What if your doctor told you to eat more fat?
That day might come sooner than you think.
In the scientific community, “High-fat” ketogenic diets are suddenly in vogue. The ketogenic diet is being studied for its potential to treat Epilepsy, Multiple Sclerosis, and even Alzheimer’s.
Today we’re here with a pioneering female scientist, Dr. Mithu Storoni, who eats a diet of 70+% fat! You’re about to learn the surprising reasons why.
On this show with Dr. Mithu Storoni, we’ll explore:
- How a ketogenic diet can prevent (and heal) neurodegeneration
- Why a healthy female scientist would suddenly cut carbs and eat more fat
- Why eating a jar of almond butter is bad for your brain
- How to avoid common low-carb mistakes
- Why cutting back on fruit might do the body good
- And much more…
Please note: Mithu is sharing her insight for the purposes of discussion only and would like to remind everyone to consult their physician before making any changes to their diet, lifestyle, or medications.
MITHU STORONI: EAT FAT, IT’S BRAIN FOOD
Abel: Today we’re here with a bona fide fat-burning woman.
Dr. Mithu Storoni has been following a ketogenic diet since 2014. She recently co-wrote a pioneering paper that utilizes a Ketogenic Diet for treatment of Multiple Sclerosis. Mithu holds a medical degree from the University of Cambridge, a PhD in Neuro-ophthalmology.
Mithu is also a yoga instructor, avid Matcha drinker, Japan-lover and is always looking for new ways to reprogram her brain.
Joining us from across the world in Hong Kong, thanks so much for being here, Mithu.
You may be preaching to the choir, but why are you so in love with fat?
I’m in love with fat. The moment I switched to eating fat, my whole world changed. @StoroniMithu Click To Tweet
For years, nutrition was regulated, set in a way, and we never shifted from the pattern. We didn’t question anti-fat recommendations.
We’ve come to a point now in science and medicine where we’re forced to reexamine everything, partially because of some accidental results of studies and partly because certain studies were buried for a long time.
We have incredible brain scans that show positive results we’d never imagined could come from eating fat. These studies demonstrate that fat is incredibly important for us and not the villain we once assumed it was.
Abel: For years, avoiding fat was the ONE thing you absolutely had to do to maintain a healthy diet.
That’s right. I spent a lot of my life, especially when I was younger, being very careful about avoiding fat. I had a diet based on carbs.
As a population, we always want to do the best and go by the data we have to form the best judgment. We want one villain and one good ingredient.
The studies from the Post Second World War pointed to fat as the villain. That’s what the studies we were shown led us to believe.
Now we’ve progressed so much and seen what 50 years of a low-fat diet has done. We have more studies, and as scientists, you should always recalibrate as you go along.
Abel: Science is starting to show surprising benefits of a ketogenic diet. A ketogenic diet has been used for a nearly a century to treat epilepsy, but new research shows its therapeutic benefits for a number of conditions.
Hippocrates used starvation to treat epilepsy. And at the start of the last century, the ketogenic diet was used to treat epilepsy. With the advent of medication, it became far less popular because it’s easier to prescribe a child something than to them what to eat.
The diets at the time were very strict and didn’t allow for the flexibility that a ketogenic diet allows today. Some diets during that time produced negative effects.
Then there was the introduction of The Atkins’ diet, which isn’t strictly ketogenic, but can be. Several papers in literature of people following Atkins showed that their migraines and epilepsy improved. So we have to look at that.
Suddenly the floodgates are opening and we’re noticing all these observational case studies, and that’s bringing our attention back.
THE SCIENCE BEHIND THE KETOGENIC DIET
Abel: When you consider multiple sclerosis, most treatment options aren’t as simple as eating fat and staying away from glucose. But in reading your paper, you can see the power of nutrition to reprogram the way our bodies and brains operate.
What are the long term implications of eating ketogenic?
MS (multiple sclerosis) is a condition that has baffled us for a long time. Its variances have merged over the years—there really is very broad spectrum. We’re usually focused on treating the inflammation associated with MS.
With multiple sclerosis, immune cells attack the nervous system. You have a barrier between your brain and your body’s blood supply. If that barrier breaks, the immune cells from your body can get to your brain. That’s part of the process of getting acute inflammatory episodes when you have MS.
