Ketogenic Diet Q&A – Facebook Live


The ketogenic diet is not beneficial to everyone. Is it right for you?

Should you follow the ketogenic diet with adrenal fatigue? Or if your gallbladder has been removed? These are just some of the questions that were answered in Dr. Lynch’s recent FB Live. The following are the top audience submitted questions on the ketogenic diet.

QUESTION:Can people with MTHFR use the Ketogenic Diet?

QUESTION:Can I do the ketogenic diet without a gallbladder?

QUESTION:Should people with adrenal fatigue do a Ketogenic Diet?

Question:If hypothyroid, ok to do a Ketogenic Diet?

QUESTION: Is it true that one must be in ketosis to burn fat?

QUESTION: Do I have to do the Ketogenic Diet to benefit?

Did you catch the FB Live where I answered the top questions on the #ketogenicdiet? @drbenlynch 

Now we want to hear from you!

Share your feedback in the comments below…

Full Transcript 

Should people with adrenal fatigue do the ketogenic diet?
When I was reading the book Keto Clarity, that was a year or two ago. I was on an airplane and I was reading that. I was like “Man, I think people with adrenal fatigue should seriously take some precaution about doing the ketogenic diet.” Why is that?

Well, stress. Stress number one. If you are stressed out and you are trying to get in ketosis, it’s not going to work. You will not get there because stress is increasing the blood glucose levels and you cannot get there using your endogenous within your own body’s ability to produce ketones. You have to combat the stress first. I’m not saying you have all stress go away. But if you’re a guy or a lady who’s constantly wired and stressed out, you need to figure out how to reduce it and calm it down because you will not get in ketosis. Monitoring your stress is very important.

Number two with this. Sleep. You’ve got to be sleeping. Believe me, I wasn’t sleeping very well. I got this Oura ring. This Oura ring has helped me immensely, and it helped me immensely because it changed my lifestyle. When I started looking at my data from the phone that was being reported from my ring, it showed me, “Ben, you’re sleeping like crap. You need to change what you’re doing.” And I’ve done that. Actually it’s kind of funny that I’m doing this presentation with you guys today because last night was the best night’s sleep I’ve had to date with this ring. What did I do? I stopped eating around 7:30 at night, still late by some people’s standards. By my standards, it was pretty early. Me, I’m usually 9:00 or 10:00. My heart rate was slow. It was below 50s. I fell asleep right away. I was in deep sleep for an hour and a half. Sleep is key. Because if you’re not getting adequate sleep, what happens? You’re stressed out. You’ve got to get adequate sleep. You can use a very inexpensive app called Sleep Cycle. Sleep Cycle is a great way to monitor your sleep. You’ve got to monitor your sleep. Very, very important.

Another one is electrolytes. This ties in also with stress. If you’re stressed out, your electrolytes you’re going to be peeing them out. When you’re on a ketogenic diet, you’re going to be peeing out more sodium. If you pee out more sodium, you’re going to be more electrolytes-deficient and you start cramping up. Sean here who’s handling the video and the media today, I remember he was shooting a video last summer and he seriously seized up because he was following a ketogenic diet, he forgot about taking salt, he added the salt back in, and bam! He was okay. You have to make sure that your electrolytes are on board. When you have adrenal issues, your cortisol levels might be lower. If your cortisol levels are lower, you’re peeing out more sodium. You’ve got to be checking that out.

A good, simple question is when you drink a glass of water, how long does it take to go through you? If you drink a glass of water and you have to walk to the bathroom within about five to 10 minutes, seriously, you are electrolyte-deficient. If you can drink a glass of water and it stays within you for a long time, say 30 minutes or so, then you’re great. I shouldn’t say you’re great. You’re probably electrolyte-sufficient. Check your stress levels. Evaluate your sleep and support your electrolytes because sodium is extremely important to any ketogenic diet.

