Keto-Friendly South Beach Diet, Dr.Arthur Agatston

Dr. Arthur Agatston Transcript by Dr. Steven Gundry | Apr 20, 2021 | Transcriptions | 0 comments Speaker 1 (00:00): Welcome to the Dr. Gundry Podcast, the weekly podcast where Dr. G gives you the tools you need to boost your health and live your healthiest life. Kimberly Snyder (00:18): Welcome to the Feel Good Podcast with Kimberly Snyder. My goal is to help you develop a holistic lifestyle based on our four cornerstone philosophy: Food, body, emotional well-being, and spiritual growth. This holistic approach will help you feel good, which I define as being connected to your most authentic, highest self, and this is the place from which your energy, confidence, creativity, true power and true beauty will start to explode. Every week, we provide you with interviews from top experts in their field, or a solo cast from yours truly to support you in living your most beautiful, healthy, and joyful life. I’m your host, Kimberly Snyder, founder of Solluna, New York Times best-selling author, and holistic wellness, nutrition and meditation teacher. Let’s get started. Dr. Gundry (01:12): Welcome to the Dr. Gundry Podcast. So the South Beach Diet is one of the most iconic low carb diet plans in the world. I think it started in 2003 thereabout. Recently, the creator of the South Beach Diet has enhanced this plan to be compatible with keto, the popular rapid weight loss diet that forces the body to burn fats rather than carbohydrates. So on this episode of the Dr. Gundry Podcast, I’ll speak with cardiologist, diet expert, and New York Times best-selling author Dr. Arthur Agatston. Yeah, actually he and I have a lot in common. So Dr. Agatston released his latest book, the New Keto-Friendly South Beach Diet in 2019. Today, we’re going to discuss the truth about ketosis, tactics for overcoming sugar addiction, and the right way to slim down. Dr. Agatston, welcome to the program. Dr. Arthur Agatston (02:18): Great to be with you, Dr. Gundry. Dr. Gundry (02:21): It’s a real pleasure. You’re a world-renowned cardiologist, but your expertise goes far beyond coronary calcium scores, which your name is synonymous with, and thank you, I guess, for discovering all of this. Okay, so you’re a guy who figured out coronary calcium scores. What was your inspiration for developing the South Beach Diet. Come on. Dr. Arthur Agatston (02:50): Well, it actually goes back to the calcium scores, and with it, we’re able to see people at risk with plaque 20, 30 years before they developed enough plaque or atherosclerosis to actually have a heart attack. And the question was why did they have plaque? And what we knew both from the Framingham study and our experience was a lot did not have very high cholesterols, and what I learned in the late 80s observing people on low carb diets really started by Dr. Atkins was that getting rid of sugar and bad carbs was a good thing. This was the late 80s. We also had learned from Dr. [Revin 00:03:40]. And I learned more locally, it was Dr. Ron Goldberg, the Chief of Diabetology at the time at the University of Miami, that pre-diabetes, or metabolic syndrome or syndrome X, was just reported, and realizing that people could be developing heart disease before they had abnormal blood sugars to the point they were diagnosed as diabetes. And he said, “Look for it in my office. People with high triglycerides, low HDLs, high hemoglobin A1Cs,” and I was seeing it all over in my practice in people without very high cholesterols but with coronary plaque. And so then, well, how can we reverse this without just giving statins, and we knew the conventional low fat diet just did not work and was very frustrating. And so while the battle there was low fat versus lower carb, we took an approach of the right carbs and the right fats. The good ones and it worked. It worked very well, although we think in retrospect there were a few errors we made at that time, and with the explosion of medical science, it was time to make some changes. Dr. Gundry (05:04): So why do you think the original South Beach Diet became so popular? What clicked for people? Dr. Arthur Agatston (05:15): Well, it was simple, and it worked. And besides it wasn’t getting rid of all carbohydrates. Certain fruits and vegetables, and we can discuss that in more detail, and certain fats were good for you, and we’ve actually changed some classifications, some fats to be better than we thought and some to be even worse than we thought at the time. So the idea, it was simpler, and at that time, we thought it was also more heart