Sugar, Keto, and Cancer: Acknowledging the Metabolic Connection

Welcome to Target Cancer podcast. My name is Dr. Sanjay Janja. I'm a hematologist and medical oncologist, also known as the "An Do" on social media. And today, I'm excited because we have Christie Kastler. She has spent a significant part of her life as a radiation oncologist and now has actually transitioned fully to something she feels very passionate about: on really bringing awareness to the data that does exist on how metabolic health and diet and nutrition, uh, are known to have impacts on things that people are very interested in learning but may have difficulty finding.

Let's start there, actually. You were saying that, you know, while you were a radiation oncologist, looking at insulin and IGF, insulin growth factor, was something you kind of kept in mind. Can you share with our viewers why that's significant and how it relates to what happens with a cancer or neoplastic tumor?

So, when we have studied, right? So the Dr. C Freed's of the world who are doing the research in, you know, on animals or in the labs, um, what we have learned is that cancer cells upregulate the number of insulin and IGF-1 receptors they have on their surface. The insulin and they upregulate their glucose transporters. They become very greedy for sugar because, doc, as Dr. C Freed pointed out, is cancer is truly a mitochondrial disease, right? So as our mitochondria, these little powerhouse, you know, energy makers in our cells, become destroyed by many different things, diet being one of them, um, the cells become more and more dependent on glucose for fuel. And so, in order to get that fuel that they need, they upregulate their glucose, you know, uh, transporters. And then insulin, which tells the cells, "Hey, open up the door, glucose is present." And then insulin and IGF-1 telling the cancer cell, "Hey, the, you know, the fuel is right. We've got all these extra carbon molecules, like let's go ahead and divide and grow." And we know this from many, many different types of cancer that if you take those cells and you stain them for these receptors, they almost invariably have elevated levels in comparison to the normal cells.

But, um, so, so how do we leverage that, right? To our advantage? Well, we know that we can all live in a ketogenic state or a very low carbohydrate, low glucose state. We don't have to bring any glucose in by mouth. Our liver will make just as much as we need, and that we'll keep it at a very low basic level day in and day out. And, and we can survive that way. And our normal cells actually seem to thrive in that setting. When they're burning fat for fuel, using ketone bodies, which are made as we metabolize that fat, um, our, our brains become alive, um, you know, are, are we feel better, our energies, you know, um, maybe our other medical issues, like maybe some mental health issues, or diabetes, or hypertension, or, you know, endometriosis, or you name it. There's so many of our chronic diseases which are really driven by the same underlying principle that as we optimize our health from a cancer perspective, all of a sudden people are like, "Oh my gosh, I feel better now with a cancer diagnosis than I ever felt in the last 10, 20, 30 years." You know, like, this is amazing.

Um, but again, we're not taking away glucose 100%, right? We can't. We need glucose to live. We just don't actually need to eat any. And we don't need to have the roller coaster glucoses which happen when we eat really more than just a few grams of carbohydrate. Um, so when we're doing that, we're making these cells that are really dependent on glucose somewhat malnourished. So they, they might still be trickling in a little bit, but we're not stimulating insulin in that same way. And, and as they become a little bit, again, malnourished, weakened, well, now we're, you know, maybe optimizing other things. Maybe we're doing chemotherapy or hormonal therapy or radiation therapy. And our normal cells are now nice and kind of protected and healthy and robust, and our cancer cells are weakened. And the data suggests that we dramatically improve outcomes and reduce toxicity when we combine those two approaches.

Pardon this interruption real quick. If you're enjoying this podcast or find it valuable for what we discuss and the education and how people see and think about cancer in general, we would very much appreciate a like, subscribe, and especially a share so we can bring that information as maximally and broadly as possible. Thank you so much for listening.

So, when we talk about when you have a cancer diagnosis and you want to reduce these things, what about for the whole concept of preventing invasive cancer from forming? So, you know, we've talked many times on this podcast about how you have this underlying environment that's kind of gotten the right ingredients or or factors to kind of invite now an invasive, you know, neoplastic, uh, tumor, with unregulated cell growth. Does getting into ketosis like one, dissuade or kind of quell, uh, or slow down that process? Or can it even potentially, uh, eliminate those little kind of environments, basically making it have to reset to, to step one? And, and I keep trying to say this is, you know, cancer is a disease of age. As you get older, that's when you just start seeing the numbers go higher and higher. And the whole concept usually is thought to be that you get these kind of, you know, injuries and you get these exposures over time, and all of those invite this little kind of, I want to call it a, you know, potion, serious, but but an environment that can foster sinister cells.

Getting into ketosis, help kind of melt away or kind of hit the, you know, the youth clock in some, some regard as it relates to those tumor types? And is it have to be all the time? Or can you even pulse it? Like, you know, two to three weeks? I told my dad that, I just randomly was like, "Dad, just go ahead and do it for like two to three weeks." And he's, he's an engineer, so he wants to know, "Son, well, what about this?" And they take me three or four days. So how many days do I need? After I'm like, "I don't know. I just feel like something is better than nothing." And you figure, well, well.

So I would say there's a couple of pieces that I'd love to unpack in in those comments. So number one, we, we consider cancer a disease of aging, right? It used to be that. So I'm, I'm, you know, been in the business a little longer than you have. And it was always, you know, 60, 70, 80-year-olds with cancer. But look at our breast cancer population, even our lung cancer, our GBM pop, they're all young now. What, what is going on? And I will challenge the idea: is it age, or is it actually insulin resistance? And insulin resistance is such a slow, you know, evolving, progressive spectrum. The longer you live, the more insulin resistant you become, unless you are doing things to prevent that. And as our food environment has changed into a more processed food, higher sugar-laden type, you know, uh, everything is processed in and in bad oils, which we could go into too, but those are all things that that can, um, increase our risk of cancer. And again, I see it happening younger and younger and younger. So it's very scary. And I'm like, please, everybody, like, I just want to scream from the mountaintops, like, can everybody just start doing this now and prevent your cancer?

