Today Dr. Ahmet Ergin – Endocrinologist/Diabetes Expert are going to talk about the Ketogenic diet for weight loss. He knows you guys have been hearing about this Ketogenic diet everywhere and from everybody. He think it’s time to hear from him who actually knows what he’s talking about.
Let’s read what Dr. Ahmet have to says…
We’re not gonna make blank statements, we are going to tell you. Who is the right person for Keto diet and who is the wrong person for the Keto diet and what to watch for. Again this is Dr. Achmed Ergin and let’s get started.
So, you guys are watching YouTube videos and everybody talks about Keto, some people put a doctor in front of their name because they are at a real MD but just you just want to throw out, you know the the titles to look more important. Now, guys remember not everything you watch is true things those general statements you may actually harm yourself quite significantly.
Now I have been getting some hostile comments because people think that I do not support Keto that’s not true. I support Keto for the right patient, now some people said Keto has to be for everybody, well, that’s not true and we are going to talk today why the Keto is not the right diet for everyone and who is the right person for the Keto diet.
Now let’s briefly discuss about the definition of a Ketogenic diet it is simple and everybody talks about this. Again to talk about Keto you don’t have to be a doctor it can be anything you can be a car mechanic and talk about Keto diet it’s not a rocket science but who is a good Keto patient is where a doctor comes in.
I do not recommend anyone to jump into Keto diet and without talking to a doctor that can have severe consequences that you don’t want to have. It’s like you know let me give you an example about it from a relationship standpoint you may see a hot girl or a hot boy you may say oh my god this is even the low of my life and you just jump into it you do everything you spend all your money. You spend all your time for that person without really understanding what they are all about. Without thinking about the consequences of the relationship without looking at all the negative aspects of this person, so when you’re in love everything is a blind. So if your goal is to just lose weight and get your diabetes under control your Sugar’s under control and you do not look at all the other consequences of a diet then you are going to have problems with it.
So it’s better to understand what it is and what it’s not and if you are a good candidate for that. Now, of course I’m going to tell you a lot more detail than you typically see an Keto video for a medical standpoint but I still do not want you to go ahead and start Keto on your own because I don’t want you to get into trouble.
Again you don’t want to treat yourself you don’t want a doctor to yourself you want to make sure you talk to a doctor it doesn’t have to be us. You can just talk to your primary care doctor or a diabetes doctor who has understanding of the Keto diet.
So, how was Keto diet found actually initial studies came around for the childhood epilepsy they found that they get the kids who were not eating a lot of carbs have less epilepsy and data studies and they found that the Ketogenic diet actually reduces the seizures in kids. Also there has been some studies short-term studies that it actually works for diabetic patients but how long it works and which diabetic patient is the candidate for the Keto diet is a question.
As you all know your body turns into fat when you actually eat fat so that’s only fuel that you need to burn. Other people will get more energy they will have mental clearness although initial transition period may be difficult you may get a Keto flu and you may have electrolyte abnormalities all those minor things that can happen to even the healthiest person but the question is can everybody go on a Keto diet then will everybody have symptoms of Keto diet.
So these are the things we are going to talk about, so, a lot of people think that the Keto diet works and I agree with that. Keto diet works but the question is how long it works and the question is what happens after a prolonged Keto diet. right?
So let’s talk about this…So you guys all know the the good side of the Keto, right? So your blood sugar goes if you’re diabetic and you start losing weight and all that good stuff but what are the things that you really do not know about Ketogenic diet.
You may lose a lot of muscle, now what happens when you’re Keto diet guys yes you lose weight but you feel tired because your muscles run on glucose and primarily glycogen has to be stored in your muscle for you to be able to workout. So, if you’re a guy or a girl who loves going to the gym you are going to have problems in terms of your performance at the gym.
Your muscles will crave for glycogen into glucose and your weightlifting your cardio will suffer through it. Now the problem is, if you trade your exercise for the diet you’re not really doing great for yourself because once you stop exercising your muscle mass goes down and that’s because you’re gonna feel tired on Keto diet.
