The Melanie Avalon Biohacking Podcast Episode #136 - Dr. Steven Gundry

TRANSCRIPT

Melanie Avalon: Hi, friends. Welcome back to the show. I am so, so excited about the conversation that I'm about to have for so many reasons. First of all, it is with honestly a legend in the whole health sphere that I and my audience swims in. I am here with Dr. Steven Gundry, who is a multiple New York Times bestselling author, books that you guys are probably very familiar with like The Plant Paradox, The Plant Paradox Cookbook, The Longevity Paradox. I actually had him on the show before for The Energy Paradox. So, I'll put a link to that in the show notes. But we are here today for his new book, which does not have the word paradox in the title. Did you think about calling it the Keto Paradox?

Dr. Steven Gundry: That was the actually one of the working titles, but we decided after seven paradox books, it was time for a change.

Melanie Avalon: The book that we're here for today is Unlocking the Keto Code: The Revolutionary New Science of Keto That Offers More Benefits Without Deprivation. Friends. I know there are a lot of keto books out there. This book actually takes an entirely new paradigm shifting and challenging approach to the keto diet, and to what is actually happening with ketosis. So, I am super, super excited to explore this concept. I will just let audience know I'm sure they're super familiar with you, but you are one of the world's top cardiothoracic, I don't even know how to say that word.

Dr. Steven Gundry: Yeah, cardiothoracic. Yep. It's a tongue twister.

Melanie Avalon: Yeah [laughs] and medical director at the International Heart and Lung Institute Center for Restorative Medicine. So, thank you so much, Dr. Gundry for coming back on the show. 

Dr. Steven Gundry: All right. Thanks for having me. It's good to be back.

Melanie Avalon: Okay, so, I have a huge, huge question to start with, and it is a why question that has been haunting me for quite a while, and I've had a lot of different thoughts on. Basically, it's the question of why do we even enter ketosis? Originally, and I think what most people think is we enter ketosis, because we run out of carbs and so we need another fuel substrate. Then I was learning about the Krebs cycle and the idea that actually we enter ketosis, because we run out of carbs to make oxaloacetate, so we can no longer burn fat. It's actually because we can't burn fat that we enter ketosis. Then I was interviewing Dom D'Agostino this week, and he was saying it's because there's a buildup of acetyl CoA in the liver and the liver just has to do something with all that energy. So, my question for you, [giggles] why do we enter ketosis in the first place?

Dr. Steven Gundry: There's only one reason that we entered ketosis and that's because if we're starving or if we're eating primarily fat, then muscles and every cell in your body except the brain can burn free fatty acids, can use free fatty acids that are liberated from your fat cells to make ATP. There's only one problem. Free fatty acids are very large, they're fat soluble, and they don't cross the blood-brain barrier quickly enough. Your brain, your neurons would be happy to burn free fatty acids like everybody else, but they can't get there, because of the blood-brain barrier. It just so happens that free fatty acids can enter the liver and the liver can convert free fatty acids to ketone bodies, which are small saturated fats that are water soluble, which can enter the brain. They're actually a backup fuel for the brain until you find your next meal. That's why we make ketone bodies. It turns out that you're the rest of your body as shown by Dr. Cahill and Owen as I talked about in the book really doesn't get a lot of benefit by burning ketones. In fact, in human studies, at full ketone production, the body only gets 30% of its energy's needs met by ketones. The rest have to come from free fatty acids. Even the brain doesn't get full benefit from ketones. Even at full ketosis, the brain needs still 30% to 40% of its energy from glucose. So, the idea that ketones are somehow some magical mystical fuel is just not supported by the human literature.

Melanie Avalon: Okay, two questions about that. First question, it's turning these free fatty acids into ketones. I'm assuming there're often free fatty acids in the liver. So, how does the liver know that it actually needs to start making ketones? Is it based on the glucose stores? 

