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Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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Episode 114
The Doctor's Farmacy

Do You Have To Eat A Ketogenic Diet All Of The Time To Get Its Benefits?

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Tap the subscribe button and new shows will be added to your library.

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The ketogenic diet has gained a lot of popularity in the past couple of years. If you’re not quite sure what it is, why it could be beneficial, or you’re well-acquainted with it and just want to learn more, this episode is for you. 

The ketogenic diet, or keto as it’s called, is a high-fat low carbohydrate diet. While some people take this to mean loads of conventionally raised meat and dairy, the true (and beneficial version) means lots of beneficial fats from things like avocados, nuts and seeds, and coconut; high-quality protein from clean sources like grass-fed meat and pasture-raised eggs; and plenty of non-starchy vegetables. 

To hash out more of the details about keto and how it can support good health, I was excited to talk with my friend and one of the leading voices in the Paleo/Primal and keto movements, Mark Sisson.

Mark and I kick off our conversation talking about his own experience tinkering with diet and lifestyle to achieve optimal health. As an endurance runner, he thought he was feeding his body right by carb-loading and leaning on whole grains; he realized fat was a missing piece and turned around some chronic health issues like IBS in the process. At 65, he looks like he’s in his 30’s, so I think we could all learn a thing or two from his journey. 

If you’re worried trying keto means never touching another carb, you’ll be relieved to hear otherwise. Mark talks about the important concept of metabolic flexibility and how when we focus on primarily burning fat the body can better handle the sugar from carbohydrates during those occasions. We also debunk that myth that you can eat as many calories as you’d like when you go keto, and why you wouldn’t want to anyway. 

Being in our 60’s, Mark and I are both adamant about healthy aging. We discuss how keto can support that, why weightlifting and muscle mass are so essential for staying fit and strong as you age, and the benefits of balanced blood sugar for longevity. 

Keto or not, there’s so much great information about eating for optimal health in this episode. I hope you’ll tune in.

Get Mark’s latest book Keto for Life at http://www.ketoreset.com/forlife/

This episode is sponsored by Joovv, chili, and my Sleep Master Class.

I recently discovered Joovv, a red light therapy device. Red light therapy is a super gentle non-invasive treatment where a device with medical-grade LEDs delivers concentrated light to your skin. It actually helps your cells produce collagen so it improves skin tone and complexion, diminishes signs of aging like wrinkles, and speeds the healing of wounds and scars. Check out the Joovv products at joovv.com/farmacy and use the code FARMACY at checkout.

One of the easiest and most effective ways to get better sleep every single night is through temperature regulation, which is why I was so relieved to discover the transformative products from Chili. The chiliPAD and OOLER system are two really cool gadgets that fit over the top of your mattress and use water to control the temperature of your bed—which helps lower your internal temperature and trigger deep relaxing sleep. Right now chili is offering my audience a really great deal. Get 25% off the chiliPAD with code hyman25 or 15% off OOLER with code hyman15, just go to chilitechnology.com/drhyman

In this modern world we place too much value on staying busy and deprioritizing sleep, which is why I have created my first ever Master Class.  It guides you through the most important steps to getting better sleep, starting today. To learn more about the Sleep Master Class, head over to drhyman.com/sleep. Sign-up today to watch the first three lessons for free. 

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn (video / audio):

  1. Mark’s wake-up call to change how he ate and exercised at 28 years old
    (3:17 / 5:42)
  2. Tenets of the Primal Blueprint
    (11:25 / 13:50)
  3. Reversing the aging process through metabolic flexibility
    (17:11 / 19:36)
  4. What is a ketogenic diet?
    (20:59 / 24:37)
  5. How long does it take to adapt to the ketogenic diet and why do people get the “keto flu”?
    (29:37 / 33:15)
  6. Can you eat too much on the ketogenic diet?
    (32:15 / 35:53)
  7. The way to know if you’re doing a ketogenic diet properly
    (35:50 / 39:28)
  8. Weightlifting and the importance of muscle, especially as you age
    (37:34 / 41:12)
  9. Why burning fat is better than burning sugar for longevity
    (40:43 / 44:21)
  10. Do you have to be “keto” all of the time to get the benefits of a ketogenic diet?
    (49:24 / 53:02)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Mark Sisson

Mark is the founder of the popular daily health blog, Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/Paleo, keto, and Whole30-friendly kitchen staples.

Transcript

Mark Sisson:
The number one benefit from all of this is getting control of hunger, appetite and cravings. That’s what everyone reports when they finally hit that keto zone.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, that’s Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you’re confused about fat, and you’ve been hearing about keto and want to know what the scoop is, this conversation is going to matter to you because it’s with the founder of the popular daily health blog, Mark’s Daily Apple, Mark Sisson, who essentially is the godfather of paleo eating, and also a huge advocate and practitioner of ketogenic diet. I have dug into his research, I’ve read his stuff. I use his blog as a source of information for myself. He’s a real inspiration for me and he is an incredible guy.

Dr. Mark Hyman:
He’s a New York Times bestselling author of the Keto Reset Diet and his latest book Keto for Life, where he discusses how he combines the keto diet with a primal lifestyle for optimal health and longevity. He’s written lots of books, The Primal Blueprint, which was credited with turbocharging the growth of the primal paleo movement back in 2009. He’s been researching stuff for three decades and educating people on why food is the key component to achieving and maintaining optimal wellness. Who knew, right?

Mark Sisson:
Really, yeah.

Dr. Mark Hyman:
Mark launched an incredible company called Primal Kitchen whose products I used and use all the time. It’s a real food company that basically takes out all the crap, puts in real food ingredients, and create all sorts of things like condiments, sauces, dressings, bars, collagen, ketchup, whey protein powders, no artificial ingredients, no added sugars, no trans-fats, no weird oils like soybean and canola, no artificial flavors, colors, dyes, waxes or preservatives. Just real food. Welcome, Mark.

Mark Sisson:
Jeez, thanks, Mark. That’s a that’s a long intro. Do we have time for a show?

Dr. Mark Hyman:
Yes. And I just want to say that his company, Primal Kitchen, was so amazing and grew so fast that it was bought up by Kraft, which some would say is a sellout. But I think it’s a good thing because the more pressure we put on big food to change, the more they’re going to change, the more they’re going to get rid of their products and start selling more your products and products that all of us actually can eat.

Mark Sisson:
Yeah, I appreciate that. I mean, I think we’re going to look back on the food movement, which is really shifting dramatically now, and look at sort of the sale of my company to Kraft that’s sort of ground zero for a massive shift in big food finally getting it, finally understanding that this is where the consumer wants to go. They want these sorts of products.

Dr. Mark Hyman:
Absolutely, so true.

Mark Sisson:
When they bought us, it was like, “We love what you’re doing. We don’t want to change a thing.” So we kept the entire company based in Oxnard. It’s run by the same people that I grew up. My team is still there. Nobody got fired. We hired more people. It’s been a phenomenal experience.

Dr. Mark Hyman:
That’s amazing. You’re 66 years old. Physically, you look about 30 or actually, the truth is you look better than probably 90% of 30 year olds who these days are pretty flabby considering 75% of us are overweight. You always were focused on exercise. You’re always an athlete, you were extreme cardio guy and endurance athlete. You had a really big high-carb diet, which was the thing at the time, carb loading and-

Mark Sisson:
Absolutely.

Dr. Mark Hyman:
It was a big deal. I was a high-carb guy back in the day because it was low fat and that was just what you did. But it led you to a big wake-up call. What happened?

Mark Sisson:
Well, I started running in my teens. I was interested in longevity for some bizarre reason as a 12-year-old. Really, seriously. And I started running. I read a lot about running and how it was supposed to be good for you. And then ’68 Cooper’s book came out on aerobics and assigned some metric to the more miles you ran, the healthier your heart would be. You would get points for putting time in and I like points so I started accumulating the miles. It started with my just jogging to and from school. It was just a convenient way to beat the bus to and from school.