If you look at the retina of people with MS, it’s thinner and progressively gets thinner. You can do imagery in the brain showing there’s something going on apart from inflammation—there’s neurodegeneration, similar to Alzheimer’s.
The fact that both of these exist is very interesting. We used to focus on calming the inflammation that gives patients acute attacks. Medication has been useful for that. There are patients that still progress, and when they do, we notice neurodegeneration. That’s where the ketogenic diet’s potential comes in.
What causes the neurodegeneration of Alzheimer’s and aging? No matter how confident we feel, there are going to be many things we don’t know. But we’re coming closer to understanding that neurodegeneration is related to mitochondria failing. When they fail, the energy supply of the brain cell is compromised.
We know that you have brain cells, neurons, and you also have supporting cells known as astrocytes, which are like the scaffolding. You also have microglia, which are inflammatory cells. Astrocytes provide the brain with lactate for nutrition—and we’ve also discovered a lactate shuttle. When the energy supply of brain cells becomes compromised, if you continue to supply glucose, you get an even more negative result than if you give nothing at all.
If glucose uptake is compromised, if there’s mitochondrial damage, or if there’s reduced glucose use by the grain (as in MS and Alzheimer’s)… if you give the brain glucose and you’re not going to use it, you need another fuel supply. That’s where ketones come in.
If you give your brain ketones when the mechanism used to process glucose becomes impaired, then the brain cells survive.
Let’s look at lesions of the brain in MS, or glaucoma, which is a disease of the eye where neurons are affected. If you have a brain cell with good healthy mitochondria that are getting a good energy supply, it can withstand heaps of damage and attack. If your brain cells are neurodegenerating, struggling, they are under attack. In that situation, if you give them glucose you are far less likely to help them than if you give them an alternative energy supply such as ketones.
Abel: So if you’re feeding your brain glucose, it’s like pouring gas on the fire.
Recent research has brought astrocytes into the forefront. We’ve always focused on neurons. We’ve assumed astrocytes had a role, but it turns out they supply neurons with lactate… but also have several other important functions such as clearing away glutamate.
Glutamate excites cells. We use it in our prefrontal cortex where pyramidal cells signal using glutamate. It’s great when we need it, but it excites cells, so we need to clear it away the moment there is too much of it. If we leave too much glutamate around, the cells are too excited and fall down dead. Not literally. It’s called excited toxicity. Lots of mechanisms are triggered and the neurons suffer.
The astrocyte, the second type of cell, clears away glutamate. One of the recent observations with sugar is that hypoglycemia prevents astrocytes from clearing away glutamate levels.
In a neurodegenerative brain, or simply an aging brain, if you have a lot of glutamate there, if you have astrocytes damaged, if you have neurons damaged, if there’s a lot of glucose around and you’re feeding the brain sugar, you’re fueling the fire.
With Alzheimer’s disease, there is definite reduction in the brain’s ability to use glucose. This is demonstrated beautifully in a special type of scan called an FDG scan by several groups, and it’s not something that anyone would dispute at the moment. This is why there are some early reports of coconut oil helping people with Alzheimer’s from MCT content, which breaks into ketones. That’s been proven.
But when does it begin? And is it the glucose problem that actually causes the Alzheimer’s? That is the most exciting point to study.
There’s a team in California looking at female aging brains, and I know that in rats it was discovered that as soon as rats hit menopause, even if they don’t have Alzheimer’s, the ability to use glucose plummets. If this also happens in humans, does it mean in 20 or 30 years time it’s predictive of us all developing some degree of dementia?
There is an inherited mitochondrial condition resulting in blindness affecting young men. In that condition, it takes about 20 years from birth to blindness. There’s another analogy—if you look at people predisposed to Alzheimer’s, when they’re around 40 and 50 (they’re still healthy and young), they have more declined ability to use glucose at that age compared to people who don’t develop Alzheimer’s.Glucose may be one of the epigenetic triggers of Alzheimer's. @StoroniMithu Click To Tweet
Abel: You went ketogenic in 2014. What was the biggest reason and what did you experience?
I was looking at the literature of neurodegeneration. It’s such a frustrating area. There is really no treatment and it’s a huge burden for the western world and beyond. It’s now coming into Asia quite significantly.
I was pretty fit and well, but I thought, “Why not try it? It’s whacky and crazy, but what’s the worst that could happen?”
