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Scot: Today, we reflect. You're really killing the mood when you laugh. Who was that?

Troy: It was Mitch.

Mitch: I'm sorry. You're just so serious. Oh my god.

Troy: That wasn't me.

Scot: Killing me.

Troy: Scot is really trying. Come on, Mitch.

Mitch: I know.

Troy: Scot is trying really hard.

Scot: I'm going to say it again. Today, we reflect. Each of us is going to come up with our top three episodes from 2022. It's a best of the best and maybe a good place to start if you're listening to the "Who Cares About Men's Health" podcast for the first time. Maybe we're going to talk about an episode you missed, and we will make you want to go back and check it out.

This is "Who Cares About Men's Health," offering information, inspiration, and a different interpretation of men's health. My name is Scot Singpiel. My favorite episodes are the ones where I talk about me. I also bring the BS to the show. Countering my BS with his MD, it's Dr. Troy Madsen.

Troy: Hey, Scot. We've had so many great episodes it was tough to choose from, but it was fun to think about.

Scot: And Mitch Sears. We had a lot of episodes about him this year.

Troy: We did.

Mitch: Yeah, not my favorite ones. But we did a lot this year too, so I'm really excited to revisit a couple of these.

Scot: Good. Was this hard for anybody else, picking out specific episodes that you were going to name your favorite, or that were the most meaningful for you this year?

For me, it was a little difficult because I think for me it was more of the entirety of the year, and all the information and everything that triggered my thinking. Some of this stuff I can't put back to one episode. It might have been a couple episodes that helped lead me to someplace that I was at. Anybody else have a hard time, or no? Troy?

Troy: I didn't. I just specifically looked for episodes where I thought, "This changed something I do." Like, I can point to a specific change. And it was surprisingly easy. So it was fun to go back and see what has changed as a result of guests we've had.

Scot: How about you, Mitch?

Mitch: Actually, no. There are episodes in the past year that I listen to again. I revisit to kind of get one perspective or another again, and remind myself of one idea or another. No, I just picked the three that I play over and over again.

Scot: That's awesome. All right. Here we go. Our top three episodes. Each one of us is going to come up with three episodes. I'll go ahead and start with Episode 103, "How Emotional Availability Can Improve Your Life."

Mitch: Oh, with Kirtly Jones? Sure.

Troy: I did not pick that one, but I almost did.

Scot: Did you? All right.

Troy: Almost did.

Scot: So, for me, that episode was good. And again, it kind of brought some thoughts that I've had in my mind together and helped me on this journey. First of all, to start to pay attention to my emotions and acknowledge them as real. There's more than anger, and there's more than nervousness.

Mitch: There's a whole wheel.

Scot: And understand that it's okay to have these emotions and it's okay to acknowledge them and it's okay to feel them, and it doesn't make you any less a man or any weaker.

And also, we all experience these emotions differently. We all handle these emotions differently depending on who we are. And there's no shame in that. It all has to do with our background and how we've experienced them before and what tools we were given by our parents and other people in our lives.

And the thing that really changed it for me, though, was in my interactions now, and this was a suggestion by Dr. Jones, I don't tell the person how they're feeling. "Oh, you seem angry." I'm curious. "I noticed something is a little off today. Do you want to tell me about it? Is there anything I can do to help?"

So just opening myself up to asking somebody about how they're doing without assigning to it and then asking them to define what it is and asking permission if they want to talk about it has been a kind of a game changer in some of my relationships. I feel a lot more confident when I can ask that question as opposed to what I used to do, was ignore it.

Mitch: Sure.

Scot: Just ignore it, right? Because it's scary. It's scary to ask those questions, because what if it's about you?

Mitch: Oh, no.

Scot: What if it's an emotion you're uncomfortable with? And I think a lot of us guys can be uncomfortable with other people's emotions.

Troy: Right. Yeah, like you said, the anger piece of it was really interesting because she pointed out anger is often a manifestation of deeper emotions. And the challenge for us is identifying what those deeper emotions are leading to anger. Yeah, I agree, that was a game changer.

Scot: So we can actually do something about it.

Troy: Yeah.

Scot: All right. Favorite episodes. Troy, you are number two.

Troy: So my favorite episodes, I'm going to go with Kirtly Parker Jones as well. And I'm going to start with the obvious one for me, and that was "Tips For Expecting Dads."

Mitch: Oh, sure.

Troy: Episode 109. I mean, how could I not go with that? It was just basically an episode for me, which I really appreciated. She gave such great advice. And it was as we were moving toward the third trimester that we had that episode, so a lot of things she talked about I thought about through the third trimester, a lot of things as we were there in the hospital awaiting the birth of our child, and as our baby was born. My mind went back to that episode quite often. So she was very insightful. Great advice. Really appreciated it.

