#142 – The truth about why keto works & why you may be doing it wrong | Dr. Steven Gundry & Dr. Casey Means

What you think you know about keto and ketones might be wrong. Keto can be great for weight loss, but there’s a better way to do it by focusing on more diverse plant food, protecting your mitochondria through mitochondrial uncoupling, and focusing on fiber. Dr. Steven Gundry, author of Unlocking The Keto Code, and Levels Co-Founder and Chief Medical Officer Dr. Casey Means discussed mitochondrial uncoupling, xxx and the outweighed impact of food on our overall health.

07:55 – A career change

Dr. Gundry shared the story of how his life changed after meeting a patient from Miami, Florida and how it sent him on a path to rediscover our relationship with food.

I’m going one about a year into this, my wife still calls it black Friday, I looked in the mirror before I went into work at Loma Linda and I said, “I’ve got this all wrong. I shouldn’t operate on people and then teach them how to eat, to avoid me in the future. I should teach them how to eat and they’ll probably be able to avoid me in the first place. I mean, what a stupid career choice. I mean, at the height of my career to say I’ve got this backwards. And so I actually resigned my position at loma Linda and I moved a few miles down the road to Palm Springs where I opened up a clinic and I asked people, “Look, I want to give you a list of foods to eat, not eat, then I want to send you to Costco or Trader Joe’s, and I want to draw blood on you every three months that insurance or Medicare will pay for, and you’re my research project, okay?” And everybody goes, “Yeah. Okay.” But that you may have found out as a former surgeon, teaching people how to eat is not, let’s just say the monetary benefits of deep teaching people how to eat is not as good as surgery, but my wife, bless her heart, said, “Hey, you’re in this for a purpose and you have a belief and okay, let’s give this a go.” And that was 25 years ago.

11:57 – Keto Code

Keto Code breaks down how a lot of what people think about what is beneficial about the keto diet is actually for different reasons.

So I’ve had a ketogenic version of my diet from the plant paradox onward and one of the things that… And it worked very well, still works very well, but one of the things it’s based on is medium chain triglycerides, MCT oils, and anyone who actually looks at the lists of my ketogenic diet, even in that book says, “Whoa, there are a lot of plant carbohydrates in here and how the heck is that a ketogenic diet?” And yet it worked very well and still does. So when I was writing my last book, The Energy Paradox, I like to back up my explanations with cold, hard research. And I firmly believe that ketones were a great fuel and that your brain loved them, your muscles loved them, they were the perfect fuel, and that ketones, being in ketosis, made you an efficient fat burner, and that’s why you lost weight, it sounds really good to me.

15:25 – Efficient fat burner

When your body is working at full capacity—burning both glucose and fat for energy—it actually becomes more efficient at storing fat than burning it off.

Fat has nine calories per gram and protein and sugars, carbohydrates have four calories per gram. So if you are really an efficient fat burner, then efficiency means you get more mileage out of a gallon of gasoline. So now wait a minute, you’re eating more than twice the amount of calories when you’re eating fat and you’re telling me you are an efficient fat burner. So you all ought to be gaining weight if that’s actually true. And some people in fact do gain weight on the ketogenic diet, a number of my patients do, like what I talk about in the book. So something’s all not right with that idea. So what in fact happens?

17:05 – The connection of seizure to the fall of ketogenic diet

The ketogenic diet fell out of favor in the 1990s, but it had a resurgence as an MCT oil-based diet.

What I found fascinating in the seizure literature was the ketogenic diet fell off when drugs came along. But in the 1990s, it had a resurgence as an MCT oil based diet, and what they found was that they could get the exact same effects using MCT oil as the predominant fat, but they could introduce far more carbohydrates and far more proteins and still achieve the anti-seizure effect.

21:11 – The beauty of mitochondria

Dr. Gundry shares why mitochondria is important in our body and why it’s the powerhouse of the cell.

The beauty of mitochondria is, as you and I know, is they have their own DNA and they can divide without the cell they’re living in dividing. So you have these two signals, one is, protect yourself at all costs by wasting fuel. Number two, make a whole lot more of yourself so that each individual mitochondria has to do less work than the one we started with. And the consequences, yeah, you are actually, if you’re doing this right, going a lose some weight, but the overall benefit is rather substantial.

23:38 – The benefits of Ketones

Ketone bodies or ketones are more than just energy fuels for extrahepatic tissues like your brain, heart, or skeletal muscle. They play pivotal roles as signaling mediators and modulators of inflammation and oxidative stress.

The benefit of ketones is not so much this conventional ideology that we all talk about and throw around these terms so liberally, which is like, “Oh, ketones are the best fuel source. The brain loves ketones,” et cetera, et cetera, but it’s more that they’re a signaling molecule, which is actually telling the mitochondria that certain state is present, i.e., maybe starvation and that they need to protect themselves by having myogenesis, producing more of them, so each one has less work. And then also doing this process of mitochondrial uncoupling, where they’re actually just leaking out wasting protons.

25:49 – Uncoupling mitochondria

Mitochondria are the powerhouse of our cells. They turn sugars and fats into energy, and they do this by creating ATP, or adenosine triphosphate. But what if you could use less of your energy to do that so that you could get more work done with less effort?

At rest, we uncouple our mitochondria are 30% uncoupled or 30% less potentially efficient than they could be. And then that goes, okay, what’s the other reason? And that’s because as more and more of us are getting focused on mitochondrial dysfunction, one of the big underlying factors in almost all disease processes is that mitochondria making ATP is hard work and incredibly damaging, so probably a baseline, preventing that damage from happening is really kind of billed into our basic design.

30:13 – Instead of keto diet go for mitochondrial uncoupling diet

Dr. Means explains what should people do if they want to lose more weight.

The takeaway is like, you don’t actually want to go on a keto diet, you want to go on a mitochondrial uncoupling diet and that’s what you’re doing with the keto diet, but people aren’t even realizing it. And this is where the magic is, is that there’s all these other things. If the end goal is really mitochondrial uncoupling, well there’s like 10 other things you can do to mitochondrial uncouple, and guess what they don’t involve just totally restricting your carbon intake and it can actually bring in all these other nutrients that are beautiful for the body.

