Episode 20: Ketogenic Diets with Terry Wahls and Paul Jaminet

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Episode 20 of the Phoenix Helix Podcast: Ketogenic Diets with Terry Wahls and Paul Jaminet

The Ketosis Controversy: Is It Healing or Harmful?

Ketogenic diets are an ongoing source of debate in the paleo community. Some people say they are the cure for all ills. Others say they are dangerous and should be avoided. Today, we hear from two experts, to discuss the pros and cons. Are all ketogenic diets alike? What does the science really say? Who can benefit most from ketosis? And what are the cautions? We take a balanced, educated look, so you can decide if it’s right for you.

Episode 20 of the Phoenix Helix Podcast: Ketogenic Diets with Terry Wahls and Paul Jaminet

Listen to the Show

There are three ways to listen:

  1. You can subscribe to my podcast through iTunes.
  2. You can listen through Stitcher.
  3. You can also listen to the episode right here through the play bar at the bottom of this post. If you subscribe to my blog by email, you’ll got notified of future episodes.

Show Notes

  • Intro (0:00)
  • Meet Our Guests (0:51)
    • Dr. Terry Wahls is a physician and author of The Wahls Protocol. She follows a ketogenic diet herself to reverse multiple sclerosis. To learn more about Terry and The Wahls Protocol, listen to Episode 7 of this podcast.
    • Dr. Paul Jaminet is a scientist and author of The Perfect Health Diet. A negative experience with a ketogenic diet let him to be a safe starch advocate in the paleo community. To learn more about Paul and The Perfect Health Diet, listen to Episode 12 of this podcast.
  • What is Ketosis (2:01)
    • Ketones are small molecules that can be made from fatty acids or amino acids. They’re unique calorie sources because they don’t need a mode of transport. They are small enough to pass through cell membranes on their own, including into the brain. In certain conditions, they are the preferred fuel source for the brain.
    • A low-carb diet is NOT the same thing as a ketogenic diet. Most people have to “work” at being in ketosis. It rarely happens accidentally. The one exception is insulin-dependent diabetics who can slip into ketosis.
  • Standard vs. MCT Ketogenic Diets (5:54)
    • MCT = Medium Chain Triglycerides that are found in coconut oil and MCT oil. You can get more ketones from these types of fats, and it allows for a higher carbohydrate intake while still maintaining ketosis. This means you can eat more vegetables and receive their beneficial fiber, resistant starch, and nutrients. A standard ketogenic diet relies on dairy for the fats and usually only allows for about 25 grams of carbs, whereas an MCT ketogenic diet allows for 60-100 grams of carbs, depending on the person.
    • Wahls Paleo Plus is the MCT ketogenic diet that Terry herself follows. She emphasizes nutrient-density through a wide variety of non-starchy vegetables and organ meats during the week. The amount of protein and carbs a person can eat while maintaining ketosis varies.
    • The Perfect Health Diet also includes an MCT ketogenic diet option. It’s similar to Terry’s program, but emphasizes the inclusion of some starchy vegetables, prepared in a way to promote their resistant starch content (cooking, cooling and reheating).
    • Both Terry & Paul emphasize that all types of ketogenic diets require focus to avoid nutrient deficiencies, and supplementation may be required.
  • What Does the Scientific Literature Say? (15:18)
    • The ketogenic diet entered clinical use around 1920 for epilepsy, where it was found to stop seizures. They didn’t consider factors beyond that and paid no attention to nutrition. For that reason, there are lots of recorded side effects that are a direct result of malnutrition: stunted growth in children, kidney stones, muscle wasting, weak bones, etc.
    • The idea of developing a nutrient-dense MCT ketogenic diet is relatively new, and most studies don’t use this type of diet. In fact, some of the studies don’t even use real food, but rather bottled formula.
    • Paul’s blog post critiquing the nutrition of the scientific studies.
    • Paul has received testimonials from people who implemented his ketogenic diet successfully for NBIA disorder, migraines, bipolar disorder, and epilepsy.
