The recent development of low-sugar, high-fat and nutritional ketogenic diets Part One Speaker: Dr. Stephen Phinney "Ketone Good Translation Group" Translation: Leo Tseng Proofreader: Ariel (November 13, 2016) (At Epworth Hospital, Melbourne, Australia) "Recent development of low-sugar, high-fat and nutritional ketogenic diet" Dr. Stephen Phinney, Ph.D. Honorary Professor, Department of Medicine, University of California, Davis, Chief Medical Officer, Virta Health Thank you Ron, very happy to be here Nice to arrive here on saturday afternoon Because it’s Saturday if I’m still in California.

But I left three days ago Thank you everyone for participating on Sunday morning Wasting a good day here I think we will stay for a long time I don't plan to come here to lecture Ron arranged for me to use this model for the first time here three years ago Just put a few slides to stimulate the problem and discuss There are more viewers today than before. Do you want to try this model? Because I stand here and face everyone Lecture for one and a half or two hours or more The content may be too much Let’s talk about it first.

Ron said I’ve been a heresy for more than ten years Many things I was forced to understand later were very different from the training I received when I was a doctor Every idea that goes against the consensus The results have evolved into the key to success in improving everyone’s metabolic problems Metabolic problems caused by eating high sugar or sugar and refined sugars I plan to talk about some so-called heretical arguments today Not only let everyone know Hope everyone reaches a certain level Able to pass exams like "Steve Phinney believes in XYZ" But maybe you think some of my arguments are credible 20 years as a medical lecturer and educator in the United States I know you can teach people knowledge that they can pass the exam But you can’t just change their thinking in the way "this is a journal showing X" You can change people’s behavior unless you change their minds One of them, you have all heard that they all said that she doesn’t exercise and people would say "what?" And you heard Sami mentioned Sorry Ron mentioned Some athletes are very interested in this So on the one hand we don’t promote sports But on the other hand, the athlete asked us how to proceed This seems to be irrelevant, so how do we proceed? Let me briefly introduce some background information related to athletes This is my speaker statement I was a professor of medicine before Have three faculty members and have been in three different schools for 20 years Finally at the University of California Davis campus I spent twelve years doing academic medical research there In this context Did some research that I think is my better But not academically successful I was indeed promoted to professor But I didn’t get the funding and academic influence I needed To run the laboratory, teach young doctors, graduate students, etc.

Finally, I gave up my academic career about 15 years ago So I am now qualified to be called a researcher in rehabilitation If you have a twelve step project I have a twelve-step project, one of which is don’t believe what others say including me I always have doubts about my research data Because I have proved that some facts I knew 30 years ago turned out to be wrong And what I know now may be wrong, maybe half of it is wrong, but I don’t know which half is Recently Ron mentioned that I am the author of this book If you look closely, I don’t have a picture to project The first author is Jeff Volek Doctor of registered dietitian If Jeff didn’t contact me in 2003 Say to me "Steve, I read your article" "I did some research myself, I believe you are right" "It looks like you have given up this field." "You must come back to fight this battle." So that colleague who was younger, smarter, stronger, and handsome than me picked me up and dusted me back on the battlefield.

