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The Ketogenic Diet with Cyndi O'Meara

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The Ketogenic Diet with Cyndi O'Meara

In ancient times, ketosis was an adaptive mechanism humans evolved with to get through leaner times. In modern times, ketogenic diets are in vogue for vanity reasons, but it has also been explored as a therapeutic tool for a number of health conditions including epilepsy.

Today we welcome back nutrition expert Cyndi O'Meara who takes us through the history of keto diets, the clinical relevance of ketosis and the pros and cons of the modern-day use of it. 


Covered in this episode

[00:30] Welcoming back Cyndi O'Meara
[02:31] Defining the ketogenic diet
[06:31] Modern day use of ketogenic diet
[10:56] Factors influencing response to ketogenic diet
[13:04] Is ketosis ok long term?
[18:26] Not all fats are created equal
[28:19] When to consider the ketogenic diet
[30:07] Red flags or cautions?
[31:50] Creative ways to boost fat in the diet
[36:42] Animals do not enter ketosis
[38:40] Nutrigenomics
[44:14] Resource suggestions for practitioners
[47:12] Medium Chain Triglycerides
[48:10] Thanks to Cyndi for joining us

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook and joining me all the way from the stunning Sunshine Coast is Cyndi O'Meara. Who's a nutritionist, bestselling author, international speaker, and founder of Changing Habits

But she is not your typical nutritionist. Cyndi disagrees with low-fat, calorie counting diets. Believes chocolate can be good for you, and thinks cheating and eating yummy food is an important part of a well-balanced diet. Cyndi must be doing something right because she maintains a healthy weight and has never, in her whole life, taken an antibiotic, pain killer, or any other form of medication. 

Cyndi graduated with a Bachelor of Science majoring in Nutrition from Deakin University in 1984, her special interest was ancestral foods. At the end of her degree, she was so disillusioned by the nutritional guidelines that she paved her own path and stayed clear of the low fat diets of the day, and not without controversy. 
Her groundbreaking book, Changing Habits Changing Lives, became an instant bestseller, and from there, she has grown a successful organic food company, certified online educational program, and groundbreaking documentary. Cyndi is about educating. Her greatest love is to teach people, in order for them to make better choices in their life, so they too can enjoy greater health throughout their life. 

Her unique, surprisingly simple, and down-to-earth approach changes and encourages others to eliminate unhealthy habits and has inspired thousands to make smarter choices about the food they choose to put in their body. 

Welcome back to FX Medicine, Cyndi. How are you? 
Cyndi: I'm good, Andrew. Thank you for that wonderful introduction. 
Andrew: You've done a heck of a lot in your life and you've done a heck of a lot for so many others. You know, I've got to say, you've been a bit of a trailblazer and a rebel rouser with regards to dietary advice. Today, we're going to be talking about the ketogenic diet. So, now, this is something that is not without controversy.

So I think firstly, we need to understand what really is the ketogenic diet because I think a lot of people get it wrong. 
Cyndi: Yeah. The ketogenic diet is when the body stops using sugars or glucose or carbohydrates in order to fuel its day-to-day activities. From running to, you know, to your cells, everything to do with energy needs. So it stops using those and it starts to use fats, which are converted in the liver through a substance called ketones. And there are two ketones that the body will make. There's some controversy that there is a third one, but people have said it's not exactly a ketone. 

But your body will use them and it's mainly for the brain. It's for the brain to continue to work. It's the most energy-starved part of our body and it needs these ketones if carbohydrates are not available to us. And we have a wonderful storage of fats in modern day, in our fat cells. And so once you stop eating carbohydrates, and let's just say, you even go on a fast, your body will start to use the fats that you have stored and create these ketones and keep you going until the next carbohydrate is available to you. 
Andrew: Okay. So this is something that really interests me. Was its birth in the medical use of, or treatment of epilepsy, or certain forms of epilepsy, is that right or was it before then? 
Cyndi: No, I think it was long before then. I think it was probably a million years ago that the birth of the ketogenic diet started. So let’s give a couple of examples of it. 

Let's say that you live in the desert region. Let's take the Himba’s of Namibia. They’re a group of people who live in the desert region of Namibia, there's not a lot of food available to them for the most part. They live on dairy foods and occasional sacrificial meat. So they may kill one of their goats in order to have meat in a celebration. 