So, especially if you’re working out if you’re not working out that’s not a problem but I think you should everybody should work out. Now when you’re cut your muscles will get weaker and if you don’t use those muscles use it or lose it so you’re going to have less muscle mass. Now your overall metabolism is determined by how much muscle you have, that’s why guys lose weight a lot easier than the girls because guys are more muscular. So if you have less muscle mass you’re going to it’s going to be a lot easier so let’s say you’re gonna Keto diet you lose butter weight and you also lost a lot of muscle.
So, what happens if you come off of Keto diet and start eating sugar then you are going to gain a lot of fat but you’re not going to gain a lot of muscle unless you start working out like crazy.
The problem is once you fall off the wagon and you do not exercise for a while it is very hard to get back into it. So as a result I would suggest be very careful about not losing your muscle and if that’s the case I will suggest eating some carbs right before or after the exercise at least to keep the exercise going. I would call this a modified diet and that works for me I tried to be on a low-carb diet not necessarily Keto diet because when I’m a Keto diet I just don’t feel like we’re not hard and I like working out hard.
Another major problem with people who go on a Keto diet and sometimes gonna dirty Keto diet, right? They do not understand the whole concept of medicine so when we treat diabetes we are not just trying to bring your blood Sugar’s down. That is just maybe one in a ten goal but then you don’t know about everything your goal is about okay I need to bring my ball showdown but that’s not everything.
When you have diabetes status end of the story it’s like your or the insulin resistance you already have underlying possible cardiovascular disease your blood sugar goes up at the end of the story. So, it’s like you know after the storm comes over you’re trying to fix things but the thing is you really need to pay attention to everything else that goes around that be. What are they, Cardiovascular Disease, Heart Attacks and Strokes. So if you’re controlling your blood sugars without reducing your risk of Heart Attack and Stroke then you’re probably going to die young with a wonderful blood sugar.
That’s not what we want, right? So we want to bring the blood sugar down along with the risk of Cardiovascular Disease. Statistically speaking again that’s this numbers talk, numbers are generally right or two thirds of Diabetics die from Heart Attack and Stroke before they become they go blind before they become dialysis dependent or dead before they lose their feet and stuff like that.
So your primary goal when you have Diabetes to avoid Heart Attacks and Strokes before you worry about dialysis. So, if you’re gonna Keto diet, right, and then you start eating bacon, red meat all this animal fat you are going to have a major problem with your cholesterol. Now, not only that on Keto diet you’re not able to exercise well because your muscle muscle mass goes down your muscle needs glycogen and glucose.
So, you end up ignoring the exercise part just because you’re enjoying the weight loss, and all this good stuff your blood sugar is down, you’re enjoying this but what you don’t see your LDL starts climbing up because of the animal that you’re eating. Your HDL which is the good cholesterol all goes down because you stopped exercising. HDL only goes up when you do cardio and enough cardio it’s not just walking the dog and you know going to the park and having a mile or two.
You know that HDL will go up and that is a very important protective factor from heart attack is that you have to keep exercising. Now, exercising for an hour cardio for example is not just going to be easy when you’re in a Keto diet. So, when you’re on a Keto diet make sure your doctor monitors your cholesterol and make sure your LDL stays below 100 and your HDL stays above 50 possibly even better if it is about 60.
So, if you’re not paying attention to your LDL, HDL and even triglycerides then you’re going to have major heart problems or stroke and that’s not what we want guys.
Another problem with Keto diet guys if you have stage 4 or stage 5 kidney disease. That is a time you have to be really careful about your protein intake. The problem is that high protein that you’re getting is you’re getting more fat but you’re getting also high protein that diet as well it’s going to put stress on your kidneys and you make progress of dialysis more. So, there’s a result so let’s say you’re a guy with a kidney function GFR down to 30 or 25 and then you just watch this Keto videos everybody talks so great and you go on a keto diet you may find yourself going to dialysis in the next year or two if you are very strict about this keto diet just because it’s been shown that the high protein diet actually kills your kidneys especially if your kidney is already weak so if you have a perfect kidney function. You’re great you know you’re just a new diabetic that doesn’t apply to you but if you have been diabetic for 15-20 years and you already have significant kidney disease you have to be extremely careful.
