--:-- [Upbeat music fades out]
--:-- Sean Rameswaram: Hello, you've heard about the 2020 presidential race. It all starts in the state of Iowa, and there is now a podcast all about the race in Iowa. It's from Spotify. It's called Uncommitted Iowa 2020. You can listen now. It drops every Tuesday, and it's absolutely free on Spotify. It's Thanksgiving time. A lot of Americans are thinking about food, but a lot of them are also thinking about a diet. A diet that is much more than a diet. It's a lifestyle. It's a culture. It's keto.
--:-- Julia Belluz: I think you're referring to ketosis, which is this holy grail fat-burning state that people on the ketogenic diet quest after.
--:-- Sean Rameswaram: Yes, Julia Ballouse, I am, and you wrote about it for Vox. What is the ketogenic diet?
--:-- Julia Belluz: It's keto time. We can't stop talking about it. No, it's like a preaching thing. It's like a cult following. The ketogenic diet. Let's break down what all this hype is about.
--:-- Sean Rameswaram: So it's this ultra high-fat, ultra low-carb diet fad craze that's just gone absolutely viral right now. But the interesting part is that there's also a lot of really legit scientists who are exploring many different kinds of health applications of the diet. So before we get to that, I guess, what is the diet? What are you eating? What are you not?
--:-- Julia Belluz: I want you to show me what you really eat every day. So you're basically eating butter, bacon, avocados. Can I ask you a personal question?
--:-- Sean Rameswaram: Of course. Has your poop ever turned green?
--:-- Julia Belluz: Steak, vegetables, lots of fat. And you're staying away from everything from too many fruits, bread, pasta, pizza, birthday cake. So many vegetables. You can eat a big-ass pork house steak if you want. Right. You just can't have the baked potato.
--:-- Sean Rameswaram: People on the keto diet get about 5% of their calories from carbs, 15% from protein, and around 80% from fats. Where did this come from? Was this like the Atkins diet where there's some dude who just said, here's an idea, is there a Mr. Keto?
--:-- Julia Belluz: So there's no one figurehead. And it is sort of a repackaging of the Atkins diet. It's sort of like the streamlined Marie Kondo version of Atkins, where he had this like multi-phase plan and you eventually reincorporated carbs. With keto, you just cut all that out and you stay that way and you live that way.
--:-- Sean Rameswaram: I sometimes see promotions for this diet on social media. Is keto big on the gram? Is it big with the influencers?
--:-- Julia Belluz: Yeah, I think it's this combination of things. So some communities that are quite influential in the diet and exercise space embraced it, like CrossFitters. Constantly varied, high-intensity, functional movement, leverage with meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar, increases work capacity across broad time and modal domains.
--:-- Sean Rameswaram: There are celebrities in Hollywood like Halle Berry. 51? I mean, look at this. You got to talk to us about this. So what do you do? Yeah, what's the workout regime? What do you eat? Come on.
--:-- Julia Belluz: I swear by the ketogenic diet. Kourtney Kardashian.
--:-- Sean Rameswaram: I'm really hungry, so I'm not in the mood. Silicon Valley has glommed onto it. People like Tim Ferriss.
--:-- Julia Belluz: The problem with the ketogenic diet is that if you don't get it perfectly right, it is the worst possible diet you could follow. And... So we all know you from the Jersey Shore.
--:-- Sean Rameswaram: There's an ex-Jersey Shore character who has like this massive Instagram following. I think he's called... Keto Guido. Keto Guido. Yeah. It looks like it's Vinny from Jersey Shore.
--:-- Vinny: My magic happens in the kitchen. I first got into eating low-carb, keto, because I wanted to lose weight. Who says he's lost 50 pounds thanks to the keto diet.
--:-- Sean Rameswaram: My man, Vinny is wilding out. I don't know what is in his keto diet, but all I do know is it doesn't take many carbs, so he gets drunk fast.
--:-- Vinny: Most of my Jersey Shore roommates make fun of me for being keto, even though they secretly love it and admire me.
--:-- Sean Rameswaram: Oh, is this the thing that they do? They do, like, the before and after, and then they got, like, the abs afterwards? Does this imply that you could just start eating certain food and you're going to be cut? Exactly.
--:-- Vinny: That's not true. I know. It can't be true.
--:-- Sean Rameswaram: Yeah, and if you search on social media, you see a ton of hashtags like keto transformation, keto weight loss, and you'll find many, many befores and after images attributed to keto.
--:-- Vinny: My one month of keto starts now.
--:-- Sean Rameswaram: So in addition to Vinny and Hallie and the Kardashians and some Silicon Valley bros, who else is doing this? Does it appeal to like a certain market?