So their diet is ketogenic. They eat very little carbohydrates. But when carbohydrates are available due to a good season, they will eat those carbohydrates. So the ketogenic diet was a diet that came about because no carbs were available due to maybe a cyclone in Papua New Guinea, where the Kitavans, who are carbohydrate eaters, had no mangoes or papaya or a banana, any of the tropical fruits available to them, and all they had was fish and perhaps coconut. There we go again, we've got the ketogenic diet. 
So it was a… we are the only animals on the planet that go into ketosis. We're the only ones that conserve our fat to ketones in order to survive. And I find this absolutely fascinating. And so, historically, it was a survival diet. But it also was, if there wasn't a lot of food around, we would use fat stores that we had stored through a very good season, such as a summer season where we had carbohydrates available to us, and then all of a sudden, there's no food available and we can't even catch an animal. And so we would go into ketosis when we were fasting as well. 

So it's two ways to go into it. One is don't eat, or eat minimally, under 500 calories, around that amount. And the other one is when we actually create it in modern day, where we are eating a lot of fat, moderate amounts of proteins, very small amounts of carbohydrates. And that is basically what we're doing now is we're beginning to go into this manipulative way of getting into the ketogenic state. 
Andrew: Right. So I was going to ask next about its modern use? It was, you know, popularized by Dr Atkins. Are there any other earlier proponents other than him? 
Cyndi: Well, they noticed that it helped children with epilepsy. I can’t even remember the year that this happening, but it was like 1930. And they also now know, in this day and age, that if no drugs work with children with epilepsy or seizures, then this will work, the ketogenic diet will work. 

But way back in the early days, they were worried about it. They were worried that it was going to cause heart disease, they were worried that it was going to cause all sorts of issues with these children. And so it wasn't popular. And I remember this so well, I was in Sydney, in Manly, I was staying at a hotel, and I noticed there was a bunch of neurologists that were at a conference and I happened to get into… I lived with one of them. And I just said, "Oh, you know, what are you guys doing?" And he said, "Oh, we're neurologists and we're just doing epilepsy." And I said, "Oh, are you looking at diet?" And he said, "No, we did that last year. This year, we're doing medications and how to manage these people that have seizures and epilepsy." And I said, "Why would you not do diet now?" And he said, "Oh, gosh, would you do that diet? It's too hard to stick to." So his whole belief was that, "Why would you put a child on it? It's a terrible diet. You don't want them to stick on it. Or why would you put an adult on it?" Because you have many adults now with epilepsy and seizures. So that's their attitude as far as, you know, that conversation went in the least. 
Andrew: But I thought the whole thing was that it was especially useful in intractable seizures that were poorly responsive to treatment, to existing treatments. 
Cyndi: To the drugs. 
Andrew: Yeah. 
Cyndi: Yeah. It's depending on whether the doctor that is, you know, helping the patient, is going to offer that, or offer a new drug that they're looking at. 
Andrew: Yeah. 
Cyndi: Yes, definitely, diet is the last option which I find…
Andrew: Crazy. 
Cyndi: Crazy. It should be the first option. It should be given to these kids and adults as a first option. 

But like, one of my daughter's friends was diagnosed at 21 or 22 with epilepsy and I said to her, "You know, changing diet will change all this." And Dr Natasha Campbell-McBride believes that epilepsy is the way that the brain is cleaning itself. And so I said to her, "You know, if  you change your diet..." And she said, "But, I'm out having fun and I enjoy my life and I'll just take this drug." 
Andrew: All right. 
Cyndi: So it's attitude. 
Andrew: Yeah. So, what about its modern use in other things like just for good health or for weight loss? 
Cyndi: Yeah. Look, it has a lot of applications and we're finding the applications…  they're doing some research on it. And you know, the applications can go from weight loss, definitely. Because as long as you are using your fat cells to go into ketosis, it works fairly well. It’s helping in cancer. But it's also, the research is two-fold. Some of the research is saying it doesn't help and some of the research are saying it does help. 

And I read a really interesting article on this recently and people who sometimes go into ketosis don't feel well. They feel sick, they struggle to get into it. Their digestive systems don't work well, they have all sorts of tiredness and then there are other people who go straight into it and feel the best they’ve ever felt in very short period of time, like 48 hours. And what this article was saying was that people who are not on a SAD diet, so the Standard Australian Diet, Standard American Diet. And people who are eating well, are more likely to shift into ketosis very, very easily as opposed to people that are on refined carbohydrates, have been pushing their insulin levels up, have glucose in their system that's way too high, in their blood system that's way too high. So… and it makes so much sense. Like to me, it has so many therapeutic adaptations that we can do for people, yeah. And I’ve even seen it done with heart disease. 
Andrew: So are you finding though, that these people that are on a poor diet, these are people that have the worst shift, the worst experiences if they try ketogenic diet, is that right? 
Cyndi: Yeah, that's what I see. Is that they seem to suffer longer. So one of the programs that I do for people is a low-joule diet. Even though I don't believe in calorie counting, why I do this very low calorie diet is to shift people into the winter of the Hunter Gatherer. Which would have been their ketogenic state. And there may not have been the fat available because in the winter the animals were not giving produce as much. So they may not have had fat meats, they would have had lean meats. They may have found a few greenery around, and that's about it. 

