 3,000 miles in 14 months living almost the whole time they start out with a little bit of provisions for a first week or two and unfortunately Stefano even now we don't teach physicians about nutrition but you know US Army surgeons in the eighteen hundred's weren't really big into grams of protein and you know amounts of carbohydrate and so on so what he wrote down is stabbed in his diary was something for me was quite prophetic a people he was a prophet in the something which I've termed the term I came up with called Kido adaptation he pointed out that when you first go in the diet of the native one is ill disposed to travel because of fatigue but this goes away within two to three weeks now this was a topic of my dissertation research I discovered this quote while I was writing my thesis and I thought I'd discovered this this guy beat me by a hundred years but it's an important observation we don't transit from being carb fed to fat fed easily it takes time and it takes the OE so you have to adapt so but he didn't write down how much fat you know when you killed a seal and he killed the caribou what do you feed the dogs what did you say for yourself your children and your loved ones we feed the dogs of MeetMe humans eat the fat exactly but so how do we know that another arctic explorer and somebody who's even more of a heretic than i before my time was this guy named ville homeo Steffensen it was icelandic origin born in canada trained in University of North Dakota and then Harvard and he was very much interested in the ethnology of the Inuit with which his Icelandic people's had had interacted over in the Greenland area over time in the history and so he lived in the Arctic learned their language learned their ways of hunting and learn how to build igloos and he travelled through areas the Arctic that Europeans had ever been to there's an island named for Steffensen in the Arctic in the Canadian Arctic and he came back to matza sapote civilization and said you know I could go for two years living on just meat in fat I never ate any vegetables and I didn't get sick and this was the time unfortunately when all the 12 vitamins were trying between 1914 and 1928 he's there saying you don't need to eat vegetables you don't need vitamin C and he was called a liar by his academic colleagues and in the press and to salvage his reputation he allowed himself be locked up in Bellevue Hospital in New York City then as now a place for lunatics and he was allowed to eat anything you want as long as it consisted of meat and fat and his get the skeptics the scientists to poo ran this project wrote down precisely what he ate and what does Stefan's aney he about 115 grams of protein per day which was between 15 and 20 percent of his daily energy expenditure he ain't over 200 grams of fat per day in his carbohydrate intake was limited less than 2% of energy and that was carbohydrate provided by the glycogen in the meat when the animals were slaughtered he ate no vegetables no visible carbs he did this for a year they were sure he was going to have scurvy within four months again talk about ethics and research is this a research project where they tried to make these guys sick there were two of them Stefan's in and one other arctic explorer and they remained hale and hearty for the whole year and by the way they ate this moderate protein very high fat diet and had no change in weight and after a few weeks had no loss of performance and they did allow them out to exercise but they had to go out with an attendant and they had this pick well-trained attendants to keep up with him when they were running around running circles around Central Park in New York City he was clearly not impaired so this then would be my estimation of indirectly of what those in women knew because I figured if Stephan Sun wanted to save his reputation he was going to do his best to recreate with market foods available New York City macro nutrient composition that he ate in the Arctic so with that is kind of the hypothesis so he ate it he survived for a year by the way he lived b85 he died he had clean coronary arteries but he died of a stroke and he did have significant calcified lesions in the Circle of Willis and the circulation of the brain I know that because I talked to the doctor who did it his autopsy who was one of my teachers in Vermont named Elliot Danforth and he did the autopsy when he was a resident in general medicine whatever at the Mary Hitchcock and in Dartmouth Hanover New Hampshire anyway I happened to stumble into some of these people so I didn't meet Stefan's Imai think I know a bit about him so the next question is okay if you can do it that's fine but is it safe I mean you're eating a lot of fat you're not eating much carbs you're not getting all those healthy phytonutrients from dark leafy greens and purple