--:-- Julia Belluz: Yeah, actually, I think it taps into the market of men who have often been forgotten in this diet space. So when you think about Weight Watchers, right, it's something that middle age-ish suburban moms are doing.
--:-- Sean Rameswaram: Poor guys. I don't know if this is all sexist, but no, but then with keto, it's sort of it meat heavy It something you can do by yourself You can quantify whether you on the diet So it has this interesting self aspect
--:-- Julia Belluz: Are you talking about data Yeah it data So you can buy breathalyzers pee strips that you pee on and they tell you whether you're in ketosis or not. And there's blood tests as well.
--:-- Sean Rameswaram: But what if you don't want to buy anything to test if you're in ketosis? Well, there are other symptoms and signs that you can look for. One of them is bad breath, also known as keto breath.
--:-- Julia Belluz: But anyway, there's this way. There's a way to do self-quantification, and maybe that's something that appeals to the dudes out there.
--:-- Sean Rameswaram: To go keto, you have to reject a lot of the things that we're told are an important part of a balanced diet. So whole grains and breads and even fruits. You really have to minimize your fruits to keep a keto diet.
--:-- Julia Belluz: So I think, yeah, at this moment where we're sort of rejecting the conventional wisdom and people are looking for alternative explanations for things, I think the diet resonates right now.
--:-- Sean Rameswaram: They're also quite anti-establishment and like to assert that, you know, like the government guidelines have been misleading us and CDC and FDA are all corrupt. And there's this diet that sort of turns the conventional wisdom on its head.
--:-- Julia Belluz: So keto diet's kind of like flipping the bird to any sort of conventional food pyramid.
--:-- Sean Rameswaram: Can we drop the F-bomb on the show? You can. You forgot.
--:-- Julia Belluz: Sort of like the fuck everything you know about conventional wisdom diet.
--:-- Sean Rameswaram: It does seem too good to be true. So let's go to Leah over here. What's your question, Leah?
--:-- Leah: Does keto really burn fat, and how does it work? Yeah, how does it work? What are you measuring with these urine and blood tests?
--:-- Julia Belluz: You're just measuring the ketone levels in your body. So when we're eating the typical high-carb diet, our bodies are fueled primarily by glucose or blood sugar.
--:-- Sean Rameswaram: So when we eat a bagel or a peach at lunch, the glucose levels in our blood rise, and the pancreas secretes insulin to turn glucose into a usable energy source.
--:-- Julia Belluz: So it's able to move the glucose from the blood into our cells. But our body didn't evolve to actually keep glucose on storage. So we just get it basically after we eat.
--:-- Sean Rameswaram: There's no long-lasting glucose stores around our body. So if we stop eating carbs, our body has this amazing ability to adapt to whatever else we're putting in there and turn that into a usable energy source.
--:-- Julia Belluz: We've known for a long period of time that when you decrease carbohydrate intake markedly, the body starts to use fat. And when you burn fat, you produce ketones and the body goes into ketosis.
--:-- Sean Rameswaram: So it's kind of like you think about our bodies like flex fuel vehicles. They can sort of adapt to whatever we're putting in them. Like a hybrid car.
--:-- Julia Belluz: Exactly. So one of those adaptations is this process called ketogenesis. And when we're in ketogenesis, the liver starts to break fat down, both from the food we're eating and from the fat that's stored in our body into this usable energy source called ketone bodies, or ketones for short.
--:-- Sean Rameswaram: And basically ketones can stand in as glucose for fuel when we're not eating carbs. So just to break it down again, so on the high-carb diet, you eat carbs like pasta or bread, your glucose levels rise, the pancreas secretes insulin, and then the insulin moves the glucose into our cells to power our body.
--:-- Julia Belluz: On the keto diet, a person eats fats like steak and eggs, the glucose and insulin levels in the body fall, the liver converts the fat into ketones, and then the ketones fuel the cells and tissues of the body.
--:-- Sean Rameswaram: So you're making the body find a way to use fat as a source of fuel. And this process is what's known as ketogenesis.
--:-- Julia Belluz: Yes. And when your body's being fueled by ketones, then you're in a state called ketosis. And that state is measurable on those P-strips or the breathalyzers or blood tests.
--:-- Sean Rameswaram: You can see whether the ketone levels in your body are higher or lower.
--:-- Julia Belluz: So is there another way to get the body into ketogenesis? Starvation.
--:-- Sean Rameswaram: Oh. So when you fast, yeah, so when you fast, think about it. Again, our bodies don't have glucose stored up anywhere. So when you're not eating, it has to turn to fat stores to start to get energy to keep going.
--:-- Julia Belluz: So that's part of the reason people can survive for as long as 73 days without food, because we start to just use the fat stores in our body and we can keep going.