Yeah, to that point, I, I love that you said that. Is when we say age, usually what we mean by that unit is the aggregate of exposure, all the things that happen over that time. And you made a very good point, it's almost like an accelerator, yeah, or a condenser, like a pressure cooker. Like literally, when you have these really high spikes that we're just not used to, even 50 years ago, from like, you know, fast food and things that just have an insanely high glycemic index, and our bodies are seeing these sugars. I want people to think of it as what would have taken 50 to 60 years, you're now putting in a pressure cooker, and then the rice gets cooked quicker because it's literally getting exposed to just far higher concentration. So it's more of a figurative age exposure. I love that.

Yeah, and it used to be that we probably got into ketosis at night or at times. Um, and now I tell you, people have fasting insulins that are quite high, meaning that they are elevated 24/7. It never turns off. And so, going back to, can we prevent these things? I'm a complete believer that we can. So, so just in my own patient experience, you know, I've seen various people for various reasons, but I have seen like, even pre-cancers, things that we would normally want to take out, a ductal carcinoma in situ, to a colonic polyp, you know, things that were like, these are precursors to cancer, like we should just take them out. And I've had some patients who have opted, "I'm not sure I want to take it out. Let me just think about that. Let me do then I'll consider it." If, and they're gone. We can't find them anymore. Um, I have seen people who even had very advanced, uh, you know, stage four breast cancers or or fungating lesions, you know, like skin lesions that have come through the, the skin surface, where already before they have embarked on their conventional therapy, because they found me early, we started a process. And while they were still getting either evaluated, staged, approved for whatever therapy, they're already seeing reduction in symptoms. So, yeah, it's, it's unbelievable.

And Jason F, I made that big point over and over. He's like, you know, you know, you know, he says it in this very calm voice that just makes it seem, "How did I not know that?" You know, he's like, "The, you know, these, there's this thought that we're overtreating like with GCS and stuff because, you know, we know that they can resolve your immune system." He didn't go so much into the keto part, but but the point is that there are modified viable things and contingencies, immune system being one, metabolic being another, where it certainly makes sense. And, and to your point, we're even seeing that. One big point that I want to highlight or just make sure, one that you agree, um, is, well, I guess it's not so much agree, it's a fact. When we're, Jason is also very keen on on realizing that insulin resistant, that means basically that the insulin is so high, it's like it's like being at 7,000 RPMs, uh, in a certain gear in your car, that you know, it's just too high, you're not going any faster. And literally, it's not working. And the problem is two parts. Number one, that you have increased circulating glucose because insulin can't say, "Yo, get out of the bloodstream, let's store it somewhere." Right? A lot of fatty liver disease we're seeing now. The second thing is that the insulin itself, those 7,000 RPMs, when you're hitting it high like that, is a growth factor. And so it's almost like this kind of, you know, invitation or or the whip of a horse to say, "Grow, grow, grow," because it's, it's doing what it's supposed to, and, you know, and not successfully. And so that's the two-part, uh, problem. I'm sure there's many more parts, but, but it, it's, it's scary when you think of it like that.

That is definitely one of the biggest, um, things because we see that if those cancers are, again, always being exposed to insulin, and our normal cells, right, aren't taking in that glucose well. But I will tell you that I can have a patient with a fasting glucose and even fasting insulin because after fasting overnight, it still gets down. But if you see what is happening all day long, I can look at how they're eating. I can look at maybe other markers, maybe triglycerides are a little bit on the high side. And when I say normal, I mean, you know, you know, I, I have very much higher standards than our conventional docs. So I mean, I want triglycerides less than 70, not less than 150. I want glucose, you know, less than 85, um, I don't want it less than 100. So, you know, you can start to see evidence. Maybe we see a hemoglobin A1C that's elevated. Like, "Okay, well, you must be having big surges after your meals, right?" So you might have insulin up all day long. And after you fast for 10 hours or 12 hours or 14 hours, it looks good. But we might see other, you know, so I look at metabolism not just from a glucose or just from an insulin. Or I'm looking at insulin and IGF-1. And, you know, and, and sometimes people are lowering glucose and insulin because they are starving themselves in ways that I wouldn't recommend. They might be doing, you know, a, um, more calorie, severe calorie restriction, or maybe they're eating a vegan diet, which is actually high glycemic but very low calorie, you know, they, you know, and we start to see problems.

And so when I'm looking at metabolism, yes, I'm looking at those things, but I'm, I'm trying to do a deeper dive for those patients, looking at what are your protein markers? You know, are, are you protein malnourished? If you can't make enzymes and neurotransmitters and hormones and digestive enzymes because you're protein malnourished, then you're never going to heal, right? We think about that, that when we give people chemotherapy or radiation or surgery, that their protein needs actually go up temporarily, trying to heal and replace. Um, and the same thing goes for fat. I can see evidence of fat malnourishment, um, you know, a low cortisol's down in the tank because they're not providing enough fat. You know, and if we think about what are every cell wall is made up of fat, and our hormones are made of fat, and our, you know, brain is all fat, you know, there's so many things that go into when we're talking about diet. Like there's so many pieces to the puzzle.

