The Ketogenic Diet, Inflammation, and Performance With Dr. Stephen Phinney

In this interview at the Symposium for Metabolic Health in San Diego, California, Mike Giardina sits down with Dr. Stephen Phinney to discuss how the ketogenic diet can prevent chronic low-grade inflammation to improve health and performance. Dr. Phinney is the co-founder and former Chief Medical Officer of Virta Health.

Dr. Phinney explains how inflammation is very complex and can be damaging but is also essential for health and survival — as long as it is modulated and controlled. Inflammation is a necessary process when healing from acute injury or infection. This type of inflammation is acute and short-lasting. Chronic inflammation is at a much lower grade, meaning there is no fever associated with it, but it lasts for months and up to many years. People with chronic diseases typically have chronic inflammation and run the risk of severe tissue and organ damage.

Doctors tend to prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or steroids to control inflammation, explains Dr. Phinney, but these medications come with a host of adverse side effects, such as lowered insulin sensitivity and catabolism. He has found that the ketogenic diet is a more viable and safer option. In January 2013, a study came out of the University of California San Francisco explaining how beta hydroxybutyrate (BHB) affects cell function. It turns out that BHB is not only a great fuel for the brain, but it also acts as a gene-expression altering signal. There are certain genes that are suppressed because they are wrapped in histones, explains Dr. Phinney, and when they are provided a level of ketones, proteins on these genes unwrap, which allows them to turn on. These genes provide an antioxidant defense we don’t have when we eat carbohydrates, which might explain why antioxidant supplementation is encouraged on a diet consisting of high carbohydrates, explains Dr. Phinney.

This inflammatory protection may apply to exercise as well. We know that vigorous exercise can lead to oxidative damage and muscle inflammation. This is a necessary stimulus to improve muscle strength and resilience. High-intensity training, while adapted to the ketogenic diet, may reduce the post-exercise inflammatory response, reducing recovery time between exercise bouts.

According to Dr. Phinney, CrossFit training while adapted to the ketogenic diet will likely have the same effect. A CrossFit athlete can expect the same training response, possibly with a higher perception of discomfort, but with the added ability to maintain a higher level of intensity with a greater frequency, leading to a greater training volume. As long as we provide an athlete enough time to fully adapt, the ketogenic diet can be used as a way to improve metabolic health as well as performance for both the general CrossFit athlete and the competitor.