vegetables and I admit those have value in the diet particularly if you're eating carbs you got to eat them because you put your natural antioxidant system to sleep with cars okay so Geoff Bullock keep mentioning his name because if they were for him we wouldn't be here talking about this well you be here talking about something else what we even talking about vesting so Geoff did a research project where he Ricky and his graduate student Cassandra Forsythe recruited 40 people with metabolic syndrome atherogenic dyslipidemia half of them were put on a low-fat high-carb weight-loss diet and half of them were put on a low-carb high-fat diet and they were on it for 12 weeks they got blood samples before and after and if you look at these pie charts here recognize that this is a 1500 calorie per day diet the low-fat diet so they restricted them with 50 hundred calories a day the low-carb diet this is how much they ate to satiety so they match the intake of this group to the low-carb group but I'll also point out that this group of overweight not particularly active people were probably burning 2,500 calories a day so 1500 is coming in the mouth realize it when you look at the pie chart in terms of what the body is burning what you're not seeing is a thousand calories is coming from body fat so this fat here intake of 59% actually is closer to the stefan's and value 75 or 80% of energy was coming from fat because the unseen stuff is coming from adipose tissue and further this fact 24% fat here would bigger and the proportion of carbs would be lower but this is by any definition of relatively high carbohydrate energy restricted diet and this is a high fat moderate protein low carb diet and so they're on it for a total of 12 weeks and if you look at the very bottom of this line you'll see this on the people on the low carb diet 36 grams of saturated fat per day people in the high carb diet 812 grams so just by chance three times as much saturated fat intake in the people using the low carb diet so big difference in saturated fat intake in particular this is the weight loss curve for the for both groups so both groups lost weight and both groups are still losing weight at the end of 12 weeks but you see the weight losses difference and you saw this data summarized in a bigger slide yesterday in terms of the efficacy of a low carbon in weight loss and people say well most of the differences water know only about one one and a half kilograms difference was Walter and the rest was greater fat loss and the people on the high fat low carb diet and the references volunteers because by Cassandra for slice of the first author and that was in the journal lipids in 2008 so I want to summarize very quickly a little bit of the data from the study this is a goldmine of data but if you look at the LDL cholesterol the top line it went up three percent and down two percent but this change in LDL was not statistically significant but if you look at the next line down to LDL cholesterol particle size this is one this is the first study that measured particles LDL particle size in it with a effect proper technique in people on a low-carb diet and this 3% increase in LDL particle size is actually very significant the bigger your LDL is the less atherogenic it is so although the LDL didn't go down the atherogenic city of the LDL was significantly reduced HDL went up 13% the high carb group which is typical for what we see only one percent in the other group in spite of their weight loss and you'll see that triglycerides went down in both groups dramatically in the low-carb group that and fascinating if you look at saturated fat the third from line from the bottom it went down proportion went down in both groups but it went down more in the group which was eating three times as much saturated fat per day so if you believe that you are what you eat I'm sorry and in this case you're not what you eat because when you adapt to a ketogenic diet and I'll show you that data in a couple slides when you adapt to a ketogenic diet you dramatically enhance your body's use of fat and guess which fat it likes to use saturated fat it becomes your high octane fuel if you eat it and turn into co2 and water it can't as dr.