Yeah. What about theoretically, can you give exogenous, meaning like you're like injecting yourself with insulin, you know, usually again, because it's necessary. But what if you did it in an empiric way, meaning you didn't wait till you were at 7,000 RPMs, like you were okay, right? Like you're doing okay, but you can't get to your goal for whatever reason? Is it conceivable to have like an isomer of insulin that's not necessarily the growth factor, right? So it's not, it doesn't like necessarily stimulate the growth of things, but still functions to bring, quote unquote, the glucose down a little bit, so you have less circulating glucose, and you're trading the insulin exogenously to be able to do so, and hopefully not, you know, exciting the, the growth factor? Of course, there's an easier way to, and safer way to do this. But in the era of having these, you know, we had, uh, the managing director of Google for Applied AI, and they're looking at all these devices that just basically will show you in real time, second to second, minute to minute, all of these markers for metabolic health. That when that technology is there, you can actually very dynamically, you know, you know, follow these things. Is that, is that theoretically something that's possible?

I think that sounds absolutely terrible, to be honest. And, and the reason for that is the diabetes industry has been trying to come up with things, right? We know that diabetics who use insulin will have far worse cancer outcomes, cancer recurrences, incidents of cancers than diabetics on Metformin. Metformin blocks carbohydrate intake or absorption, which effectively helps to lower insulin, but not to the degree that just restricting carbohydrates would have. So, are we going to end up, you know, the Pandora's Box? We're going to, we always try to do this little shortcut. You can keep eating your donuts, but take this medicine. You know, what we're really doing when we're telling somebody to stop eating these carbohydrates, these processed foods, this these overly sweetened, even, you know, our foods, even the real foods, you know, fruit has been, you know, created more sweet, you know, starch is more starchy, you know, everything is more carbohydrate-laden, whether it's real food or non-real food. But guess what comes when we eat meat? You know, you get all this robust micronutrients, you get B vitamins. If you're eating the fat, now you're getting fat-soluble vitamins. You know, if we get back to, let's just eat a nutrient-devoid diet and try to manage the sugar piece, we're still becoming more nutrient deficient.

No, 100%. And that's the answer. I didn't use. So similarly, I expect a similar answer. What about these? So to this concept of maybe having a duration of ketosis? So like, you're in ketosis and not out of circulating glucose. I heard that there are these, um, basically formulations you can take that that force you into a ketosis for four to six hours. I'm curious, number one, is that real? And number two, what if I just took it for four to six hours for five days? Am I telling exogenous ketones? I believe is what you're talking about. So either MCT oil, which can you can process in your liver, and which is a medium chain triglyceride, it's processed differently, um, than our long triglycerides. You know, so again, if this is a metabolic disease, a mitochondrial dysfunction, making ketones is a sign that you are improving your mitochondrial health. That's where, you know, like the mitochondria make the ketones. So yes, in the setting of maybe having, you know, a lot of damaged, non-functioning mitochondria, there might be a reason to bridge somebody with fuel, meaning you've just taken away the only source of fuel that they function on, glucose, right? And now they can't actually make ketones very well yet on their own. Sometimes that might provide some temporary benefit. There is a lot of research being done to say, are ketone bodies in and of themselves beneficial for cancer? But I come back to the root cause: what's driving it? Are we just trying to put another band-aid on the problem? And I've seen people who do use exogenous ketones and or MCT oil and they'll say, "Oh yeah, my ketones are awesome, but their sugar is 123." I just want anyone listening to understand, when you're in ketosis, it's not the, yes, there seems to be some effect of the ketosis, like you had mentioned, on brain health and immunity and all this stuff. Yes, that's all factual. But the ketosis occurs due to the lack of like supplied fuel from glucose. So that's different. That's a different conversation than taking ketones in addition to just having your regular glucose and insulin levels. You always do. But I heard there was where you can get forced. There's nothing you can take to force yourself into a into a ketotic state, correct? It just means you have circulating keto. Add there is, you know, a diabetes medicine that's out there right now. And what does it do? It makes you urinate out your glucose. So they don't tell you to eat differently, but you urinate out your glucose, which can put you into a ketogenic state. But guess what? When you flood your kidneys and your bladder and your urethra with sugar, higher rates of in the GU tract and and fungal, you know, in issues in the genitalia. So, so not really. Back to, we have to, I know that we think we're so smart and that we can outsmart mother nature and we can do it with drugs and and hacks. But I'm going to tell you right now, that's not where it is. You have to do the work if you want to heal.

No, 100%. And, and the reason I like to think of it that way, why it helps people understand, because, you know, that's the whole purpose of my social media, is like, you hear these things and people are just spend hundreds and thousands of dollars. I mean, I mean, totals in billions, obviously, because the her rules and cell phones and everything else. But these are the conversations. When you hear the hack, and then you hear the problematic part of it, yeah, uh, I think hopefully can help, you know, foster that, that understanding of, "Oh, this is why it's not so linear or binary, uh, you know, one: one, you know, ratio."

So we talked about ketosis, we talked about the, um, on how it basically gives a source of or puts you with a fuel that your cells can tolerate well. But a lot of cancers that, you know, often have mitochondrial injury because it's defunct, uh, to some degree, it cannot. Now, we had Dr. Siddhartha Mukerji and and S. Freed, I believe, like they both have, Sadara Mukerji's studies right now, pancreatic cancer, where he's trying to deprive certain amino acids because the whole thought is, and C. Freed as well, is that is one of the sources, depending on the cancer type, of course, and even the cancer type itself, depending on what kind you have, that they will find other essential amino acids. And, and potentially, I think it's being investigated to see what are the other fuel sources that, uh, they may be, um, basically reliant on. The cancers are, um, do you look into that at all? Is that in your real?