That will shift someone into a ketogenic diet. And if they’ve been eating fairly well, it takes them about 48 hours. If they're not, it can take up to three weeks. And especially women, women go… take longer to get into a ketogenic state than men. 
Andrew: Okay. 
Cyndi: And my belief is because of fertility. 
Andrew: So an adaptive. 
Cyndi: Yeah. 
Andrew: Like a physiological adaptation. 
Cyndi: Yeah. So, when a woman is prolonged ketogenic diet, they will go into intermittent infertility. Because that was the survival of the species. So if there's no carbohydrates around and you've got no fat on you and you're on a ketogenic diet, the body is going to say, "Well, there's not enough food for me to survive a pregnancy through a winter or a bad season." So if we look at a historical perspective, we begin to understand that staying in a ketogenic state is probably not what the human body should be on, unless it's a therapeutic reason. 
Andrew: Right. 
Cyndi: That's the way I look at it. 
Andrew: Yeah. So going into the therapeutic reasons, like I remember a two-year study, and the thing that I always remember about this is that it was "an Israeli nuclear power facility," right? So it was a controlled environment. So I'm gathering that what these people do is they'd come to work, now I don't know whether they lived there, that's the, "Where's the other meal?" But anyway. But they stuck to either a high-carb, a ketogenic, or a Mediterranean. And it was over two years and you got a very quick drop in both weight, but also lipid profiles as well with the ketogenic diet. Next, followed by the Mediterranean diet. Carb diet, poor response, poor benefits. 

The thing that I notice though is that over the two-year phase of the trial, the Mediterranean diet was only just worse, if you like, for weight loss than the keto diet. So here's my proposal to you. Do you find the ketogenic diet is better short-term, as a rescue thing, and then you move out over to a more of a cultural diet, or do you advocate the use of long-term ketogenesis? 
Cyndi: No, I agree with you entirely in the first statement. Is that ketogenic diet is a good kick-start into changing. Because it not only changes what's happening inside the body, it actually changes taste buds. It changes your perception of things as well. So your brain starts to work so much better in that state. Especially if you had been doing a low-fat, high-carb highly-refined diet, with margarine and poor fats. Like canola oil and rice bran oil and grapeseed oil. 

When you move into that keto adaptation, and that will be hard for those people, but when they move into it, they actually start to feel amazing. But I don't like that prolonged state, I love them to go then into a cultural diet. If it's Mediterranean, that's great. If that's something different than the Mediterranean, where it’s maybe meats rather than fishes. Then making sure that you eat the best of those foods as well. 

I find if you get them in that state, it cleans their system out because it is also using fat cells that may have toxins in them. 
Andrew: Yeah. So this is where I was going next is like what's in the things you're liberating. 
Cyndi: Yeah. 
Andrew: But you also mentioned just before about it's use in other things other than epilepsy, so in, for instance, autism?
Cyndi: Yes. We're seeing, in autism, huge changes. Now, is that change because we're going away from the SAD diet and putting real foods in? Changing the microbiome, which then changes the gut-brain axis. Is it because there's no sugars and we're giving ketones to the brain as opposed to sugars? You know, so to me, there's many reasons why it would help. 

If they have seizures with autism, you know, I know that the ketogenic diet reduces those as well. So, like, we're seeing with autism, diabetes, even heart disease, I’ve seen patients who have done the ketogenic diet with heart disease and reduced their serum triglycerides. 

Andrew: Yeah. 

Cyndi: As long as they use different fats. Because remembering that we are all genetically, we can turn our genes on and off. We're all genetically similar but we also have some variables and alleles and some mutations. And so some people will be able to handle the saturated fat as opposed to others that will need to be on monounsaturated fats, which is like olive oil. So, you know, you can either get a gene just to figure that out or you can figure it out yourself by listening to your body. 
And it's really interesting because, you know, I've been on this a long time, 33 years, I've been in this diet realm and I really listen to my body. And then I had a gene test done and had the results. And I noticed that where I have alleles and issues, I had intuitively adapted to what my body needed in order to live the best life that I can live with any mutations or alleles that I had. It was absolutely fascinating actually. 

But for somebody who's on the SAD diet who does something like that, it gives them an indication very quickly, that they're better off on olive oils and monounsaturated fats, as opposed to saturated fat. And it will also give them the option of, "Can I convert a plant-based omega-3 into EPA and DHA," as opposed to, "Do I need to eat fatty fish?" 