    • Current scientific studies are looking into ketosis as a therapy for Parkinson’s disease, Alzheimer’s, Huntington’s, ALS, and cancer. It’s too soon for results, and Terry doesn’t know which (if any) are using MCT versions of the diet.
    • Terry herself is conducting clinical trials into the effectiveness of the Wahls Paleo Plus diet on MS. Early results have surprised her: people benefit just as much from Wahls Paleo (the non-ketogenic version) as they do Wahls Paleo Plus (the ketogenic version of her diet).
    • Terry has received testimonials from people who have benefited from ketogenic diets for cancer; it seems to mediate the side effects of chemotherapy and radiation treatments.
  • Who Might Benefit from a Ketogenic Diet? (26:22)
    • Terry:
      • Any metastatic cancer.
      • Progressive neurodegenerative disorders, such as ALS.
      • Any other neurological condition that doesn’t respond to her regular Wahls Paleo diet. In this circumstance, she recommends intermittent ketosis (a few months in and a few months out). This is what she is now doing herself. Prior to this, she had been in ketosis for 2 solid years.
      • She recommends people look at their ethnic background, and how long their ancestors experienced winter. Experiment with ketosis for that length of time only, and if your ancestors didn’t experience winter, this might not be the diet for you. Even the Inuit go out of ketosis 2 months each year.
    • Paul:
      • Any neurological condition, such as NBIA, epilepsy, ALS, Parkinson’s, migraines, mental illness, and brain cancer.
      • Other forms of cancer during chemotherapy only, with the caveat that they should go out of ketosis once treatment is complete.
      • He believes a ketogenic diet is better as a diagnostic tool rather than a continuous treatment, and you might be able to transition to a less stringent protocol (like the regular Perfect Health Diet) and receive the same benefits.
  • Who Would You Warn Against a Ketogenic Diet?
    • Paul:
      • Everyone else.
      • He believes a ketogenic diet is more likely to cause autoimmune disease than cure it, due to the depletion of the mucus layer of the intestine, which puts bacteria directly into contact with immune cells. (Carbohydrates are necessary to maintain this protective mucus layer.) For example, there’s a theory that connects a bacterial infection with a low carb-diet and high mammalian meat consumption, leading to Hashimoto’s.
      • When Paul first went paleo, he experimented with a standard ketogenic diet, with no attention to nutrition. After 18 months, he actually developed scurvy, along with other health problems.
    • Terry:
      • She doesn’t recommend a ketogenic diet to be the first troubleshooting step for people with autoimmune disease (nor an elimination diet like the AIP for that matter). If people don’t see results on regular Wahls Paleo, she recommends functional medicine assessment. Her bias is to preserve as much diversity of food as possible, since nutrient deficiencies lead to disease.
      • However, she recommends everyone eat a low-glycemic diet.
  • How To Implement a Ketogenic Diet (46:20)
    • Terry recommends people spend 2-4 weeks at each level of her diet, before moving up to ketosis (which is level 3). This mitigates side effects from transitioning too quickly.
    • Similarly, Paul recommends doing the standard Perfect Health Diet first, before transitioning to the ketogenic version of his diet. This gives people a chance to see if they improve on the regular version without a need for ketosis. It also gives them experience with intermittent fasting (IF), and if someone has challenges with IF, they shouldn’t do ketosis.
    • Measure your ketones daily, to ensure you stay in ketosis and discover your personal carbohydrate tolerance: Urine Ketone Strips or Blood Ketone Strips and accompanying Monitor.
    • Watch out for negative symptoms.
  • Final Words of Wisdom (56:20)
    • Terry: “Hail to the Kale.” Include fiber and resistant starch in your diet through raw vegetables or cooked/reheated starches. We need to feed our microbiome as well as ourselves.
    • Paul: Gut bacteria produce short chain fatty acids that help generate ketones, so it’s mutually beneficial to feed them.
  • Outro (58:00)

Spreading the Word

If you like the podcast, please leave a positive review in iTunes or Stitcher. It would mean the world to me, and also helps others find the podcast and learn about their potential for healing.

