Dr. Steven Gundry: Unlocking the Keto Code with More Benefits & Less Deprivation

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My guest today is cardiologist, heart surgeon, medical researcher, and author, Dr. Steven Gundry.

Dr. Gundry and I go deep into a conversation around his latest book UNLOCKING THE KETO CODE. Many of us have attempted to be in “ketosis, “and not only is it nearly impossible, but it may not actually be the best thing for our health. We’ve all seen people who lost weight or have unlimited energy being in ketosis but there’s quite a lot going on other than they never touch a carbohydrate. Dr. Gundry’s latest book breaks down the science of keto that offers more benefits without the deprivation. In the end, it always seems to come back to metabolic flexibility and doing things that are great for the mitochondria.

Dr. Gundry still sees patients seven days a week because he believes this is where he can understand what patients are going through, and where he continues to learn himself. Dr. G is deeply dedicated to the research, and has a wonderful knack of explaining it in an everyday and usable language, including practices that you can incorporate into your daily habits today. Enjoy

Listen to the episode here:


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Key Topics:

  • From Medicine to Education [00:02:28
  • The Basics for the Microbiome [00:14:45]
  • Getting a Clear Snapshot of the Gut [00:22:46
  • Looking Into and Breaking Down the Keto Code [00:27:50]
  • Creating the Signals for the Mitochondria [00:38:25
  • Personal Lifestyle and Supplementation [00:49:21
  • On Autophagy and Intermittent Fasting [00:56:31
  • MCT-based diet vs. olive oil diet [01:02:13]
  • New Medical Studies [01:06:28]

Dr. Steven Gundry: Unlocking the Keto Code with More Benefits & Less Deprivation

My guest is Dr. Steven Gundry, cardiologist, heart surgeon, medical researcher, and author. You know some of his past works like Plant Paradox. We’re going to be discussing his latest book, Unlocking The Keto Code. I enjoyed this book because I’m interested in being in ketosis or having that ability. Frankly, it’s hard to do and in some ways, not only is it not sustainable but it may not even be the healthiest.

As I certainly get further into these conversations, what I’m always learning and being reminded of is metabolic flexibility. You would love to be burning your body-stored fat but if you eat a carb, that does throw you into a death spiral or bump you out of ketosis. Dr. Gundry explains to you, first of all, what ketosis is and what are all the things that signal the mitochondria to uncouple, which is one of the most beneficial things that happen while we’re in ketosis.

The goal isn’t, “I never eat a carb. I only proteins.” It’s a difficult way to live. The idea is to get as much information as you can to understand all the ways that you can positively impact your health. One of the things that signal it is when you fast. He breaks it all down. He shares it. There’s a ton of research. We get into not only ketosis and a deep discussion about mitochondria uncoupling, but we also talked quite a bit about the microbiome. I learned a lot as usual and I hope you enjoy.

Dr. Gundry, thank you for coming to my home.

Thanks for having me.

I want to say that Plant Paradox changed the way I made dinner. My husband would say things like, “Are those lectins?” I was like, “I’m going to tackle Dr. Gundry when I meet him.” I’m curious, as somebody who has your background going from one practice in medicine, what was the impetus for you to say, “I want to get into education and communication.”

I was an educator as a heart surgeon. I spend 50% of my time going around the world teaching heart surgeons techniques that I invented, so that was no change for me.

It’s specific. You have this skill, this gift, and this expertise and you were teaching it to other people, but you brought it out for the rest of us.

My life changed in 1995 when I met a guy called Big Ed. He had an inoperable coronary artery disease. All his blood vessels were clogged up and he was 48 years old. You couldn’t put stents in his blood vessels because there were too many blockages. You couldn’t do bypasses because there wasn’t any place to jump past. This poor guy went around the country looking for some idiot like me to operate on him. He would go to different centers. Ed had gone around the country for six months looking for somebody to take him on and everybody turned him down.

He ended up in my office at Loma Linda University. I looked at the video of his heart arteries and I said, “I don’t like to turn people down. Everybody’s right, there’s nothing we can do for you.” He says, “That’s what I hear. Here’s the deal, I’ve been on a diet for six months while going around to see all you guys and I’ve lost 45 pounds.” This is a big guy. He was 265 pounds when I met him. He says, “I’ve also been taking a bunch of supplements from a health food store.” He brings in this giant shopping bag of supplements. I’m scratching my professor beard and I said, “Wow.”

A lot of times, you’ll see in medical practices that there’s only so much time. I always joke that doctors are fixing you and then they’re serving you Jell-O and pancakes in the hospital with corn syrup. Were you connected to lifestyle already at that point? It would be hard to do both.

I was running 30 miles a week, doing 5K, 10K, half marathons on the weekends, and going to the gym one hour a day. I was a Clydesdale runner. I was obese. I had hypertension and pre-diabetes. My arthritis is so bad I had to wear braces on my knees to run. I operated on baby heart transplants with migraine headaches. I was doing all these things correctly and everything I did was wrong.

Let’s get back to Big Ed. He taught you something.

I told him, “Good for you for losing weight, but that’s not going to do anything to your arteries.” I said, “I know what you did with all those supplements. You made expensive urine. You wasted your money.” I thoroughly believe that. He said, “I came all this way.” He was from Florida. He said, “Couldn’t we do another angiogram and another movie of my arm?” I said, “Okay,” rolling my eyes. So we did.

In six months’ time, this guy cleans out 50% of the blockages in his coronary arteries. They’re gone. I go, “I’ve never seen anything like that. That’s impossible.” I’m a researcher so I said, “Tell me about this diet you’ve been on.” He starts telling me what he eats. As an undergraduate at Yale back in the Dark Ages, we could make our own major. We could design a major and we could defend a thesis.