healthy as well. Dr. Gundry (05:59): So I’m glad you brought that up, because one of the things, even if you look at some of my original books and my more current books, my thinking changes with time and with new research. Dr. Arthur Agatston (06:15): Hear, hear. Dr. Gundry (06:17): Yeah, and you and I both know that there are some diet recommendations out there that haven’t changed in 20 or 30 years, even though you and I both know that the research has clearly changed in 20 or 30 years. And I congratulate you on taking a stance that, guess what, I learned a few things, and guess what, there’s some new research. So this will be great for my listeners and viewers. What didn’t you know with the original South Beach Diet that you know now, and give us some examples. It would be great. Dr. Arthur Agatston (07:00): Sure. One is fat adaptation, that on the low carb diets, and we can talk what’s keto friendly versus keto, and intermittent fasting, all of which are strategies we use, but when you stop burning, you lower your starch stores, your glycogen stores in your liver and muscle, you have to burn fat. And it takes time to get your enzymes up regulated, activated so they burn fat efficiently. And it takes more than two weeks. So our first phase of our first diet was only two weeks. Now it’s much longer, and the reason is because as you’re low carb for a longer period of time, you learn how to burn fat more and more efficiently. And the first time I was stripped for a longer time, I came back from being away for six weeks. I went back to my boxing training, and I could not believe my endurance. And so that was being on the first phase of the diet for a longer period of time. Another is snacking. That we originally thought that frequent snacks help stabilize insulin levels and you’d miss that drop. What we realize now is the whole purpose of everything we’re doing … It goes beyond that, but the big problem in the country is too much sugar creating high insulin levels that get sustained and cause you to be hungry all the time. And every time you snack, besides the direct effect of increasing blood sugar and insulin levels, you actually amplify your insulin levels by what are called incretins in your small intestine, particularly GIP. So if you have the same amount of calories in one serving, you increase your insulin normally if they’re carbohydrates, and then you get a balance by activating insulin in your upper small intestine through this GIP incretin hormone. But if you take the same amount of calories, and you split it into six, seven snacks, and Americans, compared to the early 1970s, we are grazing. We’re really eating all day, and the number of snacks is so much more. And that is keeping our insulin levels high, and that’s preventing us from burning fat. And so we’ve switched from, yeah, have frequent snacks to snack as little as possible. Keep as much time in between meals as possible, including intermittent fasting. Give your insulin time to drop. So that’s another major, major change. Dr. Gundry (10:21): So what inspired you after these years of watching this diet in action to come out with the new keto-friendly version of your diet? Were there patient examples that you found? I know you and I both spend a lot of time looking at blood work in patients, challenging them with different foods or different prescriptions of food. What brought this about? Dr. Arthur Agatston (10:53): Partly, it was understanding how primary insulin is in the problem, and diagnosing your pre-diabetes, even what I call pre-pre-diabetes, because we’re insulin resistant years before we have abnormal blood sugars. The whole thing was bringing down insulin levels, and the three ways you can do it is with strict keto, where that’s severely a low carbohydrate, less than usually 20 grams a day. But our experience with the first phase of the South Beach Diet was it worked very, very well at bringing down insulin levels, reversing insulin resistance. But depending when we want to be aggressive as the [inaudible 00:11:46] Group is in Indiana, where with the advantage of keto is you can measure if you’re in ketosis or not. So patients who like measurements and where we don’t necessarily trust them that they’re eating what they say they are, you get the feedback. But as far as the physiology, things like what’s called the “keto flu,” all the other things we’ve observed, decreased joint pains, better digestion, lack of reflux, we see that all with what we call keto-friendly, not being quite as aggressive. And so that gives us a little bit more compliance. And