Dr. Steven Gundry: Yeah. We won't release free fatty acids from muscle cells until insulin levels drop. That's one of the things I go into the book why so many people following a low-carbohydrate diet or "ketogenic diet" crash and burn often for many weeks. Sometimes, people never can get into ketosis, because their insulin levels are so high that insulin actually blocks the creation of an enzyme called hormone-sensitive lipase that allows fats to be liberated from fat cells. If you think about it and I talk about this in the book. When you're eating, you produce insulin to usher sugars and proteins into fat stores to save for the winter. When you stop eating, normally your insulin level should fall, and when insulin falls, then hormone-sensitive lipase is released, because insulin is a break on hormone-sensitive lipase, and you release free fatty acids, and everything works well. 

The other thing that's fascinating is the liver cannot use ketones as a fuel. I chuckled because I quote some famous keto experts that says, "the liver loves ketones and uses them as a fuel," which is absolutely not true. Liver can't use ketones, so they're released into circulation for the brain.

Melanie Avalon: I remember when I learned that about the liver and I was so embarrassed, because I've been assuming for such a long time that the liver could fuel on ketones. So, people are burning fat, but not entering ketosis, how are they doing that?

Dr. Steven Gundry: Well, in fact, they're not burning fat. They're actually burning protein, and glycogen stores, and they're converting protein into glucose by gluconeogenesis. I see people like Miranda in the book, who is one of my patients, who was on a ketogenic diet for two years and was gaining weight. When we measured her, she was pre-diabetic, and had elevated insulin levels, and she was absolutely apoplectic that she'd been following a ketogenic diet for two years, and she kept gaining weight, and she was insulin resistant. She was eating a higher protein ketogenic diet. So, she was just converting protein to glucose and never entered ketosis.

Melanie Avalon: If people are burning fat not in ketosis, they can burn that in the individual cells or are they just not burning fat? Can you only burn fat in ketosis? 

Dr. Steven Gundry: No. You can release free fatty acids from fat cells with extreme exercise. For instance, extreme exercise is another way of releasing free fatty acids, because you literally use up your glycogen stores in extreme exercise and need an alternative fuel. Some of those free fatty acids will go into the liver and you will produce ketones. But that doesn't mean your muscles are actually using the ketones as a fuel. 

Melanie Avalon: The two options that we could be in and I don't know if this is too black and white, but you're talking about when we have carbs in that state and free fatty acids compared to free fatty acids with ketones, is there a difference in the amount of free fatty acids being released? I guess, my question here, because you're saying that ketones are not a super fuel, they're not efficient. So, are we still primarily burning free fatty acids when we're in a ketogenic state, not ketones?

Dr. Steven Gundry: Correct? Yeah. In a full ketogenic state with the work out of Harvard in humans, 70% of your energy needs are met by using free fatty acids as a fuel and only 30% are met by using ketones as a fuel. So, we've got it kind of back asswards what ketones are doing. The point of the book is, well, wait a minute, if ketones aren't this miraculous fuel what the heck are they doing that's so miraculous, because there's a lot to like about ketones. The whole book is kind of follow me down this rabbit hole to show you what ketones are doing and they're not a fuel of any significance. They are actually signaling molecules that affect how mitochondria actually extract fuel and turn it into energy and that's the subject of the book. The cool thing is you don't have to do a ketogenic diet to get the benefits that we now know what ketones do and that's exciting because you don't have to do a miserable 80% of fat diet.

Melanie Avalon: Okay, this is exciting. Approaching the mitochondria, so, listeners are probably familiar, but for those who are not, what is the mitochondria?

Dr. Steven Gundry: Mitochondria are actually engulfed bacteria that are the energy producing organelles in almost all the cells in our body. Two billion years ago, ancient cells ate engulfed bacteria and the bacteria in exchange for a nice place to live and a constant fuel supply made an agreement with these cells that they would produce ATP. These bacteria became our mitochondria. They actually have a bacterial origin. What's interesting about them is they have their own DNA, so that they can actually divide within a cell as many times as they want to without the cell actually dividing. Fun fact for all of our female listeners, we inherit our mitochondrial DNA from our mothers, fathers have nothing to do with this. As I've written before, we inherit our bacterial population of our microbiome from our mothers at birth. Believe it or not, the microbiome actually talks to their sisters, the mitochondria with what are called post-biotics, but maybe we can talk about that later. 