It's not necessarily. I mean, I try to stay up on the literature. Again, what do we know? Because patients will come and asking me for this blocker and that blocker. And I'm like, "We, number one, you know, amino acids are essential, right? For life, just as glucose is. So we are not going to give you a glucose blocker. Right? We're not going to take all the glucose out of your system. Just like we're not going to take all of the amino acids or any specific amino acid out of your system." A lot of times, I feel like the reason we get, again, focused on these things is because we are so focused on pathways and medicines and block. And like, get back to the root. Like, if, if we can heal, if we're using things, if we're processing things, if we're providing all these proper micronutrients that run, that we don't get backed up, you know, I think sometimes certain processes get stuck. And then we blame that amino acid or that, when it's not really that, it's because there's some other underlying hiccup. So, um, I, I, I still think that the data that we have from our animal, um, literature, as well as the the human studies that we have right now, are that ketogenic diets seem to work. And at least in many patients. And I will say that there are some people, you know, who sometimes I meet, I think sometimes a little too late, and, and it's hard to, you know, really reverse the course. Which is why I love the idea of prevention or at first, you know, diagnosis, not at second and third recurrences. You know, what, what can we do to really optimize them upfront? Which I, I feel like you're in a much better place. And there's some really interesting study. This is where we should go. No, uh, Dr. Elliot down in Baton Rouge, had breast cancer cell lines. And he actually, um, did some mitochondrial transfer studies. So he would take healthy mitochondria and implant them into cancer cells. And the cancer cells would slow down their growth. They would be more receptive or more responsive to chemotherapies. And he found that like the low grade, just as we would anticipate, those low-grade cancer cells had far more functioning mitochondria than the high grade. So the more there was, you know, less differentiation or, you know, the more chaotic those cells became, the fewer mitochondria, the more evacuated the mitochondria. And, and I don't know where I heard this, and hopefully I'm not misquoting what I heard, but, um, I heard that mitochondria may be so, um, awesome that they could actually transfer themselves. Like they might be able to get into a neighboring cell and heal. So I, I feel like there's got to be something out there that we can do to, again, back to enhancing our mitochondrial health and getting all of our neighbor cells really healthy so that they can heal, right? If you think about, I don't know, some society where like our neighborhood, you know, one, you know, person or one family is struggling, and we can all pitch in and help. Whereas if the whole neighborhood is gone, like who's coming in to help us?

Yeah, I mean, I think that's that, you know, we touched on that actually with, uh, Michael Levan. So he's, we basically talked about an area of science I never even knew as a medical oncologist, which is the whole bioelectric relationship. So he believes and said, you know, what happens is, you know, a cancer environment is basically just a reset. It's disengaged with the community aspect of the surrounding cells. And so it's just doing what it inherently knows, which is doing everything it can to survive. If you can resync its relationship, uh, or, or just citizenship with everything around that, that these populations will kind of go back to what is, you know, physiologically normal. Um, and then he also studies obviously regenerative medicine, which is just obviously very closely tangential. And he had mentioned that as well, the mitochondria. Well, well, really theoretically, apparently the flatworm is evidence that you can regenerate everything, even the scars like that you had previously. And he said, even the memories. Like they, that they just by any fraction of that platform, if you cut it up, whether it's the the butthole, I don't even know if it has one, it has, guess whatever it is, yeah, like it'll actually regenerate. And so, um, that, that is a concept that that is very interesting to, if the mitochondria can just kind of not even lend, but but, uh, basically harbor, you know, regeneration. That's interesting.

So tell me about, if you can, um, well, I know you can, um, the immune system. So some people have these concerns are talk about, uh, mostly what you know, are your innate immune cells, and so not the ones that are antibodies or, or, uh, vaccine related. Is it true that they kind of slow down if you're in a prolonged ketosis?

I am not convinced. Um, I think that there's a lot of us. I mean, I've been following a very low-carb diet for almost 23 years. And I used to do purposeful periodization, not not because I knew anything, but because it was always fun to kind of go off plan when you were on vacation or at a barbecue or something. And then you'd get back on plan. And then as I kind of realized that, "Oh, this is about, you know, having healthy cells and preventing cancers and Alzheimer's and all of those things," and I just stopped going off plan. So I don't know, after a decade or more of being in ketosis, I, I don't think you'd be in ketosis for a decade. Yeah, I mean, I think that you do still come out a little bit now and again, right? Because you might have, and, and I wouldn't say, you know, I don't like to call them cheats, sabotages, you know, you know, um, I, it's not like I've gone and downed, you know, sugar drinks or anything like that. But every once in a while, you have a cocktail, never a sugary cocktail, but like, "Okay, that's not really the best." And, and maybe my level is not the best that next morning. Um, and I don't test myself every day all the time, but I experiment a lot. Like, "Oh, what does this doing to me?" Or, all, you're going to have periods where your glucose goes up, maybe because you're doing a high-intensity workout, you know, you're, you are getting into an anaerobic state because you're sprinting or lifting, and you're creating a lactic acid burn, and your body's like, "Oh, wait, she needs a little glucose. Like, let's go." You know, and then as soon as you're done, though, it, it should come right back down. Um, but yeah, so that's, that's how I live. That's how my husband lives. That's how you, you know, so I, I feel like that's, um, it's easier when you have slowly grow your circle that eat similarly. Yeah, it's like how a lot of people, you know, there's a lot of jokes on social media about like, that friend that like has a gluten quote unquote allergy or sensitivity and kind of, you know, how the whole, you know, eating pattern has to be modified. But but those obviously true gluten, uh, issues, especially Celiac, are a very real thing. And people can be profoundly unwell before realizing that they just think if they had been following a ketogenic diet, they would have never had an issue.