--:-- Sean Rameswaram: I wonder, I mean, if the body thinks this is kind of like it's self-starving or it's similar to that, does this actually work for obesity? I don't believe Vinny's photos where he's all of a sudden got like a beautifully carved six-pack out there on the streets. But does this help reduce obesity? Could this be like a potential cure to America's obesity epidemic, which I hear is pretty bad, right?
--:-- Julia Belluz: Yeah the obesity epidemic is serious and Vinny abs are probably attributed to more than the keto diet He probably been to CrossFit
--:-- Sean Rameswaram: And the data we have so far suggests keto performs a lot like basically every other diet There are some people who see tremendous success There are some people who are just absolutely miserably fail and maybe even gain weight on the diet
--:-- Julia Belluz: And that's one of the weirder things about people, you know, that we are so variable depending upon your ancestry, you know, what part of the world they evolved.
--:-- Sean Rameswaram: There's a lot of people out there that eat a high-carbohydrate diet and they have zero issues with it whatsoever.
--:-- Julia Belluz: On average, most people will lose a few pounds but have a tough time sticking to it in the long run. People miss some fruits, different vegetables, grains. It's hard. It becomes a very restrictive diet.
--:-- Sean Rameswaram: So although people lose weight initially, maintaining it and keeping it off long term is a real challenge on a keto diet.
--:-- Julia Belluz: But keto does have this real potential as a treatment for a few diseases. And that's like this really serious and fascinating scientific exploration that's happening right now.
--:-- Sean Rameswaram: More in a minute on Today Explained. Thank you. It's not going to happen, but there is a show out there that you might enjoy. It is called Uncommitted Iowa 2020, and it comes to you from the people at Spotify and the people at Vice News.
--:-- Julia Belluz: You can join the host of the show, Antonia Hilton, and Vice News reporters as they break down all the ins and outs of the Iowa caucuses in this new podcast.
--:-- Sean Rameswaram: They'll tell you how this one Midwestern state became the holy grail of presidential politics, and they'll bring you in-depth reporting about what this election is all about in Iowa, what Americans are fighting for and what they want the next president or the current president to fight for.
--:-- Julia Belluz: It's all going to be there in Uncommitted Iowa 2020. The podcast comes out on Tuesdays. It's free on Spotify.
--:-- Sean Rameswaram: It's a podcast. Blues, you said this thing can actually help with diseases. I'm a little skeptical. Which diseases are they looking at?
--:-- Julia Belluz: So the three main applications that are sort of getting the most attention are epilepsy, diabetes, and cancer.
--:-- Sean Rameswaram: All right, let's go through them one by one. What are they doing? How can eating a lot more steak help you with your epilepsy?
--:-- Julia Belluz: So this is one of the keto effects that have been really well established. So for nearly a century, doctors have been prescribing this diet to treat epilepsy. Really?
--:-- Sean Rameswaram: Yeah, it's a real thing. And there's evidence from children and adults whose epilepsy wasn't controlled by medications that they experience this really big decline in seizures when they're on the keto diet.
--:-- Julia Belluz: And scientists still don't know why it has this effect. But one of the ideas is that it makes neurons more resilient during seizures. So there is some kind of healing aspect there with the diet.
--:-- Sean Rameswaram: In this case, this is actually like a pretty mainstream application of the keto diet.
--:-- Julia Belluz: And what about diabetes? Is that because what the keto diet involves lowering your sugar level altogether? So it could help with diabetes?
--:-- Sean Rameswaram: Yeah, controlling your blood sugar. Yep. That one kind of makes sense, I guess. That's the idea.
--:-- Julia Belluz: Yeah. And so this is one, it's still a little bit controversial, but it's becoming more mainstream. Yeah, so this spring, the American Diabetes Association actually came out with a consensus statement where they suggested a very low-carb diet could be this nutritional treatment option for some people with diabetes.
--:-- Sean Rameswaram: So this is based on studies where researchers have found that keto can reduce people's hemoglobin A1c, which is a measure of blood sugar, and also their reliance on medications.
--:-- Julia Belluz: But the effects tend to wane after a year, probably because it's pretty hard to stay in ketosis and to stick to this diet that involves eliminating so many of the things we're surrounded by all the time.
--:-- Sean Rameswaram: But yeah, this is definitely one of the areas that has a lot of buzz and excitement around it.
--:-- Julia Belluz: And maybe the most outlandish of all these claims is that it could help with cancer. I think so.
--:-- Sean Rameswaram: Remember when I said I was skeptical? Yes. No, and you should be skeptical because the cancer research has been mainly done in mice.