Mitochondria take sugars, amino acids, or free fatty acids, or ketones, and convert them into our energy currency ATP, adenosine triphosphate. Mitochondria are incredibly good at converting these substances to ATP. For instance, for one molecule of glucose, you get 32 molecules of ATP. Compare that to fermentation, which is what for instance yeast and bacteria do, you get two molecules of ATP for every molecule of glucose. You get a big bang for your buck by using mitochondria to make ATP. But there's a downside. Making ATP is incredibly hard work, incredibly damaging to mitochondria. The more you ask mitochondria to make ATP, believe it or not, the more they suffer. That's where what ketones actually do, come in, and I'll stop there.

Melanie Avalon: That damaging aspect to it, is that the reason that red blood cells don't have mitochondria or why do red blood cells and some of the other cells in the body not have mitochondria?

Dr. Steven Gundry: Well, the good news is they don't have to make ATP. Red blood cells only exist in our circulation for about two months. Now and then we literally grind them up and reprocess them. You're right. Red blood cells are really only one of the few cells in our body that don't have mitochondria. Muscles have huge amounts of mitochondria. Heart muscle particular, the brain neurons have huge amounts of mitochondria. Brown fat, which I talk about in the book is so loaded with mitochondria that it literally looks brown under the microscope as opposed to white fat, which is our fat storage. Fat cells have very, very few mitochondria. In between as I talk about in the book, you can turn white fat into beige fat, which has lots more mitochondria with tricks in the book, the hacks.

Melanie Avalon: I love beige fat and brown fat. I do my daily cryotherapy session. Those are super fun. This is a really random question, but given that mitochondria did evolve like you were talking about from bacteria and there was this whole relationship, do you think we would further evolve? Do you think there's a future to a new form of energy generation in our bodies or do you think we've plateaued? 

Dr. Steven Gundry: Well, one of the things we're seeing is probably a de-evolution. I talk about this in one of the chapters in Unlocking the Keto Code where we now think that one of the theories of cancer is mitochondrial dysfunction leads to cancer cell formation. I go into why this is possible. If mitochondria are not doing their job, then the cell decides that it can't trust the mitochondria anymore. It reverts to its ancient programming that uses fermentation or glycolysis to produce energy. If you like the theory which I like a lot, it's very much like those of us who remember the original windows-based computers. When you somehow screwed up and you restarted the computer, it would restart in the safe operating mode. Then you had to figure out what the heck you did. But it would work but clunkily until you fix the problem. 

This theory is, if the mitochondria aren't doing well, the cell reverts to its ancient programming, which is the ancient cell without mitochondria. What's interesting about these ancient cells is they had no contact inhibition. In other words, what that means is when one cell is growing and runs into its neighbor, they actually stop growing because that's what makes a multicellular organism. In the case of ancient cells, they just keep growing. Yeast keeps growing, bacteria keep growing, and there's nothing to stop them. That's a characteristic of cancer cells. They have no contact inhibition. 

The interesting theory and this is actually described by Otto Warburg back in the 1920s, who won the Nobel Prize for Medicine is that, cancer cells act like these ancient cells like I talk about in the book and certainly seen in my practice. If we can get mitochondria back online, if we can fix the problem that led to their dysfunction, then the cell can revert back to a normal cell. It's actually shown scientifically, and we certainly see it in our practice. So, exciting news in a way.

Melanie Avalon: That is really fascinating. I'll put a link in the show notes. I had an interview with Dr. Jason Fung for his book, The Cancer Code. We talked all about that. He was talking about how it was interesting, because we used to think cancer cells had to revert to using glucose, but it's actually probably a choice. 

Dr. Steven Gundry: Yes, they've chosen to do it. 

Melanie Avalon: That choice aspect is the reason I guess that like you said, if we fix the mitochondria, it can revert back?

Dr. Steven Gundry: Yes, that's correct. I know Jason well. I think maybe because of editorial needs he didn't make take the next step to say, "Well, here's how to get mitochondria back online" at least in my humble opinion. You can do it. I have done it with my dog, Pearl, but that's another subject.