We did some research together The research results from 2003 to 2009 make us believe This is not just a short-term diet to make some indexes like body weight better This can be a safe, sustainable and long-term plan It can help those with metabolic problems recover their health Jeff is the first author of this book because I see him as my brother and my leader He is 25 years younger than me, but he led the field when I was away Thanks Jeff So we believe that after the publication of this book Everyone will start to say that this book puts everything together We decided to formulate these into an implementation plan To manage our main target is type 2 diabetes patients Because that is probably the most serious health crisis Whether in a developed country or a developing country Because I was inspired by some people, "We should make a plan." "Let’s start doing this" "Let’s think about how to proceed." and so My medical experience is basically operation This kind of education, assistance, and changing people’s minds I will face to face, in small groups I guess if we really make this bigger Maybe after ten years we can help one million patients with type 2 diabetes In the process, an athlete connected with us His name is Sami Inkinen Where is Ron? The film Running on Fat was produced by a documentary producer Donal O'Neill It’s about a triathlon world champion His wife used to be a competitive gymnast and is now a marathon runner And the two of them decided to take a long voyage A voyage to the Pacific Someone is laughing because they set off from Monterey Bay in California Use a 22-foot long, high-tech paddling boat Paddling all the way to hawaii About 2800 miles Unsupported means that there is no supply along the way And they completed it in 45 days and 3 hours The previous record of a two-person voyage from California to Hawaii was 60 days And Sami and Meredith completed it in 45 days and 3 hours The whole process is to adopt a low-sugar diet There are several reasons why they decided to pursue this challenge with a low-sugar and high-fat diet One of the reasons is that as a world champion triathlete in training and competition Amateur triathlete Sami found out that he was pre-diabetes He was in his early 30s And he believes that the direct cause of his pre-diabetes is As a competitor of endurance sports He is encouraged and guided to adopt such diet content 10~15% fat, 20% protein and nearly 70% of energy come from carbohydrates Most of the sources are oatmeal energy gels and sugary drinks His well-trained body cannot stand so many carbohydrates He is a very smart person and he thinks maybe these dietary suggestions are not good He read some documents while thinking Also read the book on low-sugar diet and exercise performance co-authored by Jeff and I I suddenly received an E-mail with the content "You don’t know me, but I need your help." "I want to row from California to Hawaii." This guy is crazy "My wife will be with me." I think Don't approach these two people But because of their sports background This challenge is not a fantasy for them So I decided to have lunch with them and try to dissuade them Because my intuition as an intern is very conservative That is if things go wrong, I always scapegoat The argument he convinced me In his lunch meeting with Meredith and me, his argument was If I don’t advise them, they will continue to do the same.

If something goes wrong, he will blame me. He is a very persuasive person We think of some way Because there is no refrigerator on the ship, the food must be able to be stored at room temperature They don’t know how long the entire voyage will take. The best record was 60 days. So they packed more than 60 days of food The content is 70% fat 20% protein 10% carbohydrate One small problem is that Meredith ate organic vegetarian food at the time, which made the challenge a little bit difficult. But she made some concessions to eat fish but never touch dairy products We calculated the composition of this diet They packed everything and set off Sami’s main protein sources are nuts, cheese, and freeze-dried high-fat burgers Meredith eats two kinds of dried fish, olives, nuts, etc.

In short, to put it simply Their main common food is vegetables cooked in a big pot once a day They have a small stove on the boat and they cook hot food every day It’s cooked vegetables with olive oil because we have to find a way to add 70% of the fat to the diet Then divide into two Meredith will put the fish in with the vegetables And Sami put in his hamburger and started to eat They also brought some dark chocolate In short They just set off.

Their high-tech ship has satellite phones They will update the blog and in about the third week Sami wrote on the blog "There may be a mouse on the boat" "Because my cheese was eaten." It’s because of this protein and fat demand that Meredith She did eat some Sami cheese They encountered some electrolyte and mineral problems in the middle We also expected this to be the case because when you boat They each plan 16 to 18 hours a day About 10 hours are rowing at the same time, so one person rowing Most of the time, one person is paddling, and then 10 hours is two people paddling together But because they only have a small shelter area on the boat It can sleep two people, but it’s close to each other, so it’s not easy to sleep.

So they change shifts like this Boating time is so long, especially when you enter warmer waters How to deal with the problem of mineral loss Because sweat contains not only sodium but also potassium and magnesium No matter what the reason is, we have already planned for this before we set off But as the voyage progresses they become stronger There are 13 ships participating in this challenge.

This is a competition Only 6 of them arrived in Hawaii There is another two-man boat, mostly four-man boats It took another 70 days for another duo ship to complete the race The two-person ship gets weaker and weaker as the voyage progresses Because they have overtrained to the limit, it is physically and mentally exhausted in terms of exercise physiology And Sami and Meredith got stronger That is a fascinating mystery, we will not go into this detail today Why do I propose this challenge when they finish this competition Sami Previously trained as a nuclear energy engineer in Finland After he graduated with a master's degree in nuclear engineering He worked for two years in a nuclear power plant in Finland He said I find it boring and nothing exciting Most people think that is a good thing But Sami wants to try another runway He started a software company but failed.

He didn’t know how to manage a company He thought I should study business. He went to Stanford University in California for an MBA. Found it difficult to rent a house in Silicon Valley Surprised? He and his roommate wrote a software to search for houses for rent in the Silicon Valley area And the small software they wrote over the weekend became the second largest real estate search software in the United States Sami is very successful in this area, he can afford whatever he wants to do After this voyage He told Jeff and I that these things you did are very good Maybe in 10 years you can help one million type 2 diabetes patients And there will be hundreds of millions of people with diabetes in the world during that decade You will win this battle but lose the whole war We must make this a virtual network model And expand the scale of virtual online medical care to hundreds of millions of people It's that vision that made me stand here today I am the Chief Medical Officer of a company called Virta Health The name was not taken by Sami A non-Finnish colleague looked through the Finnish dictionary and found the word meaning strength and constant flow So that's what the name means in Finnish So I own the ownership and personal interests of this company.