Another thing that happens with the Keto diet it makes you dehydrated so unless you chunk a gallon or more water every day along with the electrolytes you are going to be prone to kidney stones, so if you have a family history of kidney stones or if you already had a kidney stone I would approach this very very carefully because if you have a kidney stone on once you’re going to hate your life.
It is worse than childbirth every woman says that if they have a kidney stone versus a child delivery it is horrible and it can last days it can come back on and on and on so you have to be extremely careful. If you see a doctor and if you are potentially somewhat high risk for kidney stones you may go on a potassium citrate which can actually alkalinize your urine and reduces the risk of developing kidney stones. This actually has been studied in kids with epilepsy they use a Keto diet to reduce the risk of seizures but they develop more kidney stones.
So you have to be extremely careful drink a lot of water if you’re insisting on going on Keto diet and a lot electrolytes. Maybe, use the potassium citrate as well.
The biggest channel I’m going to talk about diabetes here so if you are on insulin or a sulfonylurea agent such as glipizide, glimepiride, amaryl whatever you name it they’re different brands as well most of these are generic but regardless if you’re on any insulin or a sulfonylurea drug and if you go on a keto diet and cut the carbs to almost nothing you are going to have severe low blood sugars.
Severe low blood sugars, can lead to coma, can lead to accidents, can lead to falls, so you need to really consult with your doctor with your endocrinologist preferably or diabetes doctor to make sure that you are slowly gradually cutting down on the carbs or making a major cut on your insulin.
Every time you make a cut on your insulin or your medications the response may not be like just like what you foresee so you may you may have still have to be monitored. Now with good thing about sugar and ease we monitor you guys remotely so you check your blood Sugar’s it pops up on my screen so I know you have a low blood sugar so I can call you and let you know what’s going on.
So this kind of close monitoring has to be done for every diabetic patient not just on Keto diet but I think from being accountable standpoint I think that’s also the cool way this way to go remote patient monitoring is the key but again if you’re on an insulin or soft your agent make sure you talk to your doctor.
Another problem for a metabolism standpoint now it looks very glorious you lose bunch of weight on Keto diet right but the problem is it is so hard to maintain. So you end up losing fat and the muscle as we discussed and then suddenly there’s a party suddenly, there is some social events suddenly, there’s a family gathering Christmas, Easter, Ramadan whatever you’re celebrating and suddenly all this carbohydrates available and everybody’s eating you’re like I cannot eat that they’re gonna look like you’re a little weird guy.
They may just actually say oh you’re such a great willpower and so forth but the grams of the case you’re going to miss the enjoyment and that can happen occasionally. Once you get back into that sneaky carb situation your body will taste it again and you’re going to have cravings again and the thing is if you lose if you lose your willpower and if you get back into carbs you are going to accumulate so much fat back into your body and that fat will go around your organs.
Sometimes we call insulin resistant patients skinny fats, some people are actually very skinny especially smokers. For example they look skinny from a distance but if you you know when they do autopsy studies on these patients. For example for our one or the other reason they see that there’s a lot of fat around the liver around other organs, around the intestines body accumulates the fat around your organs not under your skin and that is the biggest problem for insulin resistance.
You don’t have to look fat from a distance but you can still be fat inside and that is a huge problem for insulin resistance. So guys if you’re losing weight and you don’t think you’re gonna stick with Keto you’re going to go back to carbs don’t even start the Keto diet because you’re going to lose muscle, and then later you are going to gain all the fat around your organs which is going to be worse.
The biggest problem is the Keto diet can lead to dehydration now another patient group with diabetes who should not be on Keto diet if you’re on SGLT-2 inhibitors what are they Jardiance, Farxiga, Invokana and Steglatro these are the four SGLT-2 inhibitors in the market. If you’re in one of these agents first of all these agents can make you prone to diabetic Ketoacidosis and if you put yourself into Ketosis then you’re looking for trouble.
Another problem is that these agents they actually work good in a way because they make you urinate blood sugar and you’re losing 300 calories on average a day by just using these agents but then they also make you dehydrated because every time you urinate glucose it attracts the water with it. So if you’re using this Jardiance, Farxiga, Steglatro, Invokana Makana you have to stay hydrated.