30:58 – What are other ways to stimulate mitochondrial uncoupling

Dr. Gundry shares one of shocking findings from World War I on how people lost weight when exposed to certain chemicals.

Well, one of the shocking findings in the book is, back in World War I, it was noted that factory workers in Germany and France were very skinny and despite eating a lot and they were running actually high temperatures and nobody knew why that was until actually the 1920s when they discovered that there was a compound in the making of gun powder called 2,4-dinitrophenol, phenol, remember that word phenol. And it’s called 2,4-DNP. And it was noted that when people were exposed to 2,4-DNP that they actually started losing weight and they started running high temperatures. So a couple Stanford doctors in 1930 began giving patients DNP as a weight loss drug. And over a hundred thousand prescriptions for DNP were written in the United States alone in the 1930s, and it was miraculous, at low dose DNP, you could lose a pound a week, at high dose, you would lose five pounds a week. I mean, miraculous. Levels would be out of business, I mean. But what was happening was, these people, it turns out DMP was the first oral mitochondrial uncoupler.

42:03 – MCT oil

Dr. Gundry shares the importance of MCT oil in people’s body and a surprising naturalsource.

The great thing about MCT oil is that MCT’s medium chain triglycerides are absorbed totally different than any other fat. They absorb directly without a chylomicron carrier from our gut. And they go directly to the liver where they are instantly converted into ketones. So you can get ketones by having MCT. So since we’re talking about fruit, you could have a bowl of fruit and have a tablespoon of MCT oil, and you would actually produce ketones, even though you ate that old stupid bowl of fruit. So that’s a really great trick and explains why I use MCT in my program. The other thing that I think is exciting is, MCTs were named for the Latin word for goat, which is Capra. So capric acid, caprylic acid, et cetera. It turns out that 30% of the fats in goat and sheet milk, are MCTs medium chain triglycerides. And so you can actually get MCTs by eating goat yogurt, goat kefir, goat cheese and get the benefits that you go, “Oh, wait a minute, cheese, cheese is bad for you.” Well, it turns out in an upcoming book, some of the longest living people in the world are goat and sheep herders, and I go into why that is, because they’re uncoupling their mitochondria because they’re making ketones, which is kind of fun.

Dr. Steven Gundry: (00:06) The signaling that sense to mitochondria is, there is only way you could possibly be in ketosis every day and that is you are starving to death. Everything else that eats fuel becomes your enemy, and so, muscles are the biggest enemy of fueling. And so you’ve got to produce insulin resistance to keep those muscles from getting the fuel that you, mitochondria have to have, and so to me, it’s no wonder that we see insulin resistance develop in long term ketosis.

Ben Grynol: (00:52)

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and this is your front row seat to everything we do. This is a Whole New Level.

Dr. Casey Means: (01:17)

Hello and welcome to a Whole New Level. This is Dr. Casey Means, co-founder and chief medical officer of levels. I am so excited to welcome Dr. Steven Gundry to the podcast today. Dr. Steven Gundry is an incredible independent thinker in the help space. We are going to talk all about his new book, The Keto Code, which is going to be fascinating because many of the things you think you know about why ketones help us are actually probably wrong. If you don’t know the ins and outs of a concept called mitochondrial uncoupling and how it is critical for all aspects of our health, weight, and longevity, stay tuned, you’re going to be blown away by this conversation. Dr. Gundry has an incredible professional history, which I can’t even scratch the surface of in this intro, but he is a world famous cardiothoracic surgeon. He is a top heart surgeon in the world with several medical patents into his name.

Dr. Casey Means: (02:09)

He has hundreds and hundreds of scientific papers and book chapters that he’s written. He’s written in eight incredible books. He was the chairman of cardiothoracic surgery at Loma Linda and has performed more pediatric heart transplant than almost anyone else in the entire world. So we are so lucky to have him here to chat with us. He actually left his surgical career when he realized how food could prevent almost a hundred percent of heart disease and totally shift his career toward focusing on getting people to learn how to eat properly and avoid heart disease and surgery. Welcome to a Whole New Level, Dr. Gundry.

Dr. Steven Gundry: (02:51)

Well, thanks for having me.

Dr. Casey Means: (02:53)

So thrilled to have you here. So I’d love to start by having you share a bit about your professional evolution. We share a similar thread in our paths in that we left the surgical world in order to help patients through food, and I’m just so interested in how this unfolded for you. So can you talk a little bit about how after doing thousands of heart surgeries and being so deep in the cardiothoracic surgery world, you decided to leave and realize that you could maybe make possibly a bigger impact by helping people understand their diets and their holistic health?

Dr. Steven Gundry: (03:25)

Yeah. My life, changed it’s about 27 years ago now, when I met a patient from Miami, Florida, who I called Big Ed in all my books, he’s a real person. He was 48 year old gentleman who was diagnosed with inoperable coronary artery disease. That means you couldn’t put stents in, you couldn’t do bypasses because everything was clogged up. And he would go around the country to the centers like mine at Loma Linda, where idiots like myself would take on just about anybody, I guess ego or whatever. Everywhere he went, he was turned out and nothing you can do for him. So he’d spent about six months doing this and he arrived at my office at loma Linda, and he brought in the angiogram, the movie of his heart from Florida six months earlier, and I looked at it and I said, “I got to agree with everybody that there’s nothing I’m going to be able to do for you, they’re right.”

Dr. Steven Gundry: (04:28)

He says, “Yeah, yeah. That’s what everybody says, but here’s the deal, I’ve been on a diet for the last six months and I’ve lost 45 pounds.” Now this guy was 265 when I met him, Big Ed. So he was over 300 when all this happened and he says, “I’ve gone to a health food store and I’ve been taking all these supplements.” And he had actually brought in this giant shopping bag full of supplements. And he said, “Maybe I get something in here.” And I was like, “Well, good for you for losing weight, but that’s not going to do anything in there. And I know what you did with those supplements, you made expensive urine, which is what I firmly believe.” I said, “You wasted your money.’ He said, “Look, I’ve come all this way. Why don’t we just get another angiogram and let’s see?”