This will be the last time I mentioned Virta Health in this speech. We just started to activate what we currently call in stealth mode Until now so I hope you haven’t heard our name And in about 6 to 9 months you may know us As a company, we use venture capital to conduct The largest non-surgical treatment of diabetes research Nearly 500 patients participated We want to show that we not only think this is effective, but also show that it is indeed effective with data And publish results in peer-reviewed scientific journals, which will make this diet different from the general short-term diet By the way, we are not a way of eating, we are not a way of life We are a comprehensive intervention Let people understand this science to change their thinking and produce long-term positive behavior changes I will preach here The main focus of my research My first research project started in 1975, as I said about 40 years ago The first article was published in 1980 and I coined the term "nutritional keto" The reason I have to create this word is because as a doctor Graduated from a recognized medical school (Annotation: Stanford University School of Medicine) The only thing I learned about ketone bodies is that they are toxic by-products of fat metabolism And as a doctor, as soon as I see ketone bodies, I should fix them on the spot Such as giving patients more insulin or carbohydrates, etc.

Most doctors and medical staff only learn this negative knowledge That comes from diabetic ketoacidosis The so-called juvenile-onset diabetes is also type 1 diabetes It is usually adolescent autoimmunity that destroys islet cells so that they cannot produce insulin Without insulin, the body’s fuel metabolism is out of control Cause very high ketone body concentrations that are toxic and fatal I will explain the difference in detail later I spent almost my entire research career Try to define the role of ketone bodies at the right concentration and look at it from the perspective of fuel metabolism and central nervous system function We think this is the fuel of the brain But in the last five years there have been significant changes, we have a deeper understanding It’s not that the research I did was the one I mentioned earlier In the language of academic debate These people have no relevant interests in the nutrition debate These people are interested in what regulates 30,000 to 40,000 genes in our body They affect the body but not at the same time Most of the genes are asleep most of the time Useless You want them to be activated only when you want to activate They should be closed when they want to close What is switching genes? I'll talk later But β-hydroxybutyrate is a very powerful and selective gene signaling tool That fits the recent hot field called epigenetics Which is to study what switches these genes We inherit these genes, not all of them turn on and off at the same time So there is this concept Beta-hydroxybutyric acid has always been an ugly duckling in various textbooks In fact, it may be a flying eagle Let’s watch a few more slides and see if anyone has a problem with this During the eight years of my medical training I live in Vermont in the northeastern United States I live in the country I cut and burned wood to keep the house warm I learned that the wood in the front yard is not very useful Because I can't put it in my stove The only way to make this wood useful is to cut it into pieces and stack up to keep it dry That way I can put it in the stove at any time to keep me warm As people say, the weather in Vermont is 11 months of winter and 1 month of muddy That is true In the eight years I stayed there, there was only one month.

There was no snow in my garden. It was July. So if you think of long-chain fatty acids as E.g. palmitic acid Sixteen carbon saturated fatty acids By the way, in the blood This is the most toxic fatty acid in the blood The higher the concentration of 16:0 palmitic acid in the blood The higher the incidence of diseases such as diabetes Cardiovascular diseases Stroke and early death So if you think saturated fats are all benign It’s not how much you eat but how much is in your blood. We’ll talk about it later If you take those 16 carbon saturated fatty acids Must be delivered in lipoprotein form Binds to albumin in the blood It can't float in the blood by itself You don’t want it to accumulate in the blood because it’s dangerous But if your liver cuts it off Cut into four pieces Four Four-carbon short-chain fatty acids There is also a hydroxyl group You can think of it as an alcohol version of short-chain fatty acids This is beta-hydroxybutyric acid It is water-soluble and can diffuse across cell membranes It does not require special passage And any cell with mitochondria in your body can burn it as energy It turns out that it is the fuel that the brain prefers to use It is a cleaner fuel than sugar Cleaner means that it produces active oxidants, which is less free radicals.

