Hosts Richard Morris and Carl Franklin interview two ketonians classified as TOFI (Thin on the Outside, but Fat on the Inside). They both have metabolic syndrome and are anything but obese. Metabolic syndrome strikes thin people, too! Get the skinny (pun intended) on TOFIs in this excellent interview with Matt Murray and Terri Lance.
It started in 2003 in Las Vegas when Richard (born 1965) gave up smoking under his
doctors' supervision (using drugs). He compensated by eating just enough
more to put on about 20lbs.
Doctors told Richard his triglycerides were getting high and so he should
diet. He started drinking SlimFast nutritionally complete meal replacements.
At his next blood test he found out he was pre-diabetic and was referred to
an internist who got him on metformin and statins.
Then, his glycemic control worsened. So, they upped the drugs.
His blood pressure started marching north, so he reduced all salt in his diet.
Shortly after, Richard met the Atkins low carb high protein diet.
That was 2005, the height of the first low carb diet craze when
supermarkets were switching from selling bread to low carb wraps,
and fast food joints were doing low carb breakfast bowls.
After 3 months of Atkins, Richard's blood glucose was normal, his lipids
were normal, and his blood pressure had normalized.
He figured he was cured! He took a victory lap and moved to Australia,
retiring from software development to concentrate on getting his health
back. He'd do it by exercising and eating clean - which meant learning
to cook, and to grow food, and to do things like hand make cheese.
Fast forward 10 years. Richard had a personal trainer working him ragged
for 3 x 30 minutes every week. He was cycling 100km a week, and his diet
had become full of things like hand made pastas, pizzas with homemade
mozzarella, lot's of meals with whole grains or pulses, all the good stuff
that he had learned to cook. Pretty good retirement, right?
But Richard had put on a lot of weight, almost as much as he had when he
was sick in Vegas. To make matters worse, he had developed a bad toe
infection that started as an ingrown toenail and wouldn't go away.
Eventually it was so bad that he took it to the ER, and they told him
it was so badly infected that he may have to lose it, and by the way
did he know he was a full on type 2 diabetic?
Defeated, he went back onto diabetes drugs (Metformin, Statins, BP meds),
and saved the toe, but he slowly got sicker and sicker. Then they wanted
to put him on a new drug called Januvia. After doing some research he found
out that in a UCLA study of cadavers that had taken Januvia there was
found a remarkable incident of pancreatic duct tumors.
The spectre of cancer was enough. After going through the stages of grief
Richard made them a deal. If he could not fix this in three months he'd take
the damn cancer pills.
Rather than getting depressed and accepting the diagnosis he studied
everything he could about nutritional ketosis, which is the new hard core
version of the low carb diet that is also lowish protein and as much fat
as you can eat. He obsessed.
After 5 months Richard was no longer diabetic by any measure known to modern
pathology. He went from having a disease that is, according to medicine,
only ever progressive and not curable - to being asymptomatic.
His HbA1c was 5.2%. Diabetic ranges start over 7.5%.
Normal is 5.0% to 6.5%. Richard's level at 5.2% is better than
many people who are very insulin sensitive. He now exercises less,
and he's healthier than ever. It's a keto miracle.
In February, 2016 Carl approached him about doing 2 Keto Dudes to provide
information, links to the studies supporting the ketogenic diet, and of course
recipes. Like Carl, Richard is a foodie. They both enjoy cooking, now more than
Carl Franklin (born 1967) has been heavy almost his entire life, with brief
periods of weight loss and good health. After he quit smoking in 1991 he gained
nearly 70 pounds, which wouldn't begin to come off until years later when
he discovered the Atkins diet.
Atkins proved to be hard to stick to. In hindsight, it's because you slowly
bring carbs back into your diet, and it's too easy to skip the fat necessary
to stay in
instead opting for 'healthy' foods like whole grain bread and
After a divorce in 2008, Carl went back to a ketogenic diet and lost 60 pounds.
He went from 379 to 319 where he hit a wall. After being remarried, the weight
slowly came back on until he was over 350.
His sugars had always been in control, though, because he occasionally would
eat low carb for 4 or 5 days. That was enough to keep it just low enough so
the doctors wouldn't be alarmed. Pressure from friends and family to watch out
for the 'dangers of low-carb dieting' always scared him away from fully
In 2014 he convinced his doctor to let him try a new weight-loss drug, QSymia,
which suppresses appetite. It worked at first. He lost about 20 pounds, but
found his appetite coming back. The dose had to be upped until he was taking
what he thought was way too much. By the time he was at the third level of
dosage increase his appetite was back to normal, and the weight came back
on with a vengence. Of course, he was eating the FDA food pyramid, which
didn't help his hunger. He went off QSymia, and gained even more weight.