You're making me just, I've never, nois, ever. And I, and I have these conversations and I'm like, "I'm doing it." And then something happens in the clinic. It's like, you know, they bring food. And I just, it's, yeah, that is a big problem. But I will say that that is one of my claims to fame. Not not getting rid of, but we ended up with a hospital policy of, you know, not bringing in food typically from. But when, as you might notice in a lot of cancer centers, chemotherapy areas, there's a lot of less than optimal food around, you know, crackers and cookies and, you know, you name it, juices. And I was, I, I like to say that I was responsible for getting that removed at the Shag. Some of my colleagues are like, "Oh, but when I was hungry, I could go around to the chemo area and grab something." You know, but, and I'm like, "We, no, you shouldn't be eating it." And if you're hungry and you need to grab it, you should be following a low carbohydrate diet because you should be able to always go without a snack. You don't ever need to have a snack. It's sad because I will have patients who are enlightened, "Sugar is bad. Processed foods are bad. These things are not good for us." And yet this is what they are pushing. And when you ask, you know, "What can I do?" "Oh, diet doesn't matter." Like, "Really? Like, come on."

So why do you think the, why do you think the data, you know, and if you, you want to quote some of the, the bigger sources, you refer, you know, your patients or listeners to, why do you think it's not in NCCN or, you know, why isn't it in the, uh, American Diabetes Association recommendations or the heart disease? I mean, I, I think there are powerful entities. Number one, but I think number two, from diet trials in cancer, they're all small. Who's going to pay for a diet trial? You know, right now, pharmaceutical agent, you know, companies pay for our chemo and immunotherapies and hormonal therapies. They pay for all of those randomized trials. There's very few that are, you know, paid for by our government. And even then, it is like, if you want to do this, you don't get the grant, right? If you're going to counter somebody or something. Or in reality, what if we say, "Oh, if we do a ketogenic diet, we can do," and I'm just making this up, "we can do, you know, 25% of the dose of chemotherapy, or we can do one cycle instead of four cycles, or we could do half of the radiation treatments, or we could, you know, maybe we don't need them at all." Tell me which company's going to pay to have us use their stuff less, right? I mean, and it was a big struggle, right? Think about when Oncotype DX came out or MammaPrint came out for breast cancer, like all of a sudden, we're going to tell, how many, 75% of women that they don't actually need chemotherapy, or whatever the number was. And it was, but, but, you know, but then the company that was doing the test was the one who was paying for that because they were so confident that their test would show that that they would end up getting the revenue down this downstream, right? Because then everybody would pay for their test for every single breast cancer patient with receptor-positive disease. And the same. So we get back to diet. And thank God, you know, we have some small institutions that are willing to pay for it. That, you know, Ohio State is, and Jeff McK and, and that oncology team is running one for stage four breast cancers right now. And, but the problem is, is I do feel like a lot of my colleagues were there. I felt like there was decent enough, you know, if you're an early adopter, which I always was, I feel like the data is very clear, like it always confirms that it seems. But well, it wasn't 20,000 patients. And it's a lot easier to control an injection, a pill, a radiation treatment. It is very hard to have a patient eat in a certain way 24/7, 7 days a week, you know, for months or years. Um, and, and I will say, but there's a way to know, right? Why can't we test? Kon? Why can't we say, "Okay, what are your strips? Or what are your finger pricks? Or what are your breath meters? Like, let's test." Because what has been shown is that ketosis, making ketones, you know, correlate with lowering insulin. And it's really about lowering insulin, lowering IGF-1. And of course, the patients that want the easy thing, isn't there a drug that'll block insulin receptors? Right? But no, then we'll die. Just like we can't block glucose. We, we need it. We just want it at like, the bare minimum. So, but I will tell you that that many people think it's going to be hard, think it's going to interfere with life. And some continue to complain because I think maybe they were, they're they're such an addiction to those foods. But those who were already eating kind of a clean diet, just didn't know quite what to do and how to. They're like, "This is, yeah, way easier than I thought it was going to be." You know, that's interesting. Interesting.

And I, you know, I respect you for a lot for saying what I think I sometimes I've alluded to without being so direct about, you know, when I first saw comments on my social media about, "Well, he's on Colitis, don't trust him. It's all money. It's pharma. It's industry. They purposely keep." Those used to be hurtful because I was like, freshly out of fellowship and I spent 15 years, hundreds of thousands, learning it. And then, but then, you know, then you get wiser. And I'm like, "There's, it, it's actually more ignorant to think that business economics and profit stuff don't apply to an industry that's clearly like for profit." And it just is what it is. It doesn't mean the whole thing's corrupt either. It just, it's an industry like anything else. Um, so, and unfortunately, in this case, it's not like your cell is, you know, to people like everyone should get 10,000. It's like this is a diet modification, a lifestyle diet modification that is, you know, relatively costless unless you guide us with you. And I do because it's, it's challenging. So I, I respect that a lot.