So it’s like the stove doesn’t cut the firewood Beta-hydroxybutyric acid is not made by the body by mistake It is clearly purposeful A highly evolved fuel and conduction signal Can produce great metabolic benefits Especially for those with impaired metabolism who have excessive inflammation index and oxidative stress So I expect the discussion will go in this direction. That's what I want to mention There is no guarantee that it will be mentioned So Jeff Volek and I tried to emphasize this point Get this picture showing the concentration of ketone bodies in the body Although it is a ketone body, most of the blood is β-hydroxybutyric acid If you drink willow juice and bagels or a few slices of toast or muffins for breakfast Your blood ketone concentration will be less than 0.1 There is no need for high-carbohydrate water, only moderate carbohydrate, there is almost no β-hydroxybutyric acid If after a night of fasting a What is written on this is This is the highest possible fasting state to 0.3 But many people are lower than 0.3 As long as they eat a high-sugar diet, it will be less than 0.3 in their lifetime This state is the normal state recognized by the medical community organization So as long as it is less than 0.3, it is completely normal Higher than that will be considered abnormal The concentration of diabetic ketoacidosis does not even start at 10 But the value is as high as 15 or 20, it will be life-threatening In the middle If you are eating a well-designed ketogenic diet Not hungry or fasting But eat the right amount of protein in your diet Reduce carbohydrates appropriately.

Most of the energy comes from fat Your value 0.5 is a threshold The value will be between 1.0 and 3.0 From the perspective of β-hydroxybutyric acid as fuel and metabolic information transmission, this is the optimal concentration range we think and so This is 0.1 this is 1 this is 10 So there is a 10 times difference from here to here 10 times difference from there to there So their ranges are not overlapping This is a very different metabolic state, one is not in the nutritional ketone state The other is in the nutritional ketone state compared to the life-threatening state, the concentration is 1/10 This is what we must understand because if you accept this idea You can go on a ketogenic diet for several months, years or decades The difference is as if you know 2 cm of rainfall per day can nourish your garden And 20 cm of rain washed away the entire garden Their concentration difference is very big We know from research in the 1960s One adapts to hunger More than 2/3 of the brain fuel source Can come from ketone bodies And the brain function is completely normal And the remaining one-third of the energy comes from glucose But not from diet Because when people fast, they don’t take glucose Glucose is produced from gluconeogenesis Its source is the secondary product of protein metabolism But there are also glycerol backbones derived from the decomposition of triglycerides In terms of fat storage, glycerin only accounts for a small part But in fact it also contributes to the new glycogen So these glucose must be produced by the body and burned But this does not mean that there is a demand for carbohydrates in the diet People are wrong to say that the brain needs a lot of glucose as fuel So in general, the energy burned by the brain No matter what you are doing Burn 600 kcal a day Approximately one-quarter of the daily energy requirement Can supply three pounds as fuel as the size of a squash in your skull All energy can come from glucose but fat cannot be used directly But most of it can be provided by ketones produced by fat Through organized and systematic fatty acid metabolism in the liver Big fatty acids Like palmitic acid Converted into β-hydroxybutyric acid to become an ideal and clean fuel Not only the brain but also almost all organs So how to make β-hydroxybutyric acid reach 1 to 3 mmol? Sometimes feel a little angry I read that many people say they are eating a ketogenic diet And they think that is equivalent to any diet where less than 30% of the energy comes from carbohydrates Low-sugar diets are generally recognized as diets where less than 30% of the energy comes from carbohydrates That includes the primitive diet There are many different interpretations of the primitive diet But the academic leader in this field has always been Loren Cordain And his definition is that about 30% of energy comes from protein 20% of energy comes from carbohydrates and 30% comes from protein And the rest is 50% from fat Jeff and I discussed with Lauren I should call him Professor Cordain a few years ago I asked why 20% carbohydrates "Steve, those carbon water is enough to supply your brain" You can use ketones to power your brain He said "Yes! But you have to eat more fat" "No one wants to eat 50% fat" "That's quite dangerous." So what we are facing is This is a reasonable argument that he can use to teach students But it’s based on ideas and not scientifically based And the big problem in nutrition is Just like the dietary guidelines issued by the United States in 1977 and even promoted to the world The result turned out to be wrong based entirely on ideological theory So let go of my dreams and take a physiological perspective How do you get into the nutritional keto state Protein intake must be very moderate This is not a high protein diet Is a moderate protein diet Because carbohydrates inhibit the production of ketone bodies For most people, the energy from carbohydrates must be 10% or less The more severe insulin resistance Insulin resistance is a characteristic of type 2 diabetes The more serious the insulin resistance, the more carbohydrate intake needs to be reduced So when we face type 2 diabetes patients who are already taking medication or insulin At the beginning we must reduce their carbon water intake to 3 to 5% To trigger this metabolic change And when we put them into the nutritional ketone state Healing effects are produced at different rates Change over time Many times Even often people’s carbon water tolerance improves So carbon water tolerance was very poor at the beginning It varies from person to person but after people recover Usually we can instruct them to eat back a higher carbon water percentage Make their food choices wider Of course not because carbon water is necessary It’s easier to just go to a restaurant or visit friends Or mother-in-law expects you to eat all the dishes on the table Let you have higher flexibility in social situations So if you want to be successful, it must be gradual and personal Why not stop here See if it is too offensive to some people’s knowledge sensitivity See if anyone has a problem before going to the next slide Yes Should we use a microphone or I can speak louder So trouble you Great Go back to the picture that entered the ketone state Is it true that the blood sugar concentration will decrease when the ketone body concentration rises? If it is true, what is the minimum safe concentration The question is the safe low glucose concentration in the keto state and whether that is normal In our metabolic hut experiment, we really put people in food prisons Full control of their diet So we know exactly what happened and what happened If the blood sugar is high, it will fall to the standard range and stay within the standard range If it was normal at the beginning, I have experimented with athletes Very high insulin sensitivity and stable blood sugar control Their blood sugar remains in the normal range We rarely see blood glucose deviating from the normal range Unless people do intense exercise in the early stages of adaptation Before the body is fully adapted to use ketones as fuel to increase fat oxidation Or they are taking diabetes medicine So we haven’t seen blood sugar lower than In the U.S.

