Introduction
Dr. Eric Westman: It’s my great pleasure to have Richard Smith back. How are you today?
Richard Smith: Dr. Westman, I am absolutely incredible, super excited for our chat today and it was a pleasure to meet you recently.
Dr. Eric Westman: You came over to the UK and gave a presentation at the Public Health Collaboration of the UK meeting in London in Euston and you traveled down to London for the meeting. It was awesome.
Richard Smith: I did. I did. It was a five hour trip for me. The UK is a little bit bigger than people will give it credit for. Not as big as the states, obviously but that was a fantastic event, incredible event.
Thoughts on the PHC UK
Dr. Eric Westman: I would love to have your thoughts and reactions to the Public Health Collaboration meeting.
Richard Smith: I think that was the third or fourth meeting that I’ve attended. I think there were good arguments on both sides in regards to a number of debates that went on. Yours was fantastic in regards to insulin resistance and what is more problematic in regards to carbohydrate content over seed oil. I think you made a solid case there and I agree. I think one of the arguments that I’ve heard over the last couple of years is that as a percentage of calories potentially seed oils are going to cause more damage. You made it super simplistic and it was in one sentence when you said, “If you were to remove seed oils but continue to consume carbohydrate are you going to reverse insulin resistance?” Even though I believe that’s a contributor, you’re not going to because of the high carbohydrate content.
Dr. Eric Westman: It’s the magnitude of the effect. That’s often lost. I was invited to offer the history aspect and that low-carb keto is not a fad. It’s actually a fad that never fades. It’s just the name has changed over time from Banting in the UK to Atkins to LCHF and now keto.
I was surprised to get a lifetime achievement award from the PHC. That was quite lovely of them to do that. I met Steve Bennett who has been helping with the PHC for a while and got to have dinner with him and Dr. David Unwin the night before the meeting. There’s so much more information. The baggage we had in my lifetime is that we had to say all of this stuff is unfounded and it’s prejudiced and there’s discrimination against what’s really a healthy thing. Now the younger researchers are coming at it afresh. It’s just so great. Dr. Isabella Cooper is taking people who are already in ketosis, looking at their metabolic profile, adding carbs back (I think she probably had to pay them to do it!) and then seeing the deterioration in the blood markers and then going back to keto to see them recalibrate back to normal which is so great to see.
I think another highlight for me was the talk about the transition of Thomas Seyfried’s cancer idea into humans. For ages his book, Cancer as a Metabolic Disease is a really great theoretical underpinning in the animal models he has. He’s not a physician. It’s a huge leap from animal models to humans. There was a one, two, three punch with Professor Tom Seyfried, Dr. Matt Phillips and Professor Isabella Cooper all talking about cancer as a mitochondrial disease. Dr. Phillips, who is a neurologist working with glioblastoma, was showing the study that he’s doing. He didn’t give any results yet and he’s not curing these glioblastomas but he’s delaying the demise, if you will, which is huge. They’re taking the worst cancer possible and trying to use keto and chemo and radiation.
I feel like this whole field is like a train passing me by and I wanna hold on. Even the new ideas about different types of ketones and giving ketones as a therapy because you can’t wait for endogenous ketosis was interesting. I went from the Public Health Collaboration to the Keto Live meeting in Switzerland and the study that’s been done needs to be replicated for knowing that giving ketones can reduce problems with sepsis which is a very serious, life threatening disease.
I come back full of new new ideas. I want to have us focus on the most important elements. What was your reaction?
Richard Smith: Speaking of ketones, that’s what I have in my bottle. I think they’re absolutely incredible for a number of reasons but that’s probably a talk for another day. The event was absolutely incredible. As you say, the ketogenic lifestyle has taken many many names over the years but this is our natural metabolic state. It’s the metabolic state that we’re born in. It’s the metabolic state that we’ve evolved in almost our entire existence. In fact, if we were to put man’s entire existence into a 365 day calendar, we’d be ketogenic for 364. To say that it’s a fad is laughable.
Dr. Eric Westman: There are so many people, including me, who were taught a certain way. We have to unlearn and teach it. I love the way that you and other people are coming at it with, “This is just normal,” or that it can be normal and even optimal.
Consuming Ketones
Dr. Eric Westman: Why are you drinking ketones?
Richard Smith: I make them. I’m one of the two companies in the UK that’s authorized to manufacture and distribute these. I’ll give you a quick rundown on why I came into doing what I do. I was once clinically an obese, type two diabetic. I suffered with chronic fatigue, depression, anxiety, arthritic pains, daily debilitating migraines which would make me blind for which I was on three different medications. I suffered from severe skin conditions. I would struggle to walk a flight of stairs in my mid- to late twenties without stopping or being severely out of breath. My doctor said that it was a fact of life. I was just getting older and here’s your medication. At the time I was not trained in nutrition but I didn’t want to resign to what he was telling me. I didn’t want to believe that this was just a fact of life. I was in my mid- to late twenties. The thought of this being the end of the road in regards to having to consume copious amounts of medications for the rest of my days just didn’t seem to make sense.