Testing adrenal fatigue, there is a whole slew of things here. Chris Kresser talked about adrenal fatigue and functional form. He did a great presentation on it. Adrenal fatigue is a term that’s over-used. But the fact of the matter is your cortisol levels can fluctuate and your cortisol metabolites can also fluctuate. This is a great lab test. This is a urinalysis test that you can get at Mark is the founder there. They’re located in Portland. It’s a great test because a lot of these tests just look at multiple levels of cortisol throughout your day, but that’s not enough. You have to look at your ability to process the cortisol, how fast you’re processing, if there’s issues there, and also what your DHEA production is. If your DHEA is high and your free cortisol is low, then you still have the ability to make cortisol, and as this patient is showing, they are peeing out a lot of it. They’re bringing a lot of them down. Keep in mind that free cortisol is about 1 to 3 percent of your total cholesterol. It’s a very small window that actually how much cortisol that you are evaluating. You can learn more by going to Dutch test. You can click on there and they have a lot of great videos. You can watch this video that Mark provides. It’s very in-depth, very fast. This is a great way to suss this out. Try to get this aligned with your health professional, and you can start getting your sleep in order, get your electrolytes in order, and then the ketogenic diet could be useful for you.

Getting adequate sleep and supporting your stress and reducing your stress isn’t easy. I know. Believe me, with three boys and juggling a lot of work and businesses, I understand how complicated it is. Electrolytes, you must maintain them and replenish them. This is really good to start. But once you’re going ketogenic, you probably need to switch to something that is more along the lines of a higher sodium. You can just use Himalayan sea salt or any type of sea salt. You need more sodium. This does not provide a lot of sodium. It’s a very good balanced electrolyte for getting you ready to go.

Adrenal cortex. If your cortisol is low or your adrenals, you’re just really wasting. You cannot wake up in the morning. That adrenal cortex might be something that you should consider. It will help support your adrenal glands. It will help support the cortisol and restore them. The trick is if you’re stressed out and you can’t get up in the morning and you don’t have frequent urination, then you probably should not be touching adrenal cortex because it’s going to be supporting your adrenals and it might make you actually more stressed out. Only use adrenal cortex if you feel that you need some additional adrenal support such as not being able to wake up in the morning.

If you have adrenal fatigue and you’re considering a ketogenic diet, those are some useful steps and tools to start supporting it.

If you’re hypothyroid, is it okay to do a ketogenic diet?
This is a trickier one. It’s not so cut and dry. Let me walk you through it. The thyroid is very, very connected to the adrenals. If you’re stressed out, you’re going to be producing more reverse T3 and that’s going to be causing you hypothyroid-like symptoms even if your thyroid function looks normal on the lab. You need to evaluate your reverse T3. If your reverse T3 is elevated, then you’re probably stressed out.

Another very, very common issue with hypothyroidism is Hashimoto’s. That is the autoimmune thyroid and that is typically associated with leaky gut and gluten and other food things that you look at and environmental toxins as well. The thyroid secret is actually just live today. My friend and colleague, Isabella Wentz, just went live with that as well. If you want to go to Thyroid Secret to learn more about hypothyroidism, you can go check out her content today and she’s going on this week. You need to support your adrenals.

Next thing you need to understand is the ketogenic diet is very anti-inflammatory. If the ketogenic diet is very anti-inflammatory, it can actually help those who have hypothyroid-like symptoms or have hypothyroid labs. It’s not a total cut and dry yes or no. It depends on how severe hypothyroid you are. If you’re severely hypothyroid, then no. You’ve got some work to do. But if you’re just kind of on the fence, ketogenic diet might help you get there because carbohydrates, eating too much is very inflammatory and inflammation can cause hypothyroid-like symptoms.

Ketones are way more efficient fuel. By default, you might actually see a lower T3 level on your lab. If you’re following the ketogenic diet and your T3 levels are lower than they were before, that doesn’t necessarily mean that you need to stop the ketogenic diet unless advised by your doctor. It could be a sign that you’re actually more efficient. It’s more efficient. Because what does the thyroid actually do? It stimulates your metabolism. If you’re following the ketogenic diet, then your metabolism is way more efficient than if you’re following a diet that’s using a higher protein, higher carbohydrate diet. If you’re more efficient, then should your thyroid have to work as hard? No. It’s a natural adjustment that is happening in your body. If it drops really low, then yes you need to check that out and work with your doctor. Again, it’s not cut and dry.

