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.
Comments on The Ketogenic Diet, Inflammation, and Performance With Dr. Stephen Phinney
Now 5th year in CrossFit, I agree that reducing carbs to 100 grams (not counting fibre) has always dramatically reduced my pains and aches, and has also increased my workout performance. I think increased workout performance is due to body feeling much better in general. It improves sleep as well. I increase my healthy fat (nuts, eggs, cheese, olive) and not protein (keep it to 130-140 grams) when reduce carbs.
Also when controlling carbs, I make sure I eat carbs which have low GI. I try to have high GI carbs only 1-3 hours before the workout, or night before if workout is early morning, so that they get burned.
When not controlling carbs, my carb intake is over 200 grams. And this generally does bring back aches and pains and affect workouts as well. But in general I eat and drink everything, I like all sorts of foods, many of which are considered junk foods, but eat them in moderation and always balance them out. End of the day I always make sure I have taken 40% carbs, 30% fat and 30% protein for the day when not controlling carbs; or 20% carbs and 50% fat maintaining protein to 30% when controlling carbs.
Fantasic. My n1 experience shows lower carb (processed and natural) decrease my aches and pains and my energy increases. Love seeing varying views on health and nutrition.
Please stop promoting a low carb or keto diet. While it can be beneficial for a short time for certain individuals, it should not be followed long term, especially in athletes and women. As a certified nutrition coach and someone who experimented with low carb, I can say it will wreck your metabolism. We need carbs. While we shouldn’t eat a standard American diet full of grains and insufficient protein, we shouldn’t be afraid of fruit, tubers, rice and properly prepared grains. Also, keep in mind that most of the studies on keto are short term and only include men. The ones that do include women do not show the same benefits for women. We need carbs for a healthy cycle.
It's unfortunate you had a bad experience, however there are a lot of medical docs, PAs, NPs and other providers (including Dr Ken Berry, Dr Andreas Eenfeldt, Dr Aseem Malhotra, Dr Sara Hallberg, Dr Tim Noakes, Dr Ted Naimen, Dr Robert Lustig, Dr Michael Eades, Dr Jeffrey Gerber, Dr Jason Fung, Dr Dominic D'Agostino, Dr Bret Scher, Dr Eric Westman, and MANY more) who have completed dozens of RCTs, meta analyses, and cohort studies that would prove otherwise. The science does support nutritional ketosis- if done right. There have even been studies done on CrossFit athletes, and some of these docs also do CrossFit.
He’s essentially saying you should cut out the majority of fibre from your diet. That’s not a good idea.
Also, how does he suggest athletes get adequate protein? As when protein is consumed in adequate amounts will knock you out of ketosis.
I really cannot understand the CrossFit philosophy of low carb for so many reasons.
Yes it may have a place in individuals in a diseased state, but stop promoting it for the general public. It’s irresponsible
Please start explaining what you mean when you say carbohydrates - it's to broad as a term. Not defining it is just lazy and irresponsible.
The Ketogenic Diet, Inflammation, and Performance With Dr. Stephen Phinney
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