Dr. Mark Hyman:
That’s what I did in medical school. I ran four miles each way every day. Four miles there and four miles back with a backpack and my books and my clothes.

Mark Sisson:
Yeah, it probably took you less time than if you’d been in traffic or something. Then I went out for the high school track team because I was too scrawny to play football, basketball, baseball, hockey. Lo and behold, I started winning races. This little bit of training that I was doing running to and from school was enough to have me win the mile and the two-mile. Through college, I started… Well, even before then, I started looking at ways in which I could enhance my performance such as it was through diet, like how could I fuel all the miles that I wanted to run? Because if you run out of miles, you get tired and you have to do it again the next day and the next day and the next day.

Mark Sisson:
The mantra of the day and of the time and for generations was carbo loading. You got to refill those glycogen stores because if you exhaust them in the run today and you want to run tomorrow-

Dr. Mark Hyman:
What’s glycogen?

Mark Sisson:
Glycogen is the storage form of glucose in your muscles. So the assumption was that your muscles need a lot of glucose to run efficiently. You can’t keep much glucose in your bloodstream as you know. There’s probably a tablespoon or teaspoon worth of glucose in your bloodstream at any point in time. So the body takes glucose and it stores it as glycogen in the muscles. You can store 500-600 grams of glycogen in the body.

Dr. Mark Hyman:
It’s like 2,500 calories.

Mark Sisson:
It’s a decent amount of calories and if you allocate some for the brain and you allocate some for basic survival functions, you wind up with about 1,800 to 2,000 usable calories in the muscles that you can use as fuel. Now, ideally, and we’ll talk about this as we get into the nuances here, ideally, you want to burn as much fat as possible and spare the glycogen. But we didn’t really know about that at the time and we thought that, again, if you remember Covert Bailey who wrote a book, I forget what the name of the book, but the line was fat burns in a carbohydrate flame.

Mark Sisson:
So you had to eat carbohydrates in order to get the fat to burn. That was the, again, the sort of science of the day. And then Tim Noakes who wrote a book called the Lore of Running was the guru of carbohydrate management. So everything-

Dr. Mark Hyman:
He became low-carb guy.

Mark Sisson:
Oh my god. It’s one of the great shifts in science.

Dr. Mark Hyman:
He actually-

Mark Sisson:
It’s one of the great heroic acts in science.

Dr. Mark Hyman:
He got vilified in South Africa where he’s from.

Mark Sisson:
It was a heroic act for him to change his mind. But over the years, as I ran more and more miles and I performed better, and I ate more and more carbohydrate, and I was skinny, I could eat 6,000 calories a day. And 1,300 grams of carbs was not a big deal for me to do. I weighed 30 pounds less then than I weigh now and the same body fat. So you’d think that all of this stuff would be like trending toward a healthier, lean, fit, happy, productive body and my race times came down. I turned out to be a pretty good runner. I finished fifth in the US National Championships in 1980 and eventually, went on to finish fourth in Ironman in Hawaii in the early days.

Mark Sisson:
But I was falling apart. I had osteoarthritis in my feet. I had tendonitis in my hips. I had irritable bowel syndrome that literally ran my life. If I were driving to the studio today to do this podcast, I have to think about how many bathrooms there were open at gas stations on the way here. Like that kind of thing.

Dr. Mark Hyman:
Wow, that’s bad.

Mark Sisson:
It was horrible. Since from the age of 14, I suffered from that. Then I had multiple upper respiratory tract infections every year. I’d get sick a lot. I thought it was the training but it turns out, it was a combination of that and the amount of sugar that I was consuming.

Dr. Mark Hyman:
Yeah, sugar suppresses immunity.

Mark Sisson:
Yeah, glucose competes with vitamin C for you GLUT4 receptor and it’s like if the sugar’s there, the vitamin C can’t get in. Anyway, all these things became clear to me and obvious to me years later, but at the time, I literally fell apart. I had to quit running. My injuries were debilitating.

Dr. Mark Hyman:
How old were you?

Mark Sisson:
I was 28.

Dr. Mark Hyman:
Wow.

Mark Sisson:
Yeah.

Dr. Mark Hyman:
Going on 68.

Mark Sisson:
Yeah, no, exactly. I couldn’t walk right in the morning for an hour. It would take me that long for my feet to sort of warm up and the arthritis in my feet to allow me to move without limping throughout the day.

Dr. Mark Hyman:
You’re having what? Breads, rice, pasta.

Mark Sisson:
Yeah, yeah. I mean all the healthy whole grains, all the stuff you’re supposed to be having.

Dr. Mark Hyman:
You weren’t having Twizzlers, right?

Mark Sisson:
No, I was not eating sugar and… Well, I shouldn’t say that. There was a point at which I had a half gallon of ice cream every night for like six years.

Dr. Mark Hyman:
Nice.

Mark Sisson:
Because I could. But at some point, pretty early on, I just realized that this was not a sustainable life. I was falling apart. The irritable bowel syndrome was ruining me. I was sick a lot. Even when I stopped training, I realized that I needed to do something about my diet. And so I started researching food. And the first thing that I realized was that whatever that I was consuming that was converting to glucose so quickly was effectively the same as eating sugar, as eating Twizzlers. I mean, I would say that the difference between a bowl of rice and a bowl of Skittles is one has artificial colors, but they both convert to glucose pretty quickly in the bloodstream.

Dr. Mark Hyman:
Yeah, below the neck, they’re the same.

Mark Sisson:
Yeah, exactly. So I started down this path of looking… Really, my goal was to be strong, lean, fit, happy, healthy, productive, with the least amount of pain, suffering, sacrifice, discipline and all this stuff. Was there a shortcut? We call it a hack today, right? But was there a way to do this that was much more efficient and effective at achieving what had been my original goal was to be healthy and live long. And that kind of, again, started a process of decades of research. I was premed in college so I’d gone down that track initially.

Mark Sisson:
I was a biology major. I was focused on evolution. So when the genetic studies started to point to all the good stuff and bad stuff happening in our body, happening at the level of gene expression, that was the most exciting thing for me. It’s like, “Are you telling me that we have these…”

Dr. Mark Hyman:
We can fix.

Mark Sisson:
“… hidden genetic switches that we can figure out how to turn them on or off based on some of the behaviors that we choose to undergo?”

Dr. Mark Hyman:
Yeah, our genes aren’t fixed. They’re actually able to be changed in their expression and turn on our-

Mark Sisson:
Single most empowering thing I think that a person can realize, can understand. So I dedicated my life to kind of figuring out these hidden genetic switches and doing the research and giving people not like my way is the only way or the best way or the right way. It’s a way that has been well researched. And if you’re frustrated at the amount of success or not that you’ve been getting in your attempts at losing weight or attempts at reducing pain or attempts at losing anxiety.

Dr. Mark Hyman:
Getting rid of disease.

Mark Sisson:
Then I’ve got a nice little template that I call the Primal Blueprint within which you could craft a lifestyle that would work for you.

Dr. Mark Hyman:
And what is the Primal Blueprint?

Mark Sisson:
So the Primal Blueprint is basically my distillation of all the behaviors in human history going back two-and-a-half million years as humans and then 60 million years as proto hominids before that, and then 100 million years of mammalian evolution before that, that got us to where we are today. This concept that our genes are a recipe that rebuilds, renews, regenerates us, recreates us, every minute of every day based on certain inputs. It’s not, as you say, it’s not a fixed, like it’s not done doing its job.

Dr. Mark Hyman:
You have a predisposition but not a predestiny.

Mark Sisson:
Correct. And so in understanding how the genes work and what turns them on or off, we can understand what the genes expect of us. We have this recipe that expects us to be strong and lean and fit. It doesn’t expect us to be diabetic. It doesn’t expect us to be grossly overweight. It doesn’t expect us to be arthritic.

Dr. Mark Hyman:
That’s not the normal human condition.

