• You’ve dealt with cancer in the past, so would you mind just starting us with you own story?
• Can you tell us a little bit about what a ketogenic diet is?
• Why do you think that a ketogenic diet is very helpful for cancer patients? What makes it so special?
• What’s your opinion on the whether or not cancer is a metabolic disease, and what does that even mean either way?
• When there is damage to the mitochondria, why do you feel like a ketogenic diet is then useful in that regard? What does a ketogenic doing to the mitochondria itself?
• Who should be doing a ketogenic diet?
• What are your thoughts about how glucose intake without cancer would affect the risk of getting cancer? Do you think that a ketogenic diet can be considered a preventative diet for cancer, or do you think it’s just a therapeutic diet once somebody already has cancer?
• What kind of things are you monitoring to determine how low someone should go with carbohydrates or any other macronutrient for that reason?
• Where does the stress level have to lie in someone implementing a diet like this for it to become not useful anymore? How can you determine if it’s going to do more harm than good for someone?
• How does digestion play a role when it comes to the ketogenic diet?
• Can you tell us a little bit about the resources that you have available for people that are interested in this?

Links Discussed:

• WildFoods.co – Use the code WILDRD for a free gift!

TRANSCRIPT:

Laura: Hi, everyone. Welcome to episode 51 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always Kelsey Marksteiner.

Kelsey: Hey guys.

Laura: So Kelsey, are you getting excited for your trip to California?

Kelsey: Yes. Oh my gosh, I’m so excited. I’m excited to do some talks because I was talking about a couple weeks ago, this will be my first sort of “real” public speaking engagement, which is kind of exciting and it seems like it going to be a really awesome retreat. I’m exited both personally and professionally to go. It should be nice.

Laura: Do you have a lot of free time where you can enjoy being outside if you’re going to be in California?

Kelsey: Yeah. I think I do have a good amount of free time which should be nice. Although I think because I’m offering sessions while I’m there as well on the days that I’m speaking, so I have a few of those so far which is great. And I’m sure probably once I’m there and people hear me speak, there might be a couple add-on’s at that point.

Laura: Yeah.

Kelsey: But there are tentative plans to maybe go wine tasting one of the days because we’re in Sonoma Valley. So that should be fun. But yeah, I mean it sounds like it’ll be hiking and yoga and just hopefully lounging around in the sun which sounds awesome right about now.

Laura: Is it cold up in New York? Or you’re back in New York now, right?

Kelsey: I am in New York today. Yeah. It’s not terrible, but it’s not warm. Let’s put it that way. How about you?

Laura: It got to high 70’s and sunny today.

Kelsey: Oh gosh. That’s so nice.

Laura: I’m like so North Carolina it’s kind of amazing. Yeah. This is a big reason why I live down here and not back up north anymore.

Kelsey: Understandable.

Laura: Every time I see people getting snow in April, I’m like no, no, no, no.

Kelsey: Yeah. In Massachusetts the other day we had a good amount of snow, maybe 5 or 6 inches. It melts immediately which is the good thing about spring, or sort of spring snow. But yeah, it’s not fun.

Laura: Yeah. That’s not my preferred situation.

Kelsey: No.

Laura: It’s funny because when I work at the Perfect Health Retreat, I used to kind of participate in the group exercise and that kind of thing. But I just have gotten to the point where since I don’t have to be working until the afternoons, I end up just spending the whole morning doing whatever I want.

Kelsey: Yeah.

Laura: Last time I brought my dog with me. So we would go on this long walk on the beach and paly with a tennis ball. Then they have some really cool equipment that they bring that’s all set up outside. So I can do my circuit training type exercises on the pool deck which is really cool. I end up just chilling out, going to the ocean. If it’s nice out, it’s a little bit of a hit or miss timing because this one starts on April 30^th which is only in like three weeks or something. North Carolina’s weather is very all over the place. Today was in the high 70s, but over the weekend on the Saturday it was in the low 50s and it felt freezing.

Kelsey: Yeah.

Laura: I’m like it’s so cold, low 50’s. But generally the weather has been pretty good. So it’s cool because I get to work with people usually about three hours every afternoon and then the rest of the day technically I can kind of do whatever I want. And I used to go to the lectures and I used to do all the group stuff, but honestly it’s just I’m at the beach and I just want to be outside.