Scot: What was it that that episode helped? Can you give us a specific example?

Troy: I think, again, it kind of got back to the emotional availability piece that we talked about in the other episode, but also there were specifics about what to expect in terms of the pregnancy itself that I found very helpful.

But also just that general theme of, number one, being emotionally available, and number two, being willing to experience and express those emotions myself. We talked about, "How are you going to feel when your baby's born? What if you feel like crying? Are you going to be okay with that?" And I was okay with that. I did. I wasn't sobbing.

Scot: Oh, no.

Troy: Of course not. My eyes might have teared up a little bit. And we talked, too, about kind of putting aside the doctor piece and just being there and just being a dad, and that's what I tried to do. I mean, I was tempted to go into doctor mode there and overthink everything and watch everything that's happening and get nervous, but I was like, "Hey, I'm just here. I'm just a dad." And it was nice to do that.

Scot: Just enjoy the moment. If somebody is not a doctor and they don't have that kind of baggage, just really just try to be in the moment and enjoy it.

Troy: Yeah, exactly.

Mitch: Troy, do you think you would've had that same approach to the entire experience had you not had a moment to talk with Kirtly Jones?

Troy: I think I might've approached it a little more clinically, like I said. So it was nice to have that, just to have my mind go back to that and have that as a reminder to myself, like, "Hey, we've talked about this. I'm ready for this. I don't want to go into this and be a doctor here." Not trying to bark out orders, but just trying to be there to . . . I didn't want to overthink things. I think that's kind of what it came down to. So it was nice just to be there, just be a husband, be a dad, and just enjoy the moment.

Scot: All right. Mitch, your favorite episode?

Mitch: So the first one we're going with Episode 106, "Robb Has a Heart Attack." And what I really liked about this one was not only did it feature a friend who's become a role model and a real supportive character in my own health journey . . . I mean, we chit-chat about . . . I've never had before a friend who's like, "Hey, just got back from the doctor and this is what happened." It's like, "Oh, wow. Great. Like, thanks for sharing that." There's this really interesting back and forth that happens.

But more importantly, talking through the episode, health is something to be grateful for, right? Health is something that is not necessarily guaranteed even if you're the healthiest guy, kind of like Robb was. He was extremely healthy and he still got hit with this very intense heart attack, right?

And the line that has always stuck out to me . . . Right now I'm back in physical therapy because I've hurt my ankle again, and any time I'm getting frustrated with my workouts, with that kind of stuff, etc., the quote that he said was, "Even in my workouts, they're less 'I have to go to the gym' and more 'I get to go to the gym' or 'I get to go for a walk.'"

And I just love that takeaway in the conversation that we had. It's just this idea that health is not some gold star that you get for working really, really hard. It is something that you are . . . There is a certain amount of luck and it's a privilege. It's something to enjoy when you have it. And that is something that I really, really appreciated.

Troy: Yeah, and it really hit home to me when you talked about getting on the treadmill after the heart attack.

Scot: Oh, yeah.

Troy: And how he kind of teared up just the fact that he was on a treadmill and exercising. It was just so meaningful to him. That was really cool to hear that.

Mitch: Oh, yeah. And compare that to Mitch of like years ago where I'm on a treadmill hating every single minute of it.

Troy: Exactly.

Mitch: And then it's like, "Oh, man. Yeah, I get to do this."

Scot: Cool. All right. Round number two. Each one of us has three episodes from 2022 that we liked, and this is round number two. Mine kind of dovetails into yours. Mine is Episode 120, which we just did not too long ago, "Just a Bunch of Dudes Being Grateful."

Mitch: Yeah.

Scot: Was that on your list, Troy?

Troy: It was a great one. It's not, but that was a great one.

Scot: Yeah. And it is just a mindset that I get to exercise, that gratefulness mindset that "This is something I can do and it's something that I enjoy," not "It's something I have to do."

How fun was it on that episode hearing what other people were grateful for? It was fun to do, and it was fun to listen to, and just all of us talking about the things we were grateful for, it was infectious. And I felt good after doing that episode, right?

Troy: It was fun.

Scot: And it made me think about power. How we talk about things and the way we frame things is really super powerful. And we talk about how you can set up your own gratitude practice, and I've done so. I was doing it before that. But it's just really cool when you go out and you start recognizing more and more things in your life that you're grateful for.

I'm grateful that I live a half mile away from this park that I can spend time with my dog in. It's a great place to play Frisbee. I never would've thought of that before I was doing my gratitude journal, but it makes me smile every time I'm walking there, and I get to spend some time with him, right? So that's pretty awesome.