In June, 2015 Carl was diagnosed with Type 2 Diabetes. His doctor knew about
the benefits of low-carb diets, and encouraged him. In 2015 Carl learned that
a close friend had colon cancer and went under
the knife. This friend had gone ketogenic to keep his cancer in check, and
it was working. Richard Morris was a mutual friend as well, and Carl had read
about his success with keto on the social networks.
That was it. He was 366 pounds. He knew low-carb was the only thing that
worked for him. It was time. He started low-carb again in January, 2016, and
this time did the research that convinced him to go full-blown ketogenic.
His doctor gave him the green light, and he began keto in earnest on February 1st, 2016.
When Carl started 2 Keto Dudes with Richard Morris, he had already lost
24 pounds and was on his way to recovery. After only 2 and a half months of
keto eating, with no drugs and no exercise, he had lost a total of 35 pounds
(11 on keto), and his HBA1C (a three-month average of blood sugar) went from
7.4 (diabetic) to 6.1 (pre-diabetic). In July, 2016, Carl was 297 (70 pounds lighter),
and his A1C was 5.9 (non-diabetic). 2 Keto Dudes is the story of
Carl and Richard as they navigate the ketogenic lifestyle.
Our bodies run on two primary fuels: glucose and fatty acids.
It's kind of like we have a car with an engine that can run on either
gasoline or diesel. We fuel up by eating food. If we eat food containing
sugars and starches (carbohydrates) we convert those quickly into glucose
and we run as glucose burners. All the cells in our bodies can turn this
glucose into energy. This is why it's sometimes called our primary fuel.
If we eat more glucose than we need for immediate exercise requirements,
our livers sweep up the extra glucose and turn it into saturated fat,
and sends this (and any fat we have eaten) off to our fat cells to be
stored for lean times.
If we don't eat any carbs and instead eat fat (and moderate protein)
most of our cells can easily burn the fatty acids
for energy. It could be the fat in our food but it could also be fat that we have
stored in case food is ever scarce. This state is called nutritional ketosis.
We often go into ketosis during sleep (if we haven't eaten a late dinner), and of course anyone doing
a fast is running their fat burning engine.
Some cells in the body (and the most metabolically active organ -
the brain) can't burn fatty acids, but your brain can use ketones.
These are small water soluble molecules that you make as a by product
of metabolising fats.
Luckily your liver makes glucose even when you don't eat any
carbohydrates, and by a quirk of fate, when it is making glucose for
your brain it is also pumping out a lot of ketones.
We evolved to be predominantly fat burners for 11 months of the year.
At the end of summer (when ripe fruit is available) we became predominantly
glucose burners. We are good at adapting from one mode to the next,
although it can take a few weeks for the machinery of fat burning to
spin up to full efficiency and put our glucose burning into idle.
Once you are adapted to burning fat (keto-adaptation)
and you start eating carbohydrates again, in a few weeks your glucose burning metabolism
will be back up at full speed.
In our modern world, however, we are burning glucose all year round,
6 meals a day. Our bodies have forgotten how to burn fat. We just store it and
never get a chance to burn it. Some of us have become so metabolically
deranged working our glucose metabolism 24/7 365 days a year that our
mechanism for safely metabolising glucose has become broken - and that
is how we got type 2 diabetes.
The Ketogenic diet addresses this by forcing your metabolism to
predominantly burn fat, restricting your dietary carbohydrates,
and relying on your liver to make all the glucose and ketones your
brain needs. Most of the rest of your body burns fatty acids
directly for energy.
When you give your body fat, it becomes good at burning fat!
When you give your body glucose, it becomes good at storing fat!
But what about the studies that show correlation between fat intake and
heart disease? If you look carefully, study after study shows that increasing
fat intake while eating more than 50 grams of carbohydrates a day
will indeed increase heart disease and all that goes with it. These
studies fail to remove the carbohydrates!
Some people are good at switching from one mode to the next.
Type 2 diabetics, however, have a broken metabolism for dealing with
glucose, so when we eat carbohydrates we get progressively worse glucose
control and consequently get sicker over decades. We can, however, hack our body
into being full time fat burners. This hack not only allows us to
maintain safe glucose levels (http://www.ncbi.nlm.nih.gov/pubmed/19099589),
with less medication (http://www.ncbi.nlm.nih.gov/pubmed/25071075),
but improves many of our biomarkers of disease.
The bottom line for us is that following the low fat model for the past
40 years has made us fatter and sicker. In 2012 some 52% of US
adults - according to the projections in this study
- were either diagnosed with type 2 diabetes (9.1%), or undiagnosed type
2 diabetics (5.2%), or they had a condition called prediabetes,
meaning they were metabolically deranged but not quite at diabetic
levels (38%). So, it is no longer just some of us. Most of us
are in trouble.
That is why we're 2 keto dudes, and why we're doing this podcast.