Kelsey: Right. Fair enough.

Laura: Yeah, and I think once you’ve heard a lot of this information, hearing it again is not always helpful.

Kelsey: Yeah.

Laura:  If itwas brand new information or something that was really going to help me change how I worked with clients, I’d probably go to the…well I don’t know. I’m such a brat. I’m like I would so much rather be outside. It would really have to be some pretty amazing lecture material for me to what to stay inside if it’s nice out, which is, I don’t know. Maybe that is not a problem, I feel like.

Kelsey: I don’t think it’s a problem, no. I mean especially for a retreat sort of situation, granted we’re working there too. I agree, I really like to enjoy the outdoors as an alternative.

Laura: Yeah. I have meals with…I almost said the patients. I guess the participants, the retreat goers. I’ll have conversations with them and get to know some of them. It’s not like I’m totally just not involved. The group exercise classes because they’re geared towards more beginners, it just doesn’t end up being very effective for me. So I’d rather just like go do things by myself. I have this interval timer, so ill set up some dumbbells and a kettebell. And there’s a chin up rack, which I’m excited because now I can actually do a real chin up on it.

Kelsey: Wohoo!

Laura: So that will be kind of cool. But just get in, get out after like 30 – 45 minutes and then just go lay on the beach for the whole time, which that’s like my dream to just be living on the ocean.

Kelsey: Yeah, Laura. I feel like you’re a beach bum. You like need to make it out there.

Laura: It’s like I love Raleigh so much, and if only we had a beach that was a closer drive. But I don’t know. It’s fine. It’s one of those things that I feel like because I don’t have it there all the time, I take it less for granted. When I lived in Australia for, I was in Bondi for six months and I could literally see the ocean from my apartment window. And this is one of the most beautiful beaches in the world, basically. It got depressing because there’d be so many days that I couldn’t go because I had work or just couldn’t get out there and it was like sad for me to see it and be like oh, I can’t even go. And it’s almost rubbing it in your face that this beautiful and amazing beach right there and you’re not allowed to go do it. I don’t know. In some ways I almost find it helpful that I’m not living at the beach because I think focusing on work would actually be really hard.

Kelsey: Yeah. I can understand that.

Laura: But that’s really cool. I think you’ll have a really good time and I’ll be excited to hear what you end up doing. Do you think this is going to be a recurring thing? Or is this just once?

Kelsey: I don’t know, actually. It’s sort of a series of retreats. I don’t know if this specific one will go again. This is the first time I think she’s running this one. I would assume it probably has something to do with how it all goes in the first place. Yeah, but I think it could be fun as a recurring that for sure.

Laura: Yeah, and It’s a nice little change of pace for you.

Kelsey: Yeah, defiantly.

Laura: That’s one of the reasons I like doing the Perfect Health Retreat is it’s just like a different environment and obviously get to kind of be in a nice location and do work instead of having to pay to go on vacation. So it’s cool.

Kelsey: Yeah.

Laura: I’m trying to think if there’s anything going on for me right now. I was mentioning to Kelsey before we got on the call this morning that I was talking to Jordan Reasoner who is one of the guys that runs the SCD Lifestyle website. We were actually talking about my experience with having added a bunch of carbs into my diet because he follows me on social and he’s been seeing a lot of the stuff I’ve been posting on Instagram and Facebook, that kind of thing. It turns out that he said he’s been adding a ton of carbs into his diet too because he’s doing a bunch of strength training right now and he’s been training for a couple months pretty high intensity as far as the volume that he’s doing.

Kelsey: Yeah.

Laura: And he said that he tries to get 300 grams of carbs every day that he’s training.

Kelsey: Nice.

Kelsey: Which is obviously a lot higher than the typical Paleo diet and certainly with SCD, if anyone’s on an SCD diet, they’re not getting that many carbs, for sure. It was really interesting to talk to him about how once he got his gut health under control with the SCD approach and doing some prebiotics, probiotics, that kind of thing, he did this process where he was increasing his carbs and doing some prebiotic supplementation and the same time so that his gut could handle them. Then eventually he got to the point where he didn’t need the prebiotics anymore. And now he’s tolerating carbs really well and he says that he feels the best that he’s ever felt since he got sick essentially, which has been I think like ten years for him or something. So that was really cool. It feels like this is happening like almost, not undercover, but….