We are still using incomprehensible mmol/dL We haven’t seen it below 3.5 mmol (Translation and Annotation: 63 mg/dL) Sometimes we see people slightly above 5.5 mmol (Translation: 99 mg/dL) And it’s the people who have fully adapted to ketones We are not sure why Some people tend to float above the upper limit of normal But we haven't seen a big change In a very Ethically controversial experiment In the late 1960s Some doctors face patients who have adapted to starvation for a month conduct experiment These people have a ketone body value between 5 and 7 mmol. They are hungry ketones. They give insulin slowly by intravenous drip Lower their blood glucose levels to levels that should cause coma or death On these people with ketone bodies between 5 and 7 mmol Say it that way ironically The only person in the room who was trembling, sweating, and anxious was the doctor himself Those whose blood sugar levels should be in a coma or death are completely sane Mentally normal And didn’t feel any threat to the body’s anti-regulatory system That represents By the way, this experiment can never be carried out under modern medical ethics.

but The results show that the human brain adapts very well Not only can β-hydroxybutyric acid be used as the main fuel, but even as the only fuel I share this experiment because someone has done it Not to endorse such experimental ethics This is my personal situation. My fasting blood glucose dropped from 3.5 to 2.5 last week (Translation: 63 to 45 mg/dL) My blood ketones go from 2.5 to 3.5 I posted this result on Facebook and everyone said "You are dying" That shows everyone’s perception If you don’t hear clearly, his blood sugar drops to 2.5 mmol (45mg/dL) After a long fast Only three days Yes But ketone bodies are in the range of nutritional ketone state You have no symptoms I felt a little dizzy when my blood sugar dropped to 2.4, so I ate Did you supplement sodium at that time I drink big bone soup twice a day Is there enough sodium in the good? Because some big bone soup recipes will be discussed later Some important differences are that the higher the ketone body, the faster your kidneys excrete sodium.

If you look at it from a different perspective than eating a lot of carbon water If you want to know the effect of eating carbon water on your body One of the things that carbohydrates do is to inhibit the excretion of sodium from the kidneys Means you will retain sodium When you take carbs out of your diet You will speed up the kidneys to excrete sodium If you don’t increase your sodium intake Most of the side effects at the beginning or after a while is that people do not eat enough salt I have a slideshow about this that should scare you Will mention later Yes please ask Regarding protein, you mentioned that the range is 0.8 to 3.2, which is quite large How do you judge it is the right amount for you The problem is how to judge the appropriate amount in this range Some people we help have severe insulin resistance They rarely exceed 1.0 And some people have no insulin resistance or insulin sensitivity improves over time Will rise to the 3 or 4 range We don’t think there is a perfect value that everyone should pursue But what value can you achieve with reasonable dietary control If you want to reach a high value and pressure your protein intake very low As a result, you will lose your net weight.

