Scott Webb (Host): The ketogenic or keto diet is often misunderstood, but my guest today is here to set the record straight and discuss the many health benefits including weight loss to the keto diet. I'm joined today by Dr. James Carlson. He's a board-certified family medicine physician practicing at Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about some of the details anyway of the ketogenic or keto diet, I'll probably abbreviate that along the way. So, let's start there. Just foundationally, like explain, I guess, what is the keto diet, what does it consist of, and maybe why was it originally created?

Dr. James Carlson: Great question. First a little bit about me, my background, and how I came to an understanding that the keto diet was the correct way to eat. My training in undergraduate was molecular cellular biochemistry. I got a degree in that at a Cornell. I went on to medical school, where I received honors in Biochemistry and whatnot. And I always have had an interest in Nutritional Biochemistry. So, a lot of this information comes not from me being a board-certified physician, but really from being a molecular cellular biochemist with an understanding of the proper way to eat. And ketogenic, shortened to keto, we also know-- it goes by many different names, right? Us older folks like myself would know it as Atkins. You know, it would be like what you see in Atkins.

Scott Webb: Yeah. Completely. Yeah.

Dr. James Carlson: The carnivore diet is another thing. The Paleo diet is another thing. And now, they're calling it something called the Lion Diet. And I always question, is it L-I-O-N or L-Y-I-N-G? You know, it's like, "I didn't have that cookie, I swear." But the ketogenic diet is absolutely fascinating, because most physicians don't even understand it at all. And we're actually taught in medical school to keep people off the diets I just mentioned, because you can cause liver and kidney failure. You know, eating all this fats going to make you heavy, raise your blood pressure, cause diabetes, cancer, things like that. Absolutely 100% not true.

Another thing about me, I've been in practice for about 35 years. And by golly, I must have put 10,000 or so people on the keto diet or a version thereof. And I do that or did that to keep them from going on medications or to get them off medications. But let me get back to the original question. So, the ketogenic diet, it comes from the fact that when you're eating more fat or less carbohydrates, we start breaking down fat-- fat in your fat cells-- and we're breaking down this fat to create energy, right? And when we're breaking down fat to create energy ketones, these molecules called ketones are formed. And this is where the whole, you know, checking the urine for ketones comes into focus. Why we call it the keto diet. Most people who are on the keto diet don't really understand its significance, right? But the term keto comes from ketones, which are the byproducts of fat, digestion, and utilization to create energy, right? So, that's the first thing about the ketogenic diet. This is essentially backing off on carbs and eating more fat, cholesterol, and protein.

But let me go, you know, back a little bit and let me make some statements about eating fat, cholesterol, and protein. We learned in medical school or learning in medical school the false concept that eating fat makes this fat, that is absolutely false. It does not. In fact, the more fat you consume, the more fat you will lose if indeed you need to lose weight. As far as cholesterol, I is concerned, this is a highly controversial thing I'm going to say, but it's true. Eating cholesterol-containing foods does not increase your risk for heart disease, stroke, diabetes, or cancer. That is absolutely 100% false, but it's still widely accepted in medicine today. You want to go low fat, low cholesterol, you want to go Mediterranean? The answer is no. The Mediterranean diet, low fat, low cholesterol is not the way for a healthy heart. It's the exact opposite.

And then, the final thing I say to my patients is that eating protein doesn't cause liver or kidney failure. And this is something that's taught in medical school that if you eat protein too much, you'll cause liver and kidney damage. And it's a hundred percent false. Now, granted, if you are on dialysis or your liver isn't functioning properly, you need to be careful with protein, but eating it in and of itself will not cause liver and kidney problems.

Host: In doing my research for this, I came across some information that indicated that keto or the ketogenic diet in its earlier form was originally designed for those with epilepsy. And wondered, "Did I read that right?" And if you could sort of could confirm or deny that.

Dr. James Carlson: Wow. That's pretty cool, because the Dr. John Freeman at Johns Hopkins University did write a book called The Ketogenic Diet, which wasn't really a big book. It was a little handheld thingy and it was definitely geared toward children with severe forms of epilepsy, including autism. And when he implemented the ketogenic diet-- and this is more fat, more cholesterol than protein, right? So, he did this more specifically. And what he noticed, I forget how he arrived at this-- probably serendipitously like everything else-- but he started treating, autism, and severe epilepsy with the ketogenic approach. And he had phenomenal results. The book is still out there, I learned about that after I started my patients on a ketogenic approach.