Dr. Steven Gundry: (05:15)

Yeah. Okay. So we do. And in six months time, this guy cleans out 50% of the blockages in his coronary arteries, 50%, and I’ve never seen anything like that. And I’m going, “[inaudible 00:05:30], tell me about this diet of yours.” And so he starts talking and I go, “Wait a minute, I…” Back in the dark ages, I had a special major at Yale University, where we could design a major and have a thesis, very much like a master’s program and defend our thesis. And my thesis was, you could take a great ape, manipulate its food supply, manipulate its environment, prove you would arrive at a human being. And so I actually defended my thesis and got an honors and then gave it to my parents and went off to become a famous heart surgeon.

Dr. Steven Gundry: (06:08)

So as he’s talking about what he was eating, I went like, “Wait a minute, this is my stupid thesis at Yale. You’re on, “the ancestral diet.”” And I go, “Let me see that bag of supplements.” Now I’m very famous for protecting the heart during heart surgery. I invented a bunch of catheters, patented them and secret sauce that we’d put down the veins and arteries of parts. And I started looking through his supplements and several of the things he was taking, I was mixing in my secret sauce and I was putting it down the veins in the arteries and it never occurred to me to swallow the dumb things. So I call my parents who were in San Diego and I say, “Hey, do you still have my thesis.” And they go, “Yeah, it’s in the shrine.” And I said, “Well, send it up.” Because I was a big fat heart surgeon.

Dr. Steven Gundry: (07:02)

I was running 30 miles a week, going to the gym one hour a day, eating a healthy, low fat diet. I had migraine headaches during baby heart transplants and arthritis. I had braces on my knees to run and prediabetes and horrible cholesterol. And so I put myself on my thesis and I started taking a bunch of supplements and I lost 50 pounds the first year. And what happened was, I started putting my patients that I operated on, on this program and sending them to Costco or Trader Joe’s for supplements, there wasn’t an Amazon back then, and lo and behold, these people’s diabetes went away, their high blood pressure went away, their arthritis went away. I’m going one about a year into this, my wife still calls it black Friday, I looked in the mirror before I went into work at Loma Linda and I said, “I’ve got this all wrong. I shouldn’t operate on people and then teach them how to eat, to avoid me in the future. I should teach them how to eat and they’ll probably be able to avoid me in the first place.”

Dr. Steven Gundry: (08:21)

I mean, what a stupid career choice. I mean, at the height of my career to say I’ve got this backwards. And so I actually resigned my position at loma Linda and I moved a few miles down the road to Palm Springs where I opened up a clinic and I asked people, “Look, I want to give you a list of foods to eat, not eat, then I want to send you to Costco or Trader Joe’s, and I want to draw blood on you every three months that insurance or Medicare will pay for, and you’re my research project, okay?” And everybody goes, “Yeah. Okay.” But that you may have found out as a former surgeon, teaching people how to eat is not, let’s just say the monetary benefits of deep teaching people how to eat is not as good as surgery, but my wife, bless her heart, said, “Hey, you’re in this for a purpose and you have a belief and okay, let’s give this a go.” And that was 25 years ago. So, anyway. So [inaudible 00:09:38] at Big Ed, look what you’ve done.

Dr. Casey Means: (09:40)

It is such an amazing and inspiring story. And I think what people listening might not realize is that this concept of reversal of atherosclerotic heart disease, so like true blockages in the heart, we’re basically taught in medical school that doesn’t happen, this is not something… And so that, I can imagine that that was just like a big moment of like, what is going on here? I’ve got to dig into this. And so I think even to this day, that’s still a paradigm that’s quite in the water of like, you don’t reverse heart disease once it happens. And so, it’s just incredible that you have now spent the last what almost 20 years or so-

Dr. Steven Gundry: (10:18)

Yeah. 20 years.

Dr. Casey Means: (10:20)

… really preaching the power of food. And it’s also interesting to me that it kind of started with supplements because now it feels like a lot of your work has moved really into whole foods, unprocessed diet, really using food as medicine realm, but that there was a role for supplements and the end of your book, which I think you talk about the supplements you take every day. So I assume that your perspective on expensive urine has changed quite a bit since then. How many do you take every day? There were like probably what 40 in the book there.

Dr. Steven Gundry: (10:49)

Oh, I take about 120 different things in the morning and about 80 at night.

Dr. Casey Means: (10:54)

So I under balled it by about three times, but yeah. And so that’s so fascinating. So I could just talk to you about your story all day, but I want to make sure we get to the book because it’s such an amazing book. And a lot of people in the Levels community are really interested in the keto diet, because obviously we’re trying to keep our blood sugar more stable. But what I love about this book is that it shows a very different picture of the keto diet that is actually much more balanced, much more focused on colorful plant foods and a really diverse probiotic rich, prebiotic rich diet.

Dr. Casey Means: (11:28)

So your book, Keto Code breaks down how a lot of what people think about what is beneficial about the keto diet is actually for different reasons than they think, and that a lot of benefits of the keto diet can actually be more impactful if you shift up the real focus on macros and bring in a lot more plant food and a lot less macro tracking. So can you start by talking about why our conventional dialogue about the keto diet is flawed and what people are missing?

Dr. Steven Gundry: (11:57)

Yeah. So I’ve had a ketogenic version of my diet from the plant paradox onward and one of the things that… And worked very well still works very well, but one of the things it’s based on is medium chain triglycerides, MCT oils, and anyone who actually looks at the lists of my ketogenic diet, even in that book says, “Whoa, there are a lot of plant carbohydrates in here and how the heck is that a ketogenic diet?” And yet it worked very well and still does. So when I was writing my last book, The Energy Paradox, I like to back up my explanations with cold, hard research. And I firmly believe that ketones were a great fuel and that your brain loved them, your muscles loved them, they were the perfect fuel, and that ketones, being in ketosis, made you an efficient fat burner, and that’s why you lost weight, it sounds really good to me.