I had no training at the time but I knew that bread bloated me so I just removed the bread. For no reason other than the hope of it trying to reduce the bloat in my belly. If I could feel like I wasn’t so obese then maybe I would feel a little bit better and maybe this would make me feel happier and less depressed. At the time, my anxiety was so severe that I would struggle to leave my house. My life was spent living in boxes. I lived in my box, my house. The only time that I would leave my box was to jump into my metal box. I would drive my metal box to another big box, my place of work. Many of us do this. Our lives are quite literally spent living in boxes and I would just work in this small box inside this bigger box all day and perform this in reverse to go home. I wouldn’t go anywhere by myself. I never felt worthy of the company of others and I always thought there was something wrong with me.
I was on antidepressants and all sorts of medications. The start of my journey began when I removed the bread, not understanding what was happening. I removed the bread, my bloat went away. I felt a lot better. Through a series of studying clinical trials, research papers, speaking to people, and watching YouTube videos, I came across this crazy lifestyle, the ketogenic lifestyle. This was back well over a decade ago. I know this has been prevalent in the US for quite some time, but ten plus years ago in the UK, this was not something that was well known. In fact, I think if you’d stopped a hundred people in the high street, you’d be lucky if one had ever even heard of the ketogenic way of living at that time, so this was crazy.
I began my journey. I didn’t understand. I began through a “dirty keto lifestyle”, if you like, trying to restrict carbohydrates, coming back to what you said in the PHC conference, carbohydrates being the biggest contributor. Super long story short, over the period of 12 months, I had lost 107 pounds, reversed my diabetes, I was off all my medication, and my anxiety and depression was well under control. It was still there, and I think for people who suffer with these conditions, it’s always there, but now I’m able to almost squash these feelings and throw them over my shoulder and forget they’re even there. I’m here today speaking with your good self. I travel the world speaking at big events, talking to and presenting to thousands of people. I would never have done that for a million dollars because the thought of standing on stage in front of so many people would have been frightening!
It makes perfect sense because the food that we consume allows us to create our neurotransmitters. The foods that we consume, the animal proteins allow us to make our aromatic amino acids, tryptophan, tyrosine, phenylalanine. These go on to create our neurotransmitters and this balances glutamate and GABA. All of these things make perfect sense. Now we’re removing the antinutrients from the grains, the seed oils and some of the other toxic plants which are blocking our body’s ability to create these neurotransmitters because it isn’t just enough to consume highly nutrient-dense foods with these aromatic amino acids in order to make the cake or fry the steak in this case. We need other ingredients, co-factors, things like zinc, iron, magnesium, B3, B6, B9, B12. And we need these co-factors in order to convert these aromatic amino acids into our neurotransmitters. If we understand that 95% of the neurotransmitters are created in the gut, then if we were to damage that pathway, which is a pathway called the shikimate pathway, then we’re unable to produce the majority of our neurotransmitters. If we don’t produce our neurotransmitters, things that we’re hardwired to chase, like dopamine and serotonin, now we’re depressed. Now we pull tryptophan through a pathway called the kynurenine pathway and this affects glutamate and GABA. It leads to glutamic excitotoxicity and it leads to a whole host of mental health problems, anxiety, depression and lots of other things. Everything comes back to what we put into our mouths. It’s super simplistic. I’m not saying this is the key to everything, but I do believe that nutrition is 95 plus percent of things.
I was clinically obese, unable to walk a flight of stairs and I went on to become a professional bodybuilder, a British and European champion. I’ve retired, obviously I’m much smaller. I’m involved in endurance sports, things like running and cycling and high rocks but these are things that I could never have even imagined doing previously in my mid-to-late twenties. Now in my forties, I genuinely feel healthier and fitter than I’ve ever felt before.
What I find incredibly frustrating – you and I spoke about this recently – is there’s lots of negativity in regards to the ketogenic way of living in social media recently. I’ve been living this way for well over a decade, maybe 12 years into my journey of very little to no carb and I’m the healthiest and fittest that I’ve ever been. How long do I need to live the lifestyle in order to prove to others that this, for me, at least, is the key to optimal health. Everyone I work with seems to reap the same benefits. They seem to improve their mental health and they reverse their insulin resistance, type two diabetes, and a whole host of other things because everything comes back to this insulin resistance and inflammation. Once we combat that intestinal permeability and we heal the gut, everything else seems to fall into place.
I quite often say to people that I found a secret and I want to tell the world about my secret. I think this is why you and I do what we do; it’s to spread the word and to help others improve their health and well-being. But it’s a tough journey.
Receiving Training
Dr. Eric Westman: Thinking back on your experience, did you go out to get special training? Did you take a course or become a certified nutritionist or did you learn on your own?