Listen to the Show

There are three ways to listen:

  1. You can subscribe to my podcast through iTunes.
  2. You can listen through Stitcher.
  3. You can also listen to the episode right here through the play bar at the bottom of this post. If you subscribe to my blog by email, you’ll got notified of future episodes.
  Have you checked out my books?   Books By Eileen Laird | Phoenix Helix

39 thoughts on “Episode 20: Ketogenic Diets with Terry Wahls and Paul Jaminet

  1. Pingback: Episode 20: Ketogenic Diets with Terry Wahls and Paul Jaminet | Paleo Digest

  2. Eileen – I’m a late bloomer when it comes to podcasts, but you are directly responsible for converting me. Thank you.

    I loved this session with Paul and Terry. I am now committed to going back and listening to both their original sessions with you. REALLY interesting stuff.

    Cheers Possum!

    • Yay! I love the written word, but I also love podcasts, because I can listen to them in the car or while doing chores. It’s a time-saving way to learn something new. It’s especially fun being host (also a lot of work, but worth it.) 🙂

  3. I heard Terry Wahls say that she drinks about a can an a half of coconut milk each day. I have been drinking canned coconut milk as well. Over time it has become less palatable and some brands have a bitter after taste. I was wondering if there is anything in particular that she does to deal with this issue.

    • My recommendation is to start incorporating the coconut milk into recipes, instead of drinking it straight-up. Terry herself has a coconut milk green smoothie every morning. I have a recipe for Coconut Creamed Collards and Shrimp Coconut Curry (you could increase the coconut milk in both recipes). Also avoid the bitter brands – they’re likely leaching something from the can that’s not good for you. My favorite brand is Aroy-D.

  4. How do I stay in ketosis all day, or is it only after starving for 6-8 hours.I have been doing paleo + for 6 weeks and lost no weight?

    • Leanne, ketosis and paleo are two very different things, and like the guests in this podcast say, you have to work at being in ketosis and measure your ketones to makes sure you’re there. There are links above to Terry and Paul’s books. Either one would be a good place to start. Read their chapters on ketosis thoroughly, and follow the steps they outline.

    • Whenever you eat you will lower your ketone body level so you could theoretically drop out of ketosis. Do not worry about it though. I just measure my ketones every morning and do not fret over it. I do find that fasting helps me get into ketosis though.
      When not fasting I do find it helps to consume tons of fat. I eat about 24 – tablespoons of coconut oil, butter, lard, avocado oil and olive oil daily plus I eat fatty proteins.
      Also, I find that dairy other than butter causes me to gain weight so that may be something you want to play around with. (Correction: I have incorporated a cup of home made kefir into my daily diet which has not affected my weight).
      Relax and enjoy… You will love Nutritional Ketosis.

  5. Hi Eileen,

    I am thinking about doing a LCHF paleo style diet without going into ketosis. The thing is that I am really skinny, 5’10/119lbs! So I think I need to at least eat 3000 k cals a day. I am thinking about having my macro as 75% from fat/10% from protein/15% from safe carbs so eating about 250g fat/80protein/110carbs. I will be getting my carbs from sweet potatoes, green veggies and berries. Of course all organic. Does this sound reasonable? I am asking because I’ve heard that high fat without being in ketosis can be harmful or even with a moderate carb intake?

  6. Question!

    I am a marathon runner. I also swim and occasionally lift weights. Am I correct in thinking that the ketogenic version of the Wahls diet is unfeasible for a person with such high energy demands? I want to achieve mental clarity, reduce anxiety and depression, and improve my sleep quality.

    Greg

  7. Pingback: Community Update - June '15 - Autoimmune Paleo

  8. It’s glucose that’s necessary to a mucus layer in the body. The body makes glucose. All these safe-starch people strike me as people trying to make excuses for continuing to have large amounts of carbohydrate in their bodies. I would respect it more if they would just say “I don’t feel like giving up starch, so I’m continuing to eat it, and so far it doesn’t seem to be negatively affecting me.” Personally I can’t eat a lot of starch. It causes weight gain and other issues. Doesn’t matter where it’s from. I ate a lot of whole-food starch back in the mid-aughts and I got faaaaat. I have zero problems with mucus when I’m in ketosis. And I don’t have to work that hard at getting into it, either. Different bodies, different results.