Dr. Steven Gundry: (13:08)

Well, so I wanted to back this up. So Workout of Harvard and also the NIH in humans show the exact opposite, at full ketosis, only 30% of energy needs are met by burning ketones, the rest is primarily free fatty acid and even at full ketosis, the brain, which supposedly think ketones are the greatest thing since slice bread, but we don’t want slice bread, no. The brain still needs 30 to 40% glucose as a fuel, so that’s the problem. The other problem is, if you look at the ketogenic literature in athletic work, even [inaudible 00:14:06] would say, “You have to get keto adapted and it may take weeks,” but the Workout of Harvard with Dr. Owens showed that at ketosis at three days, the muscles preferred fuel is ketones and then it falls off, becomes free fatty acids.

Dr. Steven Gundry: (14:26)

So wait a minute, [inaudible 00:14:29] are saying, “Well, your exercise tolerance is going to really plummet for maybe two weeks,” and yet muscles do best with ketones at three days, so you can’t have it both ways. So wait a minute, so ketones aren’t all this amazing fuel and the work in race walkers shows that in race walkers, you actually have to have far higher oxygen consumption to match the ability that you would get from more of a carbohydrate based diet. So all of these human studies are sorry, they’re really saying, “Well, wait a minute, ketones aren’t this amazing fuel. And if in fact ketones made you an efficient fat burner, what’s the problem?” Well, as we all know, fat has nine calories per gram and protein and sugars, carbohydrates have four calories per gram. So if you are really an efficient fat burger, then efficiency means you get more mileage out of a gallon of gasoline.

Dr. Steven Gundry: (15:46)

So now wait a minute, you’re eating more than twice the amount of calories when you’re eating fat and you’re telling me you are an efficient fat burner. So you all ought to be gaining weight if that’s actually true. And some people in fact do gain weight on the ketogenic diet, a number of my patients do, like what I talk about in the book. So something’s all not right with that idea. So what in fact happens? Well, you go back to the seizure literature and the ketogenic diet, the actual name ketogenic diet was coined in 1930 at the Mayo Clinic as a anti seizure diet in kids. And the original ketogenic diet was 80% fat, 10% carbohydrate and 10% protein. And it was very effective, over 50% of kids got major reductions in seizures. The problem was, as any of us who have had kids or now have grandkids, it’s nearly impossible to deprive carbohydrates from children, number one, and number two, it’s pretty impossible to take carbohydrates away from adults.

Dr. Steven Gundry: (17:05)

So what I found fascinating in the seizure literature was the ketogenic diet fell off when drugs came along. But in the 1990s, it had a resurgence as an MCT oil based diet, and what they found was that they could get the exact same effects using MCT oil as the predominant fat, but they could introduce far more carbohydrates and far more proteins and still achieve the anti-seizure effect. And that got me really intrigued because now here’s a workable diet, if you will, without this overload of just concentrated fats. And so I wanted to know, okay, well, if ketones aren’t this miracle fuel, what exactly are they doing? And it turns out professor by the name of Mark Brand wrote a beautiful paper in the year 2000 and everybody has to read it, I hope you’ve read it, and he argued, it is called Uncoupling to Survive.

Dr. Steven Gundry: (18:17)

On the surface, it makes absolutely no sense until you begin to understand what he was trying to say. In extremists, if you are starving to death, you are pouring out ketones right and left, mitochondria are the final common thing that keeps us from death, and if you are starving to death, mitochondria have to be protected at all costs. The way you protect mitochondria is basically to not make them work so hard. As I go through in the book, there is an elaborate system that we have built into our mitochondria, where we can take a lot of the protons that would normally be coupled to oxygen, to produce ATP and uncouple them from oxidative phosphorylation and basically waste protons out of trapped doors, emergency exits, and in that way, the mitochondria doesn’t have to work as hard and is protected from the significant damage that occurs during oxidative phosphorolation that I’ve rambled on in the book with the mito club and everything.

Dr. Steven Gundry: (19:45)

So he argued, and then subsequently went on to show and some fascinating papers, that if you look at very long lived human beings, they have the most uncoupled mitochondria of anybody. And now you go, wow. Now one thing I didn’t put in the book, but I like to mention on a podcasts, the other part of that is, okay, wait a minute, you’re starving a death, and you’re going to tell mitochondria to waste fuel, that’s really stupid. You should tell mitochondria to be very fuel of vision, because there’s not much lab. Well, part two of that is, okay, you’ve got to tell mitochondria to protect themselves, but simultaneously, you tell mitochondria to make more of themselves to carry the workload, and I like to use the example of a dog sled. Let’s suppose we have a dog sled and we have one dog pulling the sled.

Dr. Steven Gundry: (20:43)

Well, the dog can pull the sled, but you’re not going to go very fast and not going to go very far before the dog gets started out. Why don’t we hitch five more dogs to the dog sled then, just for the analogy of the dogs of mitochondria. And now, we’re going to go a lot faster we got a six dog sled. We’re going to go a lot farther, but we now have to feed six dogs instead of one dog. And so the beauty of mitochondria is, as you and I know, is they have their own DNA and they can divide without the cell they’re living in dividing. So you have these two signals, one is, protect yourself at all costs by wasting fuel. Number two, make a whole lot more of [inaudible 00:21:32] yourself so that each individual mitochondria has to do less work than the one we started with.

Dr. Steven Gundry: (21:39)

And the consequences, yeah, you are actually, if you’re doing this right, going a lose some weight, but the overall benefit is rather substantial. And I go on to point out, maybe you’ll agree, long term ketosis, 24 hour week after week, after week, the signaling that says to mitochondria is, there is only way you could possibly be in ketosis every day, every day, and that is you are starving to death and everything else that eats fuel becomes your enemy. And so muscles are the biggest enemy of fueling. And so you’ve got to produce insulin resistance to keep those muscles from getting the fuel that you, mitochondria have to have. And so to me, it’s no wonder that we see insulin resistance develop in long term ketosis. In fact, in my first book years ago, there’s a wonderful athlete study that they took athletes and put them to bedrest for 48 hours, and every one of them became insulin resistant within 48 hours of bedrest.