Richard Smith: I’m a certified nutritionist and the reason that I did this was that I went down a rabbit hole and I reversed all of these things that my doctor told me I was going to suffer with for the rest of my life. When I went back to see him and it was like, hey doc, look at what I’ve done: I’ve reduced carbohydrates, I’m living this ketogenic lifestyle, I’ve lost all this weight, I’ve reversed all these things, I’m off all of my medication and what I found incredibly frustrating was his response to this, which was, “It’s fantastic, but this lifestyle is not good for you. High fat causes high cholesterol, salt causes high blood pressure, red meat causes cancer,” all of these things. Basically, what he said to me was, “You need to go back to eating the way you were prior to this.” I wasn’t qualified at the time. I’m not a doctor, but this from a simplistic perspective just did not make any sense to me. Eating this way prior made me unwell. I’ve changed the food that I’m consuming and I’m living this other lifestyle which has reversed all of these things, yet you want me to go back to living the way that I was prior to this. It just doesn’t make sense to me.
The doctor told me and he stressed, incredibly powerfully, that this lifestyle was detrimental and I should come away from it. But this was the best that I’d ever felt, the best I’d ever felt in my life. I went home and my family and friends told me the same thing: “ What about your cholesterol?” It’s always worrying about your cholesterol. At that moment, I thought, well, maybe, just maybe, cholesterol is more important than we think it is. I began to investigate cholesterol and saturated fats and animal proteins compared to the bioavailability of plant compounds. It led me down this rabbit hole. Many, many years later, over a decade of research, I’m so deep down the rabbit hole that I’ve come out the other side.
What I found was that this research went against everything that I’d ever been told, so I retrained as a nutritionist. Since then I’ve studied molecular biochemistry, epigenetics, clinical blood analysis, the endocrine system, so on and so forth. I love to study. In 2024, I recorded over 750 hours of study towards medical qualifications, which is the equivalent of two hours each day. I love to study. I love to learn. A got me to C. I knew that living this lifestyle allowed me to thrive, but I wanted to understand the B. I knew that A got me to C, but I wanted to understand the B. This for me is incredibly exciting because it opens up this journey and this path of learning and understanding and being able to explain to other people why eating animal proteins is actually very beneficial, why excessive carbohydrates are damaging to the body, why grains are so damaging and so on and so forth. It allowed me to understand why living this way allowed me to achieve all of these things.
What struck me was that what I had learned from my own research went against what I’d learned when I was studying to become a nutritionist. What I was taught as a nutritionist is that plant compounds and seed oils are incredibly good for you and cholesterol is bad and red meat causes cancer. My research has found quite the opposite and those things I’ve put into real life. I know that you like research and we’ve spoken about this before and you’ll go to the nth degree to study the research paper and to learn and understand. I study research papers but I also look at it from the other perspective of what happens in the real world. Lots of these research papers can be manipulated. I think 98% of them are often funded by companies who have a vested interest, but what happens in the real world?
I’ve lived a lifestyle for over a decade. I’m in my forties, I’m the healthiest and fittest that I’ve ever been. I’m medication free and everyone else that I know that I’ve worked with and lived this lifestyle has reaped the same rewards. They are thriving living this lifestyle. The proof is in the pudding, or the proof is in the steak in this case!
Dr. Eric Westman: I had on my wall for years the biochemistry pathways. A researcher came in and said most of these pathways are not that worked out in humans. That most of these biochemical pathways are from animal studies. I was forced to look at this biochemistry pathway chart thinking, how much is known in humans and how much is yet to be understood in humans? So even the things that we learn can be reshaped, reformulated.
When you say “doing research”, you mean reading other people’s studies, right? You could become a primary data collector, which, of course, means getting some research funding or even case studies at this point can be published if there is an interesting twist. The primary data collection for me was necessary because there was no study to look back upon. Even then when people were looking at the brain needing 120 grams of glucose for the day, it was under the conditions of eating carbohydrates with hundreds of grams. Now, it’s like we’re studying and talking about metabolism when you’re on the moon. This really all has to be reassembled and recalculated if we want to know the A to C. The B has to be new data collection. Even other people commenting on how bad it is, in my mind, is either total ignorance or there’s active pushback because they don’t want you to eat meat, they’re pushing plant products and profiting off that – money likes to flow in the way money flows and the world doesn’t want to perturb that too much.
The Power of Personal Experience
Dr. Eric Westman: Your story and desire to learn more is great and it’s relatively rare. Most people will just fix themselves and get settled on that. Thank you for sharing the word. Disrupting the research business has been a part of the keto story. There are parents who have children who have problems like Charlie Abrahams with epilepsy. His parents created the Charlie Foundation and they’ve taught for the last four decades. Dr. Cooper basically is using Go Fund Me to self-fund research. If you go knock on the door of universities you need money and ethics approval and things and yet, I think what has been demonstrated over and over now is you can study keto conditions and actually see what’s happening without study sections saying no, it’s unethical. That’s a big change from 20 years ago. When we first started, there was a concern about even putting someone on a low-carb diet. The time has passed with it so that now you don’t have to worry about discrimination and prejudice against it.
I think the science is so solid and even getting back to the historical fact that we’re born in ketosis and we’ve lived in ketosis or very low-carb for most of human history. That unfortunately doesn’t count to a review committee who says, “I’ve eaten carbs and you need to prove that it’s safe.” There are research pockets that we’re seeing which is great. I wonder what your path will be to maybe generate new data or be happy researching other people. Just be aware that a lot of the data collected in the critique of what we’re doing is from non-human sources.