Mark Sisson:
It’s not the normal human condition.

Dr. Mark Hyman:
Except for now.

Mark Sisson:
Correct. And so, we messed it up. We overlooked some of these simple little fixes. And not any one single person’s fault, but as a society, we sort of crafted this strategy where we want things to be easy, so we don’t want to have to work so hard. We want to eat stuff that’s crunchy, salty, fatty, sweet and quick, and it’s kind of taken us down this path.

Dr. Mark Hyman:
What are the bullets of the Primal Blueprint?

Mark Sisson:
The bullets are eat lots of plants and animals, full stop. But the subtext is don’t eat processed crap, right? Move around a lot at a low level of activity. It doesn’t mean train for marathons, because that’s a high level of activity. It means move, it means walk. Walking is still one of the best things you can do or ride a bike easy, or swim a little bit, but move around a lot throughout. Move your body through different ranges of motion and planes of activity throughout the day because that’s what the body expects.

Mark Sisson:
If you just sit at a desk, crouched over a keyboard, you will become that hunched up-

Dr. Mark Hyman:
That’s right and you see people have that body type so much.

Mark Sisson:
The chiropractors talk about kyphosis. Everybody’s neck’s forward and all this stuff.

Dr. Mark Hyman:
I got that problem.

Mark Sisson:
Everybody has that problem. It comes with the territory of being a modern human. So move around a lot, a low level of activity. It’s lift heavy things once in a while. So our ancestors didn’t just move around a lot, they actually had to log logs back to the campsite or carry carcasses that they just came across or killed, or logged babies or climbed trees to get a lookout, or take rocks and build whatever. So there was a lot of lifting. And then sprint once in a while. That’s one of my favorite ones. It’s one of the most effective exercises we as humans can do. Sprint once in a while, and it’s not every day and it’s not even every other day. It’s like once a week or once every seven days. Just as fast as you-

Dr. Mark Hyman:
That’s it? Just run as fast as you can till you throw up and then-

Mark Sisson:
No, pretty much. It’s like six or eight seconds. It could be 20 seconds. It could be an orchestrated kind of track workout if you’re that kind of an athlete, but it’s basically going all out.

Dr. Mark Hyman:
They call it HIIT training, high interval intensity training.

Mark Sisson:
Yeah, yeah, high intensity training which is now a thing but it’s been a thing for millions of years.

Dr. Mark Hyman:
Right, we had to run really fast from the tigers.

Mark Sisson:
And somebody had to figure out that in a scientific context of how we can make that part of your lifestyle, even though it’s always been part of our lifestyle. Get plenty of sleep. I mean, sleep is huge and as I know you know, it’s one of the most overlooked, bypassed lifestyle things that people say, “Well, I’ll sleep when I’m dead.” Well, you’d be dead soon enough if you keep that attitude.

Mark Sisson:
Play, engage in play. Humans are designed to play. Our brains require play. It’s one of the reasons that we’re able to figure out complex things later on in life because we spend time actually playing and sort of practicing, whether it’s as an animal practicing escape routes or whatever. Avoid trauma, it’s an easy one, avoid traumatic incidents, but as early human, if you broke your leg or twisted your knee, you were off the back. Man, you were like dead weight for the tribe. So just being smart about wearing a seatbelt, not smoking, not over drinking. All these things are…

Dr. Mark Hyman:
Basic common sense.

Mark Sisson:
They basically are common sense and yet, I think people still need to be reminded of it now and then.

Dr. Mark Hyman:
That’s so true. So you’ve been focused a lot on longevity since you were 14, which is impressive.

Mark Sisson:
Yeah, yeah, yeah.

Dr. Mark Hyman:
And it’s funny because I have too, I had a gym teacher named Mr. Gibson in eighth grade. And he was very into physical fitness and he showed us a movie, which I still literally can see the entire movie in my head. It was so impactful. And it was all these different people who were exercising and what it did for their lives. There was this guy, Larry Lewis who was 105 years old and he ran five miles to work every day as a waiter and five miles back. There was this guy who ran the Boston Marathon on stumps. There’s one story after the other and I’m like, “This is amazing.” And I started running. I started exercising and just became a runner.

Dr. Mark Hyman:
And so we’re all really focused on aging. It’s $140 billion a year industry. We want that special pill, that lotion, that supplement, that diet that’s going to fix us. We’re all sort of scared about getting old and dying and decrepit, which is really a threat because we now have 6 out of 10 Americans who are chronically ill. And it’s true and a lot of that has to do with our food. But what you talk about a lot is how we can actually reverse the aging process, how we can unlock our full longevity potential. And you think the best way to do that is through a ketogenic diet, which is essentially the hottest diet trend out there right now. What is it and how does it work?

Mark Sisson:
So, that’s a bit of an oversimplification that the one way to do that is ketogenic diet. I think the way to do that, and if you go back and look at some of the sort of industry leaders, Michael Eades and Ron Rosedale.

Dr. Mark Hyman:
Protein power.

Mark Sisson:
Yeah, and these are guys who early on recognized that the less sugar we eat in a lifetime, the better off we are. So if you kind of use that as a guidepost. If you can figure out a way to get by with eating less sugar throughout your life, you’ll probably be healthier and live longer.

Dr. Mark Hyman:
100%.

Mark Sisson:
Yep. So how do you do that? Well, you do it by developing what we call metabolic flexibility. Most people are so dependent on every meal, three meals a day plus two snacks to keep their blood sugar up, to keep their energy up, to get through the day. Because they’re good at burning sugar but they’re terrible at burning fat. They’ve never really prompted the body to develop the mechanisms to tap into fat stores and burn stored body fat as the primary source of fuel.

Dr. Mark Hyman:
So humans are like hybrids, right? We can run on carbs or fat, on glucose or ketones.

Mark Sisson:
Or ketones. So we are born with this amazing machinery that allows us to be metabolically flexible. The concept which I’ve tried to popularize over the past couple years. Metabolic flexibility basically means you can derive energy from the fat stored on your body, the fat on your plate of food, the carbohydrate on your plate of food, the glucose in your bloodstream, the glycogen in your muscles or the ketones that your liver makes. Those are some-

Dr. Mark Hyman:
So you’ve got a lot of options.

Mark Sisson:
You’ve got a lot of options. And if you become metabolically flexible, the body goes, “You know what, I don’t even care where the energy comes from. I’m not at the effect of shifting my energy switch over from ketones to carbohydrates, or glucose to glycogen.” The body becomes adept and efficient at burning enough of these different substrates under different circumstances that it becomes irrelevant. I mean, the main thing is, how do you feel and if you feel great, and if you feel good and energetic, then I don’t care-

Dr. Mark Hyman:
That’s a clue that you’re probably doing something good.

Mark Sisson:
Exactly.
Speaker 3:
Hi, everyone. Hope you’re enjoying the episode. Before we continue, we have a quick message from Dr. Mark Hyman about his new company Farmacy and their first product, the 10-Day Reset.

Dr. Mark Hyman:
Hey, it’s Dr. Hyman. Do you have FLC? What’s FLC? It’s when you feel like crap. It’s a problem that so many people suffer from and often have no idea that it’s not normal or that you can fix it. I mean, you know the feeling. It’s when you’re super sluggish, your digestion’s off, you can’t think clearly, or you have brain fog, or you just feel rundown. Can you relate? I know most people can. But the real question is, what the heck do we do about it?

Dr. Mark Hyman:
Well, I hate to break the news, but there is no magic bullet. FLC isn’t caused by one single thing so there’s not one single solution. However, there is assistance-based approach, a way to tackle the multiple root factors that contribute to FLC. And I call that system the 10-Day Reset. The 10-Day Reset combines food, key lifestyle habits and targeted supplements to address FLC straight on. It’s a protocol that I’ve used with thousands of my community members to help them get their health back on track.