    • Dana, thanks for sharing your positive experience with ketosis. Terry Wahls does well with it, too. That said, your comment is very judgmental, which I find interesting given your closing sentence: “Different bodies, different results.” Can you find room to consider that what works and doesn’t work for you might be very different from what works and doesn’t work for others? I personally know people who need starch to stay healthy, and they have literally the opposite experience as you. There is no right answer for everyone, which isn’t surprising given how diverse the human race is.

  9. Hello ! I am so very grateful for this site.
    I have a family history of AI disease and have recently been diagnosed with Lupus and Ankolysing Spondylitus. Compared to my father who suffered too terribly with AS I am doing pretty well. Although my one hip is slowly packing up, I have few arthritic flares and seldom are they so painful that I am in bed for more than a day or two ( at my age my father was almost completely incapacitated with pain and a loss of mobility). My one constant complaint, however, is fatigue. I wake up very tired and find anything other than very mild exercise exhausting. I remain convinced that my good progress ( and improved mental health) is due to my more conscious diet – a lot of fresh fruit, fresh vegetables and home grown game meat. I do crave dark chocolate,nuts and grains ( particularly pasta ) and sometimes indulge in these as well as oatcakes with hummus or cheese . Perhaps trying to eat resistant starch will help me improve even further and give me the energy to exercise more often ? Any ideas are welcome. Thank you

    • Jacquie, I recommend trying the paleo diet if you want to improve your symptoms, including the fatigue. And for AS specifically, starch tends to be an inflammation trigger (and that includes not only resistant starch but all grains and definitely pasta). Here are 2 success stories you might find informational and inspiring: Charles’ Story (AS) and Robyn’s Story (Lupus).

  10. It is me again. I am concerned about my daughter, who despite having chronic asthma, is also very active. Unfortnately there is also a chance that she will inherit one or another AI disease in time as these are extremely prevalent in our family. Despite having a very healthy appetite, she has – since childhood – always been very thin . she has recently put herself onto a grain free and sugar free diet to help control her asthma and I am concerned that this is going to make her even thinner. Any suggestions from anyone on what borderline underweight people, highly susceptible to inflammatory diseases should do to improve gut microbiota health and prevent AI. Many thanks .

    • Here’s a good article that includes recipes for healthy weight gain shakes. She can drink these alongside her new diet. Gluten/Dairy/Sugar-Free is often very helpful for asthma, and she can replace those calories with healthier choices – but you’re right she will need to make an effort to do so.

  11. I found it odd that Paul kept commenting on the ketogenic diet in relation to yesteryear implementations (and his own oddly unhealthy trial) “with NO attention to overall nutrician” and then WARNS against it. Every book or blog or nutritionist advising FOR the diet always mentions supplements (Vit. C, etc.) that must be taken for the diet to work longterm. If this is a discussion of how a properly implemented keto diet works or can benefit WHY is Paul’s input almost exclusively about BADLY implemented keto diets? It’s like someone saying “This calorie-reduced diet didn’t work when I ate donuts and french fries everyday. Hmmm. Better beware.” I mean, really!

    • Hi Denise. This podcast covered all aspects of a ketogenic diet – how to do it well and the mistakes people often make. While I can see you disagree with Paul, remember that I also interviewed Terry on this podcast. And while the dangers of nutrient-poor ketogenic diets was discussed (and sadly most scientific studies fall into this category), we also talked about how to it as healthily as possible. In the end, it’s always n=1 (the art of the self-experiment to see what nutrition protocols work best for each of us.)

  12. Pingback: Women, Weight and the Autoimmune Protocol – Part 3 – joannafrankham.com

  13. I have been on a 3 week supervised keto diet and it has caused havoc in my body. I think the person who was monitoring had no full understanding on how to administer this diet. I was on 20 grams of carbs per day. Each day I felt worse. I couldn’t sleep, my lupus flared, adrenal glands were going crazy. For the first time I had very high blood pressure. I felt like I was going crazy. Thankfully I have an amazing Dr who explained that my body is way too sensitive for this diet. He said my body was using adrenaline for energy and is now under a lot of stress. He said I should be consuming at least 60 grams of carbs per day, which is still relatively low but enough for me to function. I was disappointed because I thought this way of eating was the answer. I know what the answer is…good old Paleo for me. Thanks for your amazing webiste Eileen.