Kelsey: I know, it does.

Kelsey: It feels like a lot of people are kind of experimenting with this approach and finding some really good results. And it’s kind of ironic because of our topic that we’re going to be talking about today.

Kelsey: Right, I know. It is very ironic.

Laura: But I will say that to me it seems like the whole carb thing is getting a lot of attention and traction and a lot of people who might have done low carb in the past I think are experimenting with a higher carb diet. What I feel like is there needs to be some kind of resource to guide people on that because I think a lot of people are afraid to just go from like 100 grams of carbs a day to 300 per day. And it’s not easy. That’s actually quite difficult.

Kelsey: Right.

Laura: I’ve been dealing with kind of trying to figure that out for myself. So I’m thinking because I’m not taking new clients right now, possibly creating some kind of resource based on that.

Kelsey: Nice.

Laura: Just because there’s a lot questions about it, a lot of confusion, a lot of not sure what the approach would be to do that, who that’s appropriate for. But I think if it’s the right fit for the person to do that kind of approach, that the health results are really kind of incredible.

Kelsey: They are.

Laura: I know I personally feel probably about the best I’ve felt. And it’s not all carbs, like I can’t lie and say it’s all carbs. It’s also my training and then I’ve really been prioritizing sleep very seriously. It’s weird. I feel like because I’m spending a lot of money on the training… and when I say a lot, I mean a lot based on the fact that a gym membership is like $50 a month or something and I do more than $50 a session. So it’s a big investment. My trainer, I think he could actually charge more. I won’t tell him that. Actually I have told him that. But I think investing that much money in something really makes you take it very seriously. And this is something I think can apply any sort coaching, or nutrition counselling, or whatever somebody’s paying a lot of money for. I think sometimes people balk at paying more money because they don’t understand what the value is.

Kelsey: Right.

Laura: But for me, having been spending this much money to train with my coach, I mean I can work out by myself, it’s not like I don’t know how to work out. But something about investing this money makes me take it really seriously. And whatever else I’m doing to support my maximal results from that training, I’m willing to do basically whatever it takes to make sure my training is going well.

Kelsey: Right.

Laura: So that means I’m eating more. I’m eating more carbs and making sure getting my micronutrients, eating things like liver, eating lots of protein. But the sleep thing is really one of the biggest things I’ve prioritized in the last couple months. I mean basically the thought process that goes through my head most evenings, because I used to do a lot of…I wouldn’t say a lot of TV. I mean it feels like a lot now, but it was maybe like a couple episodes of some 30 minute show or something, and it wasn’t even every day. But anytime I get to the end of the day and I’m a little tired and it’s like 9:00 or something…and normally in the past I would have been like oh I really don’t’ have anything else to do so I’m just going watch a little TV before I go to bed. Now that I’ve realized how much of a difference in my sleep there is when I don’t watch TV, and then looking down the road when I sleep well, I’m training better.

Kelsey: Right.

Laura: I literally just think okay, do I really want to watch TV because if I do this, then I might not train as well either tomorrow or in two days. And it just doesn’t seem as appealing anymore to watch TV.

Kelsey: Yeah.

Laura: And I’ll do it sometimes like if I want to watch a movie or if there’s an episode of a new show that I want to watch, whatever, I might do it. But it really has to be very worthwhile for me to do it at this point.

Kelsey: Right.

Laura: And I feel like that came from committing to I guess it was a 40 day no TV… and when I say no TV, I meant like no TV on my own. I was watching a couple basketball games with other people.

Kelsey: Yeah.

Laura: But it really kind of reset my expectations about what my routine looks like, and what my evenings look like, and what my sleep schedule looks like. I think, I don’t know if it was yesterday or the day before, I was in bed at 9:30 and I’m like wow, I’m such a grandma now. But seriously it makes such a difference in my training that it doesn’t even feel like a sacrifice to me. It feels like I’m making a smart investment because I’m maximizing the money I’m spending on my training.

Kelsey: Right.

Laura: So I think that’s a good thing for people to think about if you’re looking to work with someone one on one, either for training at a gym, or if you’re looking to work with a nutritionist, or whatever the health issue that you’re looking to deal with, or it may not even be health. It might be a business coach, or it might be I don’t know, anything that you’re looking to learn or improve your skills at. A lot of times people try to rationalize spending less money on things. But honesty, the money piece, part of it is just how bad do you want it?

