Jillian Michaels has no credibility.

Posted on June 1, 2018 by Dr. G

“Jillian Michaels urges fans to stay away from the Keto diet.”

Is the title of the article published in Prevention Magazine on May 21st 2018.

The fitness trainer called keto a “diet fad” that doesn’t make sense for most people. Included in this article are concerns raised by Jillian and other healthcare “experts”

Here is my response.

The Prevention magazine article is a perfect example of what it’s like when the wrong questions are asked, you wind up with the wrong answers. My critique of Prevention magazine’s article will focus on the insights of the professionals that were interviewed and i will do my best to put the comments in proper perspective for you. Please forgive me if I get too technical. After reading this response, you will be better equipped to make a decision that is right for your health and your goals. .

However, first I’d like to take a slight swipe at Jillian Michaels, professionally not personally. Specifically as it relates to how she became a celebrity and de facto “expert”.

Believe it or not, Jillian Michaels lacks credibility.

Jillian Michaels is famous for her role as one of the coaches on the hit television show, the biggest loser. A show that follows a group of obese men and women through a massive diet and exercise regimen that turns out to be a race to the bottom for weight loss and apparent fitness. During this process the contestants get off of their prescription medications, they increase their self esteem, confidence and their lives undergo a massive overhaul in a relatively short period of time. This is why Jillian Michaels appears to HAVE credibility.

What the show does not reveal is why there will never be a reunion episode of the biggest loser. I refer you back to an article I had written on the subject some months ago. All of the weight the winners and other contestants lose returns after 2 years and then some. This is true nearly 100% of the time. The data should be collected, compiled and analyzed because that number of people over, I believe 12 years, should represent a pretty significant study. But this study does not have to be done because we’ve known for a hundred years why these results are so predictable.

The biggest loser and Jillian Michaels get their results by ascribing to the idea that ‘eat less and exercise more’ is the path for you to have success and look like a fitness model. This is a lie and that will never change. The Science has been well documented for 100 years. Yet, most viewers of the show and anyone with some weight to lose who believes that they are overweight because of a defect in their genes or even worse; a character flaw and lack of willpower is the reason why you are overweight, unhealthy or obese.

What’s wrong with the Prevention magazine article. Let’s take it point by point.

Prevention Magazine / Jillian Michaels – The article begins with the assertion that the Ketogenic diet is beneficial only for those of you with severe insulin resistance which includes people with PCOS (Polycystic Ovarian Syndrome), type 2 diabetes and infertility. Jillian believes that eating too much sugar and processed carbs and “don’t eat too much food in general” is all you have to do to.

DrG- The idea that you have to have these three diagnosable medical disorders in order to have insulin resistance is the height of irresponsibility when it comes to how medical and health care professionals communicates with you. Waiting for what may be an end stage disease process like diabetes before you recognize there is a problem with insulin is insane and why we will be allocating 85% of our medical resources for the long term treatment of metabolic diseases like cerebro/cardiovascular disease, alzheimer’s and cancer.

Recognizing pre-diabetes and telling you to be careful or you will get diabetes, implies that pre-diabetes is not a disease. Pre-diabetes is a disease.

By the way, what kind of advice is “don’t eat too much food in general”? Does that mean you should push away from the table while you are still hungry. Ask anyone who has gone on a “diet” how long that lasts. Is that what Jillian Michaels does. Does she just have such superior will power compared to the rest of us.

Prevention Magazine / Jillian Michaels. Jillian states that “when you increase healthy fats, moderate protein and severely restrict carbs, you are quite literally ‘starving your cells’”

DrG What Jillian calls a severe restriction of carbs, may actually be quite normal for our genetics. We have to remember that the last few generations, are the only generations in the 50-70 thousand year history of modern humans to have unlimited access to cheap calories our entire lives. No generation in human history was fortunate enough to wake up to a refrigerator and pantry full of food, specifically glucose.

Don’t let the following paragraph make your eyes glaze over.

Where did we (humans) come from?

We need some context based on human physiology that holds up to the test of time (10’s of thousands of years) rather than the opinions of myself, Jillian Michaels or anyone else.