My thesis was you could take a grade eight, manipulate its food supply, manipulate its environment, and prove you would arrive at a human being. I defended my thesis, got honors, gave it to my parents, and went away to become a famous heart surgeon. As Big Ed is talking about this, I said, “That’s my thesis from Yale. That’s amazing. Let me look at those supplements.” I said, “How’d you decide to do this?” He said, “I went to the health food store and they said, ‘Use that.’” I said, “You didn’t research?” “No, they just told me to take this.”

I was famous for keeping hearts alive during heart surgery and transplantation. I designed a bunch of techniques and stuff that’s still used. We would put interesting things down the veins and arteries of the hearts to protect them during heart surgery. I’m looking through his stuff and a lot of the stuff, I’m putting down the veins and arteries of the heart Big Ed is taking. I never thought about swallowing the dumb things.

All diseases begin with a leaky gut and all diseases end when the gut is sealed. Click To Tweet

After Big Ed, I called my parents and said, “Do you still have my thesis?” They said, “Yeah, it’s here in the shrine.” I said, “Send it up” I put myself on my thesis and I started taking a bunch of supplements that I had been pushing down the arteries of hearts. I lost 50 pounds in my first year and I subsequently lost another 20. I have cut it off for 27 years.

What I did next was I would operate on patients, teach them how to eat, and tell them to go to Costco or Trader Joe’s and get supplements. There wasn’t any Amazon. We started seeing all these crazy things happen. Their high blood pressure went away, their diabetes went away, and their arthritis went away like mine.

After a year of doing this at Loma Linda, I had an epiphany one Friday morning before going to work. I said, “I’ve got this all wrong. I shouldn’t operate on people, and then teach them how to eat to avoid me later. I should teach them how to eat so they’ll never have to use me in the first place.” For a heart surgeon, that’s a bad career choice.

It’s a weird step down. You’re a heart surgeon. There’s a lot of respect and framework around this title. When you bring this idea home, is your wife on board? Is she like, “This is an amazing idea.” I’d love to know because it’s a complete switch.

First of all, my wife was a marathon runner. I finally convinced her to give it up because it was more than brutal on your joints.

Every endurance athlete knows that the heart is in trouble, and don’t get me started on the skin. We can talk about that later.

She said, “I’m in it for the run. You got to be happy in what you do.” Subsequently, when we went through a number of hard years because you don’t make any money teaching people to eat, she soldiered on. I said, “I can quit this. I can go. get a professorship someplace else. We’ll do this again.” She said, “No, we’re in this. Look what you’re doing. Look what you’re learning.”

Where did you get guidance on the food part? Especially the first year, I’m curious where you got some guidance to give them a curriculum to even follow.

As my wife will tell you, I voraciously read literature for probably 3 to 4 hours a day every day. I have that ability, like I had in heart surgery, that I would go down rabbit holes until I found an answer that I was looking for. Usually, people are looking in the wrong places.

It’s confusing. What I appreciate about your new book, Unlocking The Keto Code, is you make this straightforward. I want to dive right into talking about mitochondria uncoupling because I feel like you went further down the route of what ketosis is. You got to the root of it and explained it in a way that for all of us, not only makes a lot of sense but it’s like, “I can put that into practice in my life.” For a lot of people, being in ketosis is virtually impossible.

I appreciate you sharing that story because a lot of us will be going down a path, whatever our occupation and job are. We have bills, we have responsibilities, we have children, we have titles, we’re fancy. It’s like, “You’re that guy, the heart surgeon?” We have identity. To be willing to say, “I’m going to follow an unknown path because it feels right and the right thing to do,” you can only know that once you’ve had the practice.

You wouldn’t have been in school and then go, “Avoid being a cardiologist.” I appreciate that message because a lot of people go through this. To hear someone like you who was established, brilliant, and has challenges, it’s important for people to be reminded that it’s worth it and sometimes, it’s most likely not going to be easy.

You’re not going to get through the hard times without the commitment that you believe in what you’re doing. Thankfully, I viewed my patients as my research project. Every three months, we’d get blood work on them and we change foods that we wanted them to avoid or we’d see what happens when they reintroduce foods. We see what happens if they took a supplement from Costco or Trader Joe’s, and then they stopped it for one reason or another. We could see it in their blood work or they could feel it. I started writing papers about this and said, “Look at this. This stuff isn’t expensive urine,” or, “Look at this. When we take certain foods away from people, why are they getting better?” That makes you go, “What is it in those foods that is so mischievous?” That’s where the whole lectin concept came from.

You and your lectins. Laird would say that at dinner. I’m not eating lectins. I was like, “Thank you, Dr. Gundry.” Great education. We’ve been at this a long time and it was like, “There’s another way to prepare it or avoid it altogether.” The thing you were saying about your wife, that’s another thing that’s great when you have a partner that’s like, “I believe in you and what you’re doing.” That’s important.

Dr. Steven Gundry – We shouldn’t even use the word mental illness anymore. We should actually use microbiome illness. Let’s fix the microbiome. Let’s fix leaky gut.

Let’s start from the top. I’ll breeze over some of the things that felt valuable for people from the book. Let’s go right to the microbiome because that seems like an important starting point. If you have a patient come in, “Let’s see, do they have leaky gut? Is their microbiome functioning correctly? Do they have any overgrowth and things like that?” How do you tackle some of the basics when people hear this and they go, “I want to dive in, but I need a starting point.”