Dr. Steven Gundry: (23:00)

And you go, “Well, that’s kind of weird.” Well, no, it’s not, the only reason a trained athlete would be at bedrest for 48 hours was that he was injured and he could get food, and so this protective mechanism automatically kicks in and that is protect the mitochondria at all costs, and who cares about everybody else because get those energy hungry muscles out of the system.

Dr. Casey Means: (23:30)

It’s so fascinating. So just to kind of summarize what I’m hearing, which is just so interesting, is that really the benefit of ketones is not so much this conventional ideology that we all talk about and throw around these terms so liberally, which is like, “Oh, ketones are the best fuel source. The brain loves ketos,” et cetera, et cetera, but it’s more that they’re a signaling molecule, which is actually telling the mitochondria that [inaudible 00:23:55] certain state is present, ie, maybe starvation and that they need to protect themselves by having myogenesis, producing more of them, so each one has less work. And then also doing this process of mitochondrial uncoupling, where they’re actually just leaking out wasting protons, protons or electrons.

Dr. Steven Gundry: (24:14)

Protons.

Dr. Casey Means: (24:14)

Protons. Okay. But this is the part I wanted to dig in with you more because I was having trouble wrapping my head around, how does the wasting of protons lead to weight loss? Is it because you are also stimulating more mitochondria and so you’re more efficient at burning through free fatty acids that might otherwise go to fat storage or what is the mechanism behind how mitochondria lung coupling leads to weight loss?

Dr. Steven Gundry: (24:41)

You literally have to have more calories to produce the same amount of ATP and yeah, so it’s literally through fuel wasting. On the initial take it’s like, what a stupid idea, but as I talk about in the book, at rest, you and I, our mitochondria are 30% uncouple. In other words at rest, you and I waste 30% of all the food we eat just by putting these protons through these emergency exits. Now you go, “What in the world? That’s a really dumb design.” until then you go, “Okay, well, what’s happening with that?” Well, one of the theories is that we’re warm blooded animals and uncoupling produces heat. We know that brown fat is brown because the mitochondria are so dense, there’s literally brown under the microscope, but these guys are profoundly uncoupled and that’s how the heat production is accomplished.

Dr. Steven Gundry: (25:49)

Yeah. At rest, we uncouple our mitochondria are 30% uncoupled or 30% less potentially efficient than they could be. And then that goes, okay, what’s the other reason? And that’s because as more and more of us are getting focused on mitochondrial dysfunction, one of the big underlying factors in almost all disease processes is that mitochondria making ATP is hard work and incredibly damaging, so probably a baseline, preventing that damage from happening is really kind of build into our basic design. So whether it’s making heat, whether it’s preventing undo oxidative stress in mitochondria, I mean, when these… There’s five uncoupling proteins, and when they were discovered, I think in 1978, a long time ago, everyone went, “What the heck are these guys doing here? What are these guys doing?”

Dr. Steven Gundry: (27:10)

And now we know that, boy, these things are actually really essential. The other cool thing, I think, I talk about it in the book, there’s the theory of aging that goes into the cost of living hypothesis in aging, and that is in general of very small animals have very short lifespans, because they have a very high metabolic rate in general and very large animals in general have a much longer lifespan because in general they have a lower metabolic rate. And that makes us all feel good until you look at birds and birds screw the entire idea because birds in general are very small and yet a [inaudible 00:28:01] connectivity can live a hundred years, 80 to 100 years. In fact, years ago, I wanted to buy a cockatoo and we went to this crazy bird lady and she said, “How old are you?” And I said, “Hey, I’m 40.” And she said, “Well, who’s going to take care of the bird after you die.” And I go, huh.

Dr. Steven Gundry: (28:21)

And she said, “You have to show me, is it going to be your child? Is it going to be your sister because the bird is going to outlive you.” And I’m going, “Wow, this is a nutcase.” But she wasn’t nuts, she was right. A hummingbird in captivity can live 10 years and a hummingbird has a heart rate of 1100 beats a minute. And so people go, “Well, what the heck?” Well, it turns out that birds have incredibly uncoupled mitochondria. And so man, Brand’s right uncoupling to survive, but carries a lot of weight with me now.

Dr. Casey Means: (29:04)

No pun intended, there were some great puns in the book, people should definitely read it for that reason alone, but some good fasting puns. So I don’t want to get sidetracked on the hummingbird. I was thinking about a lot after reading your book, because you’d think they need so much ATP for their high heart rate, and so why would they uncouple so much because they actually have to produce all that ATP and they’re doing so much work to bring in all the nectar.

Dr. Steven Gundry: (29:34)

It’s to protect that energy producing machine, the mitochondria.

Dr. Casey Means: (29:39)

And to make more [inaudible 00:29:40] so that they end up consistently building more mitochondria.

Dr. Steven Gundry: (29:43)

And the really cool thing, like I mentioned in hummingbird, so they actually, they use retinol is actually their uncoupling agent that they get in nectar. And what’s fascinating is, when we give them all the colored sugar, they actually aren’t getting any retinol. So maybe we’re doing them a disfavor by doing [inaudible 00:30:04].

Dr. Casey Means: (30:04)

Interesting. Interesting. So the next super cool part of the book, so we’ve talked about mitochondria and coupling and really the takeaway is like, you don’t actually want to go on a keto diet, you want to go on a mitochondrial uncoupling diet and that’s what you’re doing with the keto diet, but people aren’t even realizing it. And this is where the magic is, is that there’s all these other things. If the end goal is really mitochondrial uncoupling, well there’s like 10 other things you can do to mitochondrial uncouple, and guess what they don’t involve just totally restricting your carbon intake and it can actually bring in all these other nutrients that are beautiful for the body. So I’d love for you to talk about, what are some of the other foods and lifestyle choices that also stimulate a mitochondrial uncoupling process that can kind of give us the benefits of a keto diet without the intense restriction of a lot of helpful foods?