Melanie Avalon: Oh, wow. Congrats. Your dog had cancer and you--?

Dr. Steven Gundry: Yeah, Pearl is our 16-and-a-half-year-old large female Labradoodle. A year and a half ago, she couldn't be. She couldn't urinate, she was straining, she was pushing so hard, she was literally farting funny at the time. We took her to the vet, and they did an ultrasound, and the vet comes out and says, "Oh, my gosh, she's got inoperable bladder cancer. Sorry, there's nothing we can do. We're going to send you to the oncologist." Long story short, I said, "Oh, well, that's good news. I'll put her on my program." By the time we got to the oncologist, she was peeing quite well and the oncologist said, "Well that's not going to work. I've got an emergency spot for chemotherapy for her." I said, "Well, how long are you going to give her with chemotherapy." She's like, "Well, we can probably get her a good six months." I said, "Well, thanks a lot. I'm going to do this" and she said, "Well, all those supplements are going to do is kill her." So, that was a year and a half ago. Pearl is like a racehorse now, she chases our other dogs around the yard like a puppy, she goes on three mile walks every day, and it's been a year and a half, and yeah, she's fine. 

Melanie Avalon: That's incredible. Did you keep her on a keto diet?

Dr. Steven Gundry: Believe it or not, she isn't on a keto diet. She's on my program. Oh.

Melanie Avalon: Oh, hey. [laughs] Okay, this is perfect. Well, that's wonderful. Okay, so, bringing us to the program and everything back to the mitochondria, so, a huge, huge thing you talk about in the book is and you mentioned this earlier, but how ketones are actually signaling molecules, and how they're signaling the mitochondria to do something called mitochondrial uncoupling, and you use a fantastic analogy. Did you come up with this analogy for the club? 

Dr. Steven Gundry: Oh, yeah.

Melanie Avalon: That was impressive. [laughs] So, how are mitochondria like a club and what is the role of mitochondrial uncoupling?

Dr. Steven Gundry: Mitochondria, if we think of them as the coolest, hippest new club, where people go to couple up. The club is the hottest steamiest place, there's hormones raging, there's alcohol flowing, and there's everybody trying to get in, and there's pushing and shoving to get to the bar, and everybody wants to couple with everybody else, and it's a happening place. But the problem is, things get out of control all the time in these clubs. We've got bouncers, which we'll call anti-oxidants and we've got doormen to control the velvet rope that lets people in. If things get out of control, in the club, there's only one way in. There's only one entrance and there's actually a separate exit. The object of the game is to get protons to couple with oxygen and then leave the club via the revolving back door. As they leave the club, they generate ATP. That's how it's done. But a lot of times, other people, electrons, who should be coupling with protons, want a couple with oxygen molecules and these produce free radicals and reactive oxygen species which are damaging. 

There has to be a mechanism to keep things under control to pop off the pressure in this club, if you will. Lo and behold, it was discovered in the late 1970s that mitochondria have emergency exits in the club, where when people get out of hand or when protons can't couple up with who they want a couple with, they can leave via these emergency exits. These emergency exits are controlled by what are called uncoupling proteins. There's actually five of them. These emergency exits serve as pop off valves for mitochondria to avoid damaged mitochondria. I like to use the example of a pressure cooker. Most of us have a pressure cooker and everybody knows there's a little pop off valve or release valve that the steam escapes whenever the pressure gets too high, because if it kept getting higher, you explode the pressure cooker, which my mother did when I was growing up. It was very exciting. We have released valves in mitochondria and it turns out that lo and behold, ketones actually open the release valves on mitochondria. They not only open the release valves of mitochondria to take the pressure off the work of mitochondria, but in the same signaling capacity, they tell mitochondria to divide and make more of themselves to handle the workload. 

