Qualy #43 - What are Peter's thoughts on fasting and ketosis for females？
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Summary
In this episode of The Qualies, Dr. Peter T.T.D. and I discuss fasting and ketosis for females and their role in evolution. We discuss the role of ketosis in female fertility, the benefits of fasting, and whether or not a woman should be in ketosis during pregnancy.
Transcript
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welcome to the qualies a subscriber exclusive podcast qualies is just a shorthand slang for
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subscribe so without further delay i hope you enjoy today's quali what are your thoughts on fasting and
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ketosis for females well you know again a real tough question because i find all questions of nutrition
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to be so individual that it's hard to answer them sort of you know one size fits all sort of one stop
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shop approach that said i think there are a couple things women need to be thoughtful about if any
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woman is having an issue with fertility i couldn't make a case i can't make a very compelling case for
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nutritional ketosis if a woman is trying to get pregnant and i i'm sure this is just going to piss
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off a lot of the keto herd but because of course if you're in the keto cult you believe that ketosis
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is the optimal state for everything including you know global warming but the reality is if you look at
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the fgf levels and also if you just think about it from an ancestral standpoint the higher the level
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of ketone during our evolution the more likely we were separated from food and the more likely you're
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separated from food the less genetic pressure you should have to be reproducing at that point in time
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and this this concept is so well preserved in biology i mean we had a great discussion with david
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sinclair recently to talk about this and it's even true in the case of the sirtuins which would be a you
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know one of the more important regulators of of our aging and our and including you know our
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reproductive stress so i think when you look at the fgf 21 data and the ketosis data there's a very and i
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don't want to bastardize this because i wish i'd known that i was going to be asked this question i
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would have looked up the paper it's from a researcher in texas i think he's at he might be at ut
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southwestern but he's if you search you know and his name's first name is david i'm blanking on his
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last name begins with an m though but if you mangle manglesdorf yes yes yep that's him i saw him
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presented a meeting once and it was remarkable data that looked at the differences in a male and female
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brain in the presence of changing fgf 21 levels and it was so cool to see this difference the pituitary
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gland is one of the very few pieces of tissue in the body that has what's called portal circulation
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the liver being the other one so the pituitary has a direct connection via the pituitary stock to the
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hypothalamus the long and short of it is in a calorie restricted state when ketones are elevated
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it suppresses fsh and lh in women but not in men this is super interesting to me and it has an
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it has a profound evolutionary i mean again maybe i'm just making up a story to fit this but if we're
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going to subscribe to any of occam's razor this would be a great application in a period of famine
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you would want women to stop reproducing you would want to shut off fsh and lh you would want men to
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have no impairment on their testosterone level that's all the more time that they should be out
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there and able to to get food so again i've always been kind of a little bit careful of suggesting that
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a that a woman who's trying to get pregnant be in ketosis now look i know what's going to happen
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everyone's going to say well i got pregnant when i was in ketosis yeah obviously it's possible i mean
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i'm not suggesting it's not but if we're talking about optimization the second thing of course is
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should a woman be in ketosis during pregnancy and the and the answer is i i simply don't know the
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answer clearly we evolved with mothers being in ketosis and having children i mean it'd be impossible
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for our species to be here if mothers were not in ketosis during pregnancy i mean we didn't have
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buffets but that said is it optimal you know again just because something happened in in sort of our
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evolutionary time history does that mean it's optimal no almost not at all so as a general rule
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and again i don't like to make general rules when it comes to nutrition i'm not convinced it's
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necessarily the best strategy just like i don't think it's the best strategy for kids unless they
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have seizures or something else for example so you know a far better strategy is just like
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don't eat junk food you know don't eat don't eat sugar don't eat highly refined carbohydrates
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but you know should one restrict carbohydrates to the point where they're in ketosis as a very
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deliberate act i'm not convinced that's the case and of course when you start to look at things like
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maternal diabetes or gestational diabetes rather that's where it gets a little tougher because
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ketosis can be a very effective tool for treating type 2 diabetes and gestational diabetes is not type 2
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diabetes but it has some of its features so again i really i hope there are some obstetricians out
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there who spend a lot of time on this problem because it is a huge problem there are many women
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who go through this my sister i probably have talked about this in the past and i don't think
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she'd mind me talking about it and if she does i'm in trouble but you know my sister had an operation
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when she was quite young that took out two-thirds of her pancreas so during her first pregnancy she got
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gestational diabetes which was to be expected because she had like a third of the insulin producing
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capacity and then it happened again during the second pregnancy and then after that second
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pregnancy she actually got type 2 diabetes over the course of a year going on a ketogenic diet
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actually working with a company called virta health that i'm an advisor to an investor in
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although that is unrelated to the fact that my sister wasn't getting care from them you know she
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lost 50 pounds her hemoglobin a1c went from somewhere in the 12s to in the 5s in the course of a year
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and then she got pregnant again well she decided to go off the ketogenic diet but still be much more
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diligent and strict and despite that she still you know requires insulin during this third pregnancy
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i suspect she'll have a much easier time recovering following this pregnancy but one of the things
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that's been frustrating which maybe goes back to this the question prior to this is her obstetricians
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like they have no insight like they have not a thing to offer her as far as how she should be
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thinking about managing her blood sugars other than just kind of cram more insulin into her
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exogenous insulin so yeah and this is why context matters and there's no bumper sticker that you
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could have you know the question thoughts on fasting and ketosis for females you could have
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somebody with the constellation of abnormalities that is metabolic syndrome insulin resistant type 2
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diabetic and maybe for that person their fertility might be an issue and going on a ketogenic diet
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may get them in a healthier state yeah exactly it might actually improve their fertility because of the
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inflammation and all the other stuff that could be happening as a result of what you just mentioned
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so yeah i i well said i hope you enjoyed today's quali now sit tight for that legal disclaimer this
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podcast is for general informational purposes only and does not constitute the practice of medicine
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