Can you tell me briefly, if if at all relevant, on there's it's popularized a little bit about growth hormone now on in social media. Things trend, right? And they're talking about growth hormone and that's why you should like build up your muscle mass. And what is, is there a direct either concern or relationship with growth hormone related to, you know, glucose regulation and insulin? Um, I get a lot of people that that work out that or my patients even say, "Well, I'm not on test, but like, is growth hormone a problem?" Etc. Maybe I don't know exactly the context of what's being discussed. Um, I will say that we definitely want lean mass. We want muscle mass. We know that muscle composition, the better your muscle composition, density, volume, etc., um, the, the better your cancer outcomes, better your health outcomes. But we also are going to tell people to, you know, bulk up on steroids to do those, right? That's going to raise sugar and insulin. Um, so, so we need to kind of think about how do we do this in the most natural way? We've got to stop thinking that there's a hack. So let's do some resistance training. Let's do some HIIT exercise. Let's, um, and you don't need to have, you know, chase your at your workout with a sugar drink or, you know, carbs or protein drink or whatever. Like, you just need to tell them that they need to get stronger. You know, and, and live in a nice healthy. So you're bringing fuel, you're bringing enough protein, that would be a requirement, right? If you're undereating protein, and I do feel like that's a little bit out there, it's like, you can't eat protein, you have to eat enough protein. But we can monitor that by looking, you know, at your insulin and your IGF-1. If, if people are overeating protein, and I'm not saying overeating in the word like, "I'm going to go and eat 20 steaks." You know, it's overeating in context with fat. Like, if you are taking in higher protein to fat, you will likely drive up IGF-1 into an into a place we don't want it. But if you eat adequate protein with enough fat, then we're not getting that same drive, that same increase. But we can still grow lean mass. Um, there's, there's plenty of people out there in a ketogenic communities that are putting on lean mass. It's about, are you giving enough building blocks? Are there the Legos in your kit that you can put them together? So do you have enough protein? And, and did you tell your muscles that they actually do need to get stronger? So, right, we got to use them in the proper way. But I would say that any growth hormone, any hormone in my opinion, that you are taking exogenously is causing you cancer ills.

I agree. I share that sentiment. And sometimes my friends don't like that. But, but yeah, I mean, you're, you're messing with an extremely complicated dynamic physiologic system. Like it is the, the axis, axes, and pathways is just, it's so, it, they just work 24/7 in so many different organs and areas of your body. And then you just throw something in. Like it's like the audacity, you almost feel like the audacity, the brazenness of the humans to like, just think that you could just throw something in and that it's, you know, so either one-dimensional or, or just, you know, it's, it's wild. I mean, even like, you know, I'm pretty opinionated on on lasix. There's certainly times to use it, but just to say like, "Oh, you got swelling in your legs." And like, you know, you're messing with the renal system in in such a delicate, you know, way. But that you want to know what the first thing that happens when people go on a ketogenic diet? You lose water weight. It's a diuretic. The first thing. So you see people with with very edematous legs, or I've got a number of people with ascites, and all of a sudden the ascites, it doesn't just disappear, but it doesn't accumulate to the same degree as we're optimizing their protein, you know, we're slowing down, you know, building up albumin. But also, it's a little bit of a gentle diuretic.

Yeah, 100%. So, is there anything else you'd like to share, Christie, with kind of especially as it relates to cancer survivorship? Obviously, I think that answer, uh, or that question is answered pretty clearly if you listen this far on just kind of, you know, survivorship is two things. It's really thinking about the thing that may be gone and may not, and it's called, you know, complete remission. But obviously, be a micro-metastatic disease, it comes back. But the, the concept are the same, whether it's that or a second primary. The point is, you want to be in ketosis. But I guess the question is, and, and just because you might have micro-metastatic disease, can't we do the same thing? Like, who cares where that cancer cell is? Whether it's in that original location, it's in a lymph node, it's in another organ, or it's just floating around in your bloodstream right now, not having set up shop. The same principles apply, no matter where that cancer cell is. And again, I, I want us to see, I want to see us as a conventional world going more and more. We talk about personalized cancer therapies, but what is it? Let's check the genetics of the cancer and then plug a pathway. As opposed to, let's look for circulating tumor cells. And if you don't have any, maybe you don't need systemic therapy. Maybe we can stop giving hormonal therapy to gosh, how many millions of women. Um, you know, do, do they really need it? I want to know who needs it and who doesn't. Um, if you look at the, a lot of the breast cancer recurrence, metastatic literature, they are higher insulin, higher metabolic syndrome, that they are metabolic dysfunction. And yet we give medications, we give chemotherapies, we give hormonal therapies that make patients insulin resistant. Or, right, we're putting them through early menopause, which menopause is, you know, why do people gain 10 or 20 pounds as they go through menopause? They become more insulin resistant. So we have to continue to get back to how can we help these patients improve? And I wish that we could come up with a lab panel, right? That our conventional docs can do it. And then we get our dietitians on board saying, "Look, here's the issues." And maybe depending, and this is where I don't know, I would love to do, like, we can barely get ketogenic diets into the conventional space. But what I would love is a randomized trial saying, "Okay, based on your glucose, insulin, IGF-1, whatever, could you be on a less restrictive diet versus this person?" I mean, I restrict everybody way down because over the years, if I start people with too many carbohydrates, many a time, they never get into ketosis and they struggle and they feel terrible. So they're kind of in purgatory, low carb, not burning fat. Um, and so if, so I'm like, "Everybody, just all the way down." Then we can figure out how can we relax it with time, if that's what you want to do.