Richard Smith: 100 percent. It’s more a case of I’ve lived my lifestyle and I see the benefits in myself. What I do for a living now is I consult for a couple of days a week. I present in health conferences all over the world but most of my time is spent consulting. I’ve got an online business through which I help other people adopt low-carb ketogenic lifestyles. For me, this is a journey through incremental changes towards optimal health. I see these things occurring in everybody that I work with and I want to understand further. This is real life data. I go to the research to further understand why I see these things happening.
I test my bloods regularly. This is something I’m qualified in which is clinical blood analysis. I’ve noticed how my bloods have changed over the last 10 years. I’ve noticed how the production of ketones has changed and how the levels have changed and how the longer that I live the lifestyle the more adapted that I seem to become and the better my life seems to be. Lots of these studies are also done on groups of people who are only ketogenic for a number of weeks. Professor Noakes recently released a paper and I believe it was three to six weeks that they put these athletes into a ketogenic lifestyle and even in that, when they compared to a carbohydrate athlete, they found that the carbohydrate athletes only need 10 grams of glucose per hour, not the 180 grams of these sugar companies are saying. The reason that we don’t see this research come out is that there’s no money to be made off of people understanding that we require very little carbohydrate and we make that carbohydrate, which is very important. We make this carbohydrate through a process called gluconeogenesis.
Coming back to the point that you made, the body contains around 25 trillion red blood cells. The red blood cells don’t have mitochondria and only cells that don’t have mitochondria need glucose for fuel. But even the red blood cells can make some of their own glucose. Even if we look at the pathways in the brain, many of these can upregulate and use ketones over time, whereas we believed that 70% of the brain needed glucose. We’ve switched that around and our understanding is 95 plus % of the brain and the body can be fueled by ketones. I would argue that the research that I’ve looked at also, many of these studies have never been carried out on groups of people who are ketogenic for over 12 months. What we see is that the longer you live the lifestyle, the more you upregulate the pathways and the enzymes involved with producing, transporting, and utilizing ketones. These are called the monocarboxylate transporters. We call them the MCTs—not to be confused with um medium chain triglycerides—but these are transporters that we use to transport thyroid hormone, for example. These are increased, the mitochondria increases, the enzymes within the cells are also increased. The longer that we live the lifestyle, the more that we are able to create beta-hydroxybutyrate, which is the master ketone, transport it and utilize it.
The longer that I’ve lived the lifestyle, I’ve seen my ketone levels change over the last 10 plus years in regards to my wasted ketones, the acetone, which is what we breathe out and pee out. This is what we see on the breath monitors and the urine strips. We see this being elevated initially, which is a good thing, but then people become worried over time because they see these levels drop, but this is perfectly normal because now the body is no longer wasting ketones. It’s increasing its ability to create beta-hydroxybutyrate. Over time the monocarboxylate transporters, its ability to transport and utilize the beta-hydroxybutyrate. So then we see the increase in beta-hydroxybutyrate, but as these pathways increase, the BHB in the blood even comes down because now we’re utilizing it at a higher rate. I find it incredibly interesting to see how my body has changed over the last decade.
Dr. Eric Westman: It wouldn’t make sense to spill, in the urine, a precious fuel. But early on, when you’re not adapted, you see ketones in the urine. If you’re in equilibrium energy-wise, you would want to hold on to that ketone, kind of like if you’re a carb burner, it’s not normal to see glucose in the urine unless it’s really high.
Approach to Metabolic Illnesses
Dr. Eric Westman: Do you teach people who are trying to fix a metabolic issue like diabetes, obesity differently than you teach someone who’s trying to optimize their fitness and become a bodybuilder, for example?
Richard Smith: I think everything can be taken down and stripped back to some fundamental things. Carbohydrate, I agree, is the biggest contributor to insulin resistance in the context that we understand it at least. But the first thing that I teach people, irrespective of whether they’re coming to me with diabetes or whether they want to increase athletic performance, I work with clients from across the board, people with diabetes to cancer to athletic performance, removing the grains is always the first thing that I do. Grains predominate in the diet, they’re very high in carbohydrate, but they also contain a compound called lectins which cause intestinal permeability. Lectins, even in gluten-free products, still contain wheat germ agglutinin which binds to the epithelial cells on the enterocytes lining the gut, they cause the release of a molecule called zonulin which causes a gap to appear in the tight junction between these cells and this leads to what we know as leaky gut. Fixing and healing that gut is job number one. By removing the grains, we’re removing one of the biggest contributing factors to this intestinal permeability, but by default we’re also reducing the amount of carbohydrate.