Dr. Mark Hyman:
It’s not a magic bullet. It’s not a quick fix. It’s a system that works. If you want to learn more and get your health back on track, click on the button below or visit getfarmacy.com. That’s getfarmacy with an F, F-A-R-M-A-C-Y, .com.
Speaker 3:
Now back to this week’s episode.

Mark Sisson:
So back to what is a ketogenic diet, a ketogenic diet is a diet that basically recognizes that we have not set ourselves up to become good at burning fats. And so we need to eliminate that one fuel that we’ve sort of relied on relentlessly for 10,000 years, that regular supply of carbohydrate at every meal. And if we reduce or eliminate carbohydrates for a certain period of time, the body responds, the epigenetic response of the body to turn on certain enzyme systems and upregulate certain gene systems that will build the metabolic machinery to burn fat at a higher rate and more efficiently.

Mark Sisson:
What that looks like is that we have these little powerhouses in our muscles, in other cells, they’re called mitochondria. And that’s where the fat combusts, that’s where the fat burns. Well, people who are, what we call, sugar burners and are reliant on carbohydrate every couple of hours to get through the day, the body just has no reason to build more of these furnaces, of these little powerhouses. And so you get by with as long as you continue to eat a breakfast of waffles and/or pancakes and/or toast and/or a bagel.

Dr. Mark Hyman:
The American breakfast is basically sugar for breakfast.

Mark Sisson:
Sugar for breakfast promoted by then the cereal industry and Anita Bryant back in the… you got to have your orange juice.

Dr. Mark Hyman:
That’s right. Oh yeah.

Mark Sisson:
And then that sets you up for a horrible day.

Dr. Mark Hyman:
That’s a prescription for early death is cereal and orange juice.

Mark Sisson:
Absolutely, and yet, that’s how I grew up.

Dr. Mark Hyman:
Me too.

Mark Sisson:
Everyone…

Dr. Mark Hyman:
Cap’n Crunch.

Mark Sisson:
Yeah, so the-

Dr. Mark Hyman:
The American Heart Association says that Twix are actually a heart-healthy food.

Mark Sisson:
I know. And Cheerios and what-

Dr. Mark Hyman:
Cocoa Puffs.

Mark Sisson:
By the way, the American-

Dr. Mark Hyman:
It’s because they’re low in fat.

Mark Sisson:
… Diabetes Association used to say that you can have your favorite dessert as long as you continue to take your meds too. So it’s a [crosstalk 00:22:52].

Dr. Mark Hyman:
Just take more insulin.

Mark Sisson:
That’s right. So we go back to this, if I want to develop metabolic flexibility, I have to take away the carbohydrate as a source and kind of gently prompt my body to respond by becoming better at burning fat. And we call it fat-adapted. And when you become fat-adapted and your muscles start to get comfortable burning fat as the primary source of fuel while you’re moving about your day, not just sitting around doing nothing but while you’re walking and then eventually, while you’re exercising and you get to the point where you can derive 85, 90% of your energy requirements from fat if you become good at this.

Dr. Mark Hyman:
Your body fat or the fat you’re eating.

Mark Sisson:
Exactly. Your body fat or the fat you’re easting.

Dr. Mark Hyman:
Exactly, right.

Mark Sisson:
Yeah.

Dr. Mark Hyman:
So people talk about carb loading. You only store about 2500 calories. But for fat, you probably got 30-40,000 calories of fat on your body.

Mark Sisson:
Absolutely.

Dr. Mark Hyman:
It’s a lot bigger energy store.

Mark Sisson:
By the way, 30,000 calories of fat, that’s just like 10 pounds. I got that. I mean, and I could walk 300 miles without eating. Not that I’m going to or want to but I could.

Dr. Mark Hyman:
You are, okay.

Mark Sisson:
Theoretically. So the idea is to develop this metabolic flexibility.

Dr. Mark Hyman:
Both those things don’t sound fun to me.

Mark Sisson:
No, of course not.

Dr. Mark Hyman:
Walking 300 miles or not eating.

Mark Sisson:
This is all hypothetical. But when you become metabolically flexible, you’re able to derive all this energy from your stored body fat and then an amazing thing happens, which is the liver, when you withhold carbohydrate which becomes glucose, eventually through the digestive process, when you withhold carbohydrate-

Dr. Mark Hyman:
And just to be clear for people, when you say carbohydrate, you mean refined starchy carbs. You don’t mean broccoli, right?

Mark Sisson:
Okay, so we can make that distinction. I mean all carbohydrates but I’m going to put a big asterisk by broccoli and say that when go keto, you can eat as much vegetables as you want.

Dr. Mark Hyman:
That’s right. That’s right.

Mark Sisson:
So green leafy vegetables, broccoli.

Dr. Mark Hyman:
And they’re all carbohydrates. So you talk about the refined starchy-

Mark Sisson:
But they’re locked in a fibrous matrix. So what we’re talking about is how accessible is the amount of sugar or the carbohydrate that you take in real time to the body and if it’s made less accessible because it’s locked in a fibrous matrix, as in the case of broccoli, that’s fine.

Dr. Mark Hyman:
Or any vegetable.

Mark Sisson:
Any vegetable I mean but picking on my favorite vegetable. So you not only become good at burning fat, but then the body starts to… you create these ketones in the absence of glucose. And people will typically say, “Well, I’m feeling woozy because my blood sugar’s low, my brain isn’t working because my blood sugar’s low.” That’s why they feel like they need to have a meal. That’s why they feel like they need to have a snack because they have these wild blood sugar swings throughout the day, because they’ve been so dependent on a regular supply of carbohydrate to keep their glucose up.

Mark Sisson:
Well, when you cease doing that for some length of time, the body gets wise and the brain goes, “Well, look, I know how to burn ketones. I just haven’t done it for a long time.” So the brain becomes quite adept at deriving energy from ketones. Ketones-

Dr. Mark Hyman:
So the whole theory that you need glucose to fuel your brain, that’s false?

Mark Sisson:
That’s correct, you don’t need… One of the things that’s become kind of a-

Dr. Mark Hyman:
Because you’re supposed to use 25% of all the glucose, right?

Mark Sisson:
25% of your energy.

Dr. Mark Hyman:
Right, that’s different when I went to medical school.

Mark Sisson:
That’s different. Yeah, yeah. No, I know. No.

Dr. Mark Hyman:
You’re saying that’s wrong.

Mark Sisson:
No. So the brain, let me put it one way, which is that there is no dietary requirement for carbohydrate in human nutrition.

Dr. Mark Hyman:
Yes.

Mark Sisson:
There isn’t.

Dr. Mark Hyman:
Just unpack that because there are essential amino acids from protein. There are essential fatty acids from fat, but there is no such thing as an essential carbohydrate. And we don’t need them.

Mark Sisson:
Correct. Now, we don’t need them. And I’m not suggesting that we should never consume them. But the reality is we don’t need them because we have this elaborate and elegant mechanism that takes stored body fat and in the absence of any food allows us to live for five, six, seven days. Not just survive but thrive and be mentally alert and to be willing and able to hunt for the source of food because remember, throughout most of human history, we didn’t have three square meals a day. We had food and we didn’t have food.

Mark Sisson:
And so the design of the system and again, this elegant system, phase one of the system says, the brain, when it comes across food, you got to overeat because you don’t know where the next source of food’s going to be. And so when you overeat, you take the excess amount of energy that is in the food and you store it as fuel that you get to carry around on your body.

Dr. Mark Hyman:
As fat.

Mark Sisson:
By the way, conveniently located right over the center of gravity, the belly, the but, the hips, the thighs. It’s such an elegant system that we would be able to carry this fuel with us for long periods of time and not worry about, “Oh my god, it’s noon, and I’m going to get hangry because there’s no food around or there’s deli nearby. There’s no Taco [crosstalk 00:27:44].

Dr. Mark Hyman:
Because we have the ability to use that fat for energy.