We are living in a world that we created with our intellect and sheer brute force of human intelligence. Refrigerators, food with shelf life, agricultural advances, air conditioning, heating, lights and electricity and all modern advancements are a blessing and have contributed to us living in a world far more comfortable than where our ancestors come from. However our genetics are in a very foreign place. Our genes are adapted to a world far more harsh than the one we live in. With that harshness comes adaptations that improve health and survivability.

There is a great disconnect between what our genes expect from our environment and what our intellect expects from our environment. Our genetics control our physiology and health and the genes get their signals from the environment we put them in. Our food is one example of our environment. To put it simply our physiology and therefore our health expects the food environment of 10,000 years ago, not what in your refrigerator or pantry.

What Jillian calls ‘severely restrictive’ needs to be defined. Severely restricted compared to what?

Prevention Magazine / Jillian Michaels. Jillian is correct when she touts the benefits of caloric management and restriction. Caloric restriction is tied to many benefits including disease prevention (diseases such as cancer), supporting immunity and she leaves out some, like brain health and others. Caloric restriction does reduce oxidative stress, however the mechanism for that is largely because of ketosis.

DrG. What does caloric restriction look like? As I stated before and what you all innately know. Pushing away from the table while you are still hungry 3X per day every day is not something we could or should do. As I stated above, the reduction of oxidative stress seen with calorie restriction is largely due to ketosis.

Back to our ancestors.

Let’s revisit our ancestors again. You may ask, ‘why do we care about our ancestors 10,000 years ago, didn’t they die at 30 years old, of diseases we’ve cured with modern medicine and vaccines?’. The quick answer to that question is ‘NO’. It’s no mystery that the healthiest humans were our hunter gatherer ancestors. Pre agriculture and pre civilization. The diseases you are thinking of were diseases of crowds, when hunter gatherers not that long ago began to farm and gather in close quarters like towns, villages and cities which were pretty filthy for several thousands of years until sewage, sanitation and other advancements made it possible to not pee and poop in the same water we cook with and drink.

Chronic health problems: Chronic pain syndromes attributed to arthritis, obesity, diabetes, heart disease, stroke and dementia are diseases of modern living. A result of the disconnect between what our intellect recognizes as ‘normal’ and what our genes consider to be ‘normal’.

Prevention magazine / Kristen Kizer RD: Prevention magazine then turns to the medical experts. Kristen Kizer is a registered dietician at the Houston Methodist hospital. She states that we are not supposed to be living on what would be an “emergency fuel” like ketones for long periods of time. She states that ketones are negatively charged and therefore they are acidic that can result in pulling calcium out of bones in order to buffer the acidity.

DrG. I have a feeling if I had a long protracted conversation with Kristen on the details of this topic, we would probably agree more than we disagree. However on this point, the studies on long term ketogenic diets in humans and carbohydrate restriction do not support loss of bone density as a side effect.

The studies that contradict the above statement are in mice but not to be found in humans. There is further study needed for children however. The research in children is for medically induced, long term ketogenic diets that can be 80-90% fat for the treatment on intractable epilepsy. Children have skeletons that are still growing and therefore the anabolic or growth signals needed from insulin (carbohydrate and protein intake) are reduced. Adults do not have the same needs as children for growth signaling from insulin. Adults are mostly using food for repair, children use food for both growth and repair.

In addition, people trying to improve their health and lose weight are not necessarily on as strict of a ketogenic diet that you would see with intractable epilepsy. I usually say they are on a ‘Keto-friendly-lifestyle’ in which case they would have no need to be concerned about those lifestyle changes affecting bone health.

Kristen then says something that is just wrong and unfortunately the people who get this wrong the most are our most well educated medical doctors. Makes me scratch my head everytime I hear it. She said that if ketones get too high, you may put yourself at risk for a life threatening condition seen in type 1 diabetics called ‘ketoacidosis’. You cannot fast or eat yourself into a condition of Ketoacidosis without being a type 1 diabetic. I dare you to try. Studies have been done where the subjects were fasted (fasting is the most rapid way to get into ketosis, not diet) for 40 days and they did not reach blood levels greater than I believe 8 or 9 mMol of BHB. Ketoacidosis, a condition only seen in insulin dependent diabetics, is impossible to induce in yourself. As a matter of fact ketoacidosis and nutritional ketosis are so different that should not have names that sound similar. One has nothing to do with the other. End of story.

