Low Carb High Fat - Ketogenic

Summary

In this video, Dr. Eric Westman critically examines the claims made by an influencer physician, Dr. Saladino, who moved from an enthusiastic carnivore and ketogenic diet advocate to a critic of low-carb and ketogenic diets. Dr. Westman explores the physiological impacts of carbohydrate restriction, particularly focusing on stress hormones such as cortisol, epinephrine, glucagon, and thyroid hormone changes. He underscores that while ketogenic diets induce elevated stress hormones initially, this may normalize over time with adaptation. More importantly, he emphasizes the distinction between the classical ketogenic diet used for treating epilepsy—often severe and medically supervised—and the more flexible ketogenic diets employed for metabolic health, diabetes reversal, and obesity treatment.

Dr. Westman points out that many of the cited studies—often short-term and involving small or specific populations such as epileptic children—are not directly transferable to the broader adult population using ketogenic diets for health improvement. He highlights that blood markers like thyroid hormones and cortisol may fluctuate on ketogenic diets, but these changes do not necessarily reflect negative health outcomes or cellular dysfunction. Instead, certain physiological adaptations occur as part of the body’s metabolic recalibration.

He also discusses how carbohydrate intake positively affects exercise recovery, cortisol reduction, testosterone levels, and immune function, acknowledging that these benefits may be significant for athletes or those engaging in intensive training. However, he challenges the notion that these findings universally condemn ketogenic diets, especially for non-athlete populations. Dr. Westman stresses individualized approaches to nutrition and the importance of interpreting biochemical markers in the appropriate clinical context rather than relying solely on blood values or short-term studies.

Ultimately, Dr. Westman calls for more nuanced, long-term research and cautions against broad, fear-based generalizations about ketogenic diets. He encourages those interested to monitor their own health markers with professional guidance and recognizes that multiple dietary paths can support health and vitality.

Highlights

• 🔬 Elevated cortisol and glucagon are physiological responses to low-carb diets but may normalize with adaptation.
• 🩺 Short-term ketogenic diet studies, especially in epilepsy patients, may not apply to adult keto dieters for metabolic health.
• ⚖️ Blood thyroid hormone variations on keto don’t always equal clinical hypothyroidism or poor metabolic function.
• 🏋️ Carbohydrate intake improves exercise recovery, testosterone, and reduces cortisol after intensive workouts.
• 🔄 Keto adaptation can take months; early adverse markers may reflect transition rather than harm.
• 📊 Different ketogenic diets vary widely; findings on one variation shouldn’t be generalized to all.
• 🧬 Individual metabolic responses require personalized monitoring rather than fear-based blanket dietary advice.

Key Insights

• 🧪 Adaptive Stress Hormone Response: The increase in cortisol, epinephrine, and especially glucagon during carbohydrate restriction is a well-documented physiological mechanism to maintain glucose homeostasis. While cortisol and adrenaline levels may diminish over time with metabolic adaptation, glucagon remains elevated on low carb diets as a primary regulator of blood sugar. This highlights that elevated stress hormones do not necessarily indicate pathological stress but rather a fundamental metabolic shift. Awareness of this is crucial to avoid misclassification of normal metabolic adaptation as a harmful stress state.

• ⏳ Short-Term vs. Long-Term Evidence: Many negative conclusions about ketogenic diets stem from short-term studies (e.g., three to six weeks) or highly specialized populations such as children with intractable epilepsy. These early time points often capture the “keto flu” or transition period before full adaptation. Long-term studies and clinical experience suggest many of these initial negative markers (bone remodeling markers, thyroid hormones) stabilize once adaptation occurs. Thus, premature conclusions about keto’s safety and efficacy based on transient data are unreliable.

• 🩸 Thyroid Hormone Complexity in Keto: Keto diets may reduce circulating T3 levels, but interpreting these blood values requires clinical context. Decreased circulating thyroid hormones during weight loss, regardless of diet type, can reflect a normal adaptation to reduce metabolic rate rather than true thyroid dysfunction. Moreover, symptoms and cellular hormone activity need to be assessed, not just serum levels. Overreliance on blood tests without clinical correlation can lead to misdiagnosis and unnecessary alarm.

• ⚡ Carbohydrates and Exercise Performance: Carbohydrate consumption improves key exercise-related outcomes such as cortisol attenuation, immune function, and free testosterone. For athletes or highly active individuals, carbs can be a valuable performance and recovery tool. However, since ketogenic dieters typically experience a metabolic shift prioritizing fat utilization, their “normal” ranges and performance baselines differ markedly. Therefore, benefits of carbs in exercise might not translate into a clear detriment in non-athletic keto followers.

• 🔬 Metabolic Diversity of Keto Diets: There is no monolithic “keto diet.” Variants range from extreme ketogenic protocols used in seizure management to more liberal carbohydrate restriction plans aimed at diabetes reversal or weight loss. Studies and critiques often conflate these, leading to misinterpretation. Evaluations of keto must specify the diet type, population, and medical context. This diversity necessitates cautious generalizations about keto’s benefits or risks.

• 👩‍⚕️ Importance of Individualized Monitoring: Rather than accepting broad, universal statements about the dangers or benefits of ketogenic diets, Dr. Westman advocates for personalized health monitoring. Key labs—thyroid panels, cortisol, glucose, lipid profiles—should be interpreted by experienced clinicians who consider symptoms and context. This approach recognizes metabolic individuality and the fact that biochemical markers have nuanced meaning depending on dietary pattern and adaptation status.

• 📚 Critical Evaluation of Online Influence: Dr. Westman reminds viewers of the importance of scrutinizing influencer information, particularly from medical professionals with self-reported anecdotal experiences that may not generalize. Professional training, rigorous clinical practice, and comprehensive understanding of physiology and biochemistry matter in interpreting diet-related claims. Blindly adopting one person’s experience as universal truth risks overlooking the complex mosaic of human metabolism.

This video thus offers a balanced, evidence-informed perspective on ketogenic diets, advocating for reasoned analysis, patience during adaptation, and personalized nutritional strategies rather than blanket condemnations or endorsements.