Dr. Steven Gundry: (30:58)

Well, one of the shocking findings in the book is, back in world war, it was noted that factory workers in Germany and France were very skinny and despite eating a lot and they were running actually high temperatures and nobody knew why that was until actually the 1920s when they discovered that there was a compound in the making of gun powder called 2,4-dinitrophenol, phenol, remember that word phenol and it’s called 2,4-DNP. And it was noted that when people were exposed to 2,4-DNP that they actually started losing weight and they started running high temperatures. So a couple Stanford doctors in 1930 began giving patients DNP as a weight loss drug. And over a hundred thousand prescriptions for DMP were written in the United States alone in the 1930s, and it was miraculous, at low dose DNP, you could lose a pound a week, at high dose, you would lose five pounds a week. I mean, miraculous. Levels would be out of business, I mean.

Dr. Casey Means: (32:20)

Yeah.

Dr. Steven Gundry: (32:22)

But what was happening was, these people, it turns out DMP was the first oral mitochondrial uncoupler. The problem with it was, it wasn’t making any more mitochondria, it was not producing MIT. So people lost tremendous amount of weight. They ran very high temperatures because they were generating heat from… And they started having thyroid issues. But probably the worst part was people developed cataracts and this was before cataract surgery, and I joke it’d be great to see what you look like in your skinny dress, but you’re blind. Right? And then people start dying because quite frankly, like you were mentioning, they ran out of ATP. They were so uncoupled, they literally could not make enough ATP to live. So the FDA newly formed in 1938 banned DNP from prescription. But when I discovered that literature, I go, “Wait a minute, phenol, where have I heard the word phenol?”

Dr. Steven Gundry: (33:28)

Oh, poly phenol. And that’s lots of phenols. And so what is it about this phenol ring that’s so interesting? And what’s really cool is, plants at mitochondria, they’re called chloroplast and their mitochondria chloroplast are damaged by the very thing they need to produce energy, which is photons from sunlight. We need oxygen and oxygen is damaging our mitochondria. So plants have to be protected from mitochondrial damage from sunlight and they produce polyphenols to uncouple their chloroplast so that the sunlight won’t damage them. We see polyphenols all the time in the fall because the green leaves turn all pretty yellows and oranges and reds and purples, and those are the polyphenols that have always been there in the leaves but now we can see them. So what happens is, so those polyphenols were being used by the plant to protect, to uncouple its mitochondria.

Dr. Steven Gundry: (34:45)

So then we eat polyphenols. We [inaudible 00:34:49] polyphenols very well, but it turns out our gut bacteria absolutely love polyphenols, it’s actually a prebiotic fiber for gut bacteria. They in turn make those polyphenols bio available. And so now the plants polyphenols are given to us to protect our mitochondria by uncoupling mitochondria. And every time I think about this, I start thinking about the lion king and the circle of life and, oh, we eat the plants and then we… Yeah. So these plant compounds were designed to uncouple their mitochondria to protect them and we then get the benefit. So the point of all that is, when we say eat the rainbow, what we’re really saying is eat polyphenol containing foods. And when you look at the Mediterranean diet as an example, it’s just this cornucopia of polyphenol containing foods. You look at the Okinawan diet, the Okinawan diet is the traditional, what Okana diets. 85% of their calories came from the purple sweet potato and the purple sweet potato is just a giant hunk of anthocyanins and polyphenols. So wow.

Dr. Casey Means: (36:13)

It’s amazing. And I think it’s also interesting because you talked about this in the book. I think a lot of people think that the reason we want to have polyphenols is for antioxidant capacity. And you were saying it’s actually so much, maybe not that at all, actually a lot of it is really what this is doing to the gut and then the gut producing metabolic byproducts that are incredibly helpful for upregulating uncoupling proteins. Is that accurate?

Dr. Steven Gundry: (36:43)

Yeah. That’s exactly that.

Dr. Casey Means: (36:44)

One thing I want to just make sure I understand from the molecular side is, you talked about that the polyphenols, these rings are protecting the plant from sunlight, and so does this mean that, let’s say you have a lot of sun energy, you’re driving a lot of chemical reactions through the chloro past, that’s going to generate oxidative stress and reactive oxygen species and you don’t want that type of damage in huge quantities, and so the plant has to just release [inaudible 00:37:13] some of that essentially extra energy substrate. Is that right or-

Dr. Steven Gundry: (37:18)

Yeah. So photon damage is the equivalent of oxidative damage in us. So photons, sunlight is damaging, any of us know that, but the plant requires photons to produce energy. So what’s really interesting, we’ve known in wine making, the closer the vines are grown to the sun, the higher the elevation, the more polyphenols the plant makes and because it’s far more exposed, so then you go okay, we’ve known that for a long time and now we know, oh, that’s why they make more polyphenols is to, it’s getting far more hammered by sunlight. And so you’ve got to repair the damage. The other thing that’s fascinating that I talked about in the book is melatonin. So plants are a great source of melatonin and I laugh say, “Plant doesn’t need to go to sleep.”

Dr. Steven Gundry: (38:19)

So what the ding dong is the plant making melatonin for, and that’s because there are actually only two antioxidants that have ever been discovered in mitochondria and that’s melatonin and glutathione. And I talk about it in the book, for years I used to present a paper at the World Congress of Polyphenols and the chairman, Dr. Marvin Edeas, would… The one I remember distinctly was in Lisman and he got up to this big room of researchers and he said, “If any of you here actually think that polyphenols are antioxidants, you could leave right now, because I don’t have the time to show you why that’s not true.” And I went, what, [inaudible 00:39:07], but he was absolutely right, they are not antioxidants, and our traditional antioxidants like vitamin C, vitamin E have no effect on mitochondrial antioxidation, it’s melatonin and glutathione. Now vitamin C can regenerate glutathione or, and vitamin C can regenerate vitamin E but it’s not for mitochondria.