So these are all the things that we're beginning to learn as we not only start to manipulate the foods that we're consuming. But start to look at the epigenetic on our gene expression and using food nutrigenomically as a source of turning the right genes on as opposed to putting the genes on that will creates sickness. 
Andrew: Yeah. I'm glad you mentioned, you know, like monounsaturates and things like that. Because one of the issues I have is when people talk about saturated fat. Saturated fat isn't one entity. You know, it's like, so you could have good sat fat and bad sat fat and then you got trans-fats. So you can have triglycerides that are made up of good fats or bad fats, or different fats. So how into it do you have to get to be able to look after your body when you're doing a ketogenic diet? 
Cyndi: Well, you know, for many years, it was thought that margarine, which is a saturated fat… because that's what they do, they take a polyunsaturated fat and they make it saturated. And they don't do it completely because they partially hydrogenate it, which gives you the trans-fats as well. So, you know, we were always told that that's what we should be eating. 

But I always had… when I wrote my book Changing Habits Changing Lives back in 1998, I said there are good fats and bad fats. Good fats are nature, bad fats are made by men. And it's worked, I don't see any other way of saying it, but eat fats that aren’t made by man.

 And one of the problems we’re now having with olive oil is that there's fake olive oils out there. People want to make money so they add different types of vegetable oils in there. It could be canola, or some other vegetable oil, or a soya. So I think it's really important that people buy from a trusted company that make that olive oil. So these are the good fats we should be taking. 
One of the fats that I've found in South America, was from the Inca Inchi seed. The Inca Inchi seed, when you express the oil out of there, you cold press it, it's 48% omega-3. Your coconut oils are saturated fats but have wonderful properties because one of the things that coconut oil does, it's got a medium chain triglyceride, which when you consume, it goes to the liver, it makes ketones. It helps you make these ketones, which then fuel the body. Especially… even when carbohydrates are available to you, it will create these ketones to fuel the body. 
Andrew: Right. That's why you use coconut oil in things like, you know, cooking and things like that. Is that right? 
Cyndi: Yeah, no, I do both. But that's the saturated fat versus poly. So saturated fat, because all the bonds are saturated. It means when you heat it or you put it to light, it can't pull in oxygen and they become oxidized. Whereas a POLYunsaturated means there's lots of spare bonds. Oxygen goes on those bonds, and they’re the carbon bonds, and they oxidize the fat. And people don't get this. People don't get that, you know, we've always cooked with saturated fat. We've always used lard and tallow. 
Yeah, that’s right. But I think the problem is because man will always stuff something up for commercial gain. So, for instance, even lard, you're not getting lard which isn't well-made. There's a type of lard that you need to get and not all the pastry chefs, they choose this lard. 
Cyndi: I think it was called Crisco. So it started as Crisco and it was white, in a hard block. And it was the 1920s, 1930s that Procter & Gamble, who figured out that hydrogenation of a vegetable oil for candles and soap-making. Realized that when they didn't need candles anymore because electricity came in, that they had this technology. And so, they called it Crisco and it was the vegetable form of lard or tallow. So that was the whole thing that they did. And I think it's called fairy here. But I wouldn't touch it, I wouldn’t touch it from a ten foot pole… 
Andrew: No, this was different. This is something like, you know, lard from, I'm probably going to be wrong, but let's say lard from the loin area of the pig rather than lard made from the belly, you know, something like that?
Cyndi: Yes, definitely. 

And look, the other thing that man has manipulated and I'm struggling with this one, and I don't know if you want to go down this road. But people become lazy, they just want a pill, and so now there’s new keto salts that you can stay on. 

Andrew: Oh, that’s right. 

Cyndi: Yeah, you can stay on the diet that you're on but you can now take these keto salts. In order to create ketosis, or show that the blood and urine have ketones in it. And I did a lot of research into these and I am finding there are a lot of people getting on the bandwagon. But I think if they understood how these were made and what other ingredients they're putting into them. And also, you know, there are different forms such as salts, esters, alcohols, acids. And so, when we really look into what we're doing to manipulate our cells going into ketosis without changing our diet, I think we need to consider what is it actually doing to our body. 
Andrew: Well, I'm actually wondering about... Well, if you're not doing the ketogenic diet. Let's say you're having pizza, and say, keto salts. You're not intaking anything of health, you know what I mean? 

And this is the whole thing, I think, people will do something and they'll do it incorrectly. They'll do it at a half-measure or they'll do it using some incorrect food basis. Look, the classic one is people who think the Paleo diet is high protein. 
Cyndi: I don't think anybody proposes that the Paleo diet is that. It's just the media has picked it up and decided that they're going to run with it and tell the world. 
Andrew: That's exactly right, yeah. You know, I spoke to Loren Cordain about this. Indeed, Loren Cordain spoke at our first symposium and Pete Evans asked us if he could create the diet for lunch, a Paleo diet. And when I had lunch that day, it was 90% vegetable-based. 