It was so much of a fun episode hearing other people and talking about it. I don't know how I'm going to do this, but I might start throwing this topic of gratefulness, like "What are you grateful for?" into conversations with friends. And like I said, I don't know how, but once you start doing it, it is a little infectious and it's fun.

Troy: Yeah, that was a fun one. I loved just having everyone on there, just so many people from the past years that we've talked to. It was just, number one, fun to bring them all together in one place, but like you said, really fun to hear their perspective on gratitude and the things they are grateful for.

Mitch: Yeah, it was really cool.

Scot: All right. Troy, your number two?

Troy: Okay. Number two for me, Episode 113, "Anxiety - The Hidden Tiger of the Mind."

Mitch: Oh, man.

Troy: Scott Langenecker. Was that on your list too, Mitch?

Mitch: It's on my list too. It's okay. We can talk about it.

Troy: I won't steal your thunder because it's on . . . Yeah, we can talk about it together because that's your next one too. I think, for me, he just had so many good insights into anxiety and what leads to anxiety and ways to address it.

I've mentioned it before, but anxiety is one of those things, one of those emotions in my life that I'm trying as much as I can to reduce it. And I've talked about it before. I've sometimes even leaned on anxiety as a motivator, and I don't want to do that. And so it was so good to hear his perspective on how you can reduce anxiety.

Number one, how do you identify it, which is super important when you're feeling anxious. Number two, how do you reduce it? And so I think it kind of relates to other episodes we've had as well talking about anxiety. But I think that one really got down to the crux of the issue and coping strategies and ways to hopefully try to reduce anxiety in your life, which I found very helpful.

Mitch: Yeah. So Episode 113, this is on my list too. There was something about understanding why we have it, right? There was something that I really appreciated that Dr. Langenecker brought in where it was just like, "This helped cavemen survive. There's a reason all of us have it in one way or another."

And so as someone who has struggled for most of their life with anxiety, to have that kind of perspective of, "This isn't a pathology. This isn't 'you're sick.' This isn't 'you have a problem with you.' It's just everyone has it. How do we experience it? How do we manage it?"

I actually incorporated clips from this episode into my lecturing I do at the community college, and we did a whole section on speech anxiety. They had to give a speech in front of the class and a bunch of people were very, very nervous to do it. And we talked about anxiety, what it is, what causes it, how we feel it, how we can trick it, how we can breathe and manage it. Man, oh, man, just to see them respond, to give them that kind of perspective and understanding was extraordinarily satisfying.

Troy: That's cool. That's really cool you incorporated it. I love that you actually took clips from that. I mean, there's so much that you could just re-listen to and quote from what he said.

Mitch: And that's just it. I wish I had had this perspective younger. I wish I had had this perspective earlier in my life being like, "Hey, worrying about stuff or feeling these types of sensations does not mean that there's something wrong with you. It's just something that happens and it's something that is there to help protect us. And if we can understand it, we can have a better relationship with our own mental health," which is way cool.

Scot: It was on my list as well for the reasons . . .

Troy: No way.

Scot: Yeah, for the reasons you . . .

Troy: Well, that makes it easy.

Scot: Yeah, it does, right? We'll wrap this thing up here in short form.

For all the reasons that you both said. I know that, Mitch, you've struggled with anxiety. And for some that struggle with a higher form, more anxiety than others, you might have to get some sort of other medical attention. It's not just necessarily something you can manage on your own.

Mitch: Yeah, anxiety disorders.

Scot: Right. So I don't want to oversimplify it because I know that it's been a lot more severe for you. But for me, also understanding that this had a purpose and then in our modern world, when we get anxious about things to an extent where it kind of makes us not want to act, it's just our warning system that's kind of gone wrong, right?

And knowing that and being able to go, "All right. Let's just really take a look at this situation. Is this threatening to me?" and being able to work through that and figure out if it is or not, that made me feel a lot better.

And just knowing that it's just natural. It's just like if you go swimming, you're going to get water in your nose, right? If you do certain things in your life, you should have some anxiety and it's not necessarily a bad thing. It just happens. And it might be because you want to do really well. So how do you manage it so you can continue to do the thing you want to do really, really well?

One of the things Dr. Langenecker had talked about, I don't know if you remember, is that your ability to handle that might change as you get older, and that's okay.

He told a story about firefighters. That's a very physically and emotionally demanding job, and being able to deal with that can change over time. I'd imagine, Troy, you could speak to this as well. There are not a lot of old firefighters, right? And there's a reason for that. And it's okay. Just like we physically aren't able to do the same things we used to do, sometimes mentally we can't. You have to change.