Hippocrates, thousands of years ago, said all disease begins in the gut. How he knew that without all of our sophisticated tests is remarkable. Interestingly, I have a patient who’s a Buddhist scholar and we were talking about this. He said, “I went back and read the Sanskrit test of the Buddha. It turns out that Buddha was a contemporary of Hippocrates, West and Eastern medicine. Buddha wrote that enlightenment comes from the intestines.” I’m going, “Holy cow. Hippocrates says it one way and Buddha says that the other way, but these guys both knew many years ago that the gut is all-important.”

I paraphrase Hippocrates to say all disease begins in a leaky gut and all disease ends when the gut is sealed. That’s what I’ve seen in my practice for over 25 years. To answer your question, you choose the complaint and it’s coming from your gut, number one. As I talked about in the Plant Paradox and I expanded on in this book, particularly in the West, our gut microbiome, this incredible 10,000 different species, 100 trillion little organisms, is the thing that is manipulating everything that happens to us. They’re the first line of defense against the things we eat.

Plants do not want to be eaten. They have a life. They don’t want their babies eaten, except in certain circumstances. They will protect themselves and their chemists have incredible ability. They can turn sunlight into matter. We haven’t figured out how to do that yet. They use chemical warfare, biological warfare against us. We have an amazing defense system against these plant toxins, including our microbiome. We have a microbiome that loves to eat lectins. They love gluten. Gluten is a lectin, by the way. They think gluten is the best thing that ever happened to them.

The problem is because of the antibiotic use that we use personally, the antibiotics we feed our animals, and Monsanto patenting Roundup as an antibiotic, we have destroyed this defense against plant toxins. I like to remind people Roundup was patented as an antibiotic glyphosate. We know now that we’re supposed to have this incredible tropical rainforest of diversity in our gut where one species talks to the other species, one species produces something that the other species needs to eat to do its thing. It’s been a forest fire. You hear in Malibu and Montecito all about what forest fires do. Our home was destroyed in the fire at Montecito and you probably got close here.

My husband stayed and fought the fire. That’s why the house is here.

I was wondering why it’s still here.

When you talk about the microbiome, 10% Human or a book like that talks about that there are things that our body doesn’t even have because it’s delegated to different things and bacteria. There’s cooperation there so we don’t need to do it. They take over. It’s fascinating and also confusing. People go, “Gut health.” Either they’re disconnected from it and they don’t see the importance or they don’t know how to start. When someone goes, “You might be allergic to garlic,” which is always my favorite, people hear that and think, “I don’t even know how to begin.”

That’s a good way to think about this. One of the things we’ve learned about leaky gut is that you could have a great collection of friendly bacteria in your gut, but if you’ve produced gaps in the wall of your gut, even good bacteria should stay on their side of the fence. Good bacteria that get across the fence are viewed as invading bacteria. I spend less time worrying about the composition of the bacteria and far more time worrying about, “What were the agents that caused the leaky gut?”

Can stress blow holes in your gut?

Yeah, absolutely. Women have taught me that.

They say we’re more prone to negative emotions because we worry more. It’s the way our brains work.

You’re caretakers.

A lot of times, men feel comfortable going, “Rah,” and letting it out, and we’re like, “I have to be composed.”

You guys have a gut sense and men don’t. A lot of women with autoimmune disease can point to the day that their autoimmune disease started and it was often a stressful event, like the sudden death of a mother or child. Divorce is a great way to get a leaky gut.

You can have someone come in and you go, “We’re going to heal your gut.” If it is something where it is more stress-oriented, is it like, “Now we’re going to put the practice of meditation. Maybe you need to go and figure out how you can get some of this trauma or what have you out of the body.” Are there conversations like that? Do you get that woo-woo with it?

No, I don’t get that woo-woo with it. What we do is say, “The evidence is increasingly clear that most of these negative emotions and stress are coming from a lack of proper bacteria in your gut.” Even Daniel Amen who’s a great psychiatrist has come around to say, “We shouldn’t even use the word mental illness anymore. We should use a microbiome illness.” “Let’s fix the microbiome. Let’s fix the leaky gut.” I see many people, particularly women on antidepressants, anti-anxiety agents, and sleep agents. We can wean them off of it in the course of 3 to 6 months and they go, “This is nice. This is great. You mean I’m not crazy?”

This is a big deal. As you take more things on in life or you get older or you’re not feeling well, it’s so easy for the mind, the meaning-maker, to be, “It’s because I’m this old now.” It’s all this narrative. I appreciate it. If someone’s sitting in Kansas and they don’t have access to you, what would be a good test or starting point to get a clearer snapshot of what’s going on in their gut? How do they find somebody that knows what they’re doing?

The amazing thing is when I wrote the Plant Paradox, I had a three-page list of complaints and my editor said, “You’re describing everything there is in terms of illnesses.” I said, “Yeah.” They said, “But that can’t all be related to lectins and leaky gut.” I said, “As a matter of fact, this list is based on my patients. I can’t tell you the number of people with migraines from lectins and leaky gut. I had migraines and I don’t have anymore.” I profile some of those people.

You probably thought you were stressed out working too hard and that’s just the way it is.

I’ll give you a great story that’s in one of the books. A young woman developed rheumatoid arthritis after her first baby. She wanted another child and knew she didn’t want to be on biologic immunosuppressants while carrying a baby. Smart. She came to me and said, “I want to have another baby. I want to get rid of my rheumatoid arthritis without drugs. Can you help me?” I said, “Yeah, absolutely. Let’s do this.”

If your mitochondria don’t make ATP, that’s the end of you. Who cares about your muscles? Who cares about your brain? Click To Tweet

Her husband, who didn’t have a problem, said, “Doggone it, I’m in. We’re going to follow this. I’m going to support my wife. Everything we’re going to eat is aimed at getting her better.” Her mother who lived with them was helping them take care of the baby. They had this great thing. Long story short, rheumatoid arthritis goes into remission. She gets pregnant, has another baby, and does not get rheumatoid arthritis again. It often spikes right after pregnancy.