Mark Sisson:
You’d use that fat for energy and that’s how the system’s designed. So unfortunately, we get to today where we’ve lost the ability to… We’re very good at storing fat and we still are wired to overeat. But because-

Dr. Mark Hyman:
There’s like 200 genes that protect us from starvation. But none that help us deal with abundance and excess.

Mark Sisson:
So it’s an artifact of civilization so we kind of have to override that with our cognition. But one way to do that, again, is to use a ketogenic way of eating for some period of time. Again, not necessarily for the rest of your life.

Dr. Mark Hyman:
What is keto? Define keto.

Mark Sisson:
So keto to me is cutting carbs back to 50 grams a day or less. And that is-

Dr. Mark Hyman:
Which is what is 50 grams in terms of a food, so like a bagel?

Mark Sisson:
Yeah, pretty much like a bagel with some jam on it and you’re already over the top. If you got rid of bread, pasta, cereal, rice, cookies, candies, cakes, sweetened beverages, sweetened drinks, and all you had was, oh my gosh, real food, broccoli, brussel sprouts, cauliflower, salads, you would be fine. You would be within that 50. You’d be hard pressed to 50-

Dr. Mark Hyman:
Could you have grains and beans?

Mark Sisson:
No. You don’t have grains and beans on a true keto diet.

Dr. Mark Hyman:
And fruit?

Mark Sisson:
Now we’ll talk about what peto looks like.

Dr. Mark Hyman:
Peto, okay.

Mark Sisson:
Or paleo keto or what are we going to call it?

Dr. Mark Hyman:
Pegan.

Mark Sisson:
Your pegan version of keto. What’s it going to be? Kegan.

Dr. Mark Hyman:
Kegan, okay, all right.

Mark Sisson:
Kegan, it’s a kegan diet.

Dr. Mark Hyman:
It’s like a keto vegan?

Mark Sisson:
Yeah, yeah.

Dr. Mark Hyman:
I have a friend who’s a keto vegan.

Mark Sisson:
Yeah, yeah. So you can do it, for sure. It takes…

Dr. Mark Hyman:
A lot.

Mark Sisson:
Some adherence to this. At the end of a couple of weeks though, you have shifted your metabolism to one of greater efficiency and-

Dr. Mark Hyman:
So it takes like three weeks to adapt to it.

Mark Sisson:
Yeah.

Dr. Mark Hyman:
Make sure you have enough fluids and sodium and magnesium because otherwise, you’ll feel the keto flu.

Mark Sisson:
Yeah, yeah. And some people still get the keto flu but it’s not like the flu. It’s just-

Dr. Mark Hyman:
You feel achy and tired.

Mark Sisson:
That’s your brain going, “Where’s my glucose, dude?” And until the brain kicks in and says, “Wow, these ketones are amazing.” The liver can make up to 750 calories a day worth of ketones.

Dr. Mark Hyman:
Wow.

Mark Sisson:
Like chew on that for a second. That’s unbelievable, right? So when you look at how we’re designed for survival, if you look at-

Dr. Mark Hyman:
Not from diet but just from your fat stores.

Mark Sisson:
Correct.

Dr. Mark Hyman:
Yeah.

Mark Sisson:
Yeah. We have this stored body fat and when we cut off just theoretically, if let’s say you do a fast, which we can talk about what that looks like. But you do a five-day fast. You become a closed loop. It’s amazing that the body takes fat out of storage, combusts some of it in the muscles to get you through your day. And people who do five-day fast, they work out, they’ll exercise. Not hard, heavy.

Mark Sisson:
You combust some of that fat in the muscles. Some of that fat, as you take those triglycerides and you strip out the glycerol becomes the backbone to make enough glucose through gluconeogenesis to supply whatever amount of brain cells do require some glucose. It’s not a big number. It might be 40, 50 grams a day. The liver makes ketones. The brain thrives on ketones. The brain prefers ketones.

Dr. Mark Hyman:
Yeah, the brain does way better on fat than on sugar.

Mark Sisson:
Well, on ketones. Yeah, because the brain doesn’t burn fat but it burns ketones.

Dr. Mark Hyman:
Ketones are derived from fat.

Mark Sisson:
Are derived from fat. So you have this substrate, this fat substance that then can become combusted by itself as fat. Part of it can be used to actually make glucose if needed. That’s why you don’t have an external need for carbohydrate and glucose. And then you can make up to 750 calories a day worth of ketones.

Mark Sisson:
Now one of the best things that happens in this scenario is that again, epigenetics at work turns on genes that cause the body to spare amino acids and spare protein. Whereas normally, on a day-to-day basis, you might eat a big meal and you might have more protein than you need. And then your body’s go through this work to deaminate it and pee it out because it’s too much. You don’t need that much. And so when you become this closed loop, this closed system, the only reason you need the amino acids are for structural, for repair, for building and repairing.

Dr. Mark Hyman:
Not to make sugar.

Mark Sisson:
You don’t want to combust.

Dr. Mark Hyman:
Have you read the false idea about keto? That it’s all like steak and bacon and cream and all that stuff. It’s not necessarily that.

Mark Sisson:
No. In fact, you can eat too much in a way of… Well, I mean, a lot of people who first come to keto do so because they, “I heard that I can eat 4,500 calories a day and not gain weight.” And I’m like, “Well, yeah, some of the science shows that but that’s horrible because…

Dr. Mark Hyman:
Bad idea.

Mark Sisson:
That’s a bad idea because, first of all, if you want to burn off your stored body fat, eating 4,500 calories a day will never tap into your stored body fat. That’s just trying to prime the pump with this external source of fuel that’s fat that’s circulating through your bloodstream. And that amount of calories because you’re not generating insulin, which is a nutrient storage hormone, the nutrients have nowhere to go. The body has to figure out, “How do I burn this stuff off? I can store it as fat.” And so the body undergoes this thermogenic, high heat kind of thing and…

Dr. Mark Hyman:
Well, that’s so powerful because people don’t understand that if you don’t have insulin, which is only produced by eating carbohydrates or protein can also increase insulin, if you don’t have insulin, you can’t gain weight. So if you’re a type 1 diabetic, the classic symptoms are polyphagia, meaning you eat everything in sight and you lose weight. So they could eat 10,000 calories a day and lose weight because they have no insulin, which is required to store the fat on your body. So the best way to get your insulin down is to cut out the starchy carbs and to eat more fat.

Mark Sisson:
Reasonable amounts of protein. More fat and reasonable amounts of protein. You don’t make the calories up with extra amounts of protein.

Dr. Mark Hyman:
Yeah, so 20%?

Mark Sisson:
Okay, I mean, I prefer to deal with hard numbers, like what’s a good number for protein? Maybe it’s 75 grams a day for a man is a minimum number and maybe it doesn’t exceed 120. Within a range there, you’re going to be fine. And then, because the body is so efficient, again, at conserving amino acids, protein, that it doesn’t even matter meal to meal or day to day. It might be on a four-day cycle. If you get 300 grams of protein in a four-day cycle, you’re good because it’ll just figure out with the different various protein sinks that we have in the body how to keep it and not pee it out.

Mark Sisson:
So back to this closed loop that I’m talking about. So you’re combusting fat in the muscles. You’re making a little bit of glucose through gluconeogenesis. You’re making ketones. Now, we figure out that you don’t really need that many calories to get through a day. Like we assume if we do that math that’s online, you plug in your number and your height and your weight or whatever and your activity level from one to five and you come up with some number. “Oh, it says I can have 2,700 calories a day or 3,200 calories a day for maintenance.” No bearing whatsoever on reality.

Mark Sisson:
We probably, if you, again, if you do the math, if we for long periods of time, if we say that protein… Protein shouldn’t even have a calorie assigned to it. It’s structural. You don’t burn protein so why would you even assign a value of four calories per gram to protein.

Dr. Mark Hyman:
Right, but it can turn into sugar.

Mark Sisson:
It can.

Dr. Mark Hyman:
If you eat excess amounts.