Oz like to say glom up your coronary arteries which isn't how after Genesis works but anyway saturated fat can't can't kill you if it goes away and when you calculate the saturated fat concentration in the triglycerides including the reduction triglycerides the change is dramatic and probably the most important slide or the lioness lies the bottoms by one we know that weight loss causes reduce it reduction in inflammation and with most diets but there was significant greater reduction in inflammation people on the low-carb diet and this 14 out of 14 BM we don't trust one biomarker we don't just do il-6 or TNF alpha or PI 1 or told whites ow we don't want and all 14 went down and 6 of the 14 went down great to a great a significant degree with low-carb diet and this is a robust observation that when actually get people in nutritional ketosis the reduction in saturated fat and the reduction in inflammation it's not subtle it was some of the political candidates liked us a huge so again I would I was at the opinion going into this that you needed a lot of carbs for physical performance I did a study with Ethan Sims and Ned Horton in Vermont who are phenomenal mentors but we did it on untrained people and we showed that in one week your performance went down six weeks it came way back up but they lost a lot of weight and maybe the weight loss and enhanced performance so we decided to do a study in people who a were highly trained and B we're going to lose anyway so we took some guys who were really skinny highly trained bike racers and we put them on basically the stefan's and diet and we could only lock them up in the metabolic ward for one month because that's all the time they give us to do anything this dis Bazaar my thesis committee thought that I couldn't get people to eat 85% of their calories is fat it's impossible to get a human eat eighty-five percent of his his energy as fat but here's your all know bike racers have cast-iron stomachs made him with sandwiches riding over over Loveland Pass so we got to eat this the sponson diet for a month and you know technically on the slide the top line of eodum vo2 max shows you that their peak aerobic power was not changed and by the way a five liter per minute vo2 max is a huge these guys have big edges okay they're interns time to exhaustion after four weeks of adaptation was statistically the same 151 versus 147 minutes so no change in endurance time to exhaustion but what changed dramatically if you look at the arc you hear our QC is a measure of co2 production compared to Oh to consumption and it tells you roughly the proportion of energy being used from carbohydrate and fat if you're burning all carbohydrate theoretically your RQ be 1.0 if you're burning all fat and we point seven at baseline on the run of control diet these guys had an RQ point 83 right in the middle so everybody had 5050 carpet that for two and a half hours of exercise after just four weeks of adaptations I say just because as I'll apply it a couple slides it might have been different if they would get one longer there are Q is 0.72 that was that far away from all fat we got this published in metabolism at 83 took three years to get it passed the reviewers because they were sure it wasn't true but that implies that 90 percent of their fuel was coming from that and they're exercising at nine hundred and thirty calories per hour again I was criticized it wasn't Straub stressed it wasn't enough exercise one hard enough exercise and I say you go out and exercise at 930 calories an hour for two and a half hours in a basement room looking at a concrete wall going nowhere glycogen use this shows you the use during so we did muscle biopsies before and after and that's still ethical to do by the way using me about the size of this pen the wind of the quadriceps and whack out 150 or 200 milligrams of muscle on it so they cut their glycogen use by a factor of two over three which violated all the rules from the carbohydrate loading a brilliant study spawned done in Sweden by Bayer extreme Hultman saltine did I pronounce those names right pretty good I said obvious is being nice to me the knees did but I did great research but they never did a low-carb study beyond 14 days because they didn't know about keto adaptation I asked paraben TWRP how why they didn't do a longer study said Steve you can't get people to eat that much meat because he thought it was a high protein diet not a high fat diet so this is a time to exhaustion and I've been criticized because c1 was sort of flat 2 and up and two went down and people say well that one guy went away up he biased the whole thing and yes two of the guys didn't go as long as they did when they were on the high carb diet but three of them went as long or longer and this is normal human variation and I think part of the variation is some of us take longer than four we still fully adapt SWAT guys could do it in two or three weeks but some people have some of our athletes tell us too be four months right Peter and this shows a glycogen tain pre and post they ended up at the same level did the same amount of work but they did it was a lot less glycogen so even if four weeks of adaptation they became extremely parsimonious of carbohydrate as fuel now I left that data there in that form you know our cue point 7 3 nobody really knew what that meant and along comes this guy Jeff folic he said Steve these Dutch people you can drupes group and a woman named dr.