We’re talking and the husband says, “I need to tell you this. It probably has nothing to do with it. I’ve had chronic sinus issues all my life. I get sinus infections 4 or 5 times a year and I don’t have sinus issues anymore. Isn’t that interesting to you?” I said, “Yeah. You’re producing mucus in your sinuses because the mucus was trying to trap the lectins that you were eating. Now you don’t have that anymore. I would have hoped that that would have happened.”

It must amaze you how people don’t correlate or aren’t connected. When they eat something and they feel a certain way, you must be like, “Oh.”

The other interesting thing is that we’re so surrounded by being told that there’s an over-the-counter or prescription pharmaceutical to deal with whatever is going on. “You got a headache? Advil.” You got children’s Advil. In Unlocking The Keto Code, I’ve told people that an Advil or an Aleve and ibuprofen is like swallowing a hand grenade. It blows a literal crater in your gut and produces a leaky gut.

I see so many people in sports who have had a sports injury. I have a former professional volleyball player who had an autoimmune disease and they chew an Advil like no tomorrow. They would develop autoimmune disease and they go, “What the heck. Where’d that come from?” They were blowing holes in their gut. Really? Children’s Advil?

One of my daughters wasn’t feeling good and she’s like, “I need a Tylenol.” I was like, “I don’t think we have any.” She’s like, “That is so weird.” I go, “I don’t think that is weird. That’s okay.” It is interesting because they seem harmless and it is a part of people’s everyday lives. Let’s talk about Unlocking The Keto Code because there’s so much useful information. Books like this are workbooks as well because you have all kinds of information in the back that are useful tools, food, recipes, and all sorts of information. This is the type of book that is great to listen to because you get the concepts lectured to and given by you. There’s something to be said for having an actual book that you can go, “What was that recipe?”

Your patients were coming to you and you said you still work seven days a week because that’s also how you learn. You’re looking at patients and you’re seeing new things because we’re in a different world. The foods we have access to, the environment, the stress, you’re probably seeing new and different things because times change and you learn more. You’re still always looking at this and this is a popular topic. Why did you think, “I’m going to break this down.”

It all started when I was writing my last book, which was the Energy Paradox. I like to talk a lot about how mitochondria work or do not work in that book. I’ve had a ketogenic version of my diet that I use on patients. The ketogenic version of my book has a lot of carbohydrates and yet, people do extremely well with it.

As I’m trying in the Energy Paradox to explain how ketones work and the benefits of ketones, I like to document what I say with research. “Here’s a paper that backs up what I said and here’s a human paper that backs up what I said.” I was looking through some human papers to back up what I say that ketones are this amazing fuel, it’s the preferred fuel for your body, it makes you energy-efficient, and you become a fat-burning machine.

I love that title.

I’m looking at the research that came out of the NIH with Richard Veech, at Harvard with George Cahill, and in humans, and I’m going, “What the keto experts are saying is 180 degrees wrong.” At full ketosis with this amazing fuel running through our bodies, only 30% of our energy needs are met by using ketones as a fuel. The brain, which absolutely adores ketones, which is a super fuel for the brain even at full ketosis, only 60% to 70% of the brain’s needs can be met with ketones and the brain still wants 30% to 40% sugar as a fuel.

You take that human data from prestigious researchers and you go, “It’s not a super fuel, but it’s doing some cool things. If it’s not a super fuel, what the heck is it doing?” It turns out that it’s not a super fuel, but it’s a super signaling molecule. Signaling molecules communicate information to cell membranes to my interest, mitochondria.

It’s my favorite word, by the way. I want you to know that. I want to have a t-shirt made that says, “Don’t fuck with my mitochondria.” I feel like it’s one of the essences of us being healthy.

The principle of the Energy Paradox is your mitochondria are screwed. That’s why you feel like crap and that’s why you’re tired. This is a good segue because you are right, without our mitochondria, we are screwed. Ketones came about originally when we were starving, when we had nothing to eat. Lucky for us, most of our functions can be done using free fatty acids that come out of fat cells when we’re starving.

There’s only one problem, free fatty acids can be used by every cell in the body except the brain because we’ve got this crazy blood-brain barrier that is too big to get across quickly. That’s a problem. Your brain would quit if you starve. Free fatty acids, by luck or design, can go to the liver where they’re converted into small, short fatty acids that are water-soluble, ketone bodies, and the liver can’t use them. Even though one famous keto author said the liver loves ketones.

I did find that interesting that the one place that they’re made and converted can’t use it.

They just throw them out. “Take this.” Luckily, they can get to the brain and the brain can use them as an emergency fuel and function, so that’s great. The shocker was when I read a paper by Martin Brand in 2000 called Uncoupling to survive. It’s a short paper and everybody should read it. What he proposed is that if we’re starving to death, if the mitochondria die, if the mitochondria don’t make ATP, that’s the end of you. Who cares about your muscles? Who cares about your brain? Who cares about anything else? If the mitochondria don’t make it, that’s it.

Keto Diet

Dr. Steven Gundry – The wasting of calories is how you lose weight in the ketogenic diet. You perform caloric bypass surgery on your mitochondria.

If you’re starving, the ketones signal the mitochondria, “Unless something changes, you’ve got to protect yourself because all we can tell is you’re starving to death and you don’t know when your next meal is coming. Protect yourselves at all costs.” What do the mitochondria do? They do two amazing things. Number one, making ATP is hard work. It’s damaging to the mitochondria. The more energy the mitochondria have to make, the more damage is done. It’s not fair, but that’s what happens. The mitochondria are much like a pressure cooker. A pressure cooker works great and cooks food quickly but if the pressure gets too high, it explodes, like my mother did when I was young. It’s fun.