Carbs at night. A lot of people, myself included when I was keto for a little while. I’m not keto. I don’t follow the ketogenic diet. I’m more of little carb, kind of moderate carb. If you’re on the ketogenic diet, have more carbs at night because that will prevent you from having the binge and the urges of shooting for the carbs. Carbs will definitely give people more of that sense of energy. If you’re bingeing, if you’re hypothyroid, you’re craving more energy. So it’s going to be harder for you to get rid of the carb bingeing. Again, if you go keto, then that desire for bingeing and the carbohydrates goes down.

Maybe you’re not going to full keto if you’re hypothyroid, and again it’s not cut and dry. If you’re severely hypothyroid, talk with your doctor and work with them. If you’re slightly hypothyroid, talk with your doctor again and be aware of these things that you should be considering. Just start following a low carb diet.

There’s a great app called Cronometer that was introduced by my friend Waco [?]. Cronometer is something that you get at the App Store. I use it on my iPhone. I just started using it the last couple of days. My total net carbs for the day is a lot lower than it used to be because I’m actually tracking it. If you’re not tracking what you’re eating, you are not aware of how many carbs you’re eating. Again, if you’re hypothyroid, it’s not cut and dry. I hope these things support you and get you the information that you are looking for. I can spend another hour on this alone.

Can you follow the ketogenic diet if you don’t have a gallbladder?
If you don’t have a gallbladder, what does that mean? Well, it means that you had it removed for some medical reason and the problem never was actually addressed. The doctors just took it out. That’s one thing to think about. The doctors just took out your gallbladder. Your bile is already thick and it’s still thick most likely if you already had an infection. But most commonly it’s gallstones having to do with cholesterol which is not moving through to choline deficiencies and methylation issues and so on.

The gallbladder, what it does, is it stores your bile. That’s its function. Your liver will continue to make bile and it will just drip the bile out to the bile ducts. If you don’t have this pouch anymore, your liver is going to produce the bile. It’s going to go through the common bile duct with the bile and drop it right into your small intestine. You’re just dropping the bile right in there. If you’re eating a little bit of fat and your liver is producing bile, then you should not have any problems.

If you have half a slab of butter and you have some goat cheese, then you’re going to have some issues because your gallbladder isn’t functioning very well. I will tell you right now even if you do have a gallbladder, a lot of people’s gallbladders aren’t working very well. A very simple test to look at is the GGT test, gamma glutamyl transferase, the GGT test that you order from your doctor which you can get at a very inexpensive lab. If your GGT is elevated or your ALT or AST or your cholesterol is high or your methylation isn’t working very well or your choline, your serum choline levels are low or your taurine, then you most likely are having very, very thick bile and you’re not getting it into the small intestine very well and you’re going to have intolerance to fat. You are not going to be absorbing it very well and you get gas. You’re going to get bloating and you’re going to get diarrhea or you’re going to get constipation. It can all vary depending. But diarrhea is a common one. Too much fat.

What do you do here? You can minimize the amount of fat that you’re eating. Just because you’re going keto doesn’t mean you have to eat a bunch of fat. It just means that you eat more fat. To support your bile, you can take a supplement called Ox Bile. Ox Bile you can get different strengths. I formulated this to have 250 mg of Ox Bile because 500 mg can be too strong and cause diarrhea and issues and burning in your small intestine. Only take Ox Bile when you aren’t eating fat. If you’re eating far and you notice that you’re having symptoms having to do with a sluggish gallbladder or lack of bile, then Ox Bile can be very, very useful and a game-changer. If you have your gallbladder removed and ever since you had your gallbladder removed, then taking Ox Bile can also be a possible game-changer for you.

SIBO is also associated with gallbladder issues and low bile because bile is a natural antimicrobial. Taking something like Ox Bile can help reduce the microbes in the small intestine as well. So something else to consider. I had an amazing interview with Mike Mutzel. That’s available if you type in Mike Mutzel Dr Lynch SIBO. You can watch that video.

Pro-Digestion Intensive, this is a comprehensive digestive formula that uses lipase as well. Lipase is a fat-digesting enzyme. This is a chewable so you can pop a capsule or two while you’re having your meal. Again, with meals.