Venables studied 300 people and I think Peter you showed this data yesterday so she analyzed peak fat oxidation and 300 people from obese untrained people two highly trained athletes the highest rate of fat oxidation she could find any person I have 300 with 60 grams an hour or one gram per minute so Jeff took my five bike racers then did the lowest the highest and the mean the mean was 90 says one and a half grams of fat oxidation per minute and the highest guy was almost 2 grams a minute it was probably pretty close to 2 John the fighter pilot guy that almost to agree this is prodigious fat oxidation it has been sitting out there and really unappreciated till people like Peter Defty and Jeff vola came along and so slapped me upside the head and said you know it's heresy but it's true he saw this picture of Tim Olson he won the western states took 21 minutes off the all-time course record in 2012 people said it was a fluke somebody suggested he probably had a horse hidden to the bushes and did he was consuming if he had 1400 in Ray's calories roughly he said one gel an hour 14 hours yeah the rule of thumb at the western states if you don't eat 6,000 calories of carbs you don't get the finish line because it's a 10 to 12 thousand calorie event and you can only put 2,000 of glycogen your body so you've started the starting line with this tiny little 2000 Calif you'll tank and you're looking at a 12,000 calorie expenditure how do you get there now if you look at this guy he's skinny you know take a shower – shotgun barrel that's good but if you ground him up you would find even crossing the finish line you'd find 25 or 30 thousand calories of body fat so crossing the finish line he's got fuel to do two more events if you can get him to run on fat wealthy people have done it and you've seen some of these pictures yesterday uh you know the amazing people are these ultra runners or run 100 miles or 172 miles whatever but my favorites are my friend Sami incan Anna Meredith lorry and the ones on the right there in their little high-tech rowboat here they run across the Pacific Ocean the fastest time any two men have rode from California to Hawaii with 60 days they did it on 70% fat 10% carbs 20% protein 69 days yeah 45 days in three hours key to adapt because they didn't hit the wall didn't have to stop growing every two hours eat carbs so you've seen some of the data from Geoff's faster study which is really going to change its that this is a earthquake in fizzy and sports nutrition so we had a group of runners half of whom chose to eat a high carb diet half chose e a low carb diet and on the low carb diet and their perfectly matched in terms of age performance etcetera etc and when you had them run on a treadmill for three hours you can see the even at three hours the high carb runners could only get down to 60% of energy from fat the low-carb runners did exactly what my bike racers did but jeff has defined this in a much better way than I ever did and the results are convincing people that things are it's different but it's not just not running on mostly fat it's the reduction in inflammation and it's the improvement in well-being and recovery afterwards and of course this shift not only does that is a fat oxidation higher but you shift it to the right you shift high fat oxidation rates into race pace for endurance athletes and again this will have to be in the next edition of every exercise physiology textbook it will it has to be you can't deny it because this is the second study it showed it you know I came 40 years later than I look at there one of the most amazing quotes is from this guy who was one of the high carb athletes in Jeff's study and when he heard about the results of the study said I'm gonna try that low carb thing and I know if he agrees says but I'm a I made the switch to high fat near the end of July changed my life just like you said took a few weeks nann reaping the benefits I always my body composition improves so as my performance I 100 mile outside 100 kilometer trail run a few weeks ago and broke the course record by over an hour you can imagine we got this guy's attention anyway says is besides the performance benefits overall I feel so much better yeah this is not a drug this isn't something where you come down off the drug you feel better the next day was a John the fighter pilot who eight weeks or eight days after running the western states went back to his job in Washington DC and run the ran the fastest eight miles of his life he's look if you hear he started out almost a vegetarian so think of a truck going on the highway and it's running on the fuel from this little tank it's got this big tank full of fuel the little tank is glycogen the big one is body fat which one do you want to be running on and you can do it if you make the switch so there are these benefits of reduced oxidative stress inflammation excellent fuel flow is this a boring diet you don't have to eat the stefan's and diet you can have four or five servings event of non starchy vegetables you're going to have olives you can have tomato you can have mushrooms green beans cheese because I don't believe in the ideology that you can't eat something that didn't exist fifteen thousand years ago because if we couldn't do that we couldn't come we would have to come up here on snowshoes you couldn't come up here and on high waiting cars I think cheese is a modern technology I happen to like heavy cream is a modern technology I like there are many ways of doing this wrong I'll stop right here and just say we you know you can read about this I'd be happy to if people want copies of the books that Geoff and I wrote I would have to give anybody in this audience a copy just giving your address but you can't just eat low carb you have to have the right kinds of fats includes eating saturated fats not being afraid of saturated fats because they're your high octane fuel you've got to eat enough salt because if you don't you respect carbs and restrict salt you become hyper aldosterone you make that makes your cortisol go up in this whole myth of adrenal fatigue because of low carb diets is for want of a pinch of salt it's not a high-salt diet is motor salt diet and I think Peter showed you the slide yesterday but there's a elegant study done in Canada seventeen countries hundred thousand people the optimum of salt intake not for low carbs people eating a balanced quote balance not for longevity is at five grams a day not 2.3 so one can do it doesn't that be a high salt just a modicum of salt and I'll end there thank you and picture me on my favorite mountain

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