Prevention magazine / Kristen Kizer RD: Kristen then goes on to list a series of symptoms and conditions that people are at higher risk for such as bad breath, kidney stones, muscle cramps and dizziness. She the states there are some risks for poor cholesterol outcomes, increased inflammation and moodiness.

DrG: This is kind of unfair for her to say. Just because there is partial truth to these statements, they should be examined more thoroughly.

The bad breath experienced when people quickly (in my opinion too quickly and un-healthily) move to ketogenic lifestyles is due to the acetone in your breath. Acetone is one of the 3 ketone bodies we make. When we are inefficient at utilizing ketones as a fuel source because we have been waking every day with a pantry and refrigerator full of food, we are most efficient at using glucose for fuel not ketones. If we deprive ourselves of glucose we will take protein and fat and break them down to make glucose, called gluconeogenesis (making more glucose).

We will also take our body fat and dietary fat and make ketones, but we make both ketones and glucose. If our muscles, heart and brain are preferring glucose, which they will initially prefer, you will dump the excess ketones into your lungs as acetone and your urine as acetoacetate (which is why the urine strips change color when you are testing.) Over time your muscles, heart and brain will develop the cellular machinery (enzymes and such) to better utilize ketones for fuel and they will in many circumstances prefer the ketones over the glucose. When they do, the amount of acetone that you are breathing out will drop and so will any acetone smell.

One reason is the above stated benefit of reduced oxidation which by definition means reduced inflammation, ketones are a cleaner fuel than glucose making significantly less reactive oxygen species per unit of energy produced.

With regards to the articles statements on cholesterol, that is a topic that requires its own blog post, maybe even a book. Lets just say there is a relatively small sub population of people who will have long term negative consequences with a long term ketogenic diet. Most of the research and clinical experience shows dramatic improvements in lipid profiles after an initial 3-6 month phase of elevations followed by subsequent reductions in total cholesterol and LDL. The exciting research, where its been shown that the particle size of the cholesterol becomes more favorable.

The devil in in the details

Total cholesterol, LDL and HDL are not numbers that are worth examining. It is the triglycerides, particle numbers, particle size, Lp(a) and other more detailed measurements that should be tracked it one is concerned about their cholesterol. There seems to be a lot of excitement on this level for the general population with some exceptions.

What does DrG think.

As a health care professional I have recommended the keto-friendly-lifestyle to many of my patients for many conditions from weight loss, to autoimmune disease, chronic pain, post concussion syndrome and the list goes on and on.

In my practice I promote healthy natural states. The states that our genes may find favorable based on human history that resulted in survival and success of our species. That means being in ketosis 100% of the time is not at all desirable because it is not a natural state. This also means being out of ketosis 100% of the time is also not a natural state. Being in a fed anabolic growth state all the time is an unnatural human experience.

What IS natural is the ability to go in and out of ketosis with flexibility and ease. This may require some people to spend more time pursuing ketosis in the initial 3,6 maybe 12 months in order to re-develop that flexibility that is programmed in our genes. The ‘software’ for that flexibility may not have been ‘booted up’ for quite some time, if I could borrow computing terminology.

Cycling in an out of ketosis is ideal. Some climates (yes geography matters) are more conducive to a ketogenic state most of the time and some climates are more conducive to being in a fed, anabolic, ‘glucose burning’ state most of the time. For example in the winter months here on the Northeastern U.S., our genes that control our digestion and physiology are more expecting of exposure to protein and fat as well as extended periods of fasting. However in the summer, when the sun is out and at its highest point, our genes and physiology are more expecting of the carbohydrates that are growing all around us.

Ketosis is a powerful, safe and effective tool for restoring your natural physiology back to what it should be for optimal health, brain function, immunity, body composition and fitness. It should not be a state of physiology you want to live in 100% of the time, after all that is starvation physiology. We should spend more time in starvation physiology because many genes are turned on by that experience. All humans that came before us had to endure and therefore adapt to ‘starvation physiology’. The genes that get ‘tuned on’ during these periods fight obesity, cancer, dementia, cardiovascular disease and most chronic disease.

I hope this clears up some of the questions surrounding this topic. If you have more questions on this topic, Which you should please post them here in the comments section and let’s keep the conversation going.

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