The Keto Diet: Why my friend lost weight on it…but I still don’t recommend

So it seems like the ketogenic  diet is the newest controversial diet craze. I can’t scroll through Instagram without seeing a new #ketodiet recipe. And on a more personal level, one of my best friends is a keto convert. By sticking with keto for the last few months, she’s lost a significant amount of weight and noticed a huge improvement in energy, mood and less hormone fluctuations.

So what’s the keto diet, and why can’t I bring myself to fully endorse it?

The ketogenic diet is a low-carb, high fat, moderate protein diet that forces the body to go into a fat-burning state called KETOSIS. It does so by depriving the body of carbohydates which are the main source of energy in most diets. Because of this, the body is forced to burn fat for energy (producing by-products called ketones).  So, ok; burning more fat- while eating a high fat diet- sounds awesome, right?

Here are some positive things about the keto diet:

  • It’s very low carb: this is a good thing; it’s well known by now that refined carbs (which is a heavy part of the Western diet) are a huge contributor to obesity and disease.
  • It has the potential for very quick weight loss (at least initially) because it forces the body to utilize its fat stores for energy.
  • It has the potential to help with certain medical conditions:
    • Severe childhood epilepsy: in fact, this is the most-studied positive indication for the keto diet. No one knows exactly how it helps reduce seizures, however.
    • Evidence is emerging that it may help reduce symptoms for mental health disorders: anxiety, depression, even Alzheimer’s. The data is still very new and so solid conclusions can’t be drawn at this time from the studies.
    • Help to manage and reverse metabolic syndrome disorders like diabetes, hypertension, possibly high cholesterol: this is likely due to the weight loss itself (not specifically because it’s keto)

Ok, sounds good so far. So what’s so bad about the keto diet?

  • Very fat-heavy: Fats comprise about 70% of the keto diet. And although there are “good” and “bad” fats (to oversimplify), some keto diet proponents don’t necessarily differentiate. Which is why when you google keto diet recipes, there can be ALOT of bacon/butter/ lard/ coconut oil in those recipes. Some of these things (like processed red meat) are clearly linked to poorer health outcomes. The keto diet has been shown to increase cholesterol levels as well
  • Hard to get started: For anyone starting the keto diet, they need to be aware that for up to 2 weeks while your body adjusts, you will feel like crap. It’s called the “keto-flu”, and symptoms include fatigue, dizziness, nausea, mood-swings and stomach pain. Many people don’t make it through this initial transition.
  • Hard to stick with: Any diet that restricts a whole category of macronutrients (carbs) can eventually be hard to stick with. And while I’m happy with the low-carb aspect of it to some degree, it’s never a good idea to villify a whole class of nutrients. What about bananas, root vegetables, butternut squash? In a typical keto diet these foods are considered no-nos. I have a problem with that.
  • Has known long term effects: So one of the biggest concerns with the keto diet is because it’s still relatively new, there’s not a lot of long-term data out there. Depending on what you read, you can be convinced it’s the best diet ever, or the worst of all time. The best long-term data we have right now are the studies of the epileptic children, who have been followed into adulthood. And these studies review some of the complications of long-term adherence to keto diet: including dehydration, abnormal kidney and liver function, cardiomyopathy, hypoglycemia, kidney stones…the list goes on. 

On a personal and professional level, I just can’t get on board with a diet plan that is so restrictive. The reason why many diets fail is because of this. More studies need to be done in the long-term consequences of such a fat-heavy diet. however, I do appreciate some of the creative keto recipes which are low-carb, like this keto ice cream.

How do you feel about the keto diet? Feel free to comment below!

 

Dr K

 

 

 

 

 

So are eggs an amazing super food or a cholesterol bomb? Looking at the evidence

Few foods are as controversial as the egg. It feels like one minute it is being hailed as the next super health food, and the next minute, a cholesterol-laden bomb to be avoided at all costs. This back and forth gives me-and my patients- some serious whiplash when we’re trying to figure out the answer to the simple question ” should I eat eggs or shouldn’t I???”

So you know me, I’m all about the evidence.  As much as I like Google and social media, there can be lots of biased misinformation out there. As a physician, I seek the results of  clinical studies to help guide me in my answer. So let me help summarize the latest research for you!

Long-story short: in people without underlying medical conditions, an egg a day is an excellent source of protein, vitamins, lutein, choline and some fats (mainly mono and poly-unsaturated fats ). Interestingly, the data suggests that people with diabetes and other CVD risk may have higher risk of heart disease if consuming more than 3 eggs a week. {link} (It seems like more research is needed to determine exactly why).