then the third part was the intermittent fasting, and it’s really our experience with patients. So depending on the particular patient and their desires, we use different approaches. Just a couple weeks ago, a very good friend of mine who happens to be … I say he’s my worst patient, very non-compliant. He’s a lawyer. He says I’m his worst client, so we have that. But he’s a gourmet, he’s always traveling. I just could never get him to do what I wanted, but sometimes it’s all or nothing for his personality. So we said we’re going to put you on a several day fast. We always think you need careful medical supervision when this is done so you don’t lose too many electrolytes and other problems. So we did it, and he was … Not by us. We don’t give type-two diabetics insulin in general, but he was on insulin. We got rid of his insulin in a few days. His blood sugars returned completely to normal during a week. He lost within two weeks about 15 pounds. Some of that early weight loss is fluid, and a battle of keeping patients hydrated came up with him. But he’s feeling so good, people tell him how good he looks, that this was the right strategy for him. So, depending on not so much … The science doesn’t change. It’s three strategies: Keto, keto-friendly, and compressed feeding or intermittent fasting. It’s particularly on the patient that we make the decision, and sometimes we use all three strategies. And it is all keto-friendly, but you don’t have to be in ketosis actually to get the benefits. Dr. Gundry (14:41): I think that’s a great place to ask, so what the heck is keto-friendly versus a ketogenic diet? I think my listeners hear the word “friendly” and they’re ready to go. So what’s keto-friendly that’s not necessarily putting somebody in ketosis? Dr. Arthur Agatston (15:04): Okay. Well, in our experience, being in ketosis is where you’re strictly avoiding carbs, that you’re primarily burning fat, and fat turns to ketones. And there are positive things that we know about ketones, certainly if you have seizure disorders. It’s been used for generations in kids, and we think for Alzheimer’s, neurodegenerative disease, there are advantages for actually being in ketosis. But for weight loss, improving your insulin levels, getting rid of belly fat, you are making ketones but they’re being cleared, and you can’t always measure them. And so keto-friendly is when you’re a little bit less strict, say between 20 and 50 grams of carbohydrate. And, by the way, I don’t measure my carbs. I know the way I feel. So you’re not quite as strict. Sometimes we start people on clear keto, again, if they want the quickest positive responses, but so it’s not being as strict, and we think you get all the advantages. The exceptions is in some neuro diseases where possibly even exogenous ketones may give you an advantage. But most people can lower their insulin levels, get rid of their belly fat, do extremely well without being in full ketosis. And the other part that’s the same with intermittent fasting, with our patient I mentioned it was all or nothing. We did the prolonged fast. He was certainly in ketosis. He liked measuring it. But we were using it much more for compliance rather than you couldn’t get the same physiological effects. So there may be other advantages of being in full ketosis as well, but particularly in the areas of neurologic problems where you really do want to be in ketosis. Dr. Gundry (17:21): What do you say to somebody that the ketogenic diet is just the latest craze that everyone is hopping on, including the South Beach Diet? Dr. Arthur Agatston (17:37): Sure. Well, I think the craze was the low fat diet, because low carb … Newborn babies are in ketosis, and low carb really has been around from the late 1800s and was used for type-one and adult onset diabetes, it was called. And it wasn’t until really some horrible research by Dr. Ancel Keys and the seven countries studies that led us astray, and it took non-physicians, Dr. Gary Taubes, Anita Kay Schultz, who really did the deep dive into the politics and how this really bad science evolved. And what’s clearly happened to the country was we got fatter and sicker. Really two things happened. The low fat craze, and every cardiologist knew that low fat didn’t work, and you can be on a healthy low fat diet, but it’s much tougher. So when the food industries were told, “Get the fat out,” and the food tasted like cardboard, how did they make it tasty? Well, that was a time when high fructose corn syrup came in, and it was less expensive, and it was hidden in so many foods. It’s not that