Kelsey: Right.

Laura: And how important is it to you? And does spending more money actually make you take it so seriously that you actually get the results that you’re looking for? So that’s defiantly been my experience and I’ve actually been adding more days to my training. I used just do two days a week with my coach, and now I’m adding a third day, and I even offered to pay him a little bit more because I think he deserves to be paid more.

It’s an interesting thing to be a coach. I mean I call myself a coach, but it’s like a wellness coach or whatever you want to talk about it as. It’s funny to be on the other end of that because I want to work with people that want to work with me the way that I want to work with my coach. I’ve told him before that when I don’t go in I’m like sad. I’m like oh, I wish it was a training day. I’m sad that I don’t get to go to the gym today. I think trying to figure out how to make my services give people that same experience where they’re like really excited to talk to me, or they’re really happy to be part of the coaching group, or whatever we end up doing. It’s just a great feeling and I feel like it really helps motivate almost intrinsically where you are so dedicated to the results, you’re so dedicated to the process, that making changes that are health supporting don’t feel like sacrifices. They just feel like a natural response to wanting to make that investment worth it.

Kelsey: Yeah. Even like I’ve been training now for now only a month, so it’s like not that much, but I have noticed that same sort of effect. It’s like I pay way more attention to the food that I’m eating in a good way, in the sense of okay, what am I eating and is this going to support the next training session that I’m going to have?

Laura: Right.

Kelsey: Yeah, you pay attention to sleep. You pay attention to stress because I know for me, if I’m really stressed out, the training doesn’t go as well. Or if I’m sort of distracted and I’m thinking about all the other things I’m stressed about, that really makes a difference for me, and of course that affects my sleep as well. All of those things kind of, you’re right, they intrinsically happen more easily because it’s not like this oh, I have to do this because it’s good for me. It’s like well, I want to do this because it’s going to support what I am spending my money on and goal that I’m going for here.

Laura: Yeah. It’s a cool experience and I really like that it has shifted my focus on diet to more of a like a performance enhancing approach, as opposed to thinking about oh I don’t want to over eat because it’s like want to lose weight, or whatever that stupidness is. It totally shifts the perspective, and I don’t know. I feel like for me, I‘m almost a year into training on a weekly basis with my coach. I just feel like in almost all areas of my life I just feel more confident, more able to take on things that are difficult, and I can stick to things better. It’s just weird.

I feel like I’m doing an advertisement for Matt right now, but seriously it’s just one of those things that you look at like personal training or something as being like, oh, that’s a waste of money, I can work out on my own. But honestly, I just feel like that investment for me has been really, really good and it’s really seeped into other areas of my life. And even just physically feeling as good as I do right now from the changes that I’ve made, I’m enjoying things more, I’m able to do work more effectively, work doesn’t stress me out as much. It’s crazy. I wish everyone can do it. Honestly, it’s so empowering and being able to approach health from a how can I do this to support my passion, or my having fun, and that kind of thing is so much of a better way to look at heath than like, oh, I have to go to bed because if I don’t then I’m going to feel bad tomorrow or something. It’s like, no, I want to go to sleep so I can PR again.

Kelsey: Right, right. Exactly.

Laura: Anyway, that’ll be an ongoing thing that I think both Kelsey and I are having some pretty fun experiences there. And we would encourage you guys to…I mean one on one personal training is not something you have to do to get the same result unless it’s something that you can afford or that is worth paying for because obviously budgets can be tight and you have other things to pay for. I’m lucky. I’m single, I have no children, and I don’t have to spend money on other people, so I can spend it on myself right now. But even if you just did like group coaching or anything that you feel like you’re committing to something finically, it’s pretty crazy how much that can motivate you to stick to what you’re trying to accomplish.

Kelsey: Yeah. Totally.

Laura: Anyway. Why don’t we get into our interview for the day because we’re really excited about our guest. But before we start, let’s hear a word from our sponsor.

Kelsey: Alright. So today I am really excited to introduce you to Patricia Daly. Patricia is a fully qualified nutritional therapist based in Dublin, Ireland. Following her cancer diagnosis, she left her corporate career and started studying nutrition specializing in the area of ketogenic diets. Welcome, Patricia!