To break that summary down a bit more, here are the key points:

-Eggs are extremely delicious (this is totally anecdotal from my taste buds, not from clinical studies)

-One egg contains about 200 mg of cholesterol a day, found in the yolk, but that type of cholesterol isn’t NECESSARILY the bad type

-Most studies don’t prove that eating eggs are BETTER for you than not eating them, but some studies show that you’re not WORSE OFF if you eat eggs (in moderation) than if you didn’t

-If you’re at higher risk for heart disease (especially if you have diabetes) then it seems that you can only get away with fewer eggs a week than the average person.

So what would I tell my patients after reading these studies? If they are generally healthy, I’d say eat up to 7 eggs a week without guilt! And watch what you’re eating those eggs with; we tend to sabotage a healthy meal with the accompaniments (bacon, sausage), or the way that we prepare that meal (ie: frying eggs )…and these things are worse than the actual egg itself. Want some healthy options to complement your egg? Avocado, whole wheat toast, tomatoes and other veggies in an omelette come to mind ! And one tip I like to give: if you use one whole egg and 1 or 2 egg whites you still get the benefit of that delicious yolky taste without as much cholesterol.

Have an Egg-cellent day ! (sorry, couldn’t resist 🙂 )

Dr Kim

 

So is coconut oil good or not??

So today I read an article where a Harvard professor declared coconut oil is “pure poison”. Say what now?

A few days ago, a couple of my blog readers asked me to talk about the health benefits of coconut oil. So I decided this was a perfect time to write this post I’ve been meaning to for a while now!

Over 70% people think that coconut oil is healthy, based on polls. Everywhere you look it is being hailed as a wonderful super food, and some fanatics go so far as to suggest that coconut oil is the cure for almost any disease if used in sufficient quantity.  Maybe it’s because coconut oil is made from coconut, which is a fruit (yup it’s a fruit I looked it up). Maybe it’s all the beautiful recipes on Pinterest and Instagram which  feature coconut oil as a healthy ingredient in your baked goods , smoothies and sautes. So then how could it possibly be poison?

My head hurts, you guys.

I’ll be honest, there’s so much contradictory information out there, which just goes to show how controversial the topic is. I had to really analyze the quality of the evidence, and threw out any literature that didn’t have strong studies to back the claims. I also realized that although there are many studies out there, most of them are pretty small (sometimes they only analyzed a few dozen people for example), and everyone knows that the best studies are the ones that include a large population size.

So anyway, based on what I’ve researched, here is a quick summary with some links for your viewing pleasure.

  • Coconut oil is 82% saturated fat, composed of 2/3 Medium Chain Fatty Acids (MCFA) like lauric acid, which might POSSIBLY reduce cardiovascular risk and improve brain health. It is not clear if the potential benefit of the MCFAs outweighs the known risk of the other types of saturated fat in coconut oil
  • Coconut oil does increase LDL cholesterol (in some studies, not all). LDL cholesterol is a known cause of heart disease; however, recent evidence is showing that there are actually different TYPES of LDL particles (the small dense type which is bad, and a larger fluffy particles which may actually be good). This is relatively new research which is still evolving
  • Coconut oil also increases HDL cholesterol (the “good” type which has been said to be protective for your heart-although now they’re not so sure about that either? Omg!)
  • Coconut oil is touted as a weight loss agent but the actual evidence is very small
  • Virgin coconut oil has the same fat content as the refined kind (but refined has a higher smoking point so is better for cooking)

Based on the current literature, the American Heart Association came out with a statement against use of coconut oil. Tell that to the #coconutoilforeverything crowd!

Many coconut oil advocates argue that some studies actually don’t show that high-saturated fat diet is worse for heart health than a low-saturated fat one. However,  some of those studies have been criticized, because they don’t account for the fact that when people in the studies followed a diet LOW in saturated fat, they potentially had increased the amount of refined carbohydrates in their diet to compensate (which is bad for your heart, thus messing up the overall result).

Right now, I’m not comfortable recommending a diet high in coconut oil to anyone. More research needs to be done to determine if the type of LDL particles that coconut oil increases are the “good” or “bad” type, and basically just more studies need to be done and combined to get a larger population size.

So, what do I recommend to patients? Don’t go diving headfirst into a vat of coconut oil anytime soon. Small amounts are probably ok if you don’t have underlying risk factors but for those with heart disease or at high risk, I’d probably focus on the oils widely known to be heart healthy, like olive oil.

Hope I didn’t give you too much of a headache with that one!

Dr Kim

 

I know soda’s bad but 100% fruit juice is ok….right?