it was worse or so much worse than regular table sugar. It’s that it was hidden. And so in 1980s, exactly the same time that the first national diet recommendations said “Get the fat out,” our sugar intake went way up, and that’s when the country became fatter, sicker, and diabetic. And so the challenge is to say why we should be low fat, not why we should be low carb. We did a small clinical trial early on with South Beach. Actually, it was a very impressive faculty that we had as co-authors on that paper, but we showed what everybody showed. With the low carb diet, you quickly decrease your triglycerides, you increase your HDL, and we were measuring size of LDL particles, and we documented that the LDL particle size got larger, often causing a little jump in total LDL cholesterol. We know a lot more about that, but that was a small clinical trial. But, now, there have been many other larger clinical trials, much better than the low fat trials. So the scientific evidence with clinical trials strongly supports everything that we’re doing and that we’re recommending. Dr. Gundry (20:35): I have had the privilege of working with some pretty talented folks, like self-help guru Tony Robbins, singer Usher, and more actors and pro athletes than I can count at this point. But I never imagined I’d get to take a cooking class with Gordon Ramsey, or learn comedy from Steve Martin. 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So are there any myths about the keto diet that you see perpetuated that you just wish people knew wasn’t true? Dr. Arthur Agatston (22:06): Sure. Yeah. The most important myth is that if you have saturated fat, it will increase your cholesterol and your so-called “bad” cholesterol, LDL cholesterol, and cause heart disease. There are other things about causing kidney stones and gall stones, which is a little bit separate, but the big thing is I had the higher saturated fat, more meat, and my cholesterol went up. And we know, and this is relatively recent, that dairy saturated fat, meat saturated fat, it can increase your total in your LDL cholesterol. It turns out total cholesterol is just a surrogate for total LDL cholesterol, which is a surrogate for small LDL cholesterol. It’s only small LDL cholesterol which comes from too much sugar turning into fat in our liver, and we really know what’s gone on. That’s the dangerous fact. And there are a lot of clinical trials from the [Aric 00:23:18] trial, the Mesa trial, the Quebec heart study showing that when you increase your saturated fat intake, you increase your total and large LDL but not your small LDL. So we’ve really figured out why people demonized saturated fat, and we said limit it. We didn’t know when did the original South Beach Diet, but now there’s enough knowledge that as long as you break down your increasing large LDL and not small LDL, it’s safe. Always, we say, check with your doctor. There are certain times when large LDL can be dangerous. Sometimes high HDL, the so-called “good” cholesterol, can be dangerous. That’s a little bit more sophisticated. So we’re not saying everybody, but the main metabolic problem in this country is diabetes, pre-diabetes, and insulin resistance or pre-pre-diabetes. And your triglycerides go up, your HDL goes down, and you’re making small particles years before your blood sugar will be abnormal. But you’re already piling fat into your liver. You have a fatty liver, fatty pancreas, the belly fat that we can all see, and fat in your coronary arteries that we see with coronary calcium. So that’s the main metabolic problem in the country, and you don’t have to be obese to have this metabolic problem. A lot of people, we call them “TOFI.” Thin on the outside, fat on the inside. For all the world, it’s people who don’t think they’re overweight. They just have a little belly. If you have a belly, you have fat in your liver, you’re generally eating much too much sugar and bad carbohydrates, and that’s the cause of the problem. Unless you do the proper testing, you’re not going to know it. Dr. Gundry (25:30): So in this book, you talk a lot about sugar addiction, and our friend David Perlmutter and his fifth year edition of Grain Brain makes the point that it was sugar that was the problem, not so much just grain, but the way we eat grains, it’s sugar. But what convinced you that sugar is as evil as it appears to be? Dr. Arthur Agatston (26:04): Well, I can tell you the story that’s in the book, and it’s a true story. And, yes, I’m a cardiologist diet doctor, and the whole thing started, frankly, when I was in my 40s. I was