Maggie McKay (Host): This is the fourth in a series of podcasts on integrative medicine with Dr. Yoon Hang Kim, Chief Wellness Officer. Today, we'll discuss using lifestyle to correct metabolism, obesity, and diabetes using low-carb keto medicine as a new field of medicine.

Welcome to a podcast presented by Memorial Hospital. I'm Maggie McKay. Thank you so much for joining us. Nice to see you again, Dr. Kim.

Yoon Hang Kim, MD: Likewise. I'm very grateful to be here this morning.

Host: Just to begin, would you please tell us what made you interested in lifestyle medicine and what it is?

Yoon Hang Kim, MD: So, I had the fortune of studying with Dr. Andrew Weil, who's a pioneer in integrative medicine in person. And what happened is that he tried to teach me lifestyle medicine when I studied with him in 2002 to 2004. And I was really not a good student. I didn't know how to cook. So, Dr. Weil recommended I learn how to cook with the chefs, which I did. But I would say that I still wasn't a great student until something happened. And then, I realized that no supplements can overcome lifestyle. And then by lifestyle, no amount of exercise, no quality of exercise can overcome that diet. That's what I realized.

Host: And it's hard to go anywhere without hearing somebody talking about the keto diet or we probably all know someone or several people who are on it. What are some of the benefits of keto that you've experienced?

Yoon Hang Kim, MD: So, it's an interesting story because when I was in high school, I did a book report. And I went to National Library in Singapore. And I picked a book and it was about how they treated diabetes without insulin when they didn't have insulin. So, a long time ago, like in the 1800s, when people had diabetes type 1, they just died. And they would go into ketoacidosis and there was no insulin to bring them out, so they died.

And then, scientists in England found out that you can put people on ketogenic diet, meaning to put them in a fat-burning, no carbohydrate diet, and those people survived. So, I did my book report on that, and I forgot about it. And then, I went to college, went to medical school, still forgot about it. And then during COVID, something happened. I was away from my family. I was working away from my family. I was isolated. COVID happened. And I ended up gaining about 50 pounds and diabetes came.

So, I remembered what I read in high school and began to research a lot on keto. And because part of this is that you can treat diabetes, but you don't really hear about there's a plan to reverse diabetes. When people get diabetes type 2, they usually take the medicine. They have what they call honeymoon phase where the blood sugar control is excellent. And then, it stops working. Then, they have to take more medications, add medications, and sometimes use insulin.

Now, there are people who manage diabetes fine with diet and exercise, but I wasn't one of them. So, what I decided to do was put myself in ketosis. So, I stopped eating any carbohydrates. And then in the beginning, it was very difficult and then it became easier and easier. And now, I hardly have to plan my diet. All I have to do is if I'm going to a new restaurant, I have to look at their menu so that I know what I'll be ordering or I know that I have to eat something before going to that restaurant.

Host: So, do you think you'll follow this the rest of your life?

Yoon Hang Kim, MD: I've lost 50 pounds and there's about 20 to 25 pounds that I like to lose more. And after that, I think that I may introduce some carbohydrates in the form of what they call prebiotics, so berries such as blueberries, blackberries, raspberries, and strawberries, because they provide nutrient for our microbiome so, right now, even watching those. But once I get to my ideal weight, and the diabetes is formally reversed, then, likely, I'll stay on a form of this. But probably, I will remain in ketosis until something changes, or I usually tell my patients that I intend to quit when my feet will hit the coffin, then I'll stop being in ketosis.

Host: Dr. Kim, what is ketosis and how does one achieve it?

Yoon Hang Kim, MD: So, ketosis just means fat burning state. And macronutrient-wise, we have three types of fuels. We have carbohydrates which is sugar, complex sugar, simple sugar. And then, we have protein, and then we have fat. Ketosis means you're burning the fat. There are multiple ways to enter ketosis. There's internet ketosis, people saying that you do it this way, do it that way. But simply, if you don't eat any carbohydrates, your body will go into ketosis when your liver runs out of sugar storage in the form of glycogen. So for most people, that's probably three to four days of not eating carbohydrates. And so obviously, if someone fasts, then they will go into ketosis. If they stop eating carbohydrates and eat more of a Duke Ketosis, keto diet, which is protein-driven, they'll go into ketosis. If they eat mainly like internet ketosis, fat-driven diet, they'll also go into ketosis. And if they drink a green juice, which doesn't have very high carb, low carb, low protein, low fat, they're also going to ketosis. So, there are multiple ways to get into ketosis. And depending on what patient prefers and says that it's sustainable, then that's the style that I recommend. So, I have patients who says that I'm going to just do everything by doing greens. So then, they'll do green juicing for a month and then they'll come out of it being what we call ketotarian.

Host: Oh, I've never heard that term. That sense. So, you touched a little on this, but let's talk more about the benefits of keto. What have you observed so far?

Yoon Hang Kim, MD: For me, it was for health reason. The lifestyle that I chose or didn't choose that I wasn't mindful resulted in developing diabetes and weight gain of 50 pounds. So, that has been reversed. Now, I'm trying to go to what is considered my optimal weight. And with that, my markers for diabetes has improved and markers for inflammation like CRP, C reactive protein, has decreased. My liver enzymes have returned to normal. So, these are conditions that I would say that in a matter of six months to a year. It cannot be reversed so easily using medication, but using lifestyle especially using keto diet. I don't even look at ketosis as keto diet, but it's keto medicine.