Another thing that you can consider. Many of you struggle taking fish oil and you get that burping and refluxing from the fish oil. That’s not fun. I tried it. I don’t know how many grams of fish oil. Tons of them. Some of them worked very, very well for me. Others I get that burping feel. Our fish oil contains lipase. It has a built-in natural fat breakdown enzyme built in.

Again, you can do the ketogenic diet without a gallbladder. You can eat moderate amounts of fat most likely most of you. But if you need more additional support, here you go. Otherwise you can just reduce the amount of fat that you’re eating per meal, but you also don’t want to be eating all the time because that’s going to keep your insulin up. You definitely want to be able to try to eat more during your meals instead of snacking because snacking is going to keep your insulin up. It’s going to keep your blood sugars messed up.

Can people with MTHFR go on a ketogenic diet?
Yes. I wanted to put a big slab of butter here because a lot of people think that ketogenic diet is eating butter and drinking oil. But it’s not. Alessandro Ferretti has set me straight on what a ketogenic diet is, because in the ketogenic diet you still need your vegetables. If you’re eating your vegetables and you’re steaming them or you’re eating raw salads, then yeah absolutely you can be using ketogenic diet while having an MTHFR defect. It’s not a problem. I have MTHFR. Billions of people have MTHFR. As long as you’re getting leafy greens regardless, you’re okay. It might actually be better because why? Going on a standard American diet is very inflammatory if you follow the ketogenic diet and you’re getting your leafy greens because what does MTHFR do? It makes your primary form of methylfolate which comes from leafy green vegetables. As long as you’re getting leafy green vegetables, yes.

You do need to count your carbs or evaluate carbs during a ketogenic diet, but useful carbohydrates like kale, broccoli, cauliflower, sweet potatoes – these are really very useful. Any tuber is very useful for your microbiome. If you’re not supporting your microbiome with these types of nutrients of types of foods, you’re going to have issues too. So make sure. Yes, it’s absolutely fine. You have the ketogenic diet, follow the ketogenic diet if you do it right if you have the MTHFR variant. You can learn more with this. This is a bunch of genes that we use and ran with the StrateGene report which I developed. So you can evaluate. You can run 23andMe through it and see if you have MTHFR or not. This is actually my report.

Is it true that one must be in ketosis to burn fat?
Short answer—I’m not known for those—no. You don’t have to be in ketosis to burn fat. Absolutely not. Ketosis is a pretty severe form that’s triggered by your body for starvation to conserve glucose for the organs that need it most. You burn fat more. We’re always burning fat. It’s just when you’re following the ketogenic diet you’re burning more fat than you are glucose and protein. That’s all it is. It’s just a ratio of how much fat that you’re usually burning. The short answer is you do not have to be following a ketogenic diet to burn fat.

Let me show you this. You store glucose as glycogen. Your body will use glucose immediately for your brain. Your brain is burning through glucose. After you exercise and you eat a carb-loaded meal, your body is going to take those carbohydrates and it’s going to package them into long chains of glucose. That long chain of glucose is glycogen. Your liver will store glycogen and your muscles will store glycogen. The more muscle mass you have, the more glycogen storage you have and the longer that you have during the exercise to fatigue, initial fatigue. That’s a good point to remember.

If you follow this graph, this is the minutes to depletion of muscle glycogen. This is how much oxygen is also burned. In less than 100 minutes, you burn through your glycogen and your blood glucose has dropped significantly. Look at this. Your fatty acid burning as fuel has increased significantly in about 50 minutes. Fifty minutes in a moderate exercise you are already burning fat. If you get a couple of hours of exercise a day, you’re burning more fat. During your sleep, you’re burning more fat. If you’re exercising for a long time, a total of 50 minutes, that’s when you hit the wall, because now your glucose is down, now your glycogen is down and now your fatty acids are really high. So you’re burning a lot of fats.

This individual is not in ketosis but their body is using more fat as fuel. You do not have to be in ketosis to burn fat. This individual is not in ketosis. But I bet you their beta hydroxybutarate and acetone levels and acetoacetate are probably starting to climb.