    • Your comment’s a good reminder that no single diet is right for everyone. It’s great that you were tuned in to your own body and realized quickly that the ultra-low carb approaches wasn’t working well for you.

      My own feeling is that some people do well at 20 grams of carbs a day; others may need more. In my own case, when I went ketogenic, I started out at around 20 grams of carbs/day for the first 2 or 3 weeks, then got looser about it… I now eat about 50-60 grams per day. (When I held it at 20 grams, I felt like I was missing some important enzymes from foods like blueberries, that I had to severely limit)

      All in all the keto diet has been great for me… I’ve lost about 18 pounds, and gained better physical and mental energy, and some health problems I had been having have improved. (I’m the opposite of what you described — I feel crazy if I eat too many carbs, but feel normal if I avoid eating them.)

      I have found that, regardless of how many carbs I’m eating, I absolutely have to eat a lot of high quality MCT oil every day…. currently up to about four tablespoons a day, plus some raw coconut oil. This keeps my brain and body fueled by ketones even when my carbs may drift up higher than a keto diet “purist” would approve of.

      • Thanks for sharing your experience, Sarah. Here’s to each of us finding the healing diet that’s right for us!

      • Thank you Sarah. One thing I did learn is that I need a lot more fats in my diet. This helps with my blood sugar levels and stops the sugar cravings. The person who was “guiding” me through the keto diet had me on 15 tablespoons of coconut oil a day for the first 2 weeks. Is this excessive? He also had 4 cups of coffee on the menu (of course I didn’t drink this). I paid for 3 months and he didn’t want to refund me some of my money because I signed a disclaimer. He then text me and said he would give back half. A very stressful time. Oh well with some good foods and rest I will restore my health. Thank you again for your response. Yours in good health. Eileen

    • I’m sorry you had such a rough experience, Eileen. I’m glad you have an amazing doctor to guide you to the best diet for you.

  14. To Eileen Forester — I don’t know of anyone who takes that much coconut oil in a day… 15 tablespoons is a very large amount. And 4 cups of coffee also seems over the top. In my own case, I found it helpful to start the day with one cup of coffee blended with 2 tablespoons each of coconut and MCT oil. (Both are good as sources of exogenous ketones). Then I would usually take another 2 tablespoons of each later in the day. But that’s me; I wouldn’t dream of telling anyone else how much oil to take. I agree with you that it’s best to tune into and trust your own body.

    Re: coffee, one reason it’s often recommended is that it’s autophagic (it stimulates the cells to do a kid of deep cleaning.) But in my own case, if I drink more than 2 cups of caffeinated coffee a day I feel way too wired. Personally I prefer green tea, which is just as autophagic as coffee but doesn’t leave me feeling awful when I drink it.

    BTW, here’s a secret some folks don’t realize —- lab tests have shown that decaffeinated coffee has as much of an autophagic effect as full strength coffee. So you do NOT have to drink caffeine if you don’t want to, go get the autophagic and ketogenic benefits.

  15. What are good sources of mct besides coconut? I have an allergic reaction to it (numb lips/tongue.)

    Also, any updated results from Dr Wahls? I find it interesting that she mentioned that the Wahls paleo and paleo plus (ketogenic) patients outcome in the trial are about the same. Maybe you could interview her again?

    I have been doing AIP for 18 months and still have worsening symptoms and a bad MS flare (although stomach feels better and asthma is gone:). So I was thinking of trying the ketogenic diet Dr Wahls proposes.

    • Hi Beverly. Here’s an article that talks more about MCT oil, including other sources: http://paleoleap.com/mct-oil-need-know/. Coconut oil has the highest concentration. The other options are palm kernel oil and dairy (if tolerated). It sounds it’s worth trying the ketogenic level to see if that makes the difference for you, but Dr. Wahls also suggests functional medicine testing when you hit a healing plateau or setback. Often, there are obstacles that get in the way of dietary healing, such as gut infections or hormone imbalances.

  16. Thanks for putting out this podcast Eileen. I’m somewhat sorry that I listened to it since I’ve been following a slightly modified version of the Wahls Protocol (ketogenic version) for almost a year the the benefits have been remarkable in so many ways.