The second thing that I teach them is to look for seed oils in things that they consume. If you venture into the supermarket, there are very few aisles in the supermarket that actually contain real food. There are only two aisles that I would argue with real food – the meat and fish aisle and the veg aisle. At least they are real foods, single ingredient foods. That’s what I teach people initially. I’ll always give them the challenge to venture into the supermarket and pick up the items that you would normally pick up and read the ingredients list. If it has more than one ingredient, then we don’t consume it, we put it back. What shocks me is how many of these compounds that we believe to be healthy contain lots of these vegetable oils – sunflower oil, rapeseed, grapeseed, so on and so forth. They’re incredibly detrimental. Those are the first two things that I teach people, remove the grains, stop the seed oils.
Carbohydrate restriction, once we’ve done this comes into week three for me or the third lever that we pull. By default we’ve removed the grains, I’ve already taught people to predominate animal proteins on their plate, single ingredient foods and then we start to look at vegetables that are lower in carbohydrates, so typically things that are grown above the ground. There is a caveat to this also because compounds that are grown above the ground do contain phytolectins, plant toxins, but this is a lever that we pull far later down the journey because optimal health is achieved via a series of incremental changes.
I do believe that an animal-based lifestyle is going to be more beneficial and what I teach people in the early stages, is to predominate your plate with three quarters of your plate made from animal proteins and natural fats and if you are consuming vegetables and they’re the low carbohydrate vegetables, they make up just one quarter of the plate. As we progress deeper, we learn more about other plant compounds that maybe contain lectins, things like tomatoes, bell peppers, and things that maybe have nuts and seeds which are all very good for a ketogenic lifestyle but are maybe causing problems later down the line. It’s a progression over a series of many months and it’s very much an individual approach. I think of it like a train journey. We can jump on the train and we can travel from the standard diet town which is where we all live, typically, and it’s incredibly processed, high in carbohydrate and seed oils. We travel on the train down to the next station. The next place is free of grains, for example. This town is a little bit cleaner, the sun’s a little bit brighter, there’s less rubbish on the street, and everybody’s generally a little bit happier. Then, we can jump on the train and travel a little bit further down the journey where we’ve removed the seed oils also and this place is a little bit cleaner still. Now we can jump on the train and travel further down and the stricter that we become in that sense, the healthier that we will feel.
Some people don’t want to be living a predominantly strict animal-based lifestyle, they may find that they are thriving on a “dirty keto lifestyle” or a low-carb lifestyle or a standard keto lifestyle or a strict keto lifestyle. This is all about consistency. Consistency’s key; this is all about the rule and not the exception. If this person, for example, could live 30 days out of 31 while being low-carb but living what we call a “dirty keto lifestyle” which is based on macronutrients, the carbs being less than 20 per day but not overly concerned on where they come from, they are going to be exponentially fitter and healthier than they were prior to that. If that’s all they ever do, then they will thrive. But the more levers that they can pull, the further that they can travel on this train journey and the healthier and fitter that they’re going to be. Just because they arrive at one station doesn’t mean that they can’t go back and take a step back. If they become carnivores, it doesn’t mean that they can’t go towards becoming ketogenic again, because this is all about the biggest levers to pull. As you rightly say, if we keep carbohydrates low, we’re going to thrive from that perspective.
Testing the Limits of Carb Restriction
Dr. Eric Westman: I think it’s important to see the different angles that people come to this. Having been raised in a carb-filled world, personally, and feeling like I had to be defensive to protect even just 50 people on a low-carb diet for six months within a university and publishing that paper and then another. But now I realize there never was a paper that said it was bad. It was all just prejudging. I’m coming out of it from taking away carbs. Now, with Dr. Cooper’s science and all of the humans doing this by starting with really no carbs and no seed oils and super clean diets, I wonder how much can I get away with? Can I just have a little bit? Can’t I just have a beer at the pub? Taking away carbs or adding carbs to see what the detrimental effect is and not just carbs but other elements of the restrictions, the seed oils, things like that, I think we’ll be able to tease this out. The nuance there, even genetically, if you can be studying genome-wide and then gene expression, I think we may be able to match what carb people can have. In my book, I have three levels of carbs, which is basically saying, sure, go ahead and have them. But now I wonder maybe we should all be in ketosis seeing some of the science that’s coming out.
From your vantage point of living this way, do you drink alcohol? Do you recommend not clean? Would you deign to eat at McDonald’s and just ditch the bun? How do you synthesize all that you’ve learned?
Richard Smith: Yeah, brilliant question. For full disclosure, I’m carnivore. I eat nothing but beef and lamb, eggs, and occasionally cheese. I’ve arrived at this point through many, many years, through a series of incremental changes. But my metabolic state is still in ketosis. I’m still in a ketogenic state. I think this is where the confusion comes in. We look at keto and carnivore as being two separate things, but a carnivore lifestyle is a plant-free ketogenic lifestyle.
When I began my journey, I believed that plants were the magical elixir. I believe that they were highly nutrient dense and contained these unicorn compounds that allowed us to thrive. In the early stages, my lifestyle predominated plants. I used to consume my spinach and kale smoothie with turmeric and black pepper and I was thriving. If you told me at that moment that what I was doing was not optimal, I would not have believed it because I felt so good. But what I learned over a series of these incremental changes is that I became more strict in regards to consuming more animal proteins and less plant compounds without realizing it until one day I was in my office and I realized that I hadn’t eaten a plant for six months. I did this through convenience because beef is the original fast food.