Patricia: Hi, it’s great to be here! Thanks so much for having me, Kelsey and Laura.

Kelsey: Yeah. It’s our pleasure. We’re really, really excited to have you today. I think this is going to be a great show and it’s a really interesting topic. I know that you’ve dealt with cancer in the past, so would you mind just starting us with you own story?

Patricia: Yeah. It’s a long story, so I try to keep it as short as possible. Basically 2008, so that’s nearly 8 years ago, I was diagnosed with a very rare form of eye cancer. It’s malignant melanoma, and it was literally sitting inside the eyeball on the choroid. That’s one of the layers of the eye. So very rare, especially at the age of 28 at the time.

Kelsey: Wow.

Patricia: So it was a big shock to me, my family, my friends. I knew something wasn’t going well for me health wise, but I wasn’t really as much in tune as I am now with things. So I just chose to ignore symptoms. I went then to conventional route. I didn’t have much time to research and whatever I researched was so devastating that I just put my laptop away. So three weeks later, because there were no treatments available in Ireland at the time because it was so rare, I had to go over to the UK. I went to Liverpool, had all the treatments. I had plaque radio therapy, which means that I had a general anesthetic, the plaque was stitched to the back of the eye, and then it was left in there for a calculated time, and then they took it out again four days later with another general anesthetic, and then I was sent home. And before I went home, I asked my oncologist, I actually feel really, really as low as I’ve ever felt. I mean I was never so floored. I asked is there anything I can do just to pick myself up and recover as quickly as possible? And he said no, you just go and just take it easy for a few days and then you go back to normal.

Kelsey: Right.

Patricia: That really sort of triggered something in me, sort of a curiosity I guess it was. It wasn’t really anger or anything. I was just, wow, that’s a bit odd. That really is sort of an odd thing to say to somebody who’s just been through what I have been through. That really kick started everything. I visited a nutritional therapist and was so fascinated by her approach and the way she dealt with me that I signed up for a nutritional therapy course there. So that was in September and it actually started three weeks later.

Kelsey: Wow!

Patricia: I didn’t do anything research. It just felt right. It was an instinctive decision. I started studying and then I started to make a lot of changes to my health, and also lifestyle changes. But obviously it wasn’t enough because it wasn’t even twenty months later that I was diagnosed with a relapse. I had a baby in the meantime as well, so my daughter was six months old when I relapsed. I had known it for quite a while. I knew the symptoms were back. I knew something was up.

Kelsey: Mm hmm.

Patricia: The scans weren’t showing it for a long time. They weren’t picking it up. When they finally did the tumor had doubled in size again and had moved really close to the optic nerve. So it was really putting my sight now at serious risk. They had to radiate the optic nerve. I had external photo beam therapy the second time around. It’s pretty rough treatment. It’s fairly short, but it’s hard especially with a baby in toe.

Kelsey: I would imagine.

Patricia: So the second time around was a lot harder I must say, just psychologically as well. I knew something had to change. I researched like a mad woman. I was sort of hoping to go over to Florida to the Hippocrates Institute, and I was looking at Gerson, I was looking at everything. I came across then ketogenic diet and wasn’t really convinced because my consultant kept saying don’t do anything extreme, let’s just see how the radiotherapy works. But two years later my eyesight was nearly gone. I had a lot of side effects from the treatment. I sometimes was called into the hospital to actually be a guinea pig for students to look into my eye because they literally saw everything that could possibly go wrong in one eye. That was quite exciting.

Kelsey: Right.

Patricia: The students were like oh wow, look at this cataract! And oh wow, look at this edema, and the tumor! And ooh, they were all sort of…

Kelsey: That’s not very nice.

Patricia: Yeah, exactly. You sit there sort of, okay, I’m really happy to be service.

Kelsey: Right.

Patricia: But I’d prefer it that you’d be a little bit less excited. But anyway, I do hope that at least they recognized it and they would see what it looks like if there is a tumor. So I hope that I managed to help some other people indirectly.