Troy: Yeah, that was great. Very insightful. Like both of you said, I love that he said, "We all experience this. You're not abnormal because you experience it." So I think that's a great takeaway.

Mitch: And just to echo what you were saying, Scot, as someone who has kind of dealt with anxiety disorders in the past and stuff, it doesn't belittle it in any way, shape, or form. It just makes me think of it differently, right? Why am I medicated? Well, it's because my system is too hyper-tuned. It's not that I'm sick. It's not that I'm broken. It's just I have a very sensitive system, and that's so much of a better approach to thinking about it than, "I'm broken, I'm wrong, I'm oversensitive."

Troy: It's like Spidey-Sense almost. Your Spidey-Sense is a little too strong.

Troy: That's right.

Scot: It's telling you things are dangerous when they're not. All right. Troy, what's your number three?

Troy: Okay, number three. We're going to jump back all the way to January of this past year, and it is Mitch "Project 50."

Mitch: Oh, no. That's the one you chose?

Troy: That's the one I chose and I'm going to tell you why. Like we talked about then, the whole Project 50 I found, I just couldn't put that much time in. But the thing I loved about it was that idea of working on a new talent every day.

Mitch: Oh, sure.

Troy: That was really cool. And so I went back actually to an old talent. I talked about piano playing, but I will say that episode stuck with me. In March, I purchased a trumpet.

Mitch: What?

Troy: I purchased a trumpet.

Mitch: Are we starting a ska band?

Troy: We're starting a ska band. I played the trumpet in junior high school and dropped it after that. Never really played it again. Never picked it up. I don't even know where my old trumpet is, but I said, "I'm going to get a trumpet and I'm going to learn to play this thing again." And at this point, I play the trumpet just about every day.

Mitch: Oh, that's awesome.

Troy: Granted, I don't think Laura is thrilled about that.

Scot: Or the new baby.

Troy: She actually likes it. She kind of likes it. At least she acts like she likes it. She seems to enjoy the trumpet. I don't know that the neighbors love it. But I play the trumpet every day now and I really enjoy it. So that piece of it stuck with me, and I've stuck with that since then.

Scot: What songs do you play?

Troy: I've just got this book of popular songs. A lot of them are '60s songs and stuff, and so I just play through that. I've picked out the songs in that that are easy enough that I can play it on the trumpet and just kind of cycle through it. I'll play two or three songs a day and just pick it up, and it's just fun to pick it up and play it. It's cool.

Scot: That must make you happy.

Troy: It is. It's fun, yeah.

Mitch: I just find it so interesting because just a month or two after that episode, we had the "Mitch fails the Project 50." I don't remember what we called it. But it's so fascinating because we tried the Project 50 Challenge. You rolled your eyes at some of the requirements. I could not keep up with a lot of stuff. But that hour of no phone, I still do it to this day, that morning startup, whatever, the reading non-fiction to educate myself every day. Even if something doesn't quite work, 100% of it, at least try it out. We're just figuring out what works for us, right?

Troy: That's what I thought was cool about it. You can try it or you can modify it and do it, and then after you're done, "This is what I liked. This is what I took from it." That's kind of how I approached it. So that was the thing for me, was the talent piece. And it sounds like for you, the no phone thing and all that. Yeah, I thought it was cool.

Scot: You can find one gold nugget in each episode. It's worth it. That's what I like to say. Mitch, what is your third?

Mitch: So my third is one that I actually have favorited on my Spotify playlist and everything. And it is Episode 104, "Letter From your Past Self."

Scot: What?

Mitch: I know.

Scot: You both rolled your eyes at me when I brought that up.

Mitch: And I will continue to roll my eyes publicly every time you bring it up. But today I just want . . . There is something about . . . And I think the gratitude episode is going to be right in there with it. But as someone who struggles with mental health, as someone who is constantly working on it, I cannot tell you how much being able to go back and hear positive words being spoken aloud of both to myself, from myself, to things that you said to yourself.

If I'm in a funk, I will just play that episode. And there's something about just going through that practice and hearing other men be positive with one another. It gets me out of my funk, and I love that.

And I think the gratitude episode is going to be that same way. It's something that I don't think we do too often. We joke about things, we don't treat ourselves very seriously, etc., and just to know that we could do that and to hear those types of words, I come to it a lot.

Scot: So being kind to yourself. That was one of the rules, that you had to be kind to yourself or . . . I can't remember. That's the part of it you really like, is saying nice things about yourself.

Mitch: Well, it sounds oddly simplifying. But we spend so much of our time being so negative and hard on ourselves, to be able to have an authentic appreciation for yourself is very powerful.