It's like we could hook one dog up to a dog sled and that dog had pulled the dog sled, but the dog would be doing a lot of work. On the other hand, if we hook six dogs to the dog sled, the six dogs can do the work of one dog without much effort except here's the punchline, those six dogs are going to eat a lot more food than the one dog did. That's the beauty of uncoupling mitochondria. Each one of them has to do less work, but you make more mitochondria, which are actually going to use more fuel like fat. So, fascinatingly, the more you uncouple mitochondria, the more you release this pressure route, the more weight you lose and the healthier your mitochondria get. Yay.

Melanie Avalon: The initial reason that that whole mitochondrial process happens as signaled by ketones, I'm having some cognitive dissonance here, because it would seem that we would originally, evolutionarily have released ketones while fasting so, while in an energy depleted state. So, why did ketones signal to uncouple if there was not energy around?

Dr. Steven Gundry: My life was changed when I read the paper written by Martin Brand in 2000 called Uncoupling to survive. I recommend anybody read it. It's actually a small paper. What Dr. Brand said was, "In extremes, if you're starving to death, the only thing that's important is protecting mitochondria from dying." Because if you don't protect mitochondria from dying, who cares about anything else, because you're done. He showed eloquently that mitochondria dramatically uncouple during starvation, and build more mitochondria to handle the workload, and actively repair themselves. In fact, they will devote all of their protein making capacity to making proteins for mitochondria and they will actually not make proteins for muscles because muscles are energy hogs. That, of course, is one of the long-term consequences of continuous ketosis is muscle loss. He went on to show that super, super old people actually have the most uncoupled mitochondria compared to anybody else. So, he's right in such a weird way. It's a paradox and I'm famous for paradoxes. It's like, "Wow, why in the world would you waste energy when there's not much energy?" and that's why to protect themselves at all costs.

Melanie Avalon: When more mitochondria are created through the uncoupling and the mitogenesis, then are you ultimately-- Once you build all that, are you more efficient with fuel or do you still require more fuel, because you have more mitochondria?

Dr. Steven Gundry: Actually, you become a Ferrari instead of a Toyota Prius. One of the big goofs of ketones is you actually become an inefficient fuel user. You actually waste fuel. That's actually how weight loss occurs in ketosis. Think about it. If you're an efficient fat burner. efficiency means getting more out of something. For instance, a Toyota Prius is an incredibly efficient gasoline burner. You get 50 miles per gallon. If you wanted inefficiency in fat burning and let's call fat gasoline, then you'd buy a Ferrari. Now, there might be other reasons you'd want a Ferrari, but if you wanted to waste fuel, a Ferrari is a really good way to do it. What we now know is that mitochondria, literally, waste fuel when they're uncoupled. They produce heat when they waste fuel.

For instance, one of the interesting things that I talk about in the book is having a cup of coffee, even an iced coffee. Most people notice that they get warm when they have a cup of coffee. It's because coffee is loaded with polyphenols, which actually uncouple mitochondria. It's actually the same way with alcohol. Alcohol is a mitochondrial uncoupler. That's why you could be having an ice-cold martini or an ice-cold glass of wine and the room gets hotter. That's because you're actually uncoupling mitochondria and producing heat.

Melanie Avalon: Is thermogenesis after eating from uncoupling or is that a different process?

Dr. Steven Gundry: No, it turns out as I show in the book that all of these thermogenic compounds actually work by uncoupling mitochondria. Actually, I could have entitled the book just one thing, because all of these healthy things that we're told to eat for health are actually mitochondria uncouplers and that's how they work.

Melanie Avalon: Yeah, you talk about the fascinating DNP compound. 

Dr. Steven Gundry: Oh yeah. 

Melanie Avalon: For listeners, it was basically the fat burning weight loss drug to end all drugs except it took uncoupling too far. 

Dr. Steven Gundry: Correct. 

Melanie Avalon: How did they die from it?

Dr. Steven Gundry: Yeah, so, many of them actually became very hyperthermic. They ran very high temperatures. They actually damaged their thyroids, they actually produced cataracts. This was before cataract surgery and this was an amazing weight loss drug in the 30s. You could lose five pounds a week. No one really knew why, but you could lose five pounds a week. Then, eventually, a lot of people died. What happens is, you actually uncoupled mitochondria so well that you actually couldn't produce enough ATP to live.