always very thin, considered myself an athlete, and while I was boasting about some athletic exploit with our cardiology fellows, one started laughing. I said, “What are you laughing at?” He said, “Look at your belly.” And I had gradually become insulin resistant. I always loved sugar. And that’s how I really started the original South Beach Diet. But when I would go from our first to our second phase, and began to cheat, I would overdo it to the point my wife would tell me “Arthur, no TV for you. You can only go on radio where they can’t see your belly.” And it was the summer of 2018. I was reading Robert Lustig’s book The Hacking of the American Mind, and I was learning that sugar is not a lack of discipline. It’s an addiction just like cigarettes, alcohol, video games, vaping we can say today. And it was around the same time we were on vacation with the family. We had a very healthy salmon and broccoli dinner. We can talk about the veggies with you later, but what we thought were healthy. Anyway, and for dessert, a blueberry pie from the local farm stand. And I started inhaling the blueberry pie, one of my favorites. My wife said, “Arthur, slow down.” One of my sons said, “Come on, Dad.” And so I said, “Okay, I’ll stop.” When everybody cleared out of the dining area, I snuck into the kitchen, I finished the entire blueberry pie, telling myself they’re blueberries. They’re antioxidants. They’re good for you. And reading the Lustig book, I realized right then that what I considered was my lack of discipline and cheating at times was truly an addiction. Just with that knowledge, and I realized it was going to take longer than two weeks to get rid of that addiction. I could always get rid of my cravings on the first phase of the South Beach Diet, but I would cheat with fruit or sugar or something, and they would come back. Once I stayed off the sugar, and stayed longer, because I also realized I had to get fat adapted. So with a longer phase one, I was feeling so good that it’s well over a year-and-a-half. I feel so good, I will not go back. And it’s not that I’ve had the wrong food. The last time was over Thanksgiving, and I cheated, and I finished a whole chocolate cake. But I went right back because I know how much better I feel, and I’m convinced how healthy it is. And so I have sustained, and also I know that if I have that blueberry pie, I’m going to finish the thing. And not everybody has that degree of sugar addiction, but so much sugar is being snuck into our diets, it’s quantified, we know, again a lot because so much packaged food has high fructose corn syrup. And in particular, our kids are getting addicted to sugar, just like they are to video games, and now so much the kids with vaping. What a disaster. And so when we teach patients about it, and not everybody with carbohydrate problems are addicted, but many are. And so when you explain it to them, and then it’s much easier to help them get rid of the addiction. Part of it, longer first phase, but then recognizing what’s going on. Dr. Gundry (30:33): Yeah, my first book, one of my favorite sayings was “give fruit the boot,” and I’ve been generally attacked as being anti-fruit, and everybody knows how good fruit is for you. And so many of the vegetables that we consider vegetables are not vegetables at all. They are fruits. Some of our most beloved. And I’ve seen the same thing that you’ve seen, fruit, fructose as you and I know is converted into triglycerides in the liver or uric acid, and there’s actually an increasing amount of evidence that fructose is a mitochondrial toxin. Dr. Arthur Agatston (31:19): Absolutely. Dr. Gundry (31:19): A poison. Dr. Arthur Agatston (31:20): Yes. Dr. Gundry (31:20): And we take it to the liver to get it repackaged. Dr. Arthur Agatston (31:25): Yes. Dr. Gundry (31:27): And when I’m treating my patients, my goal is to get their triglycerides to at least equal their HDL and preferably their HDL higher than triglycerides, and I personally feel the guidelines for where triglycerides are … If you say 150 triglycerides is normal, I haven’t met a human being that hadn’t been put on statin to get their LDL down. Dr. Arthur Agatston (31:57): Yeah. I couldn’t agree with you more, and what I tell patients, and I have it actually in the book, the idea have more fruits and vegetables. And the non-starchy vegetables we can talk more about, but we allow those. The thing about fruit was fruit was meant to be around, to ripen in the fall so you were insulin resistant. Grizzly bears, I have the example in the book, their insulin levels go up normally