Scot: And hearing Troy also do the same thing was good for you. That came off wrong, Troy. I mean, you're laughing, but we liked listening to other men talk about gratitude. It's nice to hear other men talk about themselves positively or being kind to themselves.

Troy: Oh, I thought you were joking because I didn't get my letter. I timed mine for a year from when I wrote it, so I didn't have a lot to say.

But your letter, I thought, was very insightful and really profound in so many ways. I thought it was really cool to listen to. And I wish I could write a letter as well written and insightful as yours was. That was a fun episode.

Scot: All right. And before we go, I want to just throw one last thing in from my perspective. I've really enjoyed, Mitch, the "

Mitch: It's Complicated" series that we've done with your health journey. Just hearing you go through this health journey as you've kind of been trying to uncover what it is that has been giving you issues throughout your life has just been so motivational and so informative. And the fact that you're sticking with it, it just is . . .

I've really enjoyed that, so thank you for being brave enough to talk about all of those things, which is really . . . I think if anybody gets the award, the bravery award on this podcast, it's Mitch. Troy and I, I think, are still a little guarded, right?

Troy: Yeah, without question.

Mitch: Someone has got to say it. I'm sorry. We don't have these conversations and I wish that there was one other person out there talking about this kind of stuff. So I'm going to talk about mine.

Scot: And I love that you do that.

Troy: No, it really is. I think it's helped so many people and I appreciate your insights and your experience. I draw a lot from what you've gone through and what you've talked about, and I think it's helped me open up a little bit more too. So I appreciate that.

Scot: And it's what this podcast is about. It's about men opening up, talking about their health, talking about their concerns, the things that stress them out or the things that they're happy about, or proud about, or grateful for. We don't have these conversations enough. So hopefully this podcast gives you some tools and gives you some inspiration to want to have those conversations in your life as well. And if not, just maybe listening to these has been helpful as well.

Gentlemen, as always, it's been a great 2022. I look for forward to new episodes in 2023. We'll do this at the end of 2023 and see where we're at. I bet you it's going to be in a different cool place.

Thank you for listening, and thank you for caring about men's health.
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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Mitch: So maybe you've heard about it on some ads or a TV show, or maybe you got a friend who's getting really into it. It's ketosis or the keto diet. And I just have a lot of questions about whether or not it really is as magic as everyone seems to make it sound. So we're going to find out today.

This is "Who Cares About Men's Health," where we try to give you some information, some inspiration, and maybe a different interpretation about your health.

I'm Mitch, and joining us today is Scot. He is the master of BS, and manager of The Scope Radio. Hello, Scot.

Scot: I am looking forward to hearing about ketosis as well. I hear it's a state that's hard to get into, but you can burn some major fat, so I want to find out if that's true.

Mitch: And also joining us is the MD that gives us a little bit of validity. That is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Just a little bit. Don't overstate it.

Mitch: And to answer some of these questions, we have the wonderful nutritionist. Thunder Jalili is back with us to let us know about this particular process.

Thunder: Hi, Mitch. I'm happy to be part of the crew again.

Mitch: All right. So before we get into kind of ketosis itself, how about you guys? Have you ever tried out a low carb diet before?

Troy: Mitch, I'll just jump in right here and say no. I absolutely love carbs, so I can't . . .

Mitch: Carbs are the best.

Troy: Carbs rock.

Scot: Why would you do that to yourself? No, not really. I mean, the lowest I've ever had, I was on a diet called the Zone Diet, which I've heard is a low to moderate carbohydrate . . .

Troy: Carburetor?

Scot: Yeah. I've known people who've tried low carb diets, and they're not nice to be around. That's not just a cliché. That's actual truth.

Thunder: And I have tried a low carbohydrate diet. Very, very short-term for just a couple of days just to see what it was like, what it's like to follow this. Not for any weight loss reason, just more of an experiment.

Scot: Thunder, how did it go for you? What did you learn?

Troy: Yeah, were you super grumpy? I was going to ask that.

Thunder: No, not really. I mean, I still ate a lot of vegetables. Those were my carbohydrate sources. So I probably didn't have the classically super low carbohydrate diet. I mean, I don't think I was any lower than 30%, to be honest. So it was fine. I did it, and then after a couple days, I just wanted to have beans and some other stuff, so I just stopped. But it was mostly just an exercise to see how hard is it to do this? How limited am I from a practical sense?

Troy: And did you feel limited?

Thunder: Yeah, a little bit, I did feel limited. I don't mind eating salads and vegetables, but I don't like passing up fruit. You guys know how I love my smoothies. So I don't like trying to decide, "Oh, I can't put this fruit in the smoothie," and things like that. So, yeah, I felt limited in that sense.