Dr. Casey Means: (39:32)

It’s interesting. So if the plant analogy about sunlight, essentially upregulating polyphenol composition for protective mechanisms, I’m curious why in humans, essentially that excess stress from like, let’s say excess glucose, for instance, you mentioned that glucose inhibits mitochondrial uncoupling, but in my mind it would be like, oh, well, if the mitochondria was getting this excess signal of energy that was driving it towards essentially going to drive towards increased [inaudible 00:40:03] stress and whatnot, wouldn’t that trigger… Wouldn’t it make sense that the cell would want to trigger uncoupling to kind of have a release file for that, but it’s actually the opposite.

Dr. Steven Gundry: (40:11)

It’s exactly the opposite because way back when it was [inaudible 00:40:17], and for instance, I’ve written, there’s actually huge books written about this, great apes only gain weight during fruit season only. We inherited those genes. And so during calorie excess, we would want mitochondria to shuttle any excess into fat storage. That would be what you would want, but that didn’t happen every day, we now have 365 days of endless summer and we’re always in fruit season, and we’re always in caloric excess season. So we don’t have a genetic program that understands that this would happen 365 days a year.

Dr. Casey Means: (41:09)

Yes, yes. That really brings it together and two awesome books that talk about this from this year as well, Nature Wants Us To Be Fat by Rick Johnson and then David Perlmutter’s drop acid, both of which talk about what you’re speaking to, the uricase mutation and various other vitamin C related mutations that basically make it so… Exactly what you said, when we are exposed to this high fructose food, the harvest, the bodies stored all as fat because that was our survival mechanism and now we have it, it is harvest every single day, but there were several other things you mentioned that can upregulate uncoupling process in the book, things like, I think I remember vinegar and even red light and MCT oil. So what is your go to list of like, these are mitochondrial uncouplers, diet and lifestyle wise that people should be thinking about.

Dr. Steven Gundry: (42:03)

Yeah. So the great thing about MCT oil is that MCT’s medium chain triglycerides are absorbed totally different than any other fat. They absorb directly without a chylomicron carrier from our gut. And they go directly to the liver where they are instantly converted into ketones. So you can get ketones by having MCT. So since we’re talking about fruit, you could have a bowl of fruit and have a tablespoon of MCT oil, and you would actually produce ketones, even though you ate that old stupid bowl of fruit. So that’s a really great trick and explains why I use MCT in my program. The other thing that I think is exciting is, MCTs were named for the Latin word for goat, which is Capra. So capric acid, caprylic acid, et cetera. It turns out that 30% of the fats in goat and sheet milk, are MCTs medium chain triglycerides.

Dr. Steven Gundry: (43:11)

And so you can actually get MCTs by eating goat yogurt, [inaudible 00:43:17] cheese, goat cheese and get the benefits that you go, “Oh, wait a minute, cheese, cheese is bad for you.” Well, it turns out in an upcoming book, some of the longest living people in the world are goat and sheep herders, [inaudible 00:43:38] going, why that is, because they’re uncoupling their mitochondria because they’re making ketones, which is kind of fun. And the other thing that I talk about, we’re now beginning to realize that cold therapy and heat and heat therapy actually are working by producing uncoupling a mitochondria. And I think the unifying theme is, okay, mitochondria, if they sense an incoming stressful event, whether that is starvation, whether that is extreme heat, whether that is extreme cold, they go into, we got to protect ourselves at all costs.

Dr. Steven Gundry: (44:27)

And the mechanism that is built in is we uncouple and because hard times are about to happen. I learned this as a heart surgeon. We, not me, but colleagues discovered heat shock protein, and we used that in heart surgery to prepare hearts for a prolonged period of ischemia, cross clamp aorta. And again, we said, oh, there’s this miracle protein called heat shock protein and it protects the heart, oh good, we want that. Well, it turns out that heat shock protein uncouples mitochondria and you go, “Son of a gun.” And the same thing with acid acid vinegar, vinegar is a short chain fatty acid and short chain fatty acids like vinegar, like acidic acid, like butyric acid berate are really good mitochondrial couplers. And getting back to how we started this, you really want your gut microbiome to have a lot of things to eat, to produce berate, to produce acetate, to produce other postbiotics that I’ve written about. And yet you’re not going to get that from a ketogenetic diet.

Dr. Casey Means: (45:51)

Fiber, we love fiber, I’m a fiber evangelist. So I was just like, had a lot of hell yeses reading your book because it’s just… I’ve always felt this way about the keto diet, I’m mostly plant based and I mean, honestly follow very similar to like what’s in your book in terms of what I eat and I’ve been able to stay with my ketones actually being between 0.7 and 1.2 most days on a largely plant based diet. And actually, the book really helped me figure out why this kind of might be the case. And so there’s just, there’s not one path to get to this end state, which I think is what your book really opens up for people. It doesn’t have to be this really restrictive thing.

Dr. Casey Means: (46:30)

It can use the physiology to understand all the different ways you can get at the same positive outcome and so, and fiber and basically supporting the microbiome so they can support you being a really big one. One question I had kind of getting molecular here about short chain fatty acids was, are they acting as genetic regulators in the sense that they’re actually upregulating uncoupling protein synthesis or is it acting more in the cell at the level of the mitochondria? What is actually happening with these? Because we talk about [inaudible 00:47:05] acids all the time and I was like, “I don’t know if I’m a hundred percent certain how exactly they work.”

Dr. Steven Gundry: (47:09)

Well, for instance, the berate serves as a substrate for beta-hydroxybutyrate [inaudible 00:47:17] which is the active ketone in us, but berate in its own right uncouples mitochondria as well as acidity. But I think the other thing that’s exciting about these short chain fatty acids is they are really histone decarboxylase inhibitors, and for those of us who really don’t particularly want cancer in our lives, that’s how cancer cells grow and reproduce. So if you have an inhibitor of histone decarboxylates, which berate and acetate, I would want a lot of that in my gut. The exciting thing about acetate people know that fermented foods are good for you, but it’s actually the short chain fatty acids that are produced during fermentation that are really the power of hitters in all of this. And that’s why apple cider vinegar, believe it or not, is actually pretty doggone good for you. And that it doesn’t have to be a mystical thing, oh, it makes you lose weight. Well, guess what? It’s uncoupling your mitochondria.