We live in this environment where we believe that fast food is the key to everything because we’re so busy. This is what everyone says: “I’m too busy.” It takes two minutes to fry a steak. It doesn’t take long to fry a steak. It’s the original fast food. You can probably cook a piece of beef in less time than it takes to boil an egg. This is what I was doing. I began to remove the vegetables because they were taking too long to cook. At this time, six months had gone by and I began to become concerned because I’m thinking, well, where are all of my vitamins and minerals coming from? All I’d eaten in the last six months was beef and eggs. Yet, my mental clarity had improved, my skin had cleared up, my energy was better, my cognition, everything had improved and I didn’t understand why. This comes back to one of the points that we made earlier on. I wanted to understand.
I knew that removing the plants and eating the meat had got me from A to C. Well, let’s understand the B. This is why I began to research what is actually found in plant compounds versus animal proteins and it astonished me because plants are not a very good source of nutrients, believe it or not. We can get into this in detail if you like, but super long story short, animal proteins quite literally contain every single vitamin and mineral that we need not just to survive but thrive. That includes vitamin C. It includes a couple of other compounds. I’ll give you one example – first on the list, vitamin A, retinol, does not exist in plants at all, zero. Plants contain a plant version of this called beta-carotene, which is not the true form of vitamin A, which is retinol. In order to convert it into retinol, it’s depleted by over 20 times. One of the interesting things with this, in order to convert beta-carotene into retinol, it costs the body T4. The body uses T4 to convert the beta-carotene into retinol, basically leaving less T4 for its conversion into T3. What I’m saying in simple terms is that excessive amounts of beta-carotene from plant compounds and supplementation can affect thyroid function and lots of other things also. The crazy thing with this is the T4 that we’ve now used to convert the beta-carotene into retinol, which has been reduced by over 20 times, the retinol that is left, we now need to convert the T4 into T3. We’ve reduced the T4 to convert the beta-carotene into retinol, but that retinol we’ve used to make that T4 into T3. So now we’re low in thyroid and in retinol. This is because we’ve eaten the beta-carotene from a plant, for example. That’s just the first on the list.
When I started to gravitate down this rabbit hole, I realized that animal proteins for me contained everything that I needed to survive. Every cell in the body’s made of protein, every cell in the body’s made of fat as a percentage of weight, minus water. Water makes up around 70% of the weight of the cell. If we remove the 70%, the 30% that we’re left with, 18% of that total weight, so over half of that weight is protein. Then it drops down to lipid or fat. Only 1 to 2% of that is polysaccharide or sugar. Yet, as a species recently in modern times, the last 2,000 to 10,000 years, we’ve been predominately in carbohydrates or glucose in our diet over the two main compounds that build everything within our body. The reason I say this is that when I started my journey, I was here and the longer that I’ve lived my lifestyle, I’ve naturally gravitated towards more animal proteins, less of the plant compounds. What began as a dirty keto lifestyle led me towards a standard keto, then a strict keto, then what I call more animal-based. I’ve gravitated into what we’ve referred to as being carnivore.
I’ve achieved this through a series of incremental changes. Does that mean that I did not consume alcohol or fast food? I’m a sugar addict. I’m a self-confessed sugar addict. I love eating sugar. We all are. Anyone who has access to and can afford it is addicted to sugar. It’s highly addictive. I have fallen off the wagon more times than I care to mention. Many people who gravitate into this journey will experience this. They’ll binge because the cravings get too much and they’ll fall off the wagon. They’ll beat themselves up and that’s it. It’s game over. But it isn’t game over because we get back up, we dust ourselves off, we continue down the journey. We begin with animal proteins, natural fats, and restrict carbohydrates. Every time we do this over a prolonged period of time, it becomes easier and easier until those cravings go away and we no longer get them. I no longer drink alcohol. I no longer consume fast food. I’m what we would call being very strict, but I don’t feel like I’m being restrictive because I love eating animal proteins, I love eating natural fats. The reason I say this is that I don’t want to think that people can’t achieve the end goal. It’s all about taking one step. Let’s reduce the carbohydrate, gravitate down that journey, make the changes that you need to over the time that you need to. If you fall off the wagon, you just pick yourself back up, you dust yourself off, and you continue down your journey.
The interesting thing about sugar addiction is that sugar will increase things like dopamine and serotonin. These are neurotransmitters that we are hardwired to chase. This has been imperative for our survival. We’re hardwired to chase dopamine and serotonin. We can elicit them naturally, which I’ll explain how, but we can also elicit them through a sugar response. If we consume compounds that contain antinutrients, things like lectins and phytic acids that block those cofactors that we mentioned earlier that prevent that production of our neurotransmitters, now our dopamine and serotonin levels come down, so we seek other means to increase them. We reach for the sugar because this gives us an artificial bump. The problem with this is every time we do so, it downregulates the receptors, basically meaning that we need more next time. We have our sugar bump and then that rise is short-lived, so we need another and every time that bump becomes less and less, so we feel like we need more and more.