We don’t want to lose power and functionality Just to pursue a higher ketone body value There are 2/3 people in our company I said not to mention the company There is a group of unknown people Two thirds of them are software developers and designers When designing and writing apps, we turn our development interventions into online tools And most of them are young men and women Everyone wants to try this new technology after joining the company So most people eat a ketogenic diet And these people are competing with each other Every morning they finish the ketone body test Holding the blood ketone meter and shouting "I'm 3.2!" I said "Yes, yes, I'm 3.7!" We do not encourage this kind of naive behavior Since I am twice older than most people in the company I act like a father OK OK You can play this game in the office but don’t let the participants do it We told the participants that if you have 0.5, it’s ok It might be better if it is 1.0 Higher numbers are just biochemical characteristics of each person Instead of representing superior metabolic or physiological conditions Say hello here first and then change over there Is the insulin resistance you mentioned all the time measurable? That is the first question The other is that the impedance is related to the rate of weight loss? If you can’t hear clearly, the problem is Does insulin resistance affect the rate of weight loss the first is Can measure Can measure The typical method of measuring insulin resistance is Insulin is given by IV drip in one arm That will allow your body to absorb glucose from the blood quickly Then give glucose to the other arm to keep blood sugar normal The more glucose you need, the better your insulin sensitivity That is called Hyperinsulinemic-euglycemic clamp (Hyperinsulinemic-euglycemic clamp) I learned this word for three weeks however That is a very difficult test.

Our general standard test is not like this The easiest way is to draw blood Check the insulin concentration is usually in the fasting state Check the blood insulin and glucose concentration check the ratio Can get the so-called insulin resistance score That is a trustworthy value Another way of judging is that we look at a person’s Blood test or physical examination report If they have the so-called metabolic syndrome Medium-Guangzhou obesity hypertension Good cholesterol HDL is too low Triglycerides are too high Hyperglycemia at the border of the normal range It's not in the diabetes area but in the border area Meet three of these five It means you have metabolic syndrome and insulin resistance If you are diagnosed with diabetes then you have severe insulin resistance We don’t need to do these measurements in most cases We can judge based on personal physical examination and general laboratory data When people with more severe insulin resistance want to help them lose weight The more severe the impedance, the more difficult it is to lose weight But if you can make him reduce his carbohydrate intake Reduce his carbon water intake to his personal tolerance Insulin resistance will be significantly improved The reason we think is I may not have the opportunity to let you see the latest research data The reason behind our ability to let people lose weight in different situations is We personalize each person’s carbohydrate intake to improve their insulin sensitivity Weight loss So it’s not low-carbon water but But to increase insulin sensitivity to allow the body to burn its own reserves Instead of burning There are questions over there, then here Can you please stand up and let everyone hear I just want to ask about the concentration of ketone bodies There are many discussions on FB You know something like "The higher the better?" "Do you need to increase the concentration of ketone bodies?" Is it better to stay in the nutritional ketone range instead of the higher the concentration, the more weight loss Can you comment on this There are two common misunderstandings One is that the higher the ketone body concentration, the faster the weight loss Another more basic misconception is that if you are nutritionally keto, your weight will definitely drop This is wrong if you observe Some culture those hunters or shepherds We think of the Inuit in the Arctic Circle Or the Maasai living in the Great Rift Valley in Africa These are cultures that have existed for thousands of years They eat very few carbohydrates They grow up Their life span is not short and can be passed down from generation to generation And continue their grazing culture They are not losing weight due to being in nutritional ketone state Therefore, it is possible to maintain a constant weight in the nutritional ketone state When most of the calories consumed are fat equal to the calories consumed We used to study cyclists who are lean and almost have no body fat and burn We kept him in the Metabolic Cabin for four weeks It’s expensive because I want to do it for a few more months But he may get claustrophobic and we will go bankrupt But during these four weeks The calories eaten are equal to the calories consumed His weight remains stable.