In my head, I thought I’d try it for three months. And I have a very tolerant husband, all our ingredients have to be slightly changed. After three months, I really felt amazing.
I felt calmer. I didn’t have fluctuating stress levels. I felt my head was clearer. Some of them probably have a placebo affect, but I really felt so good that I wasn’t going to stop. Then I looked into it more, and the more I did, the more fascinated I became by it. I was so impressed by the research results from all the teams working on this around the world.
I thought, my brain is really important to me… why not?
HOW TO START EATING FAT
Abel: When I first researched the benefits attributed to fueling the brain with fat, I thought “Whatever, that sounds totally whacky!”
But then my personality actually changed.
Once I started fueling primarily with fat instead of carbs, and my brain became fat adapted, my mood and temperament transformed. I suddenly felt clear and balanced, without cravings and lags and energy throughout the day.
Fueling with fat isn’t the jittery energy you might get from too much caffeine.
You feel very balanced as long as you’re eating enough… Eating enough calories can be one of the challenges of starting a ketogenic diet since it tends to suppress hunger.
What else surprised you about the ketogenic diet?
It was an experiment on myself. I could be as crazy as I wanted to.
I started off measuring my visceral fat level and got my body fat and other areas tested. My diet before was pretty healthy: Proteins, a lot of vegetables, huge amount of fruit. Mangoes are my weakness.
When I started doing this diet, the first thing that went was the fruit. When I followed keto very specifically, I started mapping my macros. How can I get my fat up? Protein became difficult to measure because I was probably eating more protein than would put me into ketosis in initial stages. In order to buffer that, I made sure a lot of my fat came from coconut oil, like MCTs. You can stay in ketosis even if you go a little higher in protein.
Coconut oil became my staple. The studies I read on what happens to the different types of fat on a ketogenic diet. We know a ketogenic diet and ketosis are beneficial, but we don’t want to fall into the danger of saying if something is good, it’s good in all its forms. There might be some things in it we can do a little bit better.
With fat, the longer-chain the saturated fat is, the slightly more likely it is to lead to inflammation if it’s ingested alone. Most of the studies we’ve done on a high fat diet we’ve done using palmitic acid. We do need palmitate and our body produces it, and most of the fat in our body is stored as palmitate. But when we eat palmitate, when it goes through our intestine, it causes inflammation.
If you eat only palmitate on a keto diet, it’s going to be causing inflammation. But if you eat other fats, it can balance out.
I started off eating quite a lot of longer chain fats in the form of a huge amount of cheese, for instance. But even with cheese, you can be selective about which cheese you choose. Some types have less than others. The oleate ratio is higher in some types of cheese than others, and that can balance out.
I was eating a lot of almond butter, which is good in some portion, but you have the Omega-6 to Omega-3 ratios to think about. Vegetarians can increase inflammation and risk of cancer by not watching their omega-6 to omega-3 ratio.
I also liked pecans. Pecan nuts and cheese and nothing else is not a good idea.
I started switching that, looking more at my fatty fish and omega-3 intake. I moved nuts as well to reduce omega-6s. I shifted my fats to medium-chain, and increased my fiber intake… but not through eating resistant starch in the form of fruit and starchy vegetables, but through leafy greens.
Abel: When you look at scientific research, the ketogenic diet isn’t well-defined. You could be feeding a rat 100% corn oil, or feeding them nothing, in which case your body starts breaking down muscles and so forth.
I hope future research addresses a balanced keto diet. What do you consider balanced?
The honest answer is that I still don’t know for sure.
My first priority would be to make sure the fats are balanced. Stay away from the long chain fatty acids as much as possible, bearing in mind we need some and that our body already has some.
Having a lot of mono-unsaturated fatty acids, such as is what’s found in a mediterranean diet, is good. Primary cardiovascular markers show that a mediterranean ketogenic diet which has lots of monounsaturated fats has very beneficial effects on inflammation and other conditions.
Eat more avocados, olive oil, olives, macadamia nuts… everything that tastes good!
Omega-3s mitigate some of the inflammation from longer chain fatty acids. And then add coconut oil, or MCT oil. The reason I find coconut oil fascinating is because of the emerging research regarding it’s use. There’s been studies of adding coconut oil to existing inflammatory oils and that inflammation is reduced.