--:-- Julia Belluz: But it's legit. So there are people like Siddhartha Mukherjee who the Columbia University oncologist and author of The Emperor of All Maladies a Pulitzer Prize winning of cancer He a serious guy but he studying the diet effects on cancer
--:-- Sean Rameswaram: We think that there is a relationship between insulin and many cancers. And we think that in general, reducing insulin would be helpful. We don't know what aspect of insulin is the problem.
--:-- Julia Belluz: The idea is that keto's effects on insulin and glucose levels, they might interfere with cancer cell growth. They're doing studies in mice.
--:-- Sean Rameswaram: And to be clear, they're not just studying whether the diet itself can reverse cancer, but whether keto could be used as a co-drug with cancer drugs to sort of accelerate people's treatment response.
--:-- Julia Belluz: Basically, patients with various kinds of cancer, endometrial cancer, lymphoma, breast cancer and others, will get a combination of PR3 kinase inhibitor, the drug, and be on a ketogenic diet. And we'll measure everything, insulin, etc, etc.
--:-- Sean Rameswaram: But most importantly, we'll look for a response. So the Mukherjee trial in particular, it's moving into humans this year. It's a phase one study. It's a safety study. Hopefully we'll get some signal.
--:-- Julia Belluz: But yeah, it's still way too early to say that there's a lot of stuff online about, you know, stop eating sugar to fight cancer and all that stuff.
--:-- Sean Rameswaram: And when I talked to the people who are studying this, they were very clear that we are absolutely super far from understanding whether that's true or not.
--:-- Julia Belluz: And it's possible that with some cancers, cutting out sugar might accelerate the cancer. It's possible that it might, again, interfere with tumor growth and help reverse or treat cancer.
--:-- Sean Rameswaram: But we have absolutely no idea right now. So don't believe those online videos.
--:-- Vinny: It all comes back to Vinny. You know they call me, right? Keto Guido.
--:-- Sean Rameswaram: Is there a danger that people hear these sort of potential applications, diabetes, cancer, epilepsy, and just like stop eating carbs and vegetables and fruits and just like throw back fatty steaks every day?
--:-- Julia Belluz: Yeah, there absolutely is.
--:-- Sean Rameswaram: There was a commentary in JAMA, which is a really influential journal recently, and a couple of doctors raised this issue of on a keto diet, you aren't getting much fiber. And what effect does that have on long-term health and the microbiome and other aspects that we know that fiber fuels?
--:-- Julia Belluz: And we also have evidence that the keto diet can ramp up your cholesterol levels, and that might have an effect on heart disease over the long term.
--:-- Sean Rameswaram: Doctors have also pointed to side effects like constipation and vitamin and mineral deficiencies.
--:-- Julia Belluz: So there are definitely many unknowns. It's important to say we still really don't understand the long-term effects of staying in ketosis over decades.
--:-- Sean Rameswaram: So it's still, even though we're talking about keto being this thing that flies in the face of centuries, if not millennia, of our diets, it's still kind of like choose your own adventure out there.
--:-- Julia Belluz: Actually, that's right as well. Mukherjee wrote this Times op-ed where he points out that a lot of the nutritional advice we've been giving people isn't based on hard science.
--:-- Sean Rameswaram: And one of the reasons for that is that it's really, really difficult to study the effects of single foods on the body and then how foods work in combinations.
--:-- Julia Belluz: And then foods are prepared in different ways. And then basically nutrition science is really complicated and it's hard to get clear and straightforward answers.
--:-- Sean Rameswaram: When you add one thing to your diet, you're taking something else away. If you have a health impact from that, is it the thing you added or the thing you took away?
--:-- Julia Belluz: It's a really, really tricky area of science, but that's one reason why I'm excited about the research that's being done on keto for disease now, because it might give us some answers.
--:-- Sean Rameswaram: Julia Blues writes about health for Vox. I'm Sean Ramos for him, wishing you a healthy and happy Thanksgiving from Team Today Explained.
--:-- Sean Rameswaram: The show's executive producer is Irene Noguchi. Our engineer is Afim Shapiro. The show is produced by Bridget McCarthy, Amin Al-Sadi, Halima Shah, and Noam Hassenfeld, who makes music for us, too. The mysterious Breakmaster Cylinder makes even more music.
--:-- Sean Rameswaram: Olivia Ekstrom checks the most facts and shouts to Jelani Carter at NYC for being a G. Today Explained is produced in association with Stitcher. We are part of the Vox Media Podcast Network. Thanks again for listening to the show today.
--:-- Sean Rameswaram: And if you're looking for another show, one last reminder that you can listen to Uncommitted Iowa 2020 every Tuesday on Spotify. It's a podcast that will exclusively talk to you about what's going down in Iowa and how those caucuses you keep hearing about are shaping up. Uncommitted Iowa 2020 from Vice News and Spotify. it's free