Net weight and body fat are both During these four weeks I don’t want to use myself as an example but 13 years ago I decided to practice and follow my own advice And for the past 12 and a half years, my weight has remained within the range of two kilograms My ketone body concentration The minimum is about 0.5 or 0.7. After endurance exercise, it is about 3.0 So I maintained the nutritional ketone state and did not lose weight Because my dietary fat And the right amount of protein allows me to maintain a stable weight So I don’t think the ketone body concentration can or contribute to weight loss It is to stay away from the therapeutic effect of the carbohydrate intake that the body cannot load, thereby improving insulin sensitivity That makes weight loss easy People will then reach a new weight balance point which is related to the amount of fat they consume Back to just after you lost a lot of weight in order to achieve weight stability You shouldn't add carbs back to prevent weight loss But to increase fat to maintain fullness Maintain a stable weight Yes please say I am a general practitioner in Essendon Thanks for your comment on insulin resistance From a medical point of view that seems to be the central idea you are talking about You mentioned that metabolic syndrome is an extension of insulin resistance Diabetes is a worsening condition on this road 30% of the population over 25 in Australia have metabolic syndrome And about 8% of people over 25 have diabetes What I want to say is that it is very important to actively deal with insulin resistance from the standpoint of general medicine The second is that as humans, most people become insulin resistant rather than insulin sensitive.

Can you comment on the distribution of insulin resistance metabolism and diabetes? Ok The distribution of insulin resistance in the population is actually related to the region May be related to genetic differences between different ethnic groups We (U.S.) are a little worse than Australia 9 to 10% of us have type 2 diabetes And 35 to 40% of the population is pre-diabetic So in fact, more than half of the U.S. population Suffer from a condition closely related to insulin resistance And no medicine can improve insulin resistance You can increase insulin sensitivity by having some insulin sensitizers But usually the side effects far outweigh the benefits So the only really useful tool is what we are talking about today Islanders in some Pacific Islands The prevalence of type 2 diabetes and insulin resistance is close to 75% In the Persian Gulf Arab countries too United Arab Emirates, Kuwait and Saudi Arabia We think this may be caused by their genes We work closely with Dr.

James Wortman from Canada, a pioneer in this field He himself is a mixed race of the First Nations (Annotation: First Nations is the general term for the Indian nation in Canada) And among the 2.5 million people of Canada’s First Nations The prevalence of diabetes in First Nations is 3 to 5 times that of European Canadians They live in the same town and have almost the same food sources So obviously there is the influence of race and genes We haven't figured out which genes are But we all use this technology in different regions To reduce the carbohydrate intake below the personal allowance. The results are all positive. Please say Can you comment on Metformin 16 years ago I self-diagnosed with diabetes Before the beginning of this year, I controlled my illness with exercise and low GI diet Now I see the dawn of a low-sugar diet and I have lost 15 kg My glycosylated hemoglobin is 4.8 You know I am a little dependent on Metformin because I have been taking it for 16 years From the results of my measurement, it seems that eating Metformin can easily enter the ketone state Do you like it or hate it The problem is Metformin and its role in medicine Since Metformin showed the benefits of increasing lifespan in animal mode It is no longer just a diabetes medicine It is a longevity medicine I would say it is the most Myself The least objectionable medicine I am a fully trained modern medical doctor I was trained to write prescriptions As long as the patient has no gastrointestinal side effects caused by Metformin I strongly recommend people who are taking it to continue taking If people's glycosylated hemoglobin can only be controlled at the boundary of 5.8 or 5.9 That's the best situation after sugar restriction We are not opposed to joining Metformin so that they can drop to the magical threshold of 5.7 Because all the data show that hemoglobin A1c is reduced Of course it’s best to use natural methods, but the more you drop, the more beneficial Including longevity But we haven’t conducted human experiments because it will take 120 years But it may also have the benefit of extending life If we talk about it then I will show you some animal longevity experiments Let me say again those researchers who have no interest in the nutrition debate They are researchers interested in regulating inflammation, oxidative stress, and aging It turns out that the nutritional ketone state is a very effective tool The gentleman over here and there Can you comment on polycystic ovary syndrome and insulin resistance And the role played by a low-sugar and high-fat diet I am not an obstetrician The problem is polycystic ovary syndrome and insulin resistance The diagnosis of polycystic ovary syndrome is highly correlated with severe insulin resistance Many times even people do not have those diseases such as obesity, Zhongguang or some other conditions Research in this field is extremely lacking Partly because polycystic disease is related to infertility Reproductive medicine experts will not make money if they recommend a low-sugar diet I don't want to say that But more importantly, from a medical point of view, if someone is on a ketogenic diet If she conceives successfully on a ketogenic diet, if the child has any defects, everyone will blame the diet You know I live in a litigious environment in the United States Any medically unsatisfactory result usually turns into a lawsuit That hinders the development of this field Even so, there is a Dr.