Host: And what about your autoimmune system? Does it affect that?

Yoon Hang Kim, MD: So, it also began as an accident because I do have an autoimmune condition that I went to specialists and they gave me-- it's a skin condition-- very, very strong steroids and it failed to treat it. And when I went on ketosis, I just noticed that the lesion just became less prominent and less noticeable, and the protrusions that I experienced are reversed. So, it's not in remission, but it's, I would say, about 80 percent much better than where it started. And then, what had happened is when I made this observation, I had other patients who had very, very treatment-resistant condition in terms of skin condition. So, I had recommended that they should try ketogenic diet. And lo and behold, about 80% of their condition just disappeared.

Host: Wow. Does it help with pain for patients experiencing pain?

Yoon Hang Kim, MD: Yes. I think especially if the pain comes from the nerves, I think that the ketosis, the ketones have a tendency to calm down the nervous system. And we see that in recent newspaper article. There was an article that stated that someone with bipolar condition was able to contain their bipolar condition by using ketosis.

Host: And what does it do for gut health? You mentioned that briefly.

Yoon Hang Kim, MD: So, another interesting observation that I made is that when we have yeast overgrowth or small intestine bacterial overgrowth or fungal overgrowth. What happens is that when people eat carbohydrates, their stomach bloats up, and it hurts a lot. And then, it's usually followed by diarrhea. So, I reasoned, what would happen to these people if they did not eat carbohydrates? Because as you may know, to make alcohol of any type, you need carbohydrates. You don't usually make alcohol with fat or protein. You need carbohydrates. So, I asked these people to refrain from carbohydrates. And what I've noticed is that as short as one week, a lot of these people would no longer have SIBO. And the small intestine bacterial overgrowth the failure rate with even great antibiotics is about 50% to 70%, it'll fail. So whereas doing it this way, the success rate became almost 90% to 100%.

Host: One week, that is amazing.

Yoon Hang Kim, MD: Not all. Some of the people, they have to go a little longer, like three months to six months.

Host: Right. But even one person, I mean, you know... Why did it take so long for keto to come into the mainstream consciousness? I mean, you said it's been around a long time. So, why did we just start hearing about it, I don't know, 10 years ago?

Yoon Hang Kim, MD: As I shared, the benefits of ketosis has been described in 19th Century in England. And there have been many pioneers who have utilized keto, but there are many reasons. Number one, I think that the lifestyle is probably the thing that most people want to do last, like, even for myself. And then, the second is that there is notion, there is this belief, that a balanced diet is the best diet,. And even in Dr. Weil's system, they believe the balanced diet is the best approach. And if you look at keto, it's not considered a balanced diet. It is a restrictive diet of 10% of less calories coming from carbohydrates. Now, it's not zero carbohydrates like for example, Duke Keto says you can have up to 20 grams of total carbs. So for example, I can eat two small avocados a day where I get all my vegetables as well as salad, which has very little carbohydrates.

And the other part I would say is that there's this general bias that plant-based diet is the best diet for people. And I think that what I would say is that for some people that would be true. Some people, like myself, this diet would work. It appears to be having given me the health benefits, that neither the balanced diet, the Mediterranean diet or nor the plant-based diet has either not worked or not tolerated. So, the way that I would say is that people need to find the best way to tweak their metabolism.

Host: I was in the market, a natural food store, the other day and I was looking at this milk my friend told me about that's dairy-free, it's made of pea protein. And I was looking at all the choices of all the different milks. And I was thinking it is wonderful that now they make it so much easier for people who need to do gluten-free or want to do keto or vegan. I mean, when I was little, none of that existed. So, is there anything else you'd like to add in closing, Dr. Kim?

Yoon Hang Kim, MD: So, what I would say is that all these availabilities of different styles of gluten-free, dairy-free, it's just an observation for myself. And I recommend to patients that the less people have engineered it, probably the better it is. The more we engineer it, it becomes hyper-processed and the side effects of such processing appears to have a negative impact.

So, the way that I follow the keto diet recommended to my patients is very similar to Duke Keto, which says use the whole foods, meaning not processed foods, but whole foods. And then, what I say is that after that prioritize fiber. Make sure you get your protein, make sure you get your fiber. And then, make sure that you're getting good, healthy sources of fat. And it's that simple. And then, of course, avoid GPS, which stands for grains, potatoes, and sugar.

Host: Oh, sugar. Yeah, I knew that was coming. It always winds up in these conversations. Sugar is the devil. That's what my husband says. And I guess he's right. Well, thank you so much, Dr. Kim. This has been fascinating and I can't wait to hear what you're going to talk about in episode five, which is coming up soon. We really appreciate you sharing your expertise on this.

Yoon Hang Kim, MD: Thank you. Thank you so much.

Host: Again, that's Dr. Yoon Hang Kim. To learn more, please visit mhtlc.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is a podcast from Memorial Hospital.