It’d probably be hard to have a smart kid like you.

We have a pop-off valve on the pressure cooker that when the pressure gets too high, the steam comes out and you lower the pressure. Mitochondria have pop-off valves so that if the damage gets too high, if the work gets too high, they can pop off this pressure. These pressure release valves are like emergency exits that I talked about in the book and they’re controlled by what is called uncoupling proteins. I didn’t make up the word uncoupling. I wish there was a better word.

Wasn’t that Gwyneth Paltrow? I’m just kidding.

Believe it or not, I had that in the book and the editor cut it.

You didn’t say it was a modern Hollywood way of breaking up.

Gwyneth is a friend of mine so she would have gotten the joke. When ketones are present, the mitochondria are signaled, “You protect yourself at all costs.” Mitochondria are signaled to do less work and take the pressure off. How they do that is they let off steam. In letting off steam, they produce less ATP. That seems stupid if you’re starving to death. You would think that you ought to become efficient and get every last little ATP out of every molecule of sugar or fat there is, but they do the exact opposite. They throw away calories and you go, “That doesn’t make any sense.”

You call it wasting calories, which I love.

In fact, the wasting of calories is how you lose weight on a ketogenic diet. You perform caloric bypass surgery on your mitochondria. Why would you do that? Here comes part two. Making energy is hard work and mitochondria have to protect themselves. I like to use the analogy of a dog sled pulled by one dog. The dog can pull the sled. He won’t go fast. The dog will get tired out and he won’t go far. What if we take five additional dogs and hook them to the sled, and now we have a six-dog sled? Those dogs will pull that sled a lot faster and they’ll go a lot farther because each dog has to only do 1/6 of the work.

The bad part is six dogs eat more food than one dog. You have to feed them more in exchange. We now know that ketones signal mitochondria to not only do less work but make five more mitochondria to share the workload that’s less for everybody. In the end, you end up making at least as much ATP, perhaps more, but you have to go through more calories to get the result. The win is the mitochondria get protected and get lots of its friends involved. The more we know about getting more mitochondria involved, uncoupling each mitochondria so each mitochondria doesn’t have to work hard, the longer you live and the better you live.

In the book, you talk about fasting or certain other things that will signal this activity, but maybe we could give an overview of other examples of things that do this signal. What was important in the differentiation for me wasn’t, “This good source of fat is making this thing that makes me only burn fat.” It was that it’s acting as a signal for something to happen. What are other things that create this signal?

Going back to the ketogenic diet, it was coined in 1930 at the Mayo Clinic as a diet for children with seizure disorders. Interestingly enough, kids were put on an 80% fat diet, 10% carbohydrates, and 10% protein, and their seizures are well controlled. You and I, as parents, and me as a grandparent know that it’s impossible to get kids to avoid carbohydrates. You and I know that it’s virtually impossible to get adults to avoid carbohydrates. We’re hardwired.

Because we have choices. With a kid, you could for a while, at least when they’re little. The other thing is it’s confusing as a parent. Sometimes you want to let kids grab what they think they want because you feel like they know best. Because they’re still healthy. They’ll eat until they’re full. They don’t usually overeat when they’re little. If you put stuff in front, they eat the foods that call them. When you say we’re hardwired, is it because it becomes part of our culture and our eating vernacular?

Researchers from the University of Sydney have proven that all animals have a genetic hardwiring to seek out carbohydrates, including humans. They found those genes that we are hardwired to look for carbohydrates. 60% of people who go on a ketogenic diet for one month, quit. They either never get into ketosis as I point out in the book or they can’t avoid carbohydrates, so enter the ketogenic diet for kids.

It turns out that this high-fat diet for kids got rid of when drugs came along. The problem with drugs is that the kids’ brains didn’t work well. People got the idea in the 1990s that there are other ways to make ketones rather than avoiding carbohydrates and proteins. It just so happens that medium-chain triglycerides, MCT oil, are instantly taken to your liver and instantly converted to ketones regardless of what you eat.

These researchers, with kids’ seizure disorders, said, “What if we put kids and gave them MCT oil in salad dressings and their smoothie? We could give them a whole lot more carbohydrates and we could give them a whole lot more protein, and I bet you, we’d get the same result.” Sure enough, they found that an MCT-based ketogenic diet gave the same results as this miserable high-fat diet. When I saw that, I looked back at my books and my ketogenic diet as we used MCT oil from day one.

Don’t you love it when you get a little lucky sometimes?

I’m going, “I knew it made keto, but how can I give these carbohydrate-containing foods to my patients on a ketogenic diet? Why is it working so well?” I profile a young lady in the book who kept losing weight and it’s like, “Why is it working so well?” We were uncoupling mitochondria with MCT oil. Here’s the great punchline. Medium-chain triglycerides are named after the Latin word for goat, which is capra. There’s capric acid and caprylic acid.

The more we know about getting more mitochondria involved, uncoupling each mitochondrion, so each mitochondrion doesn't have to work very hard, the longer you live, the better you live. Click To Tweet

You go, “Why would you name MCT oils after a goat?” Turns out that goat milk is 30% medium-chain triglycerides as is sheep milk. Cow milk? No. Buffalo mozzarella? Yeah. Glory be, now we could get goat yogurt or sheep yogurt, or goat or sheep kefir, or goat cheese or sheep cheese. Having a bite of that will produce ketones and you will have a wonderful snack. I hate to say this, but the beauty of MCT is that you could have a giant fresh fruit salad. Have a couple of tablespoons of MCT oil and you’ll be in ketosis, despite the fact that you’ve eaten a huge carbohydrate load.