Interesting. Yeah, it's, yeah, I, I didn't even think about that with the, you know, with the fact that obviously menopause, I mean, I guess I knew that the menopause and, and any kind of hormone therapies or anti-hormone therapies, for that matter, you know, are accelerating, you know, what the data does show to be problematic. Which is, Jason always says, Jason F, you know, Hy, we have a hyperinsulinemia problem. It's like more than anything else. And I like to bring up that point too, is, you know, I think obesity has been unfairly kind of wrapped up. When COVID comes and heart attacks, all these things, you hear that people that do worse if you're obese, if you're whatever. But like, I would love to see that kind of, uh, teased out to see, is it, you know, I think one, obesity with no, you know, normal insulin levels, at least compared to a diabetic, have drastically different complications when it comes to cancer and COVID and all these things.

True. Except they are both diseases of hyperinsulinemia, right? Insulin grows fat cells. So if you are overweight, you have too much insulin in your system. So you said insulin drives. Say that so well, right? Because insulin is telling these fat cells, like, "Take in the fat, take in the fat, take in the fat." So we are getting bigger because insulin, right, is is storing fuel away for later. But just because our fasting levels haven't reached the point because our cells are still taking in the fuel, right? But we still need insulin up to put that fuel away. So we need less insulin to put away a ketogenic diet fuel than we need if we're in a high carbohydrate. So, right. But we haven't yet reached the point that our cells no longer are taking it up. But we, that's still hyperinsulinemia. It's just not yet insulin resistant. Resistant. But I mean, if you were eating 5,000 calories, you know, 8,000 on a keto diet, you still get obese, right?

Well, that's a really interesting question because there have been some folks who have actually done some. So I think it depends on what is the underlying metabolism. Um, yes, in theory, overeating at some point. But right, there are some, you know, protein has a higher thermic effect. You know, in a ketogenic state, you actually increase your basal metabolic rate. That's also been shown. So you can eat more calories. But I want to say, um, oh, Sam.

What's Sam's last name? Did a 5,000 calorie diet and tested, and he actually got far better body composition, lost weight on a ketogenic diet. So I'm just saying, I don't think we know everything. And yes, I think if you did that forever and ever and ever, I think that certainly could also, um, raise your body right, your body size, which would be insulin, right? You still need insulin to put away fuel. So the more fuel you're bringing in, the more insulin you use. It's again, but it's a different, um, pattern.

So the point being, whether it's carbs or not, like you still need insulin is is circulating to bring to store fuel. Yes, yeah, just different levels. So I, and again, it'll be very interesting. I know that Ben Dickman is doing a lot of research right now, and his study is looking at, okay, you eat a bunch of protein, and let's actually measure your insulin. You eat a bunch of fat, and let's measure your insulin. So that, that information is coming. I think a lot of us us are very interested in in all of these pieces. But I, I think that the science is early on the nuances. How often do you have to be in ketosis? How deep do you have to be into ketosis? Can, can we augment a ketogenic diet with exogenous ketones where yes, we're making our own ketones, but then we're boosting them a little? Does that, is that better or worse? You know, or is is giving any excess fuel worse, right, or better? I, I mean, again, I think there's a lot of nuanced questions that we don't know. And I just always continue to come back to lab saying, are our inflammation markers down? Are our glucose and insulin down? Are, you know, triglycerides down? Do, do our liver markers look like there's no evidence of early fatty liver? Um, you know, all of those little pieces. Are we moving the whole person in a more optimal direction such that hopefully they can start to heal themselves? Their, their cells become so healthy that now they're trying to heal the other cells or bring them back into cell sync, into sync and cell.

Yeah, 100%. I think those have to do something with, to your point, inflammatory markers that are elevated and and metabolic, you know, regulatory things that we know have effects on the CNS, on on muscle, on nerves, on perception. I don't want anyone to be blown off or something that just because you can't, you know, exactly pinpointed on an image to start to believe that that means there isn't something that could be actually going on and improved upon. And that's where I think diet, I often recommend diet and metabolic examination are potentially very valuable. I mean, you know, the toxicity, right, the lift of doing that is very, very low. And the trade-off could be really just like, you know, I've seen people in tears, they're just so happy, like, I just feel like I've been validated for the first time, uh, because I was told I had XYZ. So I think that could be pretty powerful. And when you said you look at inflammatory markers, uh, outside of, um, is it like just the typical ESR, CRP, ferritin stuff, or do you have your own?

No, I, I usually, I usually look mainly, you know, I think platelets are another inflammatory marker, but yes, CRP, sed rate, ferritin, fibrinogen. I look at uric acid. I look even at like ceruloplasmin. I look, um, at LDH. So that's a common one for metabolism, for mitochondria. LDH. So, um, uh, I, I might pull in other things depending on what the patient is telling me or what I'm suspecting by looking at things. But there are some people who those inflammatory markers look pretty good, but then some of the other autoimmune markers actually don't look as good. So, um, maybe like some biotoxin illness or mold illness or some other. So there's a couple of different windows that you could look into. Although I kind of stick with just a basic panel just to get started so that I can understand what things might we need to be thinking about. Um, and if those don't match what the patient's telling me, sometimes I'll do different digging.

Christy, you keep telling me things that I'm just like, my eyes just like all of a sudden light up, like, did you just say biotoxin profiles and mold? Because you know, I truly believe that at least here, we're doing a disservice to our patients because we just have such a premature dead end in my opinion, where I'm the one that like, and again, at the chagrin sometimes of my, like, peers, if I'm like, something is going on, you clearly have these inflammatory markers, you're just feeling like, quote unquote, crap, and there's clearly some kind of nidus. And that's where I'll, you know, ultimately just throw the hands up and say, let's try metabolic. But oh, I mean, I just, I want to keep you covered. But these, these panels, like, are these accessible for everybody? Or, yeah, I mean, I just order them through LabCorp most of the time. Yeah, yeah. There, um, I will say that that many a time, you just improve the metabolism pieces, you put them on ketogenic diets, and it seems to heal the rest. Not always, but sometimes. There's certain things within a ketogenic diet that I will actually tell patients to avoid because, um, sometimes that's what's driving the inflammation. Certain foods that we think of as that, oh, those are healthy, those are superfoods, and they're not. But we could go down a whole another rabbit hole there. Like, what? Like what?