If you’re going to Keto diet that’s going to make you dehydrated why because the carbohydrates actually hold the water just like many urinate carbohydrates or sugar in your urine and you lose water with it anytime you cut down on the carbohydrates your body will lose water. So, as a result initial weight loss that you see oh my gosh this is working so great is actually water you’re not really losing weight in the first couple weeks in the first two weeks you mostly lose water and the problem is if you do not replace it you are going to get dehydrated.
Again that increases the risk of kidney stones that increase the risk of kidney failure so let’s think about this if you have underlying chronic kidney disease and you become dehydrated what happens you will go into acute on top of chronic kidney disease and you’re going to lose more kidney function.
So you definitely don’t want to do that if you have a chronic kidney disease especially or if you have other medications or other risk factors that can make you’re dehydrated you have to really make sure that you’re under care of a doctor who cares about you who will monitor you closely and will prevent any problem. And if there is any problem they have to intervene and make sure you do not go into severe dehydration status.
So what else happens with dehydration so you’re not only losing water with Keto diet but you’re also losing sodium and potassium. Potassium is very very important for your blood pressure so if you’re not having in our potassium you have to make sure that you are supplementing potassium it could be potassium pills it could be electrolyte drinks. You have to make sure that you are getting your potassium back in otherwise your blood pressure may spike. In other problem is that you’re losing sodium as well now when you lose sodium you that’s one of the reasons that you feel like Keto flu so losing sodium and potassium are the two major electrolytes in our body we’ll put you down.
You want to replace your sodium but you have to be careful especially if you have a high blood pressure. It is a thin balance there so like unless you have a gauge in your body which you don’t know is right. You’re just replacing but you don’t really know how much you’re replacing so that is a problem with the Keto diet. How much potassium should you replace how much sodium you should replace your is making estimation and the problem is it may not be correct and if it is not correct your blood pressure may spike or you may not take enough sodium and that may cause problems in your bones.
Sodium is not as important for your overall fluid status but also it’s important for your bones as well. If you are having chronic sodium loss that can lead to bone loss and in diabetics actually that’s a problem because patients with diabetes are more allowed to have fractures so their bones are more fragile. If you lose sodium then you’re actually losing bone as well so as a result in the long term if you stay with Keto yes your blood sugar may be great but you’re going to be losing bone down the road. You have to be really careful what you’re gaining and what you’re losing. So, blood sugar control is not everything you need to control your blood sugars in the right way I’m not saying go take medications you don’t have to take medications but you have to know exactly what kind of diet how much exercise and we have a lot of videos about these so one diet will not fit all. Keto diet will work for the healthy diabetics, young diabetics new diabetics, that’s it.
Anybody who has problems or have other complications, skinny problems, dehydration problems, medications that can cause low blood sugars, and history of kidney stones. All those people should be extremely careful about Keto diet. What happens also when your electrolyte balances off you will become more durable, you’re going to have balance problems and you’re going to have dehydration problems. You also will be constipated right, so, constipation happens because of dehydration again your bowels needs to absorb some water from your body in order to keep your stool soft. And in order to keep your regular so what happens when you’re dehydrated you become constipated and believe me that’s not fun if you’re not going to the restroom for a week you’re going to have made of discomfort intramural so you have to really make sure that you’re actually having some non starchy vegetables and fibers in your diet.
Hence, that you can actually keep going if you are not moving your bowels and if you are having a lot of processed meats that is the remedy for colon cancer yes you may have wonderful blood sugars but you may die from colon cancer because the state on the Keto diet for so long. Again this is a balance you have to know if you have if your protocol in cancer you have to know your family history you have to get your screenings done and so forth. That’s another reason to make sure that if you’re a Keto Diet for long term you have to make sure that your doctor knows about it and you are on top of it.
Therefore, to avoid problems electrolyte disturbances I would still suggest eating healthy vegetables that are high in potassium that could be broccoli this could be avocado, flax seed, chia seed, spinach could be great sources of potassium and fiber. You need to make sure that you are choosing non starchy vegetables that can be good for your Keto diet to avoid problems with lack of fiber and lack of potassium.