But, you know, the thing, and it really opened my eyes, indeed there was two dietitians there. They were, you know, standard teaching, you know at a university level. And they were sort of nodding their heads a little bit. They didn't totally agree with everything he said, but there was most of it was going, "Oh, I get it now." It's really interesting. 
Cyndi: Look, I just think, if we can just get back to real foods. So, you know, back in '80s when I started, it was just about getting people off the SAD diet and getting them back into real foods, and they got well. 

But what's happened now and why, you know, this extreme diet. Because it is an extreme diet. So we have the low-fat, high-carbohydrate diet, that was extreme. Then we had Atkins which was, you know, the high-protein, he was mainly protein, and then he came down from there. 
Andrew: Yes. 
Cyndi: And now we've got ketosis or, you know, high-fat, low-carb. It's another extreme diet, and when we do extremes, it's either because we’re trying to get well and this is what's getting us well, but it's not something that we should stay on for the next four decades. It's something that we should come in and out of, most definitely get back to real foods, and do it properly and not use these new supplements that are out. 

The ketone salts, and I looked up the patent on these ketone salts to see how they were making them. Because I wanted to know well, are they coming from plants? Are they coming from a plant? And they’re not. They're actually produced by genetically-modified Escherichia coli that has the genes of another bacteria that will produce something called PHB, which is polyhydroxybutyrate. Then when it's being produced by that genetically-modified Escherichia coli, it then goes through another step to make it beta-hydroxybutyrate. And if people knew that this is how they're making it and that we had never ever eaten BHB, in any form. Never eaten it. We've always produced it and the liver produces it. 

And so we have to consider when we start to consume these things that it may affect the microbiome. If it's a salt, it may affect our acid stomach. Oh sorry, if it's an acid, it may, you know, cause problems with our acid stomach. It could change our osmotic pressure, our minerals, we could lose minerals. Our acid-alkaline balance, kidney load. We've got to look at our digestive enzymes. We've got to look at the epithelial lining. We don't know the results of doing this because it's a prototype. We're just in the initial stages of it. 

So I'm waiting for some long-term studies before I even consider these at this point. I do believe that they're brilliant for therapeutic use. And Dr. Richard Veech talks about this, how brilliant they are to help people that who have seizures and epilepsy. But he believes that it should be an ester not a salt, an alcohol, or an acid. 

You know, there's different views out there, but I believe it's like any medication, a medication is for a short period of time or to help in a condition that cannot be changed through any other reason. But to take this medication. And that's where I see the therapeutic use of these ketone esters. 
Andrew: I just like to point out to our listeners before we go onto the next question, and that is basically that the ketogenic diet has demonstrated long-term safe use in epilepsy. So it's not that it's unsafe, it's just hard to stick to. There was a high dropout rate in those people who used it. 

And so moving on from there, how do you instigate a ketogenic diet? Do you do it slowly or do you do it like, "Day one, here we go?" And in what conditions do you choose it? 
Cyndi: Well, I would… it really depends. If you have a condition where you are at crisis, then you'd start tomorrow. 
Andrew: Right. 
Cyndi: It's because that's what you've got to do. You're in a crisis, you're in an emergency situation. You could have been diagnosed with an autoimmune disease, it could be you've had a heart attack or you've just been diagnosed with type two diabetes, even type one diabetes. 

So in my way of thinking that crisis, you start straightaway. You just go straight into it. This is what you've got to do. Remove all these foods. Put these foods in and let's start. It may be tough. You may feel bad. But over time, you will get better and better and better. There'll be symptoms that will happen that we've all recognized when we go into that ketogenic state if you've been on a SAD diet. 
Now, let's say that you're somebody who has heard about this and you don't really have a crisis. You are thinking that you should start to eat better. I would start eating better first. So get off the SAD diet and start on a real food diet, even go Paleo, you know, even just do that and just take out grain and dairy. And then if you want to then step into the ketogenic diet, then step in then. It cleans your system out a little bit and it's not going to be so hard and you will shift into it within 24 to 48 hours in the initial stages of making ketones. 
Andrew: Yeah, yeah. And any red flags or cautions, like for instance renal disease or obviously, phenylketonuria? Gout? What about gout? 
Cyndi: Now that's an interesting one. Because there's many diets that I’ve seen with gout. You know, I’ve seen alcohol is a problem with gout and the uric acid buildup. But, you know what? I haven't personally looked at any studies about gout and ketosis. But I believe that it would work well. Because I've seen people with gout, they also have inflammation in their brain. They forget things. They not only have it in their body and in their joints, they have it in their brains. So my belief is that get them into a ketogenic state, it will pull the inflammation down and therefore help the gout. But I would be monitoring them. I would. You know, because they're on drugs such as colchicine and allopurinol, and I would be judging how that was going before I would keep them on it for a long-term time. 
Be interesting to see how it, you know, worked though, getting them off carbs. You know, this sort of high-carbohydrate, high-sugar type influence on gout. Certainly, there's the purines, but that sugar sort of fructose issue seems to be prevalent as well. 
Cyndi: Very much. And, you know, they do say, "You know, don't eat red meat." And, you know, I can't remember the exact diet for it. But then this is maybe eating fish and chicken, as opposed to eating that red meat, and maybe cutting down the amount of meat. Which is the ketogenic diet, it’s a small percentage, is the protein. It's mainly the good quality fats. 
Andrew: So when you're talking about these good quality fats. To get that amount in your diet, it has to be liquid? Or do you concentrate on solid foods? 
Cyndi: That much fat in the diet? 
Andrew: Yeah. 
Cyndi: I think one of the best things, and I've seen this work with Parkinson's disease as well, is having a having a Bulletproof coffee. You know, Dave Asprey has created this through going… I think he was in the Himalayas, and he had a cup of tea with yak butter in it and then came home and put butter in coffee and then his MCT oil. So that's a liquid version of getting these fats in. 