So I'm usually an anti-nut and seed person. Um, lots of omega-sixes, oxalates, lectins. I, I have people that have lots of, like, if if they're complaining of joint or gut issues, and we, if they're eating nuts, like we just take that out, and all of a sudden they're better. If they're doing a lot of spinach or like none of the plant milks, I get those out. Typically, everyone, like coconut milk is usually okay, but some of the, the, you know, the almond milks and things can be problematic. Um, but yeah, so I, I'll start to look at their oxalate load. Um, I'll look at their, and in the cancer world too, like lots of people are doing like high-dose vitamin C, which is also an oxalate, or they're doing turmeric and some other supplements that are also high oxalate, and then we don't know why their gut is so, you know, irritated or or joints or fibromyalgia. Um, so I, I do try try to dig into lots of little spaces of nutrition to say, is there maybe something a little more specific that also needs to be brought in for this particular patient?

My heart, my, I'm, I'm literally my heart rate just going up. I'm like, this is a whole another podcast. Well, I'm not the expert there. No. So are you measuring this, the oxalate load, or you just, did you just obviously, you know, I, I look at a couple of things. I think that uric acid might be one that is maybe linked. I really look just more at symptoms. Like if somebody's got IBS or other, um, uh, fibromyalgia or really bad joint inflammation, I might try, um, something like a ketogenic low-oxalate type diet. Um, I have even put people on carnivore diets because then we get rid of all of those plant toxins. But you know, again, as a healing method, and then the patient can choose. But I, I don't, um, I'm really looking at, okay, where are all your markers going? I don't, I don't care about the foods you choose as long as everything is moving the way that we want them to. So if we're deficient somewhere, then maybe we need some swaps, or if we're still having issues, maybe we need some swaps. And forgive me, the nuts and the nuts and seeds you were saying, what was the pathway or physiology behind what they elevate?

Sometimes they are higher in omega-6 fats, they are higher in oxalates, they are higher in lectins, they are higher in phytic acids, um, and all of those things may be contributing to some of the health issues. Right, yeah. I've read that. I mean, when you break them down in that way. Okay, so I need to know where can I learn and read because I just, I have to let you go at some point. Uh, where can I continue to learn from you and our our viewers? Do you have a book? You have a podcast? YouTube?

Want to write a book? I just need someone to write it for me because I'm not a writer. But, um, no, I, um, I don't have a podcast. I've been interviewed on a few. I give some area talks. I've done a few, um, locally. I used to run a support group for folks. I think for six, seven years, I did a low-carb support group for my own patients and patients in the cancer center who are interested in low carbohydrate ketogenic diets. But, um, right now, I'm just busy running my practice, which is only, you know, two years out. Not quite two years. Um, so KessRx.com is my website. That at least gets people linked in, um, if they're interested in actually being seen. And that, you know, again, I'm not just seeing patients. I really, my tagline on my business is data-driven health. I want to see those labs. Like I feel like I can tell you to eat a ketogenic diet, but until I can look at labs and then assess, did we move the needle the way we wanted to? And if we're not, what did we miss in you? Or did are you not actually accomplishing what we had set out? Are you eating enough fat to protein? Are you, like, because it is a lot of fat, and people are used to eating in that way. So people, it's easy for people to cut out the carbs. It's hard for people to get that protein fat ratio right.

You're just making me want to just really reexamine everything that I, you know, I'm just getting to that age. I'm like, I just got to, because I keep kicking the can down the road. I know, I know what's there and and I just let myself look at, you know, just enough to somehow resist it. And I just, that needs to stop. Yeah. Well, what you need to do is, you know, just like with anybody, you, you say, I can do this for 14 days or I can do this for 30 days. And you just, you don't say I'm going to do it for the rest of my life. I'm just going to, right, do it. But most people, just within a few days, will feel much, much better. I mean, I, I had, I had someone come and see me, and I'm not sure how she found me, I think online, but had just a a neuralgia, you know, facial neuralgia. I don't know. I don't think it was, I think it was occipital neuralgia. It was refractory to medication. She'd seen me where his doctors put her on a ketogenic diet, and guess what? She's like, almost 100% back. That's it. So it's like, once you get those benefits, so if you're having any health issues and you dial it in, and you are seeing those benefits, you're like, why would I go back? Why wouldn't I stay? And sometimes you cheat, sabotage yourself, and you feel absolutely terrible, and all of those things come roaring back, and you're like, oh yeah, I do way better the other way. Why wouldn't I stay there? Yeah, yeah. That's the talk I give, you know, for intermittent fasting, just to like help, you know, a lot of people that can't find it, you know, my patients that that have difficulty, like, just do it a couple of, you know, just commit to a week or two. And even like with, you know, nicotine patches and stuff.

Well, Christie, you're amazing. I really, really appreciate your insights and, um, you've inspired me and I hope anyone else listening, they'll know where to find you. Um, anything else you want us, uh, to leave us with? Or no, I just wish everybody the best. And the sooner you get in it, you know, that's it. I know, then you're part of the club. Sooner you're just like, what? All right, Sam, thank you so much. [Music] [Music]