This is another great diagram. This is where I got it, This is another diagram to show you what’s going on here. ATPs, your cellular energy, and creatine you burn up within seconds. If you’re taking creatine for muscle performance or supporting your methylation, your body burns it fast. Then you use anaerobic glycolysis which also happens very fast. You’re using more glucose. After one or two hours, the aerobic glycolysis is kicking in and then fatty acid oxidation is going on and they can sustain you.

But look at this. You are providing only maximum rate of ATP synthesis. While fat provides a lot of calories for energy, it provides energy a lot more slowly. You only get 7 millimoles of ATP per second when you’re burning fat. But when you’re burning glycogen, you’re getting 17-40 millimoles of ATP. You’re getting a lot more ATPs. You’re getting a lot more bang for your back using glucose. But if you’re an athlete, you can use exogenous ketones if you’re following the ketogenic diet to enhance your performance if done right.

I’m going to tell you now that if you want to learn more about the ketogenic diet to see if it’s right for you because I made an assessment, go here to take it. When you go there, it’s a simple six questions that you can answer to see if ketogenic diet is right for you because if you answer those questions and it’s not, then you’ve got some work to do like we’ve already talked about. Again, go here to take that free assessment. Because if you’re working out or not working out, you need to know what you should be doing, and we provide some great tips there.

Do I have to do the ketogenic diet to benefit?
I made this question up because I’m not on a ketogenic diet. I’m not the type of person to be monitoring my blood glucose every day, to be monitoring my ketones in my blood every day because in order to do it right, you need to be monitoring your blood ketones, not your breath ketones.

But what I will say is this. Intermittent fasting is phenomenal. It’s a very, very useful tool to be using because ketogenic diet is extremely anti-inflammatory. Insulin, prolonged high insulin levels, prolonged chronically-elevated insulin levels are inflammatory. If you go to your doctor and you ask them, say, “Hey, doc, I want to look at my fasting insulin levels.” If your fasting insulin levels are high, you’re inflamed. If you’re not diabetic, you’re on the road to being diabetic. Intermittent fasting is not complicated. There’s great books on this subject, phenomenal books on this subject. I have many at home.

You can lower your carbohydrate consumption. You’re eating probably multiple hundreds of grams of carbohydrate a day. No joke. Seriously. Get the Cronometer app on your phone. Start logging it. It’s actually really interesting. When you log a food, the chronometer remembers what foods you had so it’s very easy to tap for the next time that you eat that food. It’s very quick and efficient. We always have our phones on, right? Every time you eat, tap it. You can just simply lower your carbohydrate consumption and have a more moderate protein, not high, because the protein can also go to raising glucose levels. Not all amino acids, but many of them.

You can support fat burning. You support fat burning by various nutrients, compounds, and also not being stressed out, intermittent fasting, and more exercise and longer, healthier, deeper sleep.

Big one. 80 percent satiety. I’m 207 pounds give or take. I’m 6’5. I don’t exercise as much as I should granted. I’ll admit it. I need to. My Oura ring keeps telling me, “Ben, you’ve got to exercise more.” And I do, but I’m still fit. I’m still strong. I still have my muscle tone. If I’m not exercising that hard and I’m still averaging healthy weight and I still have muscle mass, then big part of that is I eat 80 percent until I’m full and I stop because it takes time for that satiety trigger to hit. If you’re eating junk food, you are inflamed. If you are inflamed, you are not going to reach satiety.

Another pearl. Remember this. This is key. Fructose. High fructose corn syrup bypasses the satiety trigger. You can eat or drink as much high fructose corn syrup and you will not trigger the “I’m full” signal and you will keep eating. Get rid of high fructose corn syrup please. Fructose is found in many juice as well. Apple juice is very high in fructose.

Stress reduction – very, very key as well. We already talked about this many, many times. Stress will spike your blood sugar, will affect your sleep and everything else. You’ve got to be taking a very, very hard look at your stress, which is why I’ve got the Oura ring. You can use HRV apps. There’s many things that you can look at to evaluate your stress. MUSE Meditation is also very useful, the MUSE device that you can get on Amazon. You can do some meditation. It’s phenomenal.

Sleep optimization, sleep cycle, Oura ring. Great.