But you can, like I made the other night… So, I have free-range pigs and I harvested them. And I made a beautiful slow-cooked, like, stew. Actually, it was one of Pete Evan's stews. And there's a lot of fat on those pigs. And then that becomes a vegetable and meat food. 

So, like, I think people haven't got the creativity anymore and that's why it's good to get some good recipe books to teach you how to make these foods so you're not just having it in liquid form. But then having said that, we could make mayonnaise with olive oil and coconut oil. So, you know, you could put mayonnaise on your salads with your meat. Pestos, you can add lots of oils to it. 

So I'm not one that goes, I've got to take four tablespoons of olive oil. I would rather have four tablespoons of mayonnaise or two tablespoons of pesto. Or I would rather make… and my pesto is with my coconut oil as well as my Inca Inchi oil or my olive oil or my macadamia nut oil. So there are many ways to incorporate this amount of fat into the diet and it just doesn't have to be a liquid one, it can be, you know, real food. 
Andrew: Yeah, yeah. And do you have recipes in the Changing Habits Changing Lives book
Cyndi: Definitely, we have lots of recipes, yeah. 
Andrew: Great. 
Cyndi: And it's the cookbook. We've just put a new cookbook out. And it's so funny, like, I did… no, it's not funny. I did my cookbook back in the year 2000 and I was collecting recipes for probably 15 years before I finally did that cookbook. And at that stage, I didn't have to put nuts, you know, I said there was a nut, an egg… I think we have seven allergens that we now put in our brand-new cookbook. So we say, yes, this is free from egg, wheat, gluten, nuts, seeds, dairy. So we’ve had to do that with the new cookbook that’s just come out, yeah, but with the old cookbook, it just wasn’t there. 

And so this is what's happening in that very short period time, it's 17 years, but people are waking up. And the waking up is getting back to real foods. And then if we’re in a crisis state, getting into the ketogenic diet. But coming in and out of it and I think that that's important. 

And many athletes will come in and out of it because they'll need to use glucose. So if we’ve got a…so rather than the sick, let's go to the people that are really trying to improve their performance. So they come in and out and they'll use their glucose and glycogen stores as well as they'll use their ketones. So we're learning to manipulate this way of eating in order to not only get well but be superior in our performance, brain and physical. 
Andrew: That's really interesting. And Dr Zeeshan Arain, do you know him at all, down in Melbourne? 
Cyndi: No. 
Andrew: He’s a runner. He’s is a GP, but his favorite past time is running. And he decided just to try the keto diet and he's just become a huge advocate of how to do it properly and quite an amazing man. He's got some really good YouTube talks, yeah. Yeah. Good guy. 
Cyndi: I’ll have to go and listen to it. 

I think Dr Mercola did a really good job of doing a beginner's guide to the ketogenic diet. And he basically talked about the benefits of it and then he goes through that there are a few types of ways of doing it. So there’s targeted ketogenic diet, which is, you know, for something that is an issue, an inflammatory issue, or seizures or epilepsy. He talks about the cyclical ketogenic diet, which is the one I was just talking to you about. He also talks about a high-protein ketogenic diet as well as a restricted ketogenic diet. The restricted is not many calories, so really lowering the amount of food that you are consuming because that was traditionally how we went into ketosis. 
Andrew: I was looking at some papers the other week and it covered the topic of mitochondrial myopathy. Now it was a mouse study, but it was talking about the ketogenic diet significantly delaying progression of the disease. And that was using the modified Atkins diet as a ketogenic thing. So my questions is how representative of the proper ketogenic diet is the modified Atkins diet? Are they different or are they the same? 
Cyndi: The question I have to ask though is if humans are the only ones that produce these ketones. And mice don’t. I cannot see, in my way of thinking, unless they're giving them acid or salt or alcohol or ester ketones, how they can predict this?