I don't necessarily miss rice or pasta. But it's just when you start cutting the different fruits and beans and things, that's where it starts to get tough for me.

Mitch: So why don't we start the discussion here with what is ketosis itself? For someone who has never taken a physiology course, who doesn't have a degree in nutrition, Thunder, what exactly is ketosis and what does it do to the body?

Thunder: So ketosis is the metabolic state where your body is using fat for fuel. Basically, your liver has this ability to make ketones, which is kind of like a metabolic energy substrate in the liver, makes it in the liver. It can actually do this from fatty acids. To some degree, it can also do it from amino acids, which are the building blocks of proteins.

So your liver makes these ketone bodies, and it puts it into the bloodstream. And then those ketones can be used as a fuel for all the other cell types in your body.

There are a couple of particular types of cells that really need to use glucose, and if they don't have glucose, the next best bet for them is ketones. So it's important to have that. Your muscles can use ketones for energy, as an example.

So any time you're burning some degree of fat or you're using amino acids for energy, you're producing some of these ketones.

And then the last thing is "ketosis" is thrown around so much. Really, there's a window of ketone bodies, the level you can measure in the blood. And if the amount of ketone bodies circulating in your blood falls within this window, you're said to be in ketosis.

You don't have to be in ketosis to lose weight, but a lot of times, if you're doing something from a dietary standpoint or restricting calories, you are going to be in some degree of ketosis.

And you can actually have too much ketosis where the ketone bodies in your blood are so, so high, it can be dangerous, and it can cause an acidosis and potentially cause some harm, but that's pretty rare to be in that state.

Mitch: That's interesting, because one of the things I came across was what they call the keto flu. Have you ever heard of that?

Thunder: Yeah, so that's if you're just too hardcore about it and your ketones are just really high in the blood, and it just makes you kind of feel bad. It's not really the best thing physiologically. I would say that happens in people who really take the keto to the extreme.

Mitch: Bad breath, soreness, nausea, headaches, irritability. It doesn't sound super great to me, but what are some of the health benefits, I guess, of being in ketosis or using ketones? I guess even if you're not eating a strictly low-carb diet, does the body still go into ketosis? And is there any benefit from that?

Thunder: Yeah, you don't have to be in a low carb diet to have ketosis. If you just have a low-calorie diet, you would be tapping into your fat stores and producing ketone bodies that way, too.

There's not really any great benefit or great detriment of ketosis. It's just one of those natural metabolic states that we fall into from time-to-time. And it's just that in the modern context of people trying to lose weight, people will try to use that as a goal, to be in ketosis for an extended amount of time, with the idea that that means they are burning fat. But there's no specific benefit or detriment. It's just something that happens to us.

The only detriment would be if you go too extreme and you have such high ketone levels in your blood that it leads to keto flu, like you were talking about, or other similar bad effects.

Mitch: Would this be, say, maybe a dangerous thing for someone who's maybe diabetic? Or with how low the nutrients are or how many nutrients you might be missing out on from cutting carbs completely, could it potentially lead to vitamin deficiency problems and who knows what?

Thunder: So, in general, yes to a lot of the things you touched on. I'm also going to give Troy an opening here for the diabetes question if he wants to hop in, but for diabetes especially, diabetics can develop a dangerous condition called ketoacidosis, where basically there's just too much ketones, too much acidity in their blood, and it's very dangerous. They have to be careful with that. Troy, do you want to add anything to that?

Troy: Yeah. I was going to say for diabetics, they definitely would not want to do a ketosis type diet. And I'm sure anyone who's dependent on insulin, they know that. They know their carbs, they're tracking those things, and they're adjusting their insulin doses based on that. So to go to a very low-carb diet could be very dangerous.

Number one, unless they adjust their insulin, they could really drop their blood sugar low, which would be dangerous. But like you said, Thunder, one of the things I treat in the emergency department is diabetic ketoacidosis, where patients come in, their blood sugar levels are really high, but that blood sugar is not getting into the cells, so then their body is producing ketones. And exactly like you said, Thunder, they're acidotic. They're nauseous. They're vomiting. They're confused. It can be a life-threatening condition.

So certainly people with certain medical conditions, you would not want to do any sort of a low-carb diet or really be trying to achieve any kind of ketosis.

Thunder: Yeah. Correct. And the treatment for that is a lot of insulin.

Troy: Exactly. Yeah, that's how you treat it. We start them on insulin. We give them sometimes an insulin drip. Sometimes they go to the intensive care unit. It can be a very serious condition, and something I see on a regular basis.