As a matter of fact, there's a Netflix movie, documentary, called The Magic Pill, and it looks at a bunch of different people utilizing the ketogenic diet, making the dietary change. One of them, I believe, maybe one of the main focuses was an autistic child who they had a heck of a time converting. And because with autistic children, certain textures, you know, with food and stuff, it's very difficult. It was a battle to get her to change. But the cognitive function so significantly improved, it's just amazing. So, anyone listening to this, you got to watch The Magic Pill. The pill, by the way, is the food. The pill is the food we eat.

Host: Right.

Dr. James Carlson: I think I should probably take you back 26, 27 years ago. So, how did I come across this? Am I some kind of genius? The answer is absolutely not. But I was 70 pounds heavier on blood pressure pills on statins, which are cholesterol-lowering medications. And I put myself on the classic low fat, low cholesterol, and things only got worse. And then, I thought, "Maybe I'm still eating too much fat in cholesterol." So, I even lowered my fat and cholesterol to like almost zero and things got even worse. I gained weight. My cholesterol, my HDL was in the toilet, that's your good cholesterol. Blood pressure was going higher. Still didn't realize that I was eating the incorrect way.

Then, I was working with a physician who was knowledgeable in the ketogenic diet. He was knowledgeable with Atkins. And this book called Protein Power found its way onto my desk one day and I go, "Hmm, this is interesting." So, I started reading it. And I'm like with my molecular cellular biochemistry background, I said, "Oh my goodness, I am eating the incorrect way. I totally changed my eating style." Seventy pounds came off, not overnight, took me 18 months. Suddenly, I'm off my blood pressure medications. And now, I'm off my statin du jour, I think it was atorvastatin or something like that. And now, I'm losing weight. Eighteen months, 70 pounds heavier off medications. And that started my journey to trying to understand where I was taught wrong.

So, audit all the latest copyrights of my biochemistry texts, molecular cellular biochemistry texts, chemistry texts, and reread them. And it was fascinating because we would learn biochemical pathways for cholesterol and fat creation, and it starts with sugar, glucose, fructose. So basically, fat and cholesterol are made from glucose and fructose. So, the more carbohydrates you eat, the more fat and cholesterol you're going to make. And that's what clogs, you know, coronary arteries and things like that.

Host: For sure, which is bad of course. And that's where I wanted to jump in here. Maybe you can talk a little bit about what the keto diet does for blood sugar levels and maybe describe the chemistry or physiological state of ketosis.

Dr. James Carlson: Right. So, ketosis comes about from breaking down fat to create energy. So, that's where the ketones come from. These are benign dietary ketones. So, some physicians think that all ketosis is bad because there is a condition called diabetic ketoacidosis, and they confuse diabetic ketoacidosis with benign dietary ketosis. So, the chemistry is the body does not prefer carbohydrates for fuel. That's a common misconception. It actually prefers free fatty acids for fuel. But when you stop eating carbohydrates, what's left to break down to create energy is fat. And then the byproduct of that are the ketone bodies.

Host: It's really interesting. You know, there's so much out there, doctor in the world, media, social media, so-called experts. But it's so great to speak with an actual expert, and really dig into this. I guess you know what I've heard, but versus what you're going to tell me, like what are really the key aspects of the keto diet for someone who's considering it?

Dr. James Carlson: Absolutely. Very easy question to answer. Backing off, lowering your carbohydrate intake, increasing cholesterol, protein, and fat. It is that easy. You look at these social media platforms. Everyone wants to be a genius, right? So, they make it more complicated than it is. No, it's not complicated. Back off on your carbohydrates. This includes white bread, white pasta, white rice, cakes and candies, but also whole grains, multigrains, seven grains, pasta, brown fat, brown rice, yogurt, oatmeal, and fruit. Fruit is a poison basically, and you just got to really watch your carbs. So, lower the carbs, more protein, more fat, and more cholesterol.

Host: See, you broke it down so easily. I knew you were going to be a big help because when I've thought about the keto diet before and I sort of looked at the aspects or the rules, which is the next thing I'm coming to with you, I was like, this is just too much. It's overwhelming, but it really isn't. And way to sort of distill it there for us. So, what are the rules, Doctor, of the keto diet?