Also the production of MCT’s means there isn’t as great of a production of chylomicrons, these are the packages in which long-chain fats have to be put to move from the intestine. Coconut oil is a good thing to include in a ketogenic diet.
One of the people I admire greatly, Dr. Terry Wahls. In her diet, which she used to overcome MS, is the inclusion of lots and lots of colors of vegetables. That’s also really important.
Lastly, I think that one point which many of us seem to miss, especially if we’re not as athletic as you are (many of us are more sedentary), a ketogenic diet is most effective if you restrict your calories to as much as you need and not much more.
If you overfeed on a high fat diet, you will store fat. Eating to excess is not a good idea. That brings me full circle to the way in which we are designed. Is it really that eating fat is the principle thing, or is restricting your calories and avoiding carbohydrates the combination that matters? If you restrict calories and cut carbs you will end up in ketosis assuming your protein isn’t too high.
THE KETOGENIC DIET FOR WOMEN
Abel: There’s the secret to longevity and health: make sure you’re not overeating.
Restrict glucose or spikes in glucose—like when you eat a bagel or donut or a bunch of bread, which makes up the majority of our diets these days. 68% of our food in America is processed – and most of that is junk carbs.
This isn’t about eating a TON of butter, bacon, and coconut oil. It’s about letting your body become fat adapted so you’re finally off the sugar rollercoaster.
For most people, it’s harder to overeat fat and protein than carbs and sugar. Some people do struggle to burn fat, especially at the beginning.
When some women go low carb, they run into problems. What’s the best way to go low-carb for women?
From my personal experience, when you start on this kind of diet, get everything checked. Get a full blood screen. Often, if you’re young and healthy there are things that haven’t been flagged that will be when you start on a diet. I should also say it should always be done under strict surveillance by someone who knows what they’re doing.
As a female, you need to keep your calories right when you begin. When you drastically cut down on carbs and increase fat, your appetite goes. At least mine went. When there’s drastic weight loss, regardless of where it comes from, you do get some hormonal implications from that. In terms of women, there are reports of polycystic ovaries being resolved or improved following a keto diet. And it has an antiinflammatory effect.
Getting supervision, keeping your calories constant, making sure all micronutrients are coming in. If you’re eating a huge amount of fat (you shouldn’t need to), many people find it difficult to absorb what they’re eating and end up with micronutrient deficiencies.
If you’re eating jars of almond butter, you’re probably not absorbing your iron, zinc, and many essential minerals. Your thyroid needs them. Your body needs them.
Make the diet as mediterranean in style as possible. Sometimes when I’m eating at a restaurant, what I eat may not seem remarkable to the people I’m dining with because essentially it involves lots of leafy greens, heaps of olive oil, avocadoes, seafood, chicken, it’s the standard diet without anything odd about it. I’m not putting a cup of butter on my food.
I just try to stick to: 70% fat, 20% protein, 10% carb ratio. Focus on that rather than too much fat, that helps you avoid the pitfalls.
Abel: How do you know how much food to eat if you’re not counting calories?
My old habit was, in the morning I’d wake up go to Starbucks grab a bagel and coffee. You have the bagel and you get a high, you have that coffee and your eyes flip open. You’ve had that signal that you’ve had breakfast.
No matter how many raw pumpkin seeds you have, you won’t get that signal.
As I hope most people know by now, if you have a large carb load you get that spike, it crashes, and then you suddenly feel hungry. In a ketogenic diet, that completely went away for me.
Just like you, I have very good control over my appetite. Everything, including food, is used to trap us. To attract our attention. To entertain us during the day. You wake up and go to work and walk past coffee shops—there’s a sign on my street telling me there are masses of donuts at the bottom of some stairs.
This whole society is saying we want something now, want a signal now. It has become so ingrained in our world. We are not prepared to cook or think of the consequences of what we are eating.
With the ketogenic diet, you’re not just drawn to the food signal. You can think. You can plan. You can do well. That keeps you in such a calm state of mind, and you can apply that to other things.
WHERE TO FIND DR. MITHU STORONI
I’m working on a book called The Resilient Brain, it’s on stress and the scientific ways you can use to make your brain and yourself resilient to stress.
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Do you fuel with fat? How does it make your brain feel? Let us know in the comments below.