The food advertising industry is amazing. The way certain foods are marketed and labeled provides false reassurance that they are healthy. We’ve been conditioned to equate the certain words and phrases with health, like “all-natural”, “made with real fruit/vegetables “, “cane sugar”. When in many cases, it couldn’t be further from the truth!

One example I come across again and again is the juice vs soda debate. By now, EVERYONE knows that soda is not a healthy food (and if this is news to you, honey we have A LOT of work to do). But sometimes, people make the mistake of swapping coke or sprite for fruit juice, patting themselves on the back that they’re making a healthier decision.

As a doctor I’m used to giving bad news, so here’s another one for you: juice is barely any better nutritionally than soda. Even if it’s actual real fruit juice (and not those other flavored sugary drinks that pose as fruit juice but have no actual fruit listed in the ingredients)

So let’s talk about (real) fruit juice. Here are the facts:

  • Fruit juice doesn’t contain as many vitamins and nutrients -like fiber- as the actual fruit since much of it is lost during processing
  • Fruit juice usually has sugar added to it to enhance the taste
  • Even the types of juice that state proudly “no added sugars!” still has lots of sugar in it, even though it is the sugar naturally found in fruit.

The reason why this is bad is that juice is a CONCENTRATED form of sugar water with little fiber and nutrients, that quickly raises your blood sugar and provides LOTS OF CALORIES. Example, 1 orange = 60 calories. 1 8oz glass of OJ= 112 calories. In fact, some types of juice even have more sugar than soda! (Don’t believe me, CLICK HERE)

So, my common-sense tip to patients is; stay away from liquid calories as much as possible. Juice isn’t much better than soda. If you MUST drink juice “for the taste” try to dilute with water and drink it less often. And it’s  ALWAYS better to eat the actual fruit than the juice.

Hope that helps to clear things up. Stay healthy, my friends!

Dr K

What’s the deal with Vitamin D: do we really need to take a supplement?

In my practice, about half of my patients take some sort of daily dietary supplement. Many take a daily multivitamin and a large percentage also take a vitamin D supplement. Sometimes it’s just plain vitamin D3, sometimes Calcium + D3. Out of curiosity I like to ask people why they are taking a particular supplement (if I didn’t specifically recommend it) and I’m surprised to find that many people have no idea why they’re taking it! Well that’s what I’m here for. Let’s get into the nitty gritty of it.

So vitamin D helps our bodies absorb calcium, which is an important chemical needed for a host of bodily functions (CLICK HERE for more info).  And the fact is, almost half of the US population is vitamin D deficient. Why? Because the main source is good ol’ sunlight (our bodies convert UVB rays to vitamin D) and most of us are indoors/ in our vehicles/vampires during the day. As someone that craves the feeling of sunlight on my skin, that makes me sad :(.

Almost every month when I read my medical journals, there is some new study regarding Vitamin D and its benefits for a particular health condition.  Here is a short list of some evidence-based benefits of vitamin D ( check out this website for links to some legit studies)

*Maintaining and improving bone health

*Optimizing cardiovascular health, reducing blood pressure

*Mental Health: may help reduce depression, anxiety

*Reducing risk for some cancers: especially colon cancer

*Reducing fall risk

 

So how best to get my Vitamin D?

Sunlight is the most effective way, and you need to catch rays for at least  10 mins to get the recommended daily intake if you’re fair skinned and up to 20 mins if you’re darker. Now, for multiple reasons sunlight may not be be the safest way for some people (which is why you should double check with your doctor before increasing your sun exposure).

Another way is through certain foods; vitamin D is fat soluble and can be found in egg yolks, fatty fish like salmon/herring/sardines, cod liver oil, mushrooms, fortified dairy products). However, the overall concentration is relatively low in these foods so in most cases, I end up recommending a supplement

So what Type of Vitamin D supplement do I choose? 

There are two types: D2 and D3. D3 is the one most commonly found in supplements and has been found to increase blood levels of vitamin D more effectively than D2.

Great, now what dose do I need? 

In my experience I’ve found that at least 1,000 IU a day is needed to maintain normal levels for most people. In fact, I usually recommend 2,000 IU just to be on the safe side. I found some literature that reinforces my recommended daily dose (CLICK HERE) .  (Note: there is such a thing as TOO much Vitamin D though, so I would advise against taking more than 2,000 IU chronically based on current research).

I’m confident that as we learn more in the world of medicine and science, we will understand how crucial vitamin D is for our bodies and take its deficiency more seriously. I personally check Vitamin D levels on almost all my patients, and track the numbers periodically if they are on a supplement. I’ve seen improvement in bone density for sure, and some patients also report less musculoskeletal pain, less depression and more energy when they take their Vitamin D. Placebo effect? Who knows, but if they feel better after taking their vitamin then I’m happy!