Dr. James Carlson: I chuckle at that because-- you ready for the rules? Lower the carbs, eat more fat, cholesterol, and protein. That's it.

Host: Got it. Yeah. It is so simple out of the mouth of an expert. I love it. So, let's talk then about specifically, you know, just kind of go through again maybe, but what can be eaten and what should be avoided or restricted and why?

Dr. James Carlson: Great question. Very simple. So, you want to avoid-- I'll say it a little slower this time, because I said it really quick there. You want to avoid what everybody already knows, right? The white bread, the white pasta, the white rice cakes and candies, everyone's like, "Yeah, of course, I know that." But then, I also take it a step further. Avoid whole grains, multigrains, seven grains, whole wheat pasta, brown rice, yogurt, oatmeal, fruit, because all of those foods are broken down into glucose, sugar. And the most dangerous carbohydrates to eat are the complex carbohydrates. And these are the carbohydrates that dieticians, nutritionists and most physicians will tell you are better for us, but they're not. Because as opposed to simple sugars, which is your cakes and candies, complex carbohydrates give you millions of sugar molecules, and all these sugar molecules will be made by ourselves into fat and cholesterol. Uh-oh.

Host: Right. It's inevitable. Right.

Dr. James Carlson: Yep.

Host: It's so fascinating. And I definitely should have eaten before we started this, because now I'm really hungry, because you're just listing off all the things I want to eat and tell me what I shouldn't eat, which is good. Just wondering, doctor, are there side effects per se of the keto diet?

Dr. James Carlson: Yeah. Yeah. You want to know what a big one is? You're going to have to buy yourself a new wardrobe if overweight, and you got to buy clothes.

Host: I would welcome that. I could use some new threads, you know.

Dr. James Carlson: But that's a really interesting question, and there are. You can go through what they call a keto flu, where you're going through withdrawal from carbohydrates. Now, this is a transition state, because our bodies biochemically are used to using the enzymes for carbohydrate energy creation, and I call this the transition period where our cells start to use the enzymes needed to break down the fat to utilize for fuel, which is the preferred fuel source. Free fatty acids are the preferred fuel source, right? So, maybe some diarrhea, maybe some nausea. You don't really see that all that much. But some people claim they get a keto flu.

I'm going to use this question to harp on something that I feel is very important before anyone embarks on a ketogenic diet or any low carb diet for that matter, and you're on medications for diabetes, for high blood pressure. You need to speak to a physician who understands how the ketogenic diet works, because once you start eating this way, a lot of individuals can come off those medications, blood pressure medicines, diabetes. So, be very, very careful. I guess you could call that a side effect, not aware of it.

Host: Yeah. Right.

Dr. James Carlson: So, I'll throw that out there.

Host: Are there some folks that benefit more from a keto diet than others? And are there also, Doctor, some folks that it just doesn't work for? And is it mainly the people who just won't do what you tell them to do? So, both sides of the spectrum there.

Dr. James Carlson: Basically, the ketogenic diet can have benefits for just about everyone. People who need to be cautious with it would be individuals in liver and kidney failure. That's a whole 'nother, you know, conversation there. But most people-- and you're right, you're right, when I have a patient who-- I'm doing the air quotes-- "it doesn't work for," and I'm like, "Okay, well then, I'm just going to put you on blood pressure medicine and cholesterol--", "Oh, no, no, no, no, no. Okay, I'll try. I'll try it again. I'll try it again."

Host: I will really try this time.

Dr. James Carlson: And miraculously, it works. And another thing too, and I'm glad you said it, as far as weight loss is concerned, I'll sometimes forget to even mention weight loss because when I start a ketogenic approach with someone, I'm not doing it for them to lose weight, although, you know, many people have to, I'm doing it to start them on a healthy journey. Because once you start lowering your carbohydrate intake, and I call carbs the root of all medical evil, disease evil. Once you start on your lowered carbohydrate journey, your keto journey, almost immediately within a week or so, you are going to experience very healthy things. Normalization of blood sugar. You asked about blood sugar. What does it do for blood sugar? Well, it lowers your blood sugar into a healthy, normal range. But if you're a diabetic and you're on medicines like insulin, it could lower it too much, too much, so you got to be very careful with that. But once you change your eating style to the correct way to eat, you're going to be healthy in a lot of different aspects.