    It felt to me that Dr. Wahls somewhat abandoned her views as set out in her book during this podcast, seemingly to be aligned with Paul. I’ve never been a fan of Paul’s writings and I may not look any anything further that Dr. Wahls publishes.

    • Todd, while I understand your disappointment, consider this: Terry Wahls is a researcher. She starts with a theory and evolves her views based on the clinical trials she conducts. I think this is admirable. She – like you – does very well on a ketogenic protocol herself and thought it was superior. She then did a clinical research study comparing Wahls Paleo with Wahls Paleo Plus (the ketogenic diet), and discovered that Wahls Paleo was equally beneficial to the patients in the study. For that reason, she says people don’t need to add the extra challenge of ketosis. That’s not a bad thing. Paul’s views had no impact on her views. The research changed her opinion. In this interview, she said she personally likes to do ketosis during the winter and come out of it in the summer, choosing it seasonally which mimics ancestral eating patterns. If you do well on a Wahls ketogenic protocol, you can stick with it or experiment with coming out of ketosis and see if your body still thrives. Self-experimentation is the key for all of us feeling our best. No mater what though, Terry’s core recommendations remain the same and are common across all 3 levels of the Wahls Protocol: focus on nutrient-density, avoid inflammatory foods, and pay attention to other aspects of health as well – such as sleep, movement and stress management. Ketosis was never a requirement; it was just an option that people could try.

      • Great explanation, thanks, Eileen 🙂 I would like to add, to Todd, I know it can be frustrating, but I hope you don’t give up. It sounds like what you’re doing is working great for you – I would encourage you to continue doing exactly what you have been doing, and not change it at all, that being the case. Remember that Dr. Wahls’ recommendations tend to be for groups; she might give a very different recommendation to an individual patient. (If you were her patient, I suspect she would advise that you stay on the ketogenic version of her diet, that’s working for you). As my parents used to tell me, “When it works, don’t fix it.” Take care!

  17. Eileen and Sarah, thank you for your thoughtful and thought-provoking replies. Upon further reflection my prior email was unnecessary and overly harsh. I was simply disappointed that after having largely worked out a very similar dietary protocol myself by piecing together various elements of what I was reading online, I ended up eating largely in line with the Wahls Protocol prior to reading Dr. Walhs book.

    Discovering her book was a key event for me since I consider Dr. Walhs to be a knowledgeable and credible source and in reading it I came to feel very comfortable about my own dietary approach. The results have been nothing short of remarkable for me and I expect them to continue as time goes on.

    What was disappointing to me is that nothing that I every read of Dr. Wahls work prior to listing to his podcast has ever in my view placed her protocol in camp of Paul Jaminet. I’ve seen podcasts from Dr. Wahls made subsequent to this one and nothing that I’ve ever seen or heard from her would have made me think that she is aligned with Paul’s dietary protocols. Sure, there would be alignment in some areas but definitely not in all key areas.

    If in fact Dr. Wahls had changed her views I would have expected her to state that in this podcast but she did not. But having largely followed her protocol for close to one year with incredible and far-reaching results I was disappointed to effectively have her state in this podcast that she agrees with Paul when in fact Paul believes that staying in ketosis indefinitely is not healthful and is potentially dangerous. It seems strange to me that Dr. Walhs could somehow agree with that statement when her book is basically promoting that same protocol and it states nothing about being dangerous to stay on indefinitely.

  18. Hi Paul! Thanks for explaining. I do understand your point of view better now, and can see why you were a little thrown by that part of this interview.

    In my own case, when I watched the interview, I didn’t feel that she was saying ketosis is dangerous, but rather that if we base it on our ancestors’ eating habits, they would more likely have been in ketosis in the winter months…. so it may be more “natural” for some people to be in ketosis full time, than for others whose ancestors had different acess to food.

    Something that probably influences how I listen to interview like this is — having been interviewed a few times on radio and TV — ( can say that when I go back and listen to the interviews, I often hear myself saying things I then wish I had said better. It’s easier to say exactly what I mean in writing, because I can go back and fine tune the words. So if there are some contradictions between the Wahls protocol as described in her book and what she says in this interview, I’m wonder if that may be a factor.

    Take care! Always good to read your comments.

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