Melanie Avalon: Wow. So, you literally not starved but you could not feel yourself.

Dr. Steven Gundry: You ran out of energy. That's really scary. It was banned by the FDA in 1938 as one of their first official acts. But we now know that dinitrophenol was the first known mitochondrial uncoupler. It was actually discovered in munition plant workers in France and Germany in World War I, where workers making shells, gunpowder were incredibly skinny even though they ate huge amounts of food, and they ran a temperature, and they eventually realized that it was raising their basal metabolic rate. So, they were actually burning fuel, but at a prodigious rate. They had turned into Ferraris. It was researchers at Stanford that discovered this link, and they just didn't know with DNP a little dab will do you, and they just went too far.

Melanie Avalon: You also talk about what was happening with the Kitavans?

Dr. Steven Gundry: Yeah, the Kitavans are very interesting. Stephen Lundberg spent his career studying the Kitavans, which live on an island in Papua New Guinea. These guys are very thin, they smoke like fiends, they eat a diet heavy in coconut and a lot of other prebiotics, and they eat fruits and vegetables. They have no known coronary artery disease or strokes despite having lots of coconut oil and smoking like fiends. One of the interesting things is they eat a very high prebiotic fiber diet, which produces these post-biotics, which are short chain fatty acids, butyrate, and acetate, and propionic. These uncouple mitochondria actively and it turns out that nicotine is an amazing mitochondrial uncoupler. We used to think that smokers, who were invariably very thin, because smoking suppressed their appetite. But in fact, that wasn't the case. Nicotine is an incredibly efficient mitochondrial uncoupler. 

Now, I don't want anybody to go smoke and I make this very clear. But there're fascinating studies. There's a British doctor study of 65,000 different doctors and the doctors who smoke had a 50% reduction in Parkinson's disease compared to doctors who didn't smoke. Now, again, don't go smoke, please. But it just shows the power of uncoupling mitochondria. There are far better ways to uncouple your mitochondria than the cigarette. But my good friend, Dave Asprey, he uses nicotine drops and I still think there's better ways, but he unknowingly until I talked to him on this podcast was uncoupling his mitochondria with his nicotine.

Melanie Avalon: I had him on the show as well and was asking him about the nicotine. I've experimented with nicotine patches in the past. If you do experiment with them, not that we're not advocating it, but if you do, do not put on too much. You will get so sick. [laughs] 

Dr. Steven Gundry: Yeah, and plus, we forget that nicotine is an addictive substance as any tobacco company has known for ages with plausible denial as they say.

Melanie Avalon: Yeah. Oh, my goodness. Question about all of the signaling and uncoupling. Why do you think we don't see more weight loss in experiments with exogenous ketones? It seems you'd just be able to just magically take exogenous ketones and uncouple away.

Dr. Steven Gundry: The problem is they're really not all that useful, particularly, because you really can't get enough. There're so many better ways to do this. As I talk about in The Keto Code, the easiest way is time-restricted eating, time-controlled eating, some people call it intermittent fasting. But let me give you an example. If we have metabolic flexibility and hopefully your audience knows what that means, but if they don't, normally our mitochondria can shift on a dime from burning glucose as a fuel to burning free fatty acids as a fuel. 50% of normal weight individuals, normal weight have no metabolic flexibility. Half of the normal weight people can't do that. Overweight people, 88% of overweight people have no metabolic flexibility. 99.5% of obese people have no metabolic flexibility. So, they can't make that shift. That's actually really scary. But getting back to the question, if we had metabolic flexibility after about eight hours of not eating, our liver begins to produce ketones, because free fatty acids start being liberated out of fat cells. By 12 hours, you've actually gotten pretty much ramped-up ketone body production. 