And yes, a nice side effect. What a lot of people are after when they start this approach is for weight loss. And indeed, it does do that. I will say this, men tend to lose weight a little quicker than women, not always. But men tend to, which then, of course, the wife hates the husband because he's-- but women do too, as long as they're patient. And I tell people too, the one word that you really want to repeat to yourself when you start this is patience. Be patient with the outcome and understand that good things, you know, healthy things are going to start happening generally as soon as you start the low carb diet. And it may not initially be weight loss.

Host: Right. Well, I feel like, Doctor, just sort of reading between the lines here, you know that there are short-term benefits and long-term benefits, right? So, you said like maybe short-term, it's the blood sugar comes down. Maybe more long-term, it's the weight loss. But from you, from an expert, like what would you say are the short and long-term benefits?

Dr. James Carlson: That's interesting, because I would totally agree with what you said. So, almost immediately, you'll see better blood sugar control. And I've seen people whose blood sugars were like 400 start to come into the 200s and under within a week when they're really truly doing it.

Host: That's amazing. Yeah.

Dr. James Carlson: Blood pressure. I've had people with like 170/110s, which is elevated. And if I know they're going to do the ketogenic, I won't touch them with blood pressure medications. A couple of weeks, the pressure start to come down. And what you said is also true, the long-term benefit is going to be weight loss, which doesn't happen overnight.

Another, really quickly, something you hear a lot from physicians, well, we don't know what the long-term side effects or benefits are, or health effects are of the ketogenic diet. Well, I do, I've been doing it for 27 years. So, they have it.

Host: Yeah, getting you off your meds, right? Losing weight, getting a new wardrobe. Those all seem like big wins, doc.

Dr. James Carlson: Absolutely.

Host: Yeah. So, I want to just get a sense when patients come to you, when they're in your office, right? Is keto the first thing you go to, right? Like a mechanic starts small and then they replace your whole engine. Take us through the journey, if you will, to getting folks on the keto diet. Is it, you know, everybody who walks through the door, you just hand them the pamphlet? How does that work?

Dr. James Carlson: No. Because then now you're like the proselytizer, right? And people don't like that. I kind of try to get a feel for people if they're interested, if they're not interested. I don't want to sit there and preach to them. And I'll always kind of feel out. I'll ask, you know, "Are you a vegetarian?" And while I am not against vegetarians or vegans, it's just not generally a healthy way to eat. But that's a whole 'nother topic for a whole 'nother day. But I've get a feel for people, you know, if they're interested, if they're not interested, because I don't want to lose their interest. Because some people don't want to hear it, they don't want to give up their spaghetti, and they're not ready for it yet.

Host: I'll just give you a chance here at the end, and I know we opened up some other cans along the way, and maybe we'll get a chance to speak on some of these other, you know, offshoots of the keto diet. But for today, maybe just final thoughts, takeaways, when we think about the keto diet, what people think they know versus the truth. Just lay it out for us.

Dr. James Carlson: It's definitely a very healthy way to eat. You have to do it the correct way. One of the big mistakes people make is they go too low on carbohydrates. I tell people to stay between 20 and 30. Don't be afraid to eat fat. It doesn't make us heavy. Don't be afraid to eat cholesterol. It doesn't cause heart disease or anything like that. Don't be afraid of protein unless you have this condition mentioned before. It's so simple. Just lower your carbs back off on the carbs and eat more fat, cholesterol, and protein, and you're keto basically.

Host: Your keto. Right.

Dr. James Carlson: That's it.

Host: I liked that. That will be good on a T-shirt. "You're keto," perfect. Yeah. This has been great. Some podcasts are more educational for me than others, and this has been a good one. I have lots of things to tell my wife. I told her I was going to be hosting on keto, and she said, "Great. Here are the questions I want the doctor to answer." So, I'm going to fill her in. Listeners have this podcast. And hopefully, we'll get to speak again. So, thank you so much.

Dr. James Carlson: All right. Awesome, man. Thank you so much.

Host: And for more information, visit franciscanhealth.org and search Keto diet. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.