This puts us into this vicious cycle where we need dopamine and serotonin and now the only way that we can get it is from sugar, so we continue to eat the sugar. But the key to this, super simplistic, is that we stop consuming the sugar, we remove the antinutrients, the things like the lectins, the phytic acids. The aromatic amino acids, tryptophan, tyrosine, phenylalanine can now be produced and converted into our neurotransmitters efficiently. Now our neurotransmitters are being released and increased so we no longer get the cravings and the requirement for the sugar. Super simplistic.
There are things we can do to help with this. We can increase BDNF, a brain-derived neurotrophic factor. Guess how we do this? We do this via amino acids, saturated fats, omega-3s and ketosis. i.e. we live a ketogenic lifestyle, we consume animal proteins and natural fats. This allows us to combat that inhibition. Other other compounds like CCK, cholecystokinin achieved by the same sort of mechanisms, the saturated fats, the omega-3s, amino acids. When we consume the animal proteins, we produce the neurotransmitters and now our cravings for these things. We need a little bit of self-control, but understanding that if you are craving and you go and binge on a piece of beef or lamb, then you eat the beef and lamb. If you’re still hungry, eat some more. By doing so and restricting the carbohydrates actually increases the natural production of the neurotransmitters, which in itself blocks that craving that is the reason that within this situation in the first place. Super simplistic, I know, but once you understand that mechanism, it’s easy to implement.
Dr. Eric Westman: Another way to say that is that the lifestyle change that you’re doing when you’re eating this way is therapeutic. These are the mechanisms for why what we teach works without having to add in special oils or a product here and there. That’s important to remember if you’re one of my patients and your doctor wants you to be on medication for something, remember that this lifestyle is like a medication. It’s a therapeutic change for all these things.
Had you met Anthony Chaffee before this?
Richard Smith: Yes, Anthony and I do lots of work together. Anthony and I have recorded maybe four or five podcasts together, one of which was a rebuttal to Georgi Dinkov’s claim that long-term, low-carb ketogenic lifestyles increased cortisol.
Dr. Eric Westman: He’s super smart and then lived an athletic lifestyle this way. I was impressed to hear him speak. You weren’t up on the podium speaking, sadly. We got to chat off on the side.
Checking Blood Indicators
Dr. Eric Westman: Steve Phinney taught me years ago, and I keep repeating what he says, that we check the blood because it’s convenient. You can just draw the blood and not that it really tells us what we need to know. In your experience, that seems to be a growing list of if you check the blood and it’s not the same range as carb eaters, called the “normal range” on your lab tests, don’t freak out. What are the things that you can see that are not in that normal range for unhealthy carb eaters among your clients or people? I think, of course, cholesterol at first, not to worry about it. The hemoglobin A1C sometimes doesn’t normalize, even glucose. Some people are worried about ferritin. Any other labs that come to mind?
Richard Smith: It’s interesting that you say this. One of the things that I go through with clients is their blood, should they wish to do so. But what I always bounce back to them is how do you feel? We shouldn’t look at a set of bloods and they shouldn’t tell us that we’re unwell. If we feel fantastic, then what the bloods say is pretty much irrelevant. If we don’t feel well, then the bloods can give us an indication. The problem, as you rightly say, is if we look at 100 people from a normative range, the normal person is on a very poor lifestyle, they live a very poor diet, they’re on high carbohydrate, lots of seed oils,and we’re looking at a normative range, do we really want to be in that normative range if the normative range is from a group of unhealthy people?
What I find is that many people live in this lifestyle, their bloods do change over a period of time and it tends to move in a cycle. What we quite often see is a reduction in insulin, which is fantastic. Over time, we can see an increase in HbA1c, but this, in my opinion, is to do with the red blood cells living longer and we do have evidence for this. We can see this via a reticulocyte test. We see that the red blood cells are being produced less because they’re living longer. Therefore, they’ll become more glycated.
Dr. Eric Westman: There’s a technique of looking at the red blood cell survival using radionuclear techniques. That would be better to cinch that theory. I’d really love to see some direct measurement of red cell survival time. Has that been done?
Richard Smith: I’m unsure, but the test that I would usually recommend is a reticulocyte test, which measures the red blood cells over a three-week period over three months. This will give us a far better indication.
There are lots of things that we see. We see thyroid stimulating hormone come down because now it’s more efficient. These things make perfect sense because let’s look at glucose and insulin response. If we consume less glucose, then insulin becomes lower. It doesn’t mean that we’re insulin resistant or that the body isn’t producing it. It just moves less. We need less insulin to carry out that work. It’s the same thing with thyroid stimulating hormone. It’s the same thing with testosterone.