late summer and fall. The fruit ripens, they’re voracious, and their insulin levels are going up. So while they’ve gained hundreds of pounds of fat, the insulin level is blocking the access to the fat. And so when we’re having fruits year round, x-number of servings, we see patients getting into trouble, particularly diabetics, pre-diabetics, but even pre-pre-diabetics. My best example was a patient in south Florida, all of a sudden their blood sugar went off the wall, and we’re saying, “Is there an infection? Did you go on vacation? You cheated. What happened?” It took us awhile to find out here in south Florida his mango trees became ripened in the fall, and he loves mangoes. And so here’s a fruit that absolutely destroyed his blood sugar. And we see that with patients. They have high insulin levels. They have clear blood sugar/insulin problems, and they say, “Well, I’m not eating fruit.” Well, what do you have for breakfast? “Well, a big thing of cantaloupe, and pineapples, and mangoes, and berries also.” And so we’re in complete agreement on the fruit. Sometimes of the year, in moderation, and depending on an individual’s genetic predispositions, but a lot of people get into trouble because they think fruit is healthy for everybody. Dr. Gundry (34:11): Yeah, and unfortunately our fruit has been hybridized for sugar content. Dr. Arthur Agatston (34:16): Yeah. Dr. Gundry (34:16): I can go to the Santa Barbara farmer’s market and get organic blueberries that are the size of grapes, and that has nothing to do with the blueberries that you and I ate growing up. And apples, even the names of apples like honey crisp. Hmm, I wonder what that’s going to taste like? Dr. Arthur Agatston (34:37): Yeah. We talk about the amount of fiber in the skin versus the pulp, and that we’ve been hybridizing our fruit and everything for years that they have more and more sugar and less and less fiber. And the heirloom tomatoes, heirloom blueberries were not like the ones we’re having today. So it’s almost like high fructose corn syrup. There’s more and more of the fructose that we’re consuming, and that’s a major problem. Dr. Gundry (35:15): I know a lot of times people think of a ketogenic diet as a high animal protein, high animal fat diet, and I think that’s, as a general rule, a good conception of what these diets are. What do you think about a ketogenic plant based diet? Is there any room for that? Dr. Arthur Agatston (35:46): Well, I think you can be a healthy vegan. I think it’s very, very hard. And I always talk about there’s a French paradox. They have all the dairy, all saturated fat, no coronary disease. And then they talk about, well, what about Asians who are eating rice, and they certainly have some meat, but they don’t have the diabetes. They didn’t. Dr. Gundry (36:21): They didn’t. They do now. Dr. Arthur Agatston (36:21): Now, with the advent of sugar, their rate of diabetes is off the charts. But the fact is if you’re having a long grain rice that’s slowly absorbed, it’s stimulating the good incretins that don’t amplify your insulin levels, and they’re having traditionally one or two meals a day. They have plenty of time for their insulin levels to drop, and so you can be healthy on the non-classic keto high saturated fat diet, but first of all, I don’t think there’s anything wrong with the fat. America in colonial times was very high in fat, and of course, it was grass-fed. It was different than we have today, and sometimes the way things are produced today in factory farms, it’s a relatively short period, so we’re not sure about all that. But the colonial times, it was very high fat, very high animal fat, and nobody was getting heart attacks or strokes. There was not high blood pressure, and that’s because we didn’t have sugar. Really it was the late 1800s and 1900s, the sugar plantations, where our per capita of sugar went up. The bad fats, the vegetable oils or seed oils, hydrogenated first, I think they’re just as bad now. They’re artificial. And now at the same time, there was blended tobacco for cigarettes. And the first pack of Camels I think came out in 1915, they sent it to all our troops. And so we were able to inhale tobacco for the first time. So, to me, there was bad fats, more and more sugar, and processed carbohydrates in foods in general, and the tobacco all came at the same time. To me, sugar is the number one problem that should be demonized, although obviously we don’t want a smoking population. And I think that the vegetable oils, you’re really experimenting with your health. It’s an experiment I wouldn’t