William Yancy who serves at the U.S. Veterans’ Hospital He conducted research with Eric Westman of Duke University William Yancy did a small study on polycystic disease in female veterans He found it difficult to get them to follow the diet But four of them followed this diet for six months Two of them were successfully conceived within these six months Never seen before for such patients Very convincing but But from the perspective of politics, medicine, and law, this is difficult to do I know some doctors or their wives Successful pregnancy And she was born with a healthy child The process is in the nutritional ketone state And my friend and colleague James Wortman at the University of British Columbia His wife Unexpected pregnancy because of her irregular menstrual period It was not discovered until the third month of pregnancy And he loves uploading videos of his daughter Isabel on YouTube Jay is crazy about skiing He also attended Vail’s seminar last year And skiing probably beats everyone, right Ron Jay is probably in his early 60s.

It’s not timid to pursue speed. His six-year-old daughter Isabel We skied together last year At their ski resort in Whistler I lost badly She can do 800 meters vertical downhill on the black diamond slide without stopping The speed is 40 divided by 0.6, which is more than 60 kilometers per hour. She started skiing at 16 months old She has been a low-sugar baby since conception It’s not just an example but it proves the feasibility There are other doctors I don’t point out that Jay mentioned her daughter more publicly We are all proud of our results but Jay is particularly exaggerated This gentleman I wonder if intermittent fasting fits your plan Maybe we can keep this question Because You might not want me to talk about this I have some doubts about intermittent fasting My view is not completely negative but not completely positive Based on science or as much as possible What we have to talk about is where the science goes, not what the concept says I do want to talk about this, let's talk about it next hour The last one and then this one before continuing Thank you Would you like to comment on whether there is evidence that a low-sugar diet can improve fibromyalgia So the problem is low-sugar diet and fibromyalgia Pathological causes of fibromyalgia As far as the information I have read is still unclear But it seems to be related to severe inflammation Potential inflammation I will put some data later About the effect of a well-designed ketogenic diet on the inflammation index of the human body From the perspective of changing the diet, this seems to be a consistent benefit This will prevent inflammation.

We have several cases These people suffer from severe fibromyalgia When other methods don’t work, this seems to be a reasonable and effective recovery method But I can’t guarantee that I can’t tell you what percentage of people will relieve their pain and how many people will not As far as I know, there is no prospective study Sorry I can’t give you a clear answer but I try to be honest about what I don’t know I am not sure how to ask this question But if you have been keto-adapted for several years Will it be serious if you accidentally eat sugar Will your body forget I know it sounds stupid I mean you have avoided sugar for 10 or 15 years does it matter The problem is that if you continue to stay in the nutritional keto state and eat no sugar at all Then you may be careless or Temporarily weak will Maybe you go to the dessert area with two glasses of red wine A small slip Two things for people who continue to be nutritionally ketone You mentioned forget The islets are not ready to cope with the sudden burst of sugar So for the first time you will see a violent (blood sugar) reaction Because you lack the immediate response That kind of reaction is the result of repeatedly challenging the body with carbon water But after two or three days, most people’s reactions will return to a reasonable state So only the first time was more intense But we don’t recommend that people continue to challenge it Because over time you will return to the state of glucose intolerance and insulin resistance For most people You don’t eat everything just like the past one year later I thought I was 18 years old Not like this But this kind of small slip will not have much impact Most of the people who work with us Later I learned that it’s not just a little guilt that makes them uncomfortable They also feel physically uncomfortable after reversing the benefits of being in a nutritional ketone state So our experience is especially for people with weight problems, metabolic syndrome and type 2 diabetes They found that reducing carbohydrate intake to maintain personal tolerance The body will have a good feeling.

The connection between understanding leads to a virtuous circle Over time learning people become self-reinforcing Unlike most dietary "control" You know how to reduce calories, look at the number of scales to reduce It becomes harder and harder over time Our participants told us that we did not twist their handcuffs and asked They say the longer the time the easier Truly self-reinforcing We have met many people who continue to restrict sugar diet for several years And some unexpected life events prevented them from continuing And usually they will come back With more gratitude and firmer conviction Because it’s "Customer Perceived Value" It's not like I told you "Take this medicine, cholesterol will drop, it’s good for you" You don’t feel at all Here is what they feel is good if done correctly If we can train them to perform correctly this will really become a positive self-reinforcing process This doesn’t require extremely strong personality traits As long as you can do this with confidence and have the knowledge to understand that it is not harmful (End of Part One)