Scot: I'm sorry. I might have just dozed off or something. I'm a little confused. I thought ketosis . . . People do like the Atkins diet or a very low-carb diet because that puts them in the state of ketosis, which helps them burn additional body fat. Is that not true? I'm kind of getting the feeling that that's not the case.

Thunder: No. One of the ways to encourage burning body fat is to do a lower carbohydrate diet, but a lot of times lower carbohydrate diets can also be lower calorie diets. You've got to get the energy from somewhere, so you mobilize your fat stores.

One of the ways of thinking about this weight loss, fat burning, and all these different diets, there are a lot of different ways to get around the same thing, trying to produce some calorie deficit. So, really, you're not comparing the merits of a keto diet to a high protein diet or whatever other diet you want to find. It's not so much that. It's what kind of diet advice can a person follow to produce the weight loss that they want? That's really the question. Not necessarily does it have to be exactly a keto type diet or whatever else kind of diet?

But yeah, bottom line is any kind of low-calorie diet will produce some kind of ketosis because you've got to tap into your fat stores to provide the balance of energy that you're missing because you're not eating as much food. Does that make sense?

Troy: It does, yeah. And, Thunder, along the lines of weight loss, I've wondered how much weight loss . . . I know with a low-carb diet and pushing yourself toward ketosis, a lot of people do see some fairly quick results in terms of weight loss. But my understanding is that a lot of that is water weight and you get ketones in the blood.

And again, I see the extreme of this with diabetic ketoacidosis where they have these ketones in the blood that pulls fluid from the cells into the blood. That's why you often hear of people who, when they have diabetes or when they're first diagnosed with diabetes, are urinating a lot more frequently, because they're losing a lot of fluid.

And I've wondered with these low-carb diets, where you're pushing yourself toward ketosis, how much of that weight loss is truly long-term fat breakdown versus just pulling a whole lot of water out of your body and losing weight because of that water loss.

Thunder: Yeah, that's a great point. There have been feeding studies, clinical trials have been done comparing different diets over longer time periods, like a period of months, sometimes even up to a year. And a lot of times, you look at the graphs of weight loss, and they kind of look the same. There's an initial big drop in weight in the first few weeks, and then actually, the weight kind of comes up a little bit, and then it stabilizes.

So there's definitely an element of what you said, Troy, in there. You have some water loss initially, but obviously, if you stick with it for the long-term, you're going to be also losing some fat. It's just probably going to take a few weeks for it to stabilize at a certain level. You can't say what you lose in the first three days is going to be the trajectory because that's probably not accurate.

Troy: Interesting. And maybe that's kind of self-reinforcing. You say, "Wow, look at the weight I'm losing." But probably, like you said, you're not going to keep losing that amount of weight over the longer term. You're probably seeing a lot of water weight loss, and then eventually, you're going to kind of level out to where maybe it's more realistic.

Thunder: Yeah. You just kind of settle in on an amount of weight loss, and then you hit a point of diminishing returns where, in these studies, people don't necessarily lose any more weight. They just kind of stabilize at a certain level. And then if you want more weight loss to occur, you have to try something different.

Mitch: So I guess to wrap up that idea, is a keto diet worth it, or are there other ways to lose weight? Is it comparable? For me, at least, it just seems like such a lot . . . I mean, we were kind of joking, but I do love carbs. Carbs are delicious.

Thunder: Especially in the form of cookies.

Troy: Sure.

Mitch: Oh, cookies, whatever, sure. But is it worth that amount of . . . are the benefits, the increased potential for weight loss, etc., enough of a difference that would make cutting all those things out worth it, in your opinion?

Thunder: I think with any kind of change in food behavior, you have to land on something that you can stick with. So, yes, you can lose weight following this keto diet. But the question you have to ask yourself is, "Is this something you can stick with for the next 40 years or whatever?" Forty or 50 years. And if you can't, then it's going to be something you do temporarily, and then you're going to stop and then maybe fall back into old habits.

So I'm not a fan of extreme diets of any kind for exactly that reason, because I'm afraid that this is something that people just can't stick with long-term. It's like a short-term fix.

Troy: Yeah, I agree. And again, it's a theme that seems to come up again and again as we talk about diet and exercise and all that. In my mind, too, it's all about sustainability and not just that short-term fix and getting ready for swimsuit season or whatever it is. It's like, "Hey, can you do this for the next 40 years and enjoy it and have this lifestyle that's rewarding for you?"

And I guess if ketosis is, if a low-carb diet works for you, and you're good with that, you enjoy it, then great. If it's something you're doing just to try and lose the weight and looking at as a short-term fix, it just doesn't seem like a great approach.