Testosterone is the male sex hormone but it’s also used in many other things. It’s used in the production of red blood cells. If the red blood cells are living longer, i.e., we’re making fewer of them, then maybe our requirement for testosterone becomes less. It’s also used in glycolysis. Well, now we’re no longer using glucose for fuel, so now our requirement for testosterone becomes even lower. It’s also used in lipolysis, i.e. the breakdown of stored body fat for the use of beta-oxidation. This is why I believe that we see an increase in testosterone. Many people report an increase in testosterone when they become ketogenic and carnivore in the early stages and I believe that it’s because of this process of lipolysis increasing. There are many influencers who claim that their testosterone has tanked after a couple of years of being ketogenic and carnivore, but in my opinion it’s because the body fat percentage is a lot less. We’re using less of this for energy and we’re using more of the dietary fat for energy. There are at least three mechanisms there from a simplistic point of view in regards to why testosterone will become less.
My testosterone has done exactly this. It increased and it’s come down and it’s technically within a normative range but very low in that normative range. I gravitated towards endurance sports over the last few years and I’ve recently gone back into resistance training. I’ve had a few weeks back and I’m building muscle hand over fist. It’s coming back like I’ve never seen before. I’m not big currently and I’ll never get back to that because that’s not where I want to be, but my body’s healing and repairing at a rate of knots. This shouldn’t be happening in my forties. This is something that you see in your twenties. I already know that I’m going to be fitter and stronger than I ever was prior with the rate of improvement. My energy’s through the roof, I’ve got no issues with libido. Everything that we would see as a result of what we deem to be lower-end testosterone just does not play out in the real world.
This is where I think that the confusion comes in regards to looking at the bloods. There’s a danger to this because if we look at your bloods and say they’re out of a range, it’s said, and cholesterol is the perfect example, that we should remove the saturated fats. Well, wait a minute. Your glucose increases cholesterol also. If we look at beta oxidation and or glycolysis, both create acetyl-CoA. Acetyl-CoA will enter a pathway called HMG-CoA. HMG-CoA goes on to create cholesterol. It’s not just fat that makes cholesterol. We make cholesterol from sugar, from glucose also. The whole premise behind reducing the fat just does not make sense. Cholesterol is essential for the production of testosterone and estrogen!
Dr. Eric Westman: Let’s get into this on another time because there’s another set of science that has come out that I’d love to talk to you about is the lean mass hyper responder study. I went to a meeting called Keto Live in Switzerland and sat in on a lecture on glycation. Glycation of hemoglobin is just a minor thing. It’s the glycation of the proteins in the cells. To me, that was an aha moment because I’m worried about the throughput of the carbohydrate, not just the hemoglobin A1C or the glucose level. I want to know what’s going on inside. Again, we measure the blood because it’s convenient. It was an hour long lecture on all of the damage that happens with the glycation of the cellular intracellular proteins, which really helps me in the kind of thing that I’ve been seeing, which is that the number—the glucose and the A1C—if you’re not eating as many carbs, this isn’t the whole picture. It’s just a fraction of the glycation that’s going on inside the cell. The red blood cell lifespan is one thing, but also the idea that you’re just not glycating intracellular proteins like you’re used to. I think that’s where the benefit is in terms of diabetes reversal and not getting diabetes. The juxtaposition of these two meetings was just great to be able to see things and different angles, coming at it from lowering carb, raising carb, and adding other kinds of things. I’m still holding out that I want to know if adding something to what we already do is there incremental benefit of something. Lowering the carbs, getting adequate protein, running on fat for fuel, that’s the main thing.
Richard Smith: We look at all of these medications and plant compounds and magic elixirs for increasing antioxidant benefit when ketones increase glutathione. We do this naturally without having to consume any medication. The body makes glutathione. When we produce ketones it increases nitric oxide, it helps to block NLRP3 and inflammasomes. It increases mechanical efficiency, the heart blood flow, and brain function. Ketones are the body’s natural way of healing and repairing. It’s super simplistic but there’s no money to be made off of telling people to live a ketogenic lifestyle.
Watch the full video here.
Speaker Bios
Eric Westman, MD, MHS, is an Associate Professor of Medicine at Duke University, the Medical Director of Adapt Your Life Academy and the founder of the Duke Keto Medicine Clinic in Durham, North Carolina. He is board-certified in Internal Medicine and Obesity Medicine and has a master’s degree in clinical research. As a past President of the Obesity Medicine Association and a Fellow of the Obesity Society, Dr. Westman was named “Bariatrician of the Year” for his work in advancing the field of obesity medicine. He is a best-selling author of several books relating to ketogenic diets as well as co-author on over 100 peer-reviewed publications related to ketogenic diets, type 2 diabetes, obesity, smoking cessation, and more. He is an internationally recognized expert on the therapeutic use of dietary carbohydrate restriction and has helped thousands of people in his clinic and far beyond, by way of his famous “Page 4” food list.
Richard Smith
Richard Smith is the founder of Keto-Pro, a UK-based company providing keto-friendly products and support, and a nutritionist and professional athlete who reversed his own Type 2 diabetes and ill health through a ketogenic lifestyle. He is a British bodybuilding champion who uses his personal transformation and expertise to educate others on the benefits of the diet through his company, podcast appearances, and social media.
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