Mark Sisson:
It can so and I guess, if you burn it in a bomb calorimeter, you get some amount of thermic effect.

Dr. Mark Hyman:
How do you know if you’re doing a ketogenic diet properly?

Mark Sisson:
Well, the main thing is can you skip a meal or two and feel just fine. And if you can, you’re-

Dr. Mark Hyman:
It cuts hunger. So with ketones, it cuts your hunger.

Mark Sisson:
The number one benefit from all of this is getting control of hunger, appetite and cravings. That’s what everyone reports when they finally hit that keto zone. They go-

Dr. Mark Hyman:
So it’s not bad willpower that people want to crave and eat other food? It’s just biology, right?

Mark Sisson:
It’s biology. It’s absolutely biology and people come to this point pretty quickly where they go, “Jeez, Mark, three meals a day, it’s just too damn much food. I just don’t feel hungry. I feel like I’m overeating at three meals a day.” And so typically, what they do is skip breakfast. They wake up in the morning, I have a cup of coffee. I go about my day, I do a hard workout. I’m like, not only do I not need to eat, I don’t feel compelled to eat. I don’t want to eat. I might have my first meal at 1:00 or whatever.

Dr. Mark Hyman:
It’s like time-restricted eating.

Mark Sisson:
It’s what it is. And so then you get to the point where you’re eating maybe two meals a day. And then from there, it’s like even those two meals feel like… If I have two regular, what would have been in the old days, regular meals, now it’s like, “I’m going to have lunch, kind of a smaller lunch, because I want to enjoy a regular dinner. If I have a regular lunch, then I won’t be hungry for dinner.” It’s amazing how hunger dissipates…

Dr. Mark Hyman:
It is, yeah.

Mark Sisson:
… in this context.

Dr. Mark Hyman:
But you don’t get super skinny. I mean, you look good, right?

Mark Sisson:
I’m at work to keep my weight on.

Dr. Mark Hyman:
Although I noticed, Mark, is I actually have a problem. If I don’t have things like sweet potatoes or some like black rice, like that, I will lose too much weight.

Mark Sisson:
Yeah. Do you lift weights?

Dr. Mark Hyman:
I do. I’ve started.

Mark Sisson:
Okay.

Dr. Mark Hyman:
Yeah.

Mark Sisson:
Lifting weights is what causes you to keep muscle on. If you don’t lift weights, especially as you get older. Like when you get to be 45, you’ll see what I’m talking about.

Dr. Mark Hyman:
I’m 60. I found that, Mark, long ago.

Mark Sisson:
I’m just messing with you but-

Dr. Mark Hyman:
I’m biologically 39 because I did my telomere.

Mark Sisson:
As you get older, the importance of lean tissue becomes more and more critical.

Dr. Mark Hyman:
Muscle is a forgotten organ.

Mark Sisson:
So you forgot and people think, “Well, if I’m jogging in my 50s and 60s and 70s or riding a bike, that that’s accomplishing what I need to accomplish,” and it’s not. Actually, it’s much more important to spend some time in the gym lifting heavy weights, like the heaviest weights you can lift without getting hurt. Without getting hurt is the key component. I don’t want to…

Dr. Mark Hyman:
So my trainer tells me I should do like more reps. Like I do three sets. It’s pretty hard. I feel like my maximum I could do. Sometimes it is but is that the same or is it more better to do heavyweights?

Mark Sisson:
How many reps do you do? Are we talking six or 35?

Dr. Mark Hyman:
I do like 10 to 12 and I do three times.

Mark Sisson:
That’s fine. That’s at standard. That hasn’t changed in decades. That’s still and there’s no right answer there. There’s no magic. It’s like, whatever you feel good going-

Dr. Mark Hyman:
Is that building enough muscle or should I do more heavier weights and fewer reps?

Mark Sisson:
Heavier weights and fewer reps builds more strength over time. But there’s no… I can’t tell you that that’s where you need to go. But I’ll give you an example. It’s sometimes the type of weights you’re doing. So if you’re just doing bicep curls, that’s for the beach but that doesn’t really impact bone density, muscle mass throughout. So hex bar deadlifts, do you ever do those?

Dr. Mark Hyman:
Yeah.

Mark Sisson:
Yeah, that’s the best thing you can do.

Dr. Mark Hyman:
What about just a regular deadlift?

Mark Sisson:
Yeah, they’re good but I’m too concerned with my back. So I lift heavy with a hex bar deadlift.

Dr. Mark Hyman:
Oh really?

Mark Sisson:
Yeah. But I do it once every week and I do three sets. I keep adding weights until-

Dr. Mark Hyman:
How much do you do?

Mark Sisson:
Do up to 300 pounds.

Dr. Mark Hyman:
Ugh!

Mark Sisson:
I do one to two rep max on 300.

Dr. Mark Hyman:
One to two reps.

Mark Sisson:
Yeah, yeah. I can do 335 on one but it’s too much. I wind up taking too long to do it. I’m afraid I’m… Again, I don’t want to hurt myself so I do but that’s like that one exercise impacts the entire body. It’s not just what you would see obviously from doing the weight of the glutes and the lower back and the hamstrings and the quads. But it’s pulling on the shoulder muscles. My grip strength is sometimes the thing that gives out more than anything else.

Mark Sisson:
But, that one exercise then has an effect on the pulse of growth hormone and testosterone through a… It involves so many muscles and including major muscles that then when you go do the pull-ups and the pushups and the dips and the squats and all the other lunges, then the impact is greater, the muscle building effect is greater because you did that…

Dr. Mark Hyman:
Yeah, I like that, I like that. So I should do that first.

Mark Sisson:
Or last or whatever but I mean, yeah.

Dr. Mark Hyman:
All right, that’s amazing.

Mark Sisson:
If you do it first a lot of times, you won’t have the strength to complete the other stuff.

Dr. Mark Hyman:
So what is the biology of doing… You mentioned you can burn fat, but why is that better? What does it do in terms of longevity? What do the science show?

Mark Sisson:
So, burning sugar is in and of itself a… It produces reactive oxygen species at a greater rate than combusting fat through the mitochondria. So the more energy you can derive through this metabolic pathway that uses the mitochondria, the better off you are. A lot of times people burn sugar in the cytosol of the cell, not even-

Dr. Mark Hyman:
The way I think about it is interesting. So when you eat a lot of sugar calories and starchy calories, it burns dirty in your mitochondria and releases a lot of waste products, which is these reactive oxygen species or oxidative stress or free radicals that are driving aging. And when you burn ketones more like hybrid, like an electric vehicle, it burns clean, right?

Mark Sisson:
Yeah, like a 93 octane fuel.

Dr. Mark Hyman:
Yeah. It burns much cleaner. Is that true?

Mark Sisson:
That’s true. I mean, that’s the simplest way of looking at it. Then there are other nuances to this which are when you become good at burning fat then when you skip a meal or when you have this very easy to manage compressed eating window, all the good stuff happens when you’re not eating. The longer you can go, and that’s why fasting has become the rage. The longer you can go without eating, the more your body says, “Oh, this is a great time to do some housecleaning.” And the term autophagy is thrown out probably too much now, but the body does tend to want to clean up and consume damaged proteins.

Dr. Mark Hyman:
Autophagy means like you’re literally eating yourself.

Mark Sisson:
Correct.

Dr. Mark Hyman:
Eating all the waste products.

Mark Sisson:
Eating the waste products.

Dr. Mark Hyman:
Pac-Man goes around and cleans up.

Mark Sisson:
Correct. But then if you never fast, you just become this increased collection of garbage in your body.

Dr. Mark Hyman:
All three meals, three snacks, eat late at night, after dinner snack and wake up, you eat right away. That’s a bad idea.