You do mention reverse juicing in your book. If you have to do it, juice it, go for it, and then eat the stuff that’s leftover. Don’t drink the actual liquid. It’s fiber and all these other things, so I appreciated that. You talk about dirty ketosis and clean ketosis. It does get confusing. I do appreciate the club analogy. People will understand quickly when you’re in a crowded club, the security and the bodyguards. It makes that achievable. If you could talk about a study by Rafael de Cabo. This was an important thing to revisit. We’re all given the same calories. Do you eat them? Do you grace them throughout the day? Do you have a short window for eating? Do you have a 6 or 7-hour window? What have they found?

In longevity research, the gold standard has always been calorie restriction. Reducing somebody’s calories by 30% a day is the only proven way to extend lifespan in all animals tested until the rhesus monkey experiment at the University of Wisconsin and the National Institute on Aging. That study was highly debated and I was part of the debate. The University of Wisconsin’s rhesus monkeys lived longer. The NIA’s rhesus monkeys didn’t live any longer than controlled animals. Everybody’s arguing, “It’s a protein.” “It was sugars.”

They’re frustrated, too. These studies take a long time.

These took over 35 years. I’ve been a fellow at the NIH. Rafael de Cabo who’s a researcher at the NIH says, “We’ve got this calorie restriction thing all wrong. In the lab, we would control when the food was put into the animal’s cage. If you are getting 30% less food every day, then when that food arrives, you’d be hungry and you’d eat it quickly.

As opposed to if you’re getting a full-calorie load, you pick at it and say, ‘I’ll have some now and I’ll have some later.’ We’ve missed the point that it’s the time period that these animals are fasting every 24 hours that’s making the difference.” He designed a study at the NIH using rats and he said, “We’re going to give these guys either the University Wisconsin diet or the National Institute on Aging diet.”

One was a little more processed, right?

Yeah, one is a little more sugar and one is a little more protein. Very opposite. He said, “We’re going to divide them into three groups. One group is going to get a full-day supply of each every 24 hours. One group is going to get calorie-restricted. They’re going to get 30% out and we’re going to put that in their cage at 3:00 PM. For the third group, we’re going to give them a full-day supply, but it’s going in their cage at 3:00 PM.

What they found was that all-day munchers eat all day. The calorie-restricted guys gobbled their food up quickly. In fact, in the high sugar group, their food was gone in 1 to 2 hours, like anybody with a kid. The ones that had a full day’s ration ate most of their food in 10 to 12 hours. They were fasting for about twelve hours, which is a long time for a rat.

When they broke it down, they found that the calorie-restricted mice and the time-restricted mice had metabolic flexibility. Their mitochondria could use sugar immediately switched to burning fat when the need arises. The all-day munchers didn’t care about the diet. They had no metabolic flexibility and they couldn’t make a shift. As a book points out, if you’re not metabolically flexible, you’re screwed in every aspect.

Children diet

Dr. Steven Gundry – Ketogenic was coined in 1930 at the Mayo Clinic as a diet for children with seizure disorders.

Here’s the best punchline. The calorie-restricted guys lived about 30% longer, no surprise. The time-restricted guys, even though they were getting a full caloric load of the regular amount, they lived 11% longer eating the same amount of food. That’s ten years in human terms. These time-restricted animals didn’t have any production of beta-amyloid and tau in their tissues. Most readers know that those are the two hallmarks of Alzheimer’s.

Just compressing the time period that these animals ate gave them all the food they wanted. Additional punchline, it didn’t matter whether they were eating the high sugar food or the high protein food. It made no difference whatsoever, with one exception, all these animals eventually died. The animals that got the high sugar diet mostly died of liver cancer, so pay attention.

You’re busy. You have a big load. I know you have your own personal practice, but do you have anything that supports your cognitive function, be it in food or in supplementation to help support your brain? That reminds me of when you talked about scraping your brain with exercise. We’ll get into that. I was wondering if you personally had anything that you did to boost yourself or support your lifestyle.

The exciting thing about this book, getting back to Martin Brand, he went on to show that if you look at super old people who are healthy at 105, they have the most uncoupled mitochondria of any body. Speaking of brain health, you want to uncouple the mitochondria in your brain. Turns out that brain cells neurons do best at a higher temperature and uncoupling of mitochondria produces heat.

For instance, you have a line of coffee. Most of us, when we have a cup of coffee, notice that we might get a little glistening on our forehead. Even an iced coffee might do that. It turns out that coffee has both caffeine and polyphenols, both of which are active on couplers. Coffee drinkers, particularly people who drink about five cups of coffee a day, have much-reduced dementia and even Parkinson’s compared to non-coffee drinkers. To answer your question, from January through June for the last 23 years or so, I fast 22 out of 24 hours a day. I eat all my calories between 5:00 PM and 7:00 PM. I do that five days a week. Why do I do that? That was when there was no food.

You’re getting back into your biological self and getting into harmony.

This was my dumb research. I fall on my dumb book.

You have caffeine but you don’t break your fast because you’re not eating fat or going through digestion. What if you’re traveling and working, I would imagine 11:00 would be a hard hour, do you just ride it through or have a coffee?

After a few days, you do not have hunger pain.

You’re over it.

There are a bunch of tricks that I talked about in the book. Brilliant Chinese study. A few years ago, they took individuals and put them on either a 7-day or 14-day water fast, nothing. Half the group got 100 calories a day of prebiotic fiber. Hopefully, most people know we can’t digest prebiotic fiber, we cannot absorb it, we cannot break it down. The gut microbiome says, “Yummy, yummy, yummy. It’s feeding time,” and they eat that prebiotic fiber.