One of the most impressive studies that I mention in the last book, and again, I reprised it in this book is looking at Italian athletes. They took Italian athletes, and put them on a training table, and that means they controlled their food. They divided them into two groups. One group had a 12-hour eating window. They ate breakfast at 8 o'clock in the morning, they ate lunch at 1 o'clock in the afternoon, and they had to finish dinner by 8 o'clock at night. The second group, same food had a seven-hour window. They ate breakfast, break fast at 1 o'clock in the afternoon, they had lunch at 4 o'clock in the afternoon, and they had to finish dinner by 8 o'clock. They had to eat the exact same food the exact same amount. They followed them for three months. The group with a 12-hour window had no weight loss. They had no change in insulin like growth factor which IGF-1, which is really probably the premier marker of preventing aging. The group that had the seven-hour window lost weight, maintained their muscle mass and plummeted their IGF-1. Same food, same everything except they just compress the eating window. So, what happened? 

Well, instead of stopping their ketone production, which was just starting to get good at 12 hours, these guys push another five hours of ketone production. They were awash with ketones for a much larger part of the day than the folks in the 12-hour eating window. Knowing this, one of the easiest ways to implement this is to compress your eating window and in unlocking The Keto Code, I hold your hand and we just do it one-hour every week. For instance, if we eat breakfast at 7 o'clock next week, I ask you to eat breakfast at 8 o'clock. Come on, anybody can do that and I let you take the weekends off. Then the following week, we're going to push breakfast to 9 o'clock. "Hey, already did 8 o'clock. Let's go to 9 and you take the weekend off." By five weeks, we've got you up to eating breakfast at noon without a problem. It's just a training program for learning how to eat. So, that's number one. 

Number two, which is really exciting. All these hacks, we know that from children, MCT oil, medium chain triglycerides are unique among fats and that they're absorbed directly from the intestines, go directly to the liver, where they are automatically converted into ketones regardless of how much carbohydrates or proteins you're eating. I joke and I don't want people to do this. You could have a fresh fruit salad and have a tablespoon of MCT oil and you would produce ketones, even though you're carbo centric diet. That's exciting. This was actually based on children epilepsy, who really failed the high fat keto diet, but they found that giving kids MCT oil produce the same effects as a ketogenic diet, but they can have all the carbohydrates and proteins they want. I realized that all my ketogenic programs in my books was in fact doing that, because I used MCT oil in all my programs. Here's the best part. It turns out that goat milk and sheep milk, 30% of the fats in sheep milk are MCTs. So, you can get a huge bang for your buck by having goat yogurt or sheep yogurt, you can have goat cheese or sheep cheese, and actually generate ketones just by having yogurt or kefir or cheeses from goats and sheep. Wow.

Melanie Avalon: The big paradigm shift with all is on top of that, that it's not so much that the ketones. Adding the ketones to a carb rich diet are providing fuel, but it's because they're changing the metabolic machinery.

Dr. Steven Gundry: That's exactly right. They're just signaling mitochondria to uncouple.

Melanie Avalon: People often say, "do a keto diet" and they feel cold. Wouldn't the opposite have happened? I know like keto, they might not actually be-- Let's assume that someone's doing keto diet, and they're actually producing ketones burning fat, wouldn't they get really hot?

Dr. Steven Gundry: Some people do actually get hot, but we used to measure ketone production in our patients fasting. I would say 50% to 80% of the people who swore that they were in ketosis weren't in ketosis, and they were getting cold for the exact opposite reason that they were insulin resistant, and they actually couldn't generate ketones, because insulin was blocking the ketone production. You can go weeks, and weeks, and weeks on a high-fat diet, and still not generate ketones, because as I show in the book, one of the effects of a high saturated fat diet is actually to increase insulin resistance, exactly the opposite of what you want.

Melanie Avalon: Insulin resistance, that requires actually eating saturated fats compared to, I guess, burning fats endogenously that we're saturated?

Dr. Steven Gundry: Yes, that's correct. Believe it or not, most of the fat that we store as fat, that animal stores fat is oleic acid, which is the primary constituent of olive oil, which surprises everybody. But that's actually our preferred fat storage molecule. Oleic acid is a monounsaturated fat. It's when we add other saturated fats, that things start getting turned around in terms of making what are called ceramides, which was one of the subjects of my last book. We make saturated fats, primarily ceramides from fructose in our diet. As most all of us know, our diet is awash with fructose, whether it's in processed foods, whether it's in high fructose corn syrup, whether it's in our fruit that has now been bred for fructose content and we actually produce mischief ceramides in our liver. One of the papers I quote "the energy paradox is death by ceramides." Ceramides are one of the biggest causes of insulin resistance that people aren't aware of.

