Ep:74 BEING IN KETOSIS IS USELESS! It's all about fat adaptation. - by Robert Cywes

hi folks this is dr rob silves the carb addiction doc and today we're going to improve your understanding of the entire ketogenic space and there's something that most people don't quite grasp or understand and that is the difference between ketosis and fat adaptation huge difference so important to understand as you move away from doing a diet which is a terrible thing to do and make this a way of life by the way as you listen to this if you like the content at the end or sometime in between hit the subscribe button it helps us and if you really would like to help us make a donation through our patreon account we put these videos on for free but it costs us a significant amount of time and money to produce them i make no personal money from this but i'd like to cover the costs of the production that's up to you whatever you can afford anyway let's talk about the difference between ketosis and fat adaptation ketosis simply means having ketone bodies in your bloodstream now ketone bodies are a fuel currency they form a form of energy they're a molecule made up of fat beta-hydroxybutyrate um a subset a little tiny block of fat think of it like pennies or ketones and the dollar the big card is fat so when you break the dollar up into little pennies those are ketones and when you increase the amount of ketones in your bloodstream that's called ketosis i could sit here and drink eight ounces of olive oil and get myself into ketosis and you can measure that by pricking your finger or by peeing on a stick and you call it it's called pink purple or being ketones keto mojo is a a great device that gives you both your blood sugar and your ketones but all because you put fat in your face it doesn't necessarily have benefit not right away because think about this if you drive a gasoline car and on a given day you now say no this gasoline is too expensive i want to put diesel in my car and you pour diesel into your engine of course it's going to ruin the engine it takes time it takes time for that engine to be rebuilt so that it can use a different fuel source in exactly the same way your body when exposed to more and more fat and less and less sugar that you put in your mouth in fact if you can be on a zero carbohydrate or close to zero carbohydrate high fat diet and you initiate that slowly so that you don't get keto flu and you don't have the rashes and all the other things you slowly introduce that to your body and you slowly over the course of about three or four or five or six weeks transition from being a sugar based consumer to a fat based consumer and obviously protein comes along with fat i'm not talking about protein it always comes along for the ride you can slowly transition your body to be in ketosis in a happy healthy way where you don't get keto flu you don't kill a rash and for those people out there that say oh there's no there's no bad thing from cutting out sugars yeah when you cut out sugars you get the keto flu it's miserable it is no different than quitting smoking try it sometime anyway if you do it slowly you can transition into ketosis and now as your cells become more and more exposed to seeing ketones in the bloodstream as a fuel source those cells that can use ketones begin to use ketones more and more and they down regulate the enzymatic pathways that burn sugar and they upregulate the pathways that allow ketones to get into the cell through receptor-mediated channels and they upregulate the use of fat preferentially as a fuel source but that takes time that's called fat adaptation and the the measurable the way we can measure that transition where the cells preferentially no longer use sugar but prefer to use fat we measure that by checking your insulin because insulin resistance is what the body uses to protect itself against sugar there's a whole video on that and as your insulin numbers come down it means your cell at first is not afraid of using kind of afraid and cells but it's not trying to protect itself from flooding itself with sugar and as your insulin content comes down more it means the cell is using fat more often and it doesn't matter whether the fat comes from your mouth or from your own fat cells if you're trying to lose weight then the ketones primarily should come from your own fat cells and the most important thing there is not to eat carbohydrates and slowly lower that insulin amount at first you feed yourself fat on a high fat diet which maintains ketosis because you're so still so insulin resistant that fat struggles to get broken down from your own fat cells remember insulin blocks the mobilization of fat but as your insulin levels come down now your body will use its own fat more readily so at first you want to be on a close to zero carbohydrate high fat diet to introduce yourself to ketosis and you may not you lose weight awfully rapidly you lose a little bit of water weight to begin with but then it stagnates a little bit and then as your own insulin comes down because it's your cells are no longer trying to protect themselves from this overwhelming sugar in your bloodstream now you're able because that insulin level comes down to loosen up and release fat from your fat cells so the transition is away from eating fat to now using your own fat if you're interested in weight loss and then hopefully when you get to a normal weight where you don't have a lot of fat to give then you want to start eating fat again so it's important to consume a high fat diet to begin with to drive ketosis and then on the back end to eat fat as a fuel source because you don't want to use your muscles and then in that in between time you want to have a little bit of fat so you're not relying on gluconeogenesis for fuel but most of your fat needs comes from your fat cells and that's how you accelerate weight loss fat adaptation is measured by a very low level of insulin and i'll give you an example i've got some some blood work here which i'm going to go through i'll show you what that adaptation looks like and this is so important for our diabetics i'm going to pull up i've got a bunch of blood because i do we've done over 30 000 uh um sets of blood work and i got a whole bunch here these are by permission from the patients so here's somebody who is in um fat adapted ketosis the person is skinny normal weight actually and what's interesting is if you just look at a lipid profile triglycerides are 45 below 75 is where i want them to be her triglycerides are at 45 because that's really how she transports sugar that's being converted to fat her hdl cholesterol is 90 above 75 that's about as intravascularly healthy as you can be but her ldl oh my god it's 268 most doctors would be having a heart attack on your behalf no in the face of a low triglyceride high hdl those lipids are fine what is she doing she's in fat adapted ketosis she's transporting fat from her fat cells to her tissues because that's what she uses for fuel think about this if you stick a needle in your car's fuel line that's going from the tank to the engine and you measure a lot of gasoline and let's say gasoline let's say you've got a diesel car oh actually if let me flip it around you measure gasoline that's fine you stick it in there and you measure diesel oh my god it's a gasoline engine it's going to destroy the engine so all you're doing when you're measuring your lipids is you're sampling the fat in your bloodstream and if the fat comes from excess sugar being converted to fat that equates with harm it's a marker of harm but if you are in fat adapted ketosis you want your fat to be high the worst thing she could do is put herself on a statin be that as it may so she's just transporting fat from her fat cells and fat from a diet to her body as a fuel source she's fat adapted so absolutely fine there the just for to pertain to this particular discussion now we look at a c-peptide and we look at her insulin well a c-peptide is . 54 0. 54 most doctors most endocrinologists would immediately diagnose that person as having type 2 diabetes her um hemoglobin a1c however 4.

9 4. 9 i'm just trying to find her insulin number her insulin 1. 4 think about that if you're diabetic she only has 1.

4 units of insulin in her bloodstream and this is fasting blood work and then the other values we look at is her glucagon which is at 18. her blood sugar let's have a look at this her blood glucose 79 okay and this is early morning blood worth that's reflected with the dorne effect why let me interpret that blood work a little bit better for you okay we started with the lipids and we want to see a high ldl in the face of low triglycerides and high ldl uh hdl high hdl low triglycerides ldl somewhere between 140 and 200 she's a little bit higher which is fine her bmi by the way is 20. 9 20.

9 she's an olsen twin not quite but a very healthy person her lipids are low her blood sugar is nice and low her insulin is see a peptide to maintain that blood sugar is very low and a glucagon which is producing that sugar because she's not consuming any is also nice and low so despite because remember insulin controls glucagon so despite having a very low insulin number her glucagon glucon's also low that is a vibration it's very very tightly controlled and she is in fat adapted ketosis about as healthy as you can be now we can talk about inflammatory markers that are all great her testosterone levels her estrogen levels all of those are in fantastic shape and her a1c is below 5. that is fat adapted ketosis and one of the reasons why that's important is if you look at those numbers and you have type 1 diabetes if you have type 1 diabetes think about how much insulin you inject into yourself every day if this person at 1. 41.

5 units of insulin a c-peptide of 0.