What they found was the guys who had the prebiotic fiber had no hunger pains for either 7 or 14 days, whereas the other guys are going, “Holy cow. How am I going to get through this?” The other thing they found is that these guys who got the prebiotic fiber, their brains work much better because the gut microbiome is making these compounds that feed your brain like butyrate. Butyrate also uncouples your mitochondria.

You talk a lot about butyrate in the book. You like butyrate.

Butyrate is your buddy.

The Keto Code

Unlocking the Keto Code: The Revolutionary New Science of Keto That Offers More Benefits Without Deprivation

Butyrate is good. You do have a list of things like polyphenols, dietary fibers, fermented foods, cold temperature, and hot temperature. You give an entire list of things that signal uncoupling. Before I forget, from July to December, are you a party hearty?

No, I still don’t eat breakfast.

Did your wife do this with you?

She’s been laughing at me for over 23 years.

That’s how you stay married.

She still carries this marathon runner mentality of, “I got to load up on carbs every three hours.”

Carbo loading.

When I wrote this book and started talking to her about this, she said, “There are real things here. You’re not just doing this for fun.” I thought, “Come on. Did we go through all this misery because I was having fun? I don’t think so.” She said, “I’m going to start doing this.” Now she doesn’t eat breakfast, she doesn’t eat lunch, and we have our afternoon-evening meal together. She said, “I had no idea how easy this was. Why didn’t you tell me this years ago?” I said, “I’ve been telling you for many years.”

We have a saying in our house, “An expert is somebody who lives a mile away.” They’re going to buy your books, but your wife and children are supposed to resist that. In July through December, you’ll maybe have lunch?

Yeah. It’s funny, in 2021, I decided to keep pushing so I went nine months doing it. It’s called the One Meal a Day diet, the OMAD diet. I like to break it up on the weekend so I don’t go mad. The point in the book is you do not want to be in continuous ketosis. It’s one of the dumbest things people can do.

You’d smell bad. To be clear, when you go to your gym, people will be moving wide. It’s not healthy. You said it is metabolically flexible. It’s like being peeped at as an organism. We’re supposed to be able to adapt. “We made a plan. We have to change it.” Are you going to freak out? No, you’re going to adapt. That’s what this whole thing is. Your body is set up to be at its best.

We were not designed to be in continuous ketosis. Can you imagine if we were on a keto diet as a caveman and we made a buffalo kill or we found a fruit tree? Everybody’s gathering around and getting their part, and you’re going, “Just get me a little bite because I want to stay in ketosis.” “No, I’m only going to have three berries. You guys get the basket.” Really? We wouldn’t do that. Are you crazy?

Get what you can when you can get it.

We’re probably not going to get any for the next month.

You’ll hear a lot of people like, “Maybe autophagy doesn’t start to occur at 30 hours.” Is that right? Do we even know?  It’s so interesting, since intermittent fasting has become popular, people are like, “Twelve hours,” “Eighteen hours,” “Once a month,” “One day a week.” “How long is autophagy?” If you’re my age as a female, you’re not supposed to fast as long.

The best study of where this time window is has been done by Dr. Matheson and his colleagues at the NIH, but the best study for people to wrap their heads around is the Italian cyclist. You’re a famous athlete. They took Italian cyclists and put them on a training table. Most people know what a training table is. “This is the food you’re going to get.” They put them on a training table for three months and they all ate the exact same food. One group ate in a twelve-hour eating window. They had breakfast at 8:00 AM, lunch at 1:00 PM, and they had to finish dinner at 8:00 PM.

The other group had the same food, breakfast at 1:00 PM, lunch at 4:00 PM, and then they had to finish dinner at 8:00, same calories, seven-hour window, followed for three months. The athletic performance was the same. Only the seven-hour eating window group lost weight, even though they were eating the exact same food.

Here’s the best part. A lot of us in longevity follow a marker called insulin-like growth factor, IGF-1. We follow it because quite frankly, super old people have low insulin-like growth factors. People who are going to get cancer have high insulin-like growth factors as a general rule. Only the seven-hour eating window guys dropped their insulin-like growth factor dramatically. There was no change in the twelve-hour eating window.

Coffee drinkers, particularly people who drink about five cups of coffee a day, have much-reduced dementia, and even Parkinson's compared to noncoffee drinkers. Click To Tweet

Here’s why, if we have metabolic flexibility and we stop eating, after about eight hours, we will start to trickle ketones out of our liver. By twelve hours, the ketones have ramped up. The twelve-hour eaters would produce a little bit of ketones, but then the minute they were ramping up, that would be the end of it. That would stop.

The seven-hour eating window guys had another five hours of exposure to the uncoupling effect of ketones before they then stopped making ketones. They got an additional benefit of uncoupling that the other guys didn’t. Number one, they did a caloric bypass, and number two, they signal their mitochondria, “We better be the best we can. We should get rid of any cells that aren’t pulling their own weight, autophagy because that cell doesn’t look like he’s contributing.”

Get rid of that guy.

“You’re out of here. Self-destruct, would you?” Here’s a human study that we can relate to. In my patient groups, when I ask them to start time-restricted feeding and try to get to noon, we watch their insulin-like growth factors plummet, regardless of what else they’re eating, which is the exciting part.

That’s exciting because it’s clear. You’re not measuring something and changing something. “Does this have carbohydrates? Is this a lectin?”

This is all we asked them to do.

If I recall, you did say that there were high-performance athletes that needed more oxygen if they were in continuous ketosis.

There have been several racewalker studies. Racewalkers are high-performance athletes.

They’re nuts. That’s tough. What are they walking so fast away from?