Andrew: Right.

Cyndi: So I think it's a good way of, "Okay, well, this is what we've done," but we have to realise that every cell, except for the liver cells, will use ketones. The liver makes it, but doesn't use them. And we are the only animal that will make ketones and use it. So to do my studies, I’d have to go and look at that study to see, well, how did they do that? And what was it they gave them? Did they give it a salt, an alcohol, an acid, or an ester? And was it a BHB, you know, was it hydroxybutyrate or was it another ketone? So I would be very questioning
Andrew: I think they used the diet, but I get your point. About if the mice dont have it. It’s kind of like feeding rabbits cholesterol when rabbit's aren’t a meat-eater, you know, it's like, "Hello?" 
Cyndi: Yeah, when I realized that we were the only ones that did it, I went, "Well, we can't do mice studies," because you're never going to get the exact results. But I shouldn't say that without reading the study and understanding the study. So let me not question the study, but just question the idea of the study. 
Andrew: Yeah, yeah, yeah. What about genetics? Do you find that the ketogenic diet has… is there any evidence out there showing that it's got better facility or better use in certain variants, certain, you know, SNP alleles for instance, with regards to not just epilepsy but other things, even cardiovascular disease for instance maybe? 
Cyndi: Definitely, yeah. Because I'm still learning, I can't tell you exactly, you know, what those genes are. I can't remember the SNPs or the name of it. It will be our SNPs, or our alleles and it's how we turn them on and how we turn them off. And what foods we use and what is good for us. And innately, you will know if you are listening to your body. But to start listening to your body, you have to start getting well. And most people these days are not in a state of wellness, they're in the state of crisis, or ill health. 
Andrew: You know, the more I learn, and I am not learned, but the more I learn about our genetic alleles, our SNPs and the more research that's coming out about the dietary effects. Indeed the exercise effects on our microbiota, I just wonder whether they are going to be the two standards that you need to know to guide successful therapy in the future. To actually choose what's going to work for you and what's going to work for somebody else? 

And they're even doing this with medications now, even with treatment for helicobacter pylori, there’s certain alleles that will require a patient to use double the amount of the PPI to get the same effect on killing the H. pylori. So it's kind of like, you know, you need to know this stuff to dis it. You know, I don't think medicine is there yet but this is out there, it's done. Tamoxifen, they know who is going to respond and who isn't. 
Cyndi: Yeah, look, and it is there and that was very much highlighted in last year's conference with Dr Mark Houston, the cardiologist. Who said that, you know, the protocol for heart attack is five medications. I think it was beta blockers, aspirin, Plavix, cholesterol lowering drugs, and a blood pressure tablet. He says that's standard, everybody gets it. It's not questioned. But he said, "What about the 50% of the population who if they take aspirin…

Andrew: ..that are going to die anyway…

Cyndi: Well, if they take aspirin, it will cause more problems than it will help. So the integrative doctors are starting to do this and nutritionists and naturopaths are way ahead, they're already looking at the DNA, you know. Now, just because you have a gene doesn't mean you can't change your potential for health versus ill health. But it's about understanding the lifestyle changes that we have to make in order to do this. 

For instance, if we look at the gene which is called GSTT1, it gives you an increased risk of vitamin C deficiencies in individuals that don't meet the RDI. Now, how many people aren't meeting the RDI to vitamin C? But it also gives you action steps and the action steps are to make sure that you're eating foods that are high in vitamin C. You know, it's not hard. It's more oranges, more watermelons, more strawberries, organic if you can get them. So we actually can understand each of these things and understand the lifestyle changes. And this is what we call nutrigenomics. 

And we know that nutrition is not about just growth and fueling us to have energy to do the things that we want to do. It's actually speaking, food speaks to our genetics. And if we give it the wrong food, that speech to those genetics is going to come unplugged and we're going to present with all sorts of diseases. But if we give the food to our genetics and speak to it in the way that it has been spoken to for million years, through the generations, and it's the same types of foods that we have eaten and adapted to. Then we're going to present with health. And I think epigenetics and nutrigenomics is going to be the most powerful tool to get people well, who we're struggling to get them well because we're just giving them standard of care, which is you have this, you take this drug.
Andrew: Yeah, that's going to personalise medicine. 
Cyndi: Yeah, personalised medicine it. That’s it.
Andrew: Yeah. You were talking about, you know, putting people on five medications and what I was talking about is basically, if you look at standard cardiac care post-infarct. You're going have up to, well, some people say 50%, what I read is around about 40%, there's residual risk. So even if you do best "standard care," you're going to have almost half of those people that are still going to have an event. Or a death, you know? So it's kind of, well, shouldn't we really be looking at this personalised medicine? We really need to be looking further into the genomics of it. 
Cyndi: I'm excited. Look, it actually excites me what we're learning.
Andrew: So just to the last point, Cyndi. Where can praccies get good resources to learn how to instigate, how to manage the appropriate use of the ketogenic diet? Indeed, how to sway from the ketogenic diet onto then a more cultural type, wholefood diet? 
Cyndi: Well, as I mentioned before, I think Dr Mercola has done a really good job of just summarising it very quickly and very easily. Foods you're allowed, foods you're not allowed, what it does, what effects you may have as a result of it. And it's free online, you don't have to pay for it. 