volunteer for. Dr. Gundry (39:09): What do you think about always staying in ketosis, or should we break ketosis? Any thoughts? Dr. Arthur Agatston (39:18): I don’t know. As far as long term studies, I will say one of the other myths, and this is a problem we saw back to the early days of South Beach and what’s now called the “keto flu.” And we have this experience when somebody is doing very well on the diet, and they sometimes call and they say, “I had to get off the diet. I was so weak and tired, so I got myself a big load of bad carbohydrates.” It’s not hypoglycemia. It’s dehydration. And so when you’re low carb, either low carb friendly or keto, first of all, you’re initially getting rid of your carbohydrate stores in the form of glycogen, which is stored with a lot of water. So you’re losing water that way. And when your insulin levels are coming down, you’re reabsorbing less salt. And I’m convinced that what we’ve always called essential hypertension, we didn’t know the cause, is high salt levels due to high insulin levels. The reabsorption. So the number of times that somebody comes, we have there a week, and even though we always warn them, it still happens. In fact, it happens to me on the days where I exercise heavily, even though I’m having fluids and then showering, running into the office, and if I’m not careful with my fluids and salt intake, all of a sudden, I’m dizzy. I’m ready to pass out. It goes very quickly with fluids. But what I tell them, if you got weak and dizzy, that’s a very good sign. It means the diet’s working, you’re getting dehydrated, your insulin level is dropping, and if you keep up with your fluids and salt, you will be absolutely fine. And that’s turned out to be true. I’m still amazed, and I had a trainer during a vacation, and he’s like Mr. America, and he said, “Boy, I’ve been feeling so weak lately.” And it was a summer, it was hot. He’s working out. I said, “What are you doing with your salt intake?” I knew he knows he’s supposed to have fluids. He said, “Oh, no, no, no. I don’t have any salt.” This is another big myth. And he thought, oh, I’m the diet that the cardiologist … He’s going to tell me, oh, no, no, no, I’m not having salt. I’m being good. I said, “Start your salt.” The guy, his weakness went away in no time. And there are a lot of people walking around, if they’re on a good diet, even though they’re generally feeling well, they’re a little weak. When they’re consuming less food, they’re also getting less fluid that way. So keeping up with salt and fluid, and the idea that we should all be on a low salt diet, and here I’ll defer, talk to your physicians or people who are salt sensitive. But it was in the New England Journal 2014 or 2016, the PURE Study, that there is much higher mortality on severely low salt diets than on higher salt diets. So high salt, if you’re having a fast food diet, that’s too much salt and too much fast food. But if you’re on a healthy diet, you don’t have to be low salt. Extra salt will be excreted in your urine. Dr. Gundry (43:09): Yeah, I think that’s such an important point. This is a news flash for my listeners. Probably hopefully not for my listeners, but we have a distinguished cardiologist who says if you’re doing a keto program, get your salt intake up, and I couldn’t agree with you more. We dramatically excrete sodium chloride when we’re in ketosis, and when I do my ketogenic times, you’re hearing it here, I’ll go lick about half a teaspoon of salt every night. And my wife says, “What are you doing?” I said, “I’m salt loading. Leave me alone.” But, you’re right, that’s one of the biggest mistakes of a ketogenic diet. This is well researched as well. Dr. Arthur Agatston (43:58): Yeah, and one of my colleagues also gets frequent migraines, and by having salt and fluid, most of them are resolved. And, again, when I come in after exercising hard, and forgetting to drink and have that salt lick, I will get everything from scotoma, the beginning of a migraine, not much of a headache. I’ve had double vision. From exercise, dehydration, resolves immediately when I get my fluid and salt intake up. So this is from personal experience, endless experience with our patients. And even though we warn them, it happens. And, again, I say you’re weak, you’re tired, that’s a really good sign. “What? It’s a good sign? I need sugar.” You don’t need sugar. You need fluids. It means you’ve lowered your insulin level. You’re following the diet, and you will do great on it. Dr. Gundry (45:01): Very good. Well, Dr. Agatston, it’s been great having you on this episode