We talked about fasting insulin. When you eat, your insulin goes up. If your insulin levels are chronically elevated or chronically high, you are not going to get into ketosis. It’s not going to happen. If you are having breakfast and you’re like “Oh, I’m going to have my snack,” you’re going to bust out your granola. Then you have your lunch and you snack and you eat dinner. Your insulin levels are high, higher than they need to be all day. You go to sleep and you wake up at night because your blood sugar is whacked. If this is you and your blood sugar is whacked and you can’t fall asleep until you have a snack, this is classic. Your insulin has been high all day.

What do you do? You change it. You have your bigger breakfast, then you don’t eat until your lunch. Now your insulin levels are dropped. And then you have eight solid hours of sleep and now your insulin levels are low for eight hours. Compare this to that. This is a great, great image to take away. If you’re eating throughout the day like every hour, every couple of hours, that’s not good. You need to reduce it. Snacking is the devil for a ketogenic diet.

Why did I show this? This is a lot of science. What I’m going to do is I will show you this and I’m going to keep it very simple and I’m going to skip most of it. NADH. When you eat food, your body takes that food and turns it into fuel so you can turn that fuel into energy so you can do things. ADH is part of that very, very important nutrient that goes to your mitochondria to make ATP. If you are eating a lot of food, you are having a lot of ADH. The more food that you eat, the more NADHs you have.

How do you get rid of NADH? You exercise. You burn it. You burn it off. If you have a lot of NADH, your body is going to say, “Hey, my cells are fuel. You’re going to get insulin resistance. You’re going to become diabetic.” What happens when you’re diabetic or you’re insulin-resistant? You start getting eye issues. You start getting inflammation. You start getting neuropathy. You start getting ulcers and circulation issues. Very, very significant problems. Why? That food has to go somewhere. Your fuel tank is full, and so your body is going to say, “You know what? We have to get rid of it.”

If you can take that glucose go into your Krebs cycle to make more NADH because you already have too much of it from eating too much, it’s going to send it down these other pathways that are reactive and damaging. ROS stands for reactive oxygen species. Reactive oxygen species, reactive oxygen species again. All of these are very inflammatory.

If you eat too much or you eat a lot of carbohydrates, a lot of glucose-containing foods and carb glucose and a very high protein, Paleo is all the rage now too. Paleo amino acids can turn into glucose just like carbohydrates and you can be pushing your glucose and you can be increasing all these reactive oxygen species which do what? Cause pain.

What is the heart of depression? Inflammation. Inflammation and pain are really, really key and linked. Dr Kelly Rogan wrote a book called Mind of your Own that she talks about serotonin myth and she bust it completely, and the center of depression is inflammation. When you are over-eating, you are getting inflamed. I know a lot of you and many of you, myself included, when you are depressed, you go to carbs and you feel better. But you know what? It’s short-lived because you’re increasing the inflammation right away again. Look at this. You need glutathione to help neutralize this as well. PQQ will probably also help this.

But do you know what the best way to reduce the reactive oxygen species is? To stop eating so much. The ketogenic diet is also very useful here. Fructose will produce a lot of NADH as well. It’s a big problem. Very key points here.

If you struggle, if you’re the type of person that says, “Hey, I want to switch to ketogenic diet, but I can’t seem to have enough energy to keep eating carbs,” if you have to keep eating carbs in order to keep your energy up, then your insulin levels are probably all out of whack. There’s a lot going on that you can talk with your doctor with. But it also might be because you’re not able to burn your fat. If you can’t burn your fat, there’s nutrients which are required by your body to help take those fats so you can burn them and use them as fuel. Nutrients that are needed to help burn fast as fuel is carnitine, alpha r-lipoic acid and biotin. These are all really, really important for the oxidation pathway in your body which uses and produces ketones, and you also need these basically in general for other things as well. But these nutrients are essential to help you burn fat as fuel. So know to not have to add the ketogenic diet because the benefits, as I already showed you, is reducing the glucose, the carbs so you don’t have all these reactive oxygen species.

But now if you want to know if the ketogenic diet is right for you, I made an assessment for you. Again, you can go here to take it. You go there. You take that simple assessment and you’ll know right away if it’s good for you or not.

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