I really like Mark Sisson's information. So Mark Sisson talks about is constant ketosis is necessary? So you can go on his Mark's Daily Apple. I think Peter Attia, he's a medical doctor, is worth listening to his talks, A-T-T-I-A. I really Dominic D'Agostino. He was the one who figured out how to stop Navy Seals.. when they couldn’t blow oxygen, because they would be detected, how to get them.. ahh, I can't remember the exact terminology that he uses, but how to not let them have seizures by eating the ketogenic diet, so Dr Dominic D'Agostino. So I'm sure you've probably... 
Andrew: Are we talking about nitrogen? 
Cyndi: Nitrogen, yep. 
Andrew: Yeah, nitrogen sickness, Like... 
Cyndi: They have seizures as a result of it. And Dominic D'Agostino figured out, if they went on a ketogenic diet, they wouldn't have it. 
Andrew: Oh really? 
Cyndi: Yeah, he's really fascinating, his work on what he's done. He's actually done a patent. So if you go to the patents, you can look at patents and find out how people do these things. He's actually got this amazing philosophy of how to get them into that state. And it's free online, you just go "patent by Dominic D'Agostino." I can actually send you these links if you'd like and you can put them on the show notes. 
Andrew: Yes, please. 
Cyndi: I'll send you all of these links so you can put them on the show notes. So there's so much online, there's so much information on it. But my one caveat with is don't stay on it, come in and out of it, unless it's for therapeutic use. And number two is be very wary of any supplements at this point. 
Andrew: Yep. 
Cyndi: It's a prototype, we don't know the long-term effects of these supplements. So they would be my two things that I would really like to let practitioners know about because I do know a lot of practitioners that are starting to sell these supplements to their patients. 
Andrew: Right. 
Cyndi: Without really understanding them and understanding what this is all about. 
Andrew: What about using food product though, medium chain triglycerides, what about its use? 
Cyndi: Caprylic acid, or MCT, what that does is it helps the liver make the ketones. So definitely, go there, they work perfectly. And like, Dr Veech works with a gentleman who has Parkinson's, and he's had it, I think, for about 15 years. He does a Bulletproof every single morning in order to bring his ketones up. And remembering that ketones only stay in the blood for about six hours, if you consume, you know, so MCT, it will stay for about six hours. So then, you need to do it again to keep those ketones up. And the same went for ketones that you consume, they don't stay in the stay in the system for 24 hours. They’ll only stay in the system a couple of hours. And if it's a salt, then you have to keep taking it and then you take way too much salt. So, we could go on about that but we don't have time. 

Andrew: Thank you so much once again. I've got to say, I love the way that you bring everything back, concentrating on whole natural foods. And I would urge everybody to read your book Changing Habits Changing Lives to get some recipes, if nothing else, but also the good tips, good healthy tips that you have and that you give for practitioners, indeed, laypeople. For you know, to get out of the SAD diet. Well done. 
Cyndi: Thank you. I appreciate that, Andrew. 
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Cyndi O'Meara
Changing Habits
Book: Changing Habits Changing Lives
What's with Wheat? Documentary
Dr Robert Atkins: The Atkins Diet
Dave Asprey
Dr Zeeshan Arain
Dr Mercola: A Beginners Guide to the Ketogenic Diet
Dr Mark Sisson: Mark's Daily Apple
Dr Peter Attia
Dr Dominic D'Agostino
Dr Richard Veech

Research explored in this podcast:

Shai I, Schwarzfuchs D, Henkin Y et al. Weightloss with a Low-Carbohydrate, Mediterranean or Low-Fat diet. NEJM 2008 July 17; 359(3):229-241

Aholas S, Auranen M, Isohanni P et al. Modified Atkins diet induces subacute selective ragged-red-fibre lysis in mitochondrial myopathy patients. EMBO Mol Med 2016 Nov 2; 8(11):1234-1247

Other podcasts with Cyndi include:


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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