of True Confessions. Dr. Arthur Agatston (45:10): You mean you’ve been recording this? It’s going to the public? Oh my goodness. Dr. Gundry (45:14): Sorry, sorry. So how do people find you, find the New Keto-Friendly South Beach Diet? Because people know about you, but how do they find you? Dr. Arthur Agatston (45:30): Naturally, Amazon and all the other popular places where books are sold, and we have southbeachdiet.com for information as well. Dr. Gundry (45:41): All right. Great. Well, this is going to be really useful to a lot of folks, and you’ve debunked a lot of great myths. And thank you for sharing your personal stories because I do the same thing, and this is partially how we learn, by experimenting on ourselves as well as inviting our patients to experiment with us. So good for you. Dr. Arthur Agatston (46:05): And I think for both of us, as getting more senior, we’ve lost some of our filter at this point. If it can help people, we say it. But thanks. This has been a real pleasure for me. I enjoyed it. Dr. Gundry (46:18): It’s great, and hopefully we’ll have you back on in the future, and we’ll keep digging into this. Because we’ve got to talk about lectins, and that’s a whole nother story. Dr. Arthur Agatston (46:27): Oh, yeah, I would love to. I’ve been learning about lectins, and very interesting. Dr. Gundry (46:33): All right. Thanks a lot. Dr. Arthur Agatston (46:34): Thank you. Dr. Gundry (46:36): So now we’ve got a audience question. Speaker 5 (46:41): Hey, movie lovers. Who needs a theater when you have Pluto TV? Grab your popcorn and your streaming device because free movies are here. Pluto TV is your home for movies. Great movies are playing anytime on over 20 exclusive movie channels of action, horror, rom-coms and more. Watch hits like Saving Private Ryan, Pretty in Pink, and Charlie’s Angels all for free. No signups, no fees, no contracts. Ever. Download the free Pluto TV app on any device. Dr. Gundry (47:09): David M. wrote in and asked, “In your podcast with David Sinclair, you discussed taking activated charcoal to help detoxify the heavy metals out of your system when fasting. I do time-restricted eating, and eat in a six to eight hour window. When should I be taking the activated charcoal? During the last meal prior to fasting?” Well, so one of the things we’ve talked about, and I’ve done videos on this, is that one of the dangers of a modern water fast is that you and I are just filled with heavy metals, petrochemicals, pesticides, herbicides that we actually hold in our fat. And while they’re in our fat, like a fatty tuna or a fatty swordfish, or a grouper down in Dr. Agatston’s neck of the woods, they keep all those heavy metals in their fat. And they’re swimming around, they’re strong as anything, but when we dramatically start accessing our fat stores, those heavy metals, those toxins come out. And they’re taken to our liver. Our liver has phase one, phase two detoxification enzymes, but our liver has a horrible system of detoxifying heavy metals. So liver in its wisdom puts those heavy metals into the bile and says, “Well, we’re just going to squirt them into the small intestine, and we won’t worry about them.” The problem is we reabsorb those heavy metals, so we have a circular pathway of never getting rid of many of these toxins. Chlorella and activated charcoal will bind with these heavy metals and then you will actually excrete them. So what I recommend for people, if you’re going to do a water fast, and I do them, you’ve got to be careful during that water fast. And if you’re going on an active, aggressive weight reduction program by whatever you want to use like a keto-friendly South Beach Diet, then I think it’s well worthwhile taking daily or multiple times a day activated charcoal and chlorella. And, as many of you know, I have a product that does that that I won’t mention the name. So thanks for your question. That’s a great question, and that’s the mechanism of why you should do this. Okay. Thanks very much. We’ll see you next week on the Dr. Gundry Podcast. Disclaimer. On the Dr. Gundry Podcast, we provide a venue for discussion, and the views expressed by my guests do not necessarily reflect my own. Thanks for joining me on this episode of the Dr. Gundry Podcast. Before you go, I just wanted to remind you that you can find the show in iTunes, Google Play, Stitcher, or wherever you get your podcasts. And if you want to watch each episode of the Dr. Gundry Podcast, you can always find me on YouTube at YouTube.com/drgundry. Because I’m Dr. Gundry and I’m always looking out for you.