Mark Sisson:
It’s a bad idea. And what’s ironic to me is that even going back 15 years ago in the bodybuilding, in the weightlifting, in the general health community, the mantra was don’t go more than two hours without eating. Bring your Tupperware, little meals with you with some amount of protein, some amount of carbs and no fat. Skinless chicken breast and all that stuff. It was a horrible concept. And yet, the thought process was you don’t want to cannibalize your muscle tissue. And if you go more than three hours without eating, you’ll cannibalize your muscle tissue.

Mark Sisson:
Now, all of that was predicated on an assumption that glucose was the primary fuel that we needed. When we ran out of glucose, it would cause the brain to go into a state of, “Oh my god, send a signal to the-”

Dr. Mark Hyman:
That you eat your muscles.

Mark Sisson:
“… adrenals to secrete cortisol so we can basically melt some muscle tissue and send some amino acids to the liver to become glucose.”

Dr. Mark Hyman:
Exactly.

Mark Sisson:
It was a horrible… Again, it was all based on a concept that somehow assumed that glucose was the muscle fuel that we needed. And if we didn’t manage glucose, all hell broke loose. Now we know that fat is the preferred fuel for human movement and human activity, and that ketones are not just a legitimate alternative energy source. They’re probably a preferred energy source in many cases.

Dr. Mark Hyman:
Now as a doctor, I see a lot of patients and I test them and I see the results. And it’s humbling because you can come up with all these great theories. But then you see the individual in front of you and I’ve had patients I put on a ketogenic diet eating butter and coconut oil all day and they lose 20, 30 pounds, their cholesterol comes down 100 points, their triglycerides drop, their good cholesterol goes up. Somebody else does that and all their numbers go terrible and they start getting really bad cholesterol numbers. I’m one of those guys, if I eat too much of saturated fat, I get in trouble. How do you understand sort of how to personalize this?

Mark Sisson:
All right, so a couple of things. First of all, we’ve never had this conversation so I don’t know what your stance is currently on this but I I’ve been pushing for 15 years to take the weight off cholesterol as a bad guy. Cholesterol is not the [crosstalk 00:45:01].

Dr. Mark Hyman:
In the blood or in the diet?

Mark Sisson:
Both, but let’s just talk blood cholesterol right now. I don’t think cholesterol is a bad guy. Cholesterol’s one of most important…

Dr. Mark Hyman:
Molecules.

Mark Sisson:
… molecules in human body. It’s integral to life. The body makes 1,300 milligrams a day whether or not you have any in your diet and to vilify it and spend a trillion dollars for the last 15 years to try and eradicate it in humans is absolutely unconscionable.

Dr. Mark Hyman:
Through statin medications.

Mark Sisson:
Through statin medications. So, and I shared with you before the show, so I just had some blood work done. I’m between 245 and 290 on my total cholesterol.

Dr. Mark Hyman:
Total cholesterol

Mark Sisson:
But my HDL is 98.

Dr. Mark Hyman:
That’s the good close cholesterol.

Mark Sisson:
That’s the good cholesterol. My triglycerides are always below 75, sometimes 45 or 50. My A1c is 4.9, which you know to be…

Dr. Mark Hyman:
That’s your average blood sugar. It’s really low.

Mark Sisson:
Really low? Fasting insulin is between six and seven. It can be as high as 45 in some people. So all my markers are great except that if you didn’t ascribe to that whole cholesterol theory, you’d go, “Oh my god, Mark, we got to put you on…” Everything looks great. By the way, I had a full scan of my carotids and all my blood supply to my coronary arteries, my liver. I mean, they were digging in so deep I thought, “Oh my god, they’re looking to see if I have colon cancer,” but they were trying to get at my kidney supply., and they still you’re clean. You got like the blood supply for 30 year olds. It’s clean as can be. That’s all that counts, Mark. I don’t care what my cholesterol numbers are.

Dr. Mark Hyman:
But aren’t some people more at risk though?

Mark Sisson:
Some are. But again…

Dr. Mark Hyman:
It’s lean mass hyper-responder phenomenon.

Mark Sisson:
Yes. And it all I think comes down to, and I’m not a doctor so I’m only giving you my opinion. You can opine with greater… I guess you have more liability for saying it than I do. I have no liability as long as I say I’m not a doctor. But it’s inflammation and oxidation that are the primary culprits here. And so if you have an otherwise inflammatory lifestyle, inflammatory diet, we can talk about sugar, we can talk about stress, and then we can talk about some familial predisposition. Yes, but in general, so back to your two people.

Mark Sisson:
Some succeed wildly on the ketogenic diet and some not so much. But the not so much, if you’re evaluating just on short-term blood markers, I’m not going to say it’s not working. I’m just going to say that if you’re keto and you’re good at burning fat, you got to transport the fat somehow to the muscle cells. There are a lot of things going on here.

Dr. Mark Hyman:
We just don’t know.

Mark Sisson:
And we just don’t know. Now some people, having said all of that, some women in particular are not good responders to keto and maybe…

Dr. Mark Hyman:
Yeah, who shouldn’t be on it?

Mark Sisson:
Well, so, I think pregnant women. Probably, if you want to do this and you insist on doing this, work with somebody who knows what they’re doing. And I wouldn’t introduce a three-year-old kid to a ketogenic diet.

Dr. Mark Hyman:
Do you think it’s something everybody should be on or?

Mark Sisson:
I think at some point in their lives, everybody should be on it because it’s the human experience.

Dr. Mark Hyman:
The cyclical keto, this idea.

Mark Sisson:
Cyclical keto, yeah.

Dr. Mark Hyman:
Do you ever go above the 50 grams of carbs here?

Mark Sisson:
Oh my god, I have… Last night, I’m visiting here in Los Angeles. My daughter is a great chef and she made a lasagna last night. Like I’m not going to not eat two servings of that, I mean, and it was somebody’s birthday and we had some pie. I didn’t sleep as well as I would have had I not done that. But I also, like I’m totally comfortable in-

Dr. Mark Hyman:
So you’re in and out.

Mark Sisson:
In and out. And that’s…

Dr. Mark Hyman:
That’s what we historically did.

Mark Sisson:
That’s exactly so when we talk about were humans always keto? No, there were periods of time when there was no access to food. You were, like automatically, you were obligatory keto when you didn’t eat. But because you didn’t eat, processed crap and industrial seed oils that would affect your insulin sensitivity and all these other things, even if you came across a treasure trove of bee honey or it was late in the season and you had a bunch of fruit, you’d store it as fat but then you go right back to being keto when the food supply was cut off.

Mark Sisson:
And you didn’t go, as some of these people do, “Well, whenever I have more than 60 grams or 70 grams of carbs, I get kicked out of keto.” I was kicked out of keto means nothing to me. Like I don’t even care what your keto numbers are.

Dr. Mark Hyman:
So you don’t think about measuring it or tracking it?

Mark Sisson:
No. I think it’s a parlor trick. So what’ll happen is people who are new to keto will go, they’ll chase the numbers, right? So they’ll say, “Well, I didn’t eat any carbs today and I just had MCT oil and I had my Bulletproof coffee and whatever, and I’m showing 4.5 millimolar or six millimolar. Yeah, baby. I’m keto.” Well, you’re keto. You’re producing ketones, but one of the things you got to look for is you’re just pissing those out. So your body has not become good at using them yet. You’ll get there. But right now, your livers going crazy trying to make ketones and you don’t know how to burn them. So once you build the metabolic machinery to burn ketones and once you build the facility-

Dr. Mark Hyman:
It doesn’t go away when you have a pie and lasagna.

Mark Sisson:
No, exactly, exactly. So let’s talk about that. But once you build that… You spent three weeks, four weeks building that metabolic machinery. You reset your metabolism to one of metabolic flexibility and metabolic efficiency. Then, if you go off the wagon one meal or eat one day of 300 grams of carbs, you might feel bad, but you just come right back to where you were. It doesn’t shift all the way back to being a sugar burner.

Mark Sisson:
Now, if you did it for three more weeks of just doing sugar, the body would say, “Well, I guess we don’t need this expensive machinery lying around burning fat all the time now. I guess we’re going to just go back to burning sugar. So we’ll let all these things atrophy.”