Hope that helps to sum up Vitamin D. Let me know if there was a question you had that I didn’t explain!

Dr K

 

Multigrain/honey wheat/rye bread: How we’re being tricked that they are healthy

The bread aisle in the grocery store can be a headache. You know that “white bread” is a huge no-no, and that whole wheat is supposedly healthy….but there’s lots of other types of bread out there. Multigrain, honey wheat, rye…and look at that healthy looking multi-grain bread with the seeds sprinkled on the top of the loaf! And they’re a nice brown color, ie not white. So, good….right?

Not necessarily.

Most of us by now know that whole grains are healthy. But why, and how do all the other non-white breads stack up?

Firstly, WHOLE GRAIN means that the product contains all the parts of the grain. So using wheat for example: the product contains the bran, endosperm and germ . These are the parts that contain the nutrients, fiber etc and this is why these things are healthy. Also, very importantly, whole grains are more slowly digested in the body which causes less of a blood sugar spike and help keep us full longer.

However, some whole wheat bread may be processed in a way that it doesn’t contain all the germ. So its not whole GRAIN, but still whole wheat.

So how do you know what type of bread to eat? Simple simple tip. Avoid anything where the word “WHOLE” is not in the first ingredient.

Look at the ingredients, if the first ingredient is whole grain flour that’s the best. Whole wheat flour and you’re still in good shape. You might see enriched wheat flour- that’s REFINED = not WHOLE. This simple tip will help you navigate the bread aisle, and help you to see that most rye bread, raisin bread, honey wheat bread etc, are actually NOT whole grain/wheat bread. Sorry!

So now we can navigate the bread aisle with confidence! Happy, healthy eating 🙂

 

Dr K

Let me share what I’m learning! Pearls from Nutrition & Health Conference 2018

Exciting times in the world of health and nutrition!

I am currently attending the 15th Annual Nutrition and Health Conference, sponsored by University of Arizona Center for Integrative Medicine. This is actually my second year attending, and if you’ve been reading my blog and checked out my bio, you know how much I emphasize nutrition as a HUGE part of disease treatment and prevention. I must unreservedly credit this conference for helping to ignite and reinforce this interest, from the first time I attended in 2016.  To this day, I still use some of the information I learned there.

So my plan this year is to share things that I learn with YOU, dear reader! I’ll distill the information into quick, relevant posts for your viewing pleasure and edification..and some of the more interesting presentations will earn themselves a post of its own.

So as an example, today I learned:

-Dietary changes have been clinically proven  to reduce chronic pain, and offset some autoimmune disease

-How Cocoa Flavanols may help reduce cardiovascular disease (yay, chocolate?)

-That not all “whole grains” are REALLY whole grains,  and some are as bad as white flour (oh crap) 

-That intermittent fasting may really boost health 

So stay tuned for the upcoming posts! And don’t forget to subscribe for email updates 🙂

Dr K

 

MD Musings: What my patient taught me when she went vegan

Every day, I learn something new from my patients. Every day, they surprise and inspire me. I’ve decided to highlight some of their stories (with their permission of course! No HIPAA violations over here, sir!)

Before I enter the exam room, I always review the patient’s vital signs (blood pressure, heart rate, weight) and compare them to the vitals from the last few visits. So, the other day when I noticed the 15 lb weight loss in 6 weeks by my obese middle-aged patient, I skipped into the room and immediately asked “how did you do it?”. We’d been working on her weight loss for months without significant results. She smiled smugly, her eyes twinkling with satisfaction.

” I went on a vegan diet” . 

“Really? Are you finding it easy to maintain?” 

“Yup! Much easier than I thought once I put my mind to it!”

This is a patient who grew up in a culture where a meal wasn’t a meal unless it included a meat protein, and cheese=life. But she substituted these things with vegan-friendly products like tofu, and didn’t feel like she was missing out. And best of all, she noticed positive changes to her energy level, sleep quality and just overall felt better. All from changing the way she eats!

So here are some important reflections from this patient encounter that I’d like to share:

  • The most important part of embarking on healthy eating lifestyle is deciding you want to do it, and then taking action to achieve your goal
  • Healthy eating does not necessarily have to feel restrictive, or like you’re missing out on stuff you love.
  • You can find healthier substitutions for the things you enjoy , rather than eliminating it altogether 
  • Once you start reaping the benefits of a healthier diet, it will help fuel the desire to maintain it.