I basically then said enough is enough. They said they want to do Avastin injection. That’s an angiogenesis inhibitor to inhibit blood vessels from growing that feed the tumor because that was my main problem. There were loads of blood vessels causing chaos in the eye. Or the option would than have been also removing the eye. And that’s when I said okay, I have nothing to lose. I just tried this ketogenic diet. There was hardly any information at the time. There was German literature and that’s what I relied on, sort of Dr. Johannes Coy, Ulrike Kämmererand all those, because Thomas Seyfried, Dominic D’Agostino, Colin Champ, they weren’t really as much on the plan as they are now.

So that’s what I did then and literally I had to be very, very strictly supervised at the time. I went back a few weeks later. I mean it was probably four or five weeks, and the consultant, he just looked at me and he said, wow, this looks like the calm after a big storm. He saw the results which was amazing.

Kelsey: Patricia, tell us a little bit about what a ketogenic diet is because I’m sure some of our listeners maybe have heard that term before, but they’re not quite sure what that means exactly.

Patricia:  Yeah, of course. A ketogenic diet basically mimics fasting, a fasting state. That’s probably the easiest way to sort of explain it. It’s a diet that is generally very low in carbohydrates, but we’ll probably come to that. I say in general it’s very low carb, and that it’s very high fat, and low to moderate protein. And I think that’s the big difference to other low carb approaches, like for instance Atkins, where people think they can just eat steaks till the cows come home, literally.

Kelsey: Right.

Patricia: In the ketogenic diet, it’s very different in that we really have to keep an eye on protein as well. And again, the high fat has probably has to be a little bit sort of modified as well depending on the person because lot people have a lot of internal fat that they can use.

Kelsey: Right.

Patricia: It depends on the patient and how high the fat content is off the ketogenic diet. So for some people who have a lot of weight to lose, which some kinds of patients have, it’s not necessarily high fat, but it’s still ketogenic. Still the goal is to achieve nutritional ketosis, so to basically get the body into a fat burning state instead of mainly relying on glucose or sugar. So it’s a metabolic switch.

Kelsey: Okay, got it. Does that usually just start as a restriction in carbohydrates and then you kind of figure out what your fat and protein intake is once you do that first?

Patricia: Yeah. That would be usually the first step that I educate people around the carbs and they start reducing those and replacing them gradually with a little bit more fat. Most people, they have to go back in protein a little bit as well. A lot of people, they do tend to be a little bit higher in protein on a standard western diet than they need to be on a ketogenic diet.

Kelsey: Got it. Okay. Why do you think that a ketogenic diet is very helpful for cancer patients? What makes it so special?

Patricia: The first thing that most people always say, oh, it’s all about the blood sugars. It’s once blood sugar is low, then the cancer cells don’t have the preferred fuel anymore, and that’s that. But its unfortunately not that simple. It’s definitely one aspect that we know that if blood sugar levels are at a constant low steady level, then insulin levels gradually come down as well. Insulin is an important pathway for cancer cells. Insulin like growth factor 1 as well is important and promotes cancer growth. If we manage to really reduce that, then that’s one important goal as well.

Kelsey: Got it.

Patricia: And then ketosis has a lot of wide ranging effects as well for cancer patients. Angiogenesis, which I’m probably one of the prime examples where we saw that that was drastically reduced as soon as I was in ketosis, so the growth of excess blood vessels. And that makes it harder to for a tumor to metastasize, so to spread to other sites. We also know that ketosis can have an impact on inflammation It reduces systemic inflammation, which usually in cancer patients can be a big problem. But also gene expression, so epigenetics, we know that there’s lots going on. But there’s so much research into a lot of different mechanisms and pathways especially when it comes to cancer. I think we’re only at the start at really uncovering what exactly is going on, and all the benefits, and also the caveats.

Kelsey: Right. And it seems like a lot of what you hear now a days with ketogenic diets and cancer is a lot of people’s individual experiences with trying ketogenic diet for their own cancer diagnosis. I think there is a lot of research, but yeah, we’re just kind of scraping the surface of it I think right now and it’s more that personal experience that you hear about now.

Patricia: Yeah, exactly. The human clinical trials, they are underway. But I’m not quite sure when we can expect the first results. I don’t know if they can say for definite, okay, that’s how long we’re going to run the trail for, and that’s when it’s definitely when we’ll have all the definite results. I think, unfortunately, as a cancer patient, we don’t have the luxury of time and that was the case for me as well. Will I wait for the evidence until I desperately start implementing it? And especially with patients, until it’s really solid, strong evidence. And a lot of people just looked