Mitch: So why do you guys think that the keto diet is so popular, then? I mean, some of the numbers that I was able to kind of pull up were saying that in the last year, 24.5 million Google searches were trying to figure out whether or not keto was right for them. It continues to have more and more people being a part of it. Why keto? Why cutting out all carbs? Why is that the diet of the time?

Thunder: That's a complex question to answer, but I think maybe some of the themes that are involved there are people are looking for some sort of program that they can easily follow that has noticeable quick results.

People are looking for any kind of crutch or help. A lot of times, if an individual is overweight and wants to lose weight, they don't feel great about it and they may be approaching it from a place of desperation. So if they can latch on to something that they see has worked for other people, and they're like, "Oh, all I have to do is cut out carbs. I can do that," I think that has a pretty powerful element.

And then there's also the element of marketing. I mean, not that there's a specific company marketing keto, but there are a lot of lifestyle-, nutrition-, exercise-based websites that market keto is the way to go. So you have also that marketing that's out there in the ethos that is always promoting keto. So that gets people to try it.

And then the last thing I'll say to that is keto diets have definitely been studied. Low-carb diets have definitely been studied in clinical trials. And the general conclusion is they don't work really any better for weight loss than any other diet. But a lot of times, people will see medical research like that and they will rationalize and say, "Well, that's the averages, but I think it'll work for me." And then they're willing to take the plunge that way anyway because they figure there's no harm in trying.

So that's my personal take of some of the things that are involved in keeping keto popular and really any other kind of fad diet or supplement that comes around.

Scot: Hey, Troy, what about the medical benefits of keto diets? I remember on thescoperadio.com one time we did an interview with a doctor that said there was some evidence that showed that for young children that had epileptic seizures, some of them responded really well to low carbohydrate diets that put them in that state, that ketogenic state.

Are there other health benefits that you're aware of? I mean, you'll see it on the web. People will claim diabetes, cancer, epilepsy, Alzheimer's disease. What do you know about that?

Troy: I'll say, in my opinion, and this is purely my opinion, I think the detrimental effects of a low-carb diet are probably greater than the health benefits. And the reason I say that is because I think a lot of low-carb diets lead to higher meat consumption, and primarily a lot of red meat consumption. So, right there, you have the detrimental effects there.

When we talked about that before, there are those rare exceptions where being in a state of ketosis does help maybe some children with seizure disorders.

Certainly, if you have weight loss, and it's a decent amount of weight loss, and you're able to maintain that that's going to help with potentially reversing diabetes, like a type 2 diabetes, and potentially helping with some of those long-term effects of being overweight. But again, in my mind, the sustainability of a low-carb diet I think is just a challenging thing for probably most of us.

And again, I think probably a lot of the protein intake in the form of meat . . . At least a lot of people I know who are on low-carb diets, they tell me they are eating a lot of meat. It's often a lot of red meat. And I think the health effects of that there, you're talking about increased risk of colon cancer, other types of cancers, certainly increased risk of heart disease, vascular disease, leading to risk of stroke, all those sorts of things. So I think it's kind of a mixed bag, quite honestly.

Thunder: Yeah. And if I could just add on to what Troy was saying, too, I think there are certain medical conditions, like you mentioned epilepsy, where this type of very high-fat, ketogenic-type diet may be required. Sometimes people have inborn errors of metabolism and they have to do kind of crazy special diets. Sometimes these patients are backed into a corner, so to speak, because they just may have to do that to move on.

But for most of us who are not in that camp of medical conditions that require it, then I would agree with Troy that the risks are probably outweighing the short-term weight loss benefits.

Troy: Yeah. And I will say anytime anyone asks me, "What kind of diet should I do?" and we say this again and again, I say the Mediterranean diet. The reason I say it is because there are so many good studies out there looking at long-term health effect impacts on heart disease risk, cancer risk, stroke risk, weight loss, and it does the trick.

And certainly, I don't consider it a fad diet. It's a very, I think, manageable, sustainable long-term diet. And it's certainly not a low-carb diet either.

So, in terms of just scientific evidence, that's the one diet that just seems again and again to come up over many years, lots of really good studies published in very strong reputable journals that really show beneficial health effects.

Thunder: Yeah, 100% agree with Troy. And also it's more of a moderate carb diet, and it's delicious because you get to eat a lot of delicious foods.

Troy: Yeah, exactly.

Mitch: Well, thank you so much for joining us, Thunder, and kind of enlightening us a little bit about keto and what it can and cannot do. I guess keto isn't really magic. So thank you so much, Thunder, and thank you for caring about men's health.

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