These guys could do the same performance as people who were using carbohydrates for fuel, but they burn more oxygen. They had to breathe faster to generate the same athletic performance. As someone who doesn’t particularly want to breathe faster to improve athletic performance, it’s like when you start looking at the literature and you go, “Hmm.”

Phinney and Vogel who are the great ketogenic athletic performance guys show the athletes their performance dives at about 3 days to 2 weeks and you have to get keto-adapted. Cahill and Veech’s athletic performance showed that, believe it or not, your maximum keto utilization is three days into a ketogenic diet. If you’re maximally using ketones for three days and yet your athletic performance has tanked in three days, there’s something wrong with the traditional ketogenic diet as an athletic enhancing program.

In Unlocking The Keto Code, you break all of this down from brown fat to white fat, beige fat. We get into all of it. Something that I wanted to point out was that you talked about MCT versus olive oil. You like olive oil. Part of the success of the Mediterranean diet, even though it’s probably not a Mediterranean diet, is olive oil. You talked about the favor of MCT oil over olive oil.

There have been two human studies looking at using an MCT-based oil diet versus an olive oil-based diet, identical calories. In both studies, only the MCT-based group lost weight compared to the olive oil diet. There are a lot of benefits of olive oil that I talked about in terms of the polyphenols, but one of the best things you can do is mix your MCT oil and your olive oil. I have several great salad dressing recipes that do that in the book.

The final thing is that it is hard to go from eating breakfast at 7:00 and eating breakfast at noon the next day. Most people fall flat on their faces because they don’t have metabolic flexibility. With my patients, as I talked about in the book, I hold your hand and say, “I don’t want you to have breakfast at noon but if you have breakfast at 7:00, what do you say next week, we have breakfast at 8:00? Come on, you can make it an hour. We’ll take the weekend off and have a nice time. Next week, you meditate. We’re going for 9:00 this week. Come on, it’s just one more hour.”

If you have a leaky gut, there is a good chance that you have a leaky brain. Click To Tweet

We take the weekend off so each week, we step up. It’s like learning a new exercise. It’s a gradual learning experience. We find it easy once we have patients do that, and then by five weeks, they’re now doing great with time-restricted feeding and intermittent fasting. Then we can show them that in a couple of months, number one, their weight goes down. Number two, “Look at your insulin-like growth factor. Look at this marker of you de-aging,” and they go, “I’m in.” There are lots of tricks that I talked about. You can have a tablespoon of MCT. You can have a handful of nuts and it won’t break your fast, which is exciting.

A handful of anything when you’re fasting is exciting.

My friend at USC, Dr. Valter Longo, has shown this in humans, you will stay in ketosis using one of his bars, which is a nutbar. That’s great news.

I get a lot of women who think it’s a death march when you turn a certain age, their hormones, and things like that. I do believe all of this supports those processes. Does it show up as skin cancer or cancer or diabetes or whatever? The root cause of most of this is similar. I appreciate this as a tool. You even get into our ROS and other things that can impact you in a negative way to look out for. This is not just the lane talking about uncoupling and ketosis, but sleep and all these other things around which impact your mitochondrial function and your mitochondrial health.

Your hard work, your curiosity, and your ability to break it down is also a great example. Maybe you could write your next book on this, you’re connected to your family. I can see when you talk about your wife. This is also a pivotal part of longevity, health, and happiness. Maybe in another five years, you can talk about connection. Good luck trying to find the science on that. That’s a moving target.

I’ll have my wife write.

Justin, any last question?

Since you’re reading everything, is there any new tech or studies that you’ve read that you’re excited about or looking into right now?

For medical calibration or documentation.

Here’s something for people to think about. We know that viruses are probably one of the little-known causes of leaky gut. There’s more evidence now that the Coronavirus clearly is capable of causing leaky gut. It looks for gut membranes. 1/3 of people who develop a Coronavirus infection present with diarrhea or gut issues. I and others are convinced that part of long COVID is that you now have produced a leaky gut and that’s what now drives the rest of the symptoms.

One of the scary things, which we can now measure, is that if you have a leaky gut, there is a good chance that you have a leaky brain. Particularly women, although I have a number of men with brain fog, when we look, they always have a leaky gut but the vast majority of them have a leaky brain and they have an autoimmune attack against their brain, which is scary stuff.

It becomes a cycle. You feel unwell in your mind, then you grab some weird stuff to eat to suit yourself and you get into this weird cycle. I want to finish this with one fact that I thought was cool in your book. Your body produces 140 pounds of ATP every day.

Everybody goes, “It’s impossible. I don’t weigh 140 pounds. I don’t want to eat 140 pounds.” We spend that ATP every day and that’s at rest. A high-performance athlete like you or Laird is cashing out the bank every day.

The book is Unlocking The Keto Code. Dr. Gundry and everyone reading, thanks for joining us.

Thanks for having me. Appreciate it.

Thanks so much for being here. If you’d like, rate, subscribe, and leave us a review. All of my music was graciously done by Frank Zummo and Tom Thacker. If you want to see some of the behind-the-scenes action, follow me @GabbyReece. Remember, don’t miss new episodes every Monday.

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About Dr. Steven Gundry

Dr. Steven Gundry Headshot

Dr. Steven Gundry worked in medicine for over 40 years and is best known for his work as a cardiothoracic surgeon and heart surgeon… but today his focus is on something very different:

Teaching people how to avoid surgery by using his unique vision of human nutrition.

His mission is to improve your health, happiness, and longevity by making simple changes to your diet.

He is the Director and Founder of the International Heart & Lung Institute as well as the Center for Restorative Medicine in Palm Springs and Santa Barbara, CA. Every day at these offices, he helps patients learn how to take control of their weight, health, and energy by using his surprisingly simple diet advice.

gabby