Dr. Casey Means: (48:29)

Yes. Drink that crowd juice, get every last sip because you want those postbiotics that they’re making. Yeah. It’s amazing. Something you were talking about with the plants and being closer to the sun, having more polyphenols really it’s kind of like a takeaway I had, it was like, we want our plants to have been stressed in a sense, we want them to have had to work harder because we’re going to get all those benefits. And in our unfortunate industrial agriculture, mono cropping, pest [inaudible 00:48:55] world, our plants don’t have to work hard, they’re just essentially babied with chemicals and it’s just… Yeah. And so now… So you talk about two reasons why pesticides and glyphosate and conventional produce is problematic. One that has to do more with the [inaudible 00:49:13] effect of those of chemicals in the mitochondria and then also the effect of what’s happening to our plants. So could you talk a little bit about conventional produced soil health and how this is just so bad for us on multiple levels?

Dr. Steven Gundry: (49:24)

Yeah. Plants are, you are what you eat, but you are [inaudible 00:49:29] the thing you’re eating [inaudible 00:49:30] and the plants are not eating what they used to eat and our soil is so depleted. In one of my lectures, I show a picture from a Senate document in 1936 that says, “Our soil is now so depleted of nutrients that you could eat all day every day and never get the essential vitamins and minerals that would reduce health.” And I say, “When was this documented?” And people guess and it was 1936.

Dr. Casey Means: (50:04)

No.

Dr. Steven Gundry: (50:05)

Yeah, 1936, we already knew this.

Dr. Casey Means: (50:08)

Oh God.

Dr. Steven Gundry: (50:09)

Yeah.

Dr. Casey Means: (50:09)

It’s so bad.

Dr. Steven Gundry: (50:10)

It’s so bad. Yeah. The soil is a living organism as well and plants have to be delivered their nutrients from the fungi and the bacteria that live in the soil and they’re all gone and everything’s gone. And so yeah, we can produce a head of lettuce, it looks like a head of lettuce, but it has nowhere near what it was supposed to have. And luckily Europeans are, for the most part, a lot smarter than us and there’s really big movements to ban roundup and glyphosate or just to not use it at all. But I mean, it’s everywhere in us. I mean, it’s in our wine, it’s in all of our organic oats. I mean, it’s everywhere.

Dr. Casey Means: (50:59)

And then there’s also a secondary effect of this chemical honor mitochondria. Is that right?

Dr. Steven Gundry: (51:04)

That’s correct.

Dr. Casey Means: (51:05)

Aside from just screwing up our food, what’s it actually doing to our ourselves?

Dr. Steven Gundry: (51:09)

Well, yeah, it looks like it’s a pretty cool mitochondrial toxin in its own right. And [inaudible 00:51:16] didn’t bother tell us that roundup was actually patented as an antibiotic because… Oh, by the way, because bacteria used the [inaudible 00:51:25] pathway, which is what plants use and we don’t use it, but oh, by the way, we just invented an antibiotic that targets the [inaudible 00:51:35] pathway, and we’re not going to tell you, but it’s going to kill all of your microbiome because your microbiome uses the [inaudible 00:51:42] pathway, have a nice day.

Dr. Casey Means: (51:44)

Oh my God.

Dr. Steven Gundry: (51:45)

We’ll let people stew about that. Yeah. Organic plants will have more polyphenols and quite frankly, the more polyphenols in you, the better.

Dr. Casey Means: (51:59)

Yeah. I have to turn my camera here. I’m now growing some plants inside here.

Dr. Steven Gundry: (52:04)

Oh, that’s cool.

Dr. Casey Means: (52:05)

So it’s totally pesticide free, but I have a world famous cardiothoracic surgeon on the line here, and so I have just a question, the number one killer in the United States for both men and women is [inaudible 00:52:18] heart disease. How much of that burden of disease do you think is preventable? Could you have a hunch of how much could just be totally avoided if we totally cleaned up our diets and lifestyles?

Dr. Steven Gundry: (52:30)

Oh, a hundred percent. Seriously, a hundred percent. That’s why I changed careers, a hundred percent.

Dr. Casey Means: (52:37)

Yeah. So like 700,000 deaths per year.

Dr. Steven Gundry: (52:41)

There are people who do not eat like us who do not develop coronary artery disease. I mean, the [inaudible 00:52:52], one of my favorite people to talk about and Papua New Guinea, they smoke like [inaudible 00:52:58] and there has never been a recorded coronary artery lesion or a stroke in these people. And by the way, as I talk about nicotine as an uncoupler, but [inaudible 00:53:09], do not smoke.

Dr. Casey Means: (53:11)

Well, I think that’s a good note to end on because that is a note of empowerment. It is in our control. It is in our control on the tip of our forks, the answer. And I am so grateful for the message you were putting out into the world. It has inspired me. It has inspired my career and I know is going to inspire people listening to this conversation. So you’re doing incredible work, and I just want to commend you and thank you so much, Dr. Gundry.

Dr. Steven Gundry: (53:36)

Well, thanks. I’m going to keep doing it. You won’t be able to [inaudible 00:53:41].

Dr. Casey Means: (53:42)

Anything you want to call out in terms of where people should find you, what they should be following.

Dr. Steven Gundry: (53:46)

Well, I have the Dr. Gundry podcast and you can find me on YouTube, Instagram. You can find me at drgundry.com. You can find me at my website for supplements and food, dundrymd.com.

Dr. Casey Means: (53:58)

And you’re taking patients?

Dr. Steven Gundry: (54:01)

Oh yeah. I still see patients. I see patients six days a week. On the weekends, I’ve got a… This is Friday, I’ve got a full schedule tomorrow and Sunday. Yeah. And on the seventh day, I don’t rest. I’m at Gundry MD. So I actually work seven days a week.

Dr. Casey Means: (54:16)

Oh my gosh.Dr. Steven Gundry: (54:17)

So I better have good uncoupled mitochondria.

Dr. Casey Means: (54:20)

You better, yes. And everyone get the book. Thank you so much.

Dr. Steven Gundry: (54:23)

All right. Take care.