And now this lady has inspired me to challenge myself and institute “Vegan Days” into my diet. I’m not sure if I can personally maintain a pure vegan diet (because, bacon…sigh) but I do believe that even small changes matter , and that ultimately a plant-based diet has irrefutable benefits.

Do you want to join me on my “vegan days” journey? I’ll post any tasty recipes or foods that I discover and let you know how it makes me feel!

 

When your “cold” is actually allergies

Around this time last year, mommy dearest started getting frequent colds. She would feel like she was coming down with something; malaise, cough congestion, sneezing. She was treated a few times by her PCP for an “upper respiratory infection”, and when she described her symptoms to me, I agreed with the diagnosis. However, after feeling better for a few days,  poor mom would come down with yet another “cold”.

Then her PCP then decided to try another approach, and prescribed my mother an antihistamine… and ta-da! All cured. I’m surprised it took so long to figure out she might have been suffering from allergies. Probably because she’d never had seasonal allergies before, and so many of the symptoms overlap.

So how do you know if it’s allergies or a cold? Actually, I was going to write a whole article on this, but my friend who is also a blogger and ALLERGIST, already wrote a great article about this (click HERE). Thanks, Dr Gupta!

But to give a one-liner: if your symptoms seem worse depending on the environment, if you are experiencing itchy or runny eyes, and seems to occur around the same time every year…it may be allergies! Be cautious about self-diagnosing and treating with OTC allergy meds, especially if you are elderly. Talk to your doctor about what treatment is right for you!

In the next post we’ll overview how to treat sinus congestion/ congestion…stay tuned 🙂

MD Musings: Why are we always looking for a Magic Pill?

If I had to list the top 2 ailments where people come in to my office asking me to prescribe “something”, it would be “something” for WEIGHT loss and ENERGY.  Of course, I’ve also been asked for “something” to help fix a range of ailments like insomnia/bloating/ hot flashes/body aches/you get the idea.

Every time I get these requests, it strikes me as very strange, and an insight into the nature of our culture. How have we gotten to the point where we think the solution to our physical ailment must always be some external treatment, some prescription med or supplement?

Why is it so surprising to people when they hear;  what you actually NEED is not a Magic Pill, but to be mindful and purposeful about what food you’re putting in your body. You NEED to get up and get your heart pumping and your joints moving. You need to take care of yourself; body, mind and spirit.

I like to remind people that when we are not feeling well, this is usually a sign that something is awry in our bodies. And a Magic Pill may sometimes help improve certain things, but some changes have to come from US. When I draw labs on a patient and I see high cholesterol, elevated sugars, reduced kidney function…I can certainly whip our the prescription pad for a statin, a diabetic pill, an ACE inhibitor (which are all evidence-based medications), but the conversation should never stop there. At the same time I have to take a step back and say “but WHY are these things all out of whack?”

The answer usually has something to do with that patient’s  weakness for white bread, pepsis, 11 pm binge eating when they’re stressed out. It usually has something to do with poor sleep, lack of exercise, sometimes depression. There is ALWAYS something about a person’s lifestyle that can be modified to help fix some of their health problems. And I love being able to help empower people to take control of their own bodies and health through education.

So why are you on 15 different drugs, instead of a weight loss regimen? Part of the reason is because as doctors, we are extremely well-versed in the use of prescription medications . We’re comfortable prescribing medications because we know the mechanism of action (mostly), we understand the pharmacokinetics, side effects etc. We learned a lot of cool things in med school about medications. What most of us DIDN’T learn a whole lot about is diet, nutrition, exercise. We know these “lifestyle modifications” matter, but we’re not so great in teaching our patients how exactly to modify their lifestyle.

And of course, when your blood pressure is 180/110 we’re worried about you having a heart attack or stroke, so we feel good about throwing you on blood pressure meds. They work, and we get measurable results . So you’re happy, I’m happy…until you end up on 10 medications to treat various problems, then one of those medications are making you dizzy, so I need to add another medication to counteract that…but then THAT new medication is making your mouth super dry….you get the idea.

So, what’s the purpose of this post? I think it’s just me throwing out my thoughts. It’s the beginning of a conversation we need to have as a society, as a culture. A conversation I have with my patients every day. Sometimes the answer is so simple. Sometimes the answer is helping that person lose 10% of their body weight, and voila! Lower sugars, better blood pressure and cholesterol, and less knee and back pain!! But no….there also isn’t a Magic Pill for that 10% of weight loss. Like I tell everyone, if there was a magic pill that works so well, everyone would be on it and we’d all be walking around looking like Naomi Campbell. And even Naomi has to work out, you guys.