Melanie Avalon: I actually just interviewed also this week, Rick Johnson about all things fructose. Friends, you have got to get Unlocking the Keto Code. There are so many things that we didn't even remotely touch on. One of my favorite takeaways that was also a mind shift was you talk about how people think fermented foods, the benefit from fermented foods is the probiotics, but really, it's not. It's their post-biotics that they contain.

Dr. Steven Gundry: That's correct. Most fermented foods, we think of this probiotics' friendly bacteria. But most of those bacteria never make it into our gut, they're destroyed by stomach acid. Yet, we know how good these things are for us. The fermentation process produces what are now called post-biotics. One of those post-biotics is acetic acid, vinegar. Acetic acid acetate is actually a mitochondrial uncoupler. Lo and behold, things like apple cider vinegar, balsamic vinegar work their magic, not through some mystical thing, but by actually being mitochondrial uncouplers. So that's the benefit of fermented foods. We also know that in a study out of Stanford that I quote in the book, "people who are given either prebiotics that are fermented food base or just plain old prebiotics, the folks who get it in the form of fermented foods with prebiotics." Actually, I have a more diverse microbiome, which is really good for you and have far less inflammatory markers than just eating the prebiotics themselves. Get your fermented foods, have low-sugar kombucha, have apple cider vinegar. I put balsamic vinegar in my San Pellegrino water, and that's my Diet Coke, and I'm going to uncouple my mitochondria. So, why not?

Melanie Avalon: I'll put a link in the show notes to that study you've just mentioned, because it's fascinating. Because it was looking at a high-fiber diet-

Dr. Steven Gundry: Correct.

Melanie Avalon: -compared to fermented foods, supplementation, and I think it really was a paradigm shift for a lot of people. Well, this has been absolutely amazing. Again, listeners, you've got to get this book. Like Dr. Gundry said, he handholds you through the whole process of how to have this new version of the keto diet, which is not your typical, high fat keto hangry if people aren't adapting feeling. We even talk about like polyphenols. There's just so much in the book. [laughs] So, the last question I ask every single guest on this show and it's just because I realize more and more each day how important mindset is. So, what is something that you're grateful for?

Dr. Steven Gundry: I'm grateful that my 16-and-a-half-year-old Labradoodle is still around playing with me and laying with the other dogs. I'm grateful that in my research looking into those that I applied that knowledge and it is not a placebo effect, but she's still here.

Melanie Avalon: That's fabulous. I'm actually, currently wanting to develop a pet food. I'm going to have to rethink [laughs] the approach we're taking. Well, this has been absolutely amazing. Thank you so much. I cannot thank you enough for all of the work that you do. It is life changing, and profound, and has affected so many people, and you also have a code for our audience. So, you can go to your website. Is it Gundry--?

Dr. Steven Gundry: gundrymd.com.

Melanie Avalon: The code GUNDRY30 will get you 30% off.

Dr. Steven Gundry: Off everything on the website. 

Melanie Avalon: Is the book on the website? 

Dr. Steven Gundry: The book is on the website, but you can find the book wherever you get your books. amazon.com, barnesandnoble.com. Please, please, please get it from your local bookseller. As you know, COVID has decimated them. They'll have my books, because I've had four New York Times bestsellers. So, it'll be there.

Melanie Avalon: Awesome. Are you currently writing your next book?

Dr. Steven Gundry: Yeah, I'm working on that, but it's a secret, but it's going a place where the gut microbiome is taking me. So, there you go. 

Melanie Avalon: Oh, oh I'm excited. Okay. Well, hopefully, you can come back for that one in the future. Thank you so much, enjoy the rest of your day, and this has been wonderful. 

Dr. Steven Gundry: All right. Thanks for having me. I appreciate it. 

Melanie Avalon: Thank you. Bye. 

Dr. Steven Gundry: Bye-bye.