Dr. Mark Hyman:
You dropped a little bomb earlier, I’m going to come back to it, is you said you had the lasagna and the pie and you didn’t sleep as well. So you’ve hacked sleep and what does eating lasagna and pie have to do with sleep? And tell us how you figure out how to sleep because 70% of Americans have trouble sleeping.

Mark Sisson:
So I typically sleep great. I go to bed at 10:30 or 11:00, wake up at 7:07 with certainty every day. By the way, no matter what time I go to bed, I wake up at 7:07. But I have blackout curtains in the room. If I’m away from home, I keep the room at 67. When I’m home, I have a ChiliPad. Do you have a ChiliPad?

Dr. Mark Hyman:
Does your wife likes it warmer?

Mark Sisson:
Yeah, yeah. And softer. Softer so you literally have a half of like a pad on her side that’s three inches of just foam. So my side of the bed is like down like…

Dr. Mark Hyman:
Yeah, yeah. I have a ChiliPad two. It’s a game changer.

Mark Sisson:
It’s a game changer.

Dr. Mark Hyman:
That’s like a pad that puts cold water through it so you feel cooler.

Mark Sisson:
Yeah, it uses cold water. It’s not wet but it uses cold water circulating through microtubules to keep your sleeping surface cool. And it’s so… Once again, if we look at primal ancestral man, we slept on a cold ground covered with a heavy skin, right? And that’s what we’re doing. I love a big duvet cover on top of me. But I keep that thing at… I keep it at 64 and 65 when I’m in Miami, but I’ve hacked sleep so I’m really good at sleeping except when I go off the wagon.

Mark Sisson:
And so last night, again, it was grandma’s birthday. And grandma made a blueberry pie and my daughter made lasagna and I’m not going to be that guy who goes, “I’m keto. I can’t do that.” No, I’m like, I ate it. I loved it. It was fantastic. Had two glasses of wine. And then I went to sleep great but then I woke up at 2:00 and my liver says, “Now’s the time we’re going to make you pay for it.” So my heart was racing a little bit more. I had a little bit more higher insulin, promotes sort of a higher cortisol response and I had that standard kind of thing that the body says-

Dr. Mark Hyman:
Cortisol keeps you awake.

Mark Sisson:
This is good news, bad news, Mark. When you clean up your act, you burn fat, you feel better, you have energy all day, you don’t get sick. You look great, you feel great but then, when you screw up…

Dr. Mark Hyman:
You pay for it.

Mark Sisson:
You really notice it.

Dr. Mark Hyman:
That’s exactly what I’ve noticed as a physician treating patients when they clean up. They’re going to go, “I used to feel good all the time. I don’t feel as bad.” I said, “You felt bad all the time. You just didn’t realize it.”

Mark Sisson:
You got desensitized to it, exactly, yeah.

Dr. Mark Hyman:
Amazing. So talk about this whole trend of fasting, intermittent fasting, time-restricted eating, fasting mimicking diets. They seem to all do the same thing and keto is part of that because it activates these healing responses. So tell us about what those healing responses are, why they’re important, why we should care.

Mark Sisson:
Well, I mean, I would want to care because, again, as a vain older guy who’s facing an inevitable decline over time, I want to stem that decline as much as I can. So, as I said earlier, this was first put in my head by Art DeVany. Do you know who Art DeVany is?

Dr. Mark Hyman:
Mm-mm (negative).

Mark Sisson:
He’s the original ancestral health guy, brilliant mind. And he basically said, “We’re most human when we’re not eating. All the good things happen when we’re not eating.” So eating and again, if you look at it from a historical context, eating is just like pulling the train over to the side and filling it full of coal. And it’s just resting and getting energy stores taken in. And in the case of humans, it’s overeating in most cases and loading up the energy and then all the good stuff happens when you head down the tracks again, and you’ve stopped eating, and now you’re basically metabolizing food. You’re using your muscles to move through different planes of motion. You’re using your brain to create. You’re using your heart to love.

Mark Sisson:
In not eating, your body is recognizing that this is a state where the best opportunity to repair can happen. If you just think about two sort of cells that are surrounded by a lot of nutrition, a lot of nutrients. Let’s say one cell surrounded by a lot of nutrients. The cell goes, “Man, my job is to pass the genetic material along to the next generation. That’s my only job, just to pass the genes along down. There’s so much cool stuff around. There’s so much nutrition. I’m going to divide and make two of me.” That’s the telomere thing by the way.

Mark Sisson:
And then those two cells go, “Man, this is awesome. Let’s divide again. What the hell? There’s plenty for everybody.” Meanwhile, that same cell when faced with not a lot of nutrition around goes, “Jesus. I mean, there’s not enough for me, let alone two of me so I’m going to take some of that damaged protein inside the cytosol. I’m going to take some of that damaged fats and I’m going to consume those. I’m going to burn those. I’m going to combust those. I’m going to use those for fuel. And while I’m at it, I’m going to fix some of the DNA that’s been kind of not working recently. I haven’t had reason or time to fix it, but I’m going to fix that DNA.” And so the cell cleans itself up.

Dr. Mark Hyman:
Cleans itself. Yeah, it’s amazing. It turns on the right genes for healthy aging. It builds your own stem cells and reduces inflammation and turns on antioxidant systems and improve your brain function. It’s super powerful and you can kind of play with all these different approaches to eating and see what feels good to you. And I liked how you talk about keto not being a permanent state. It is a thing that we use to go in and out of so it’s such a powerful strategy for a healthy longevity and aging and you’re 66. You look amazing. I love that. You are an inspiration for me and your books are so great. The latest book, 21 Day Biological Clock Reset, is just something you have in your new book Keto for Life, which is great.

Dr. Mark Hyman:
And I think it’s good to know that keto for life doesn’t mean keto all the time. It just means a way of eating that turns on all the mechanisms that control our aging, that regulate our blood sugar, that help us have better cognitive function. I’ve had a patient who was in early dementia and we put on a ketogenic diet, was like the lights came back on. It was just amazing to me. I’ve seen it in kids, little kids who are autistic or had really autistic aggressive behaviors, put them on keto, and they literally stopped having all those behaviors and wake up a little bit. And of course, weight loss, diabetes, we see increasing studies showing-

Mark Sisson:
I mean you could cure diabetes. Type 2 diabetes, you can cure it.

Dr. Mark Hyman:
Yeah, 60% are cured with a ketogenic diet in a year. It’s pretty amazing. And I think your work is not only on bringing the science to light but you actually created food products that help people enjoy delicious yummy food. And now you guys sent them to me. I have so much in my cupboard, I love it.

Mark Sisson:
You have to give it to patients.

Dr. Mark Hyman:
I know, it’s amazing. That’s a good idea. Do you want to bring one? I have to get a box every month or something. It’s great. I have no idea why. Maybe just had a dream that it’s pretty awesome. And I just love that you’ve been that force in the world that has educated people with this. You’re the original dude doing this and the fact that Kraft Foods is starting to pay attention and the big food is starting to pay attention is a great thing.

Dr. Mark Hyman:
So I really am so happy that you’re doing this. For his latest book, go to ketoreset.com/forlife. That’s ketoreset.com/forlife. You can check out all his stuff on exercise on YouTube on micro workouts, his ancestral rest postures. You can look at how to be part of the research he’s doing. You can look at all the great products that Primal Kitchen has. They’re amazing. There’s more and more coming from you. You’re still going strong and I just love that.

Dr. Mark Hyman:
Mark, thank you so much for being on The Doctor’s Farmacy.

Mark Sisson:
Thanks for having me, man.

Dr. Mark Hyman:
And if you love this podcast, please share with your friends and family on social media. Please leave a comment. I’d love to hear from you and subscribe wherever you get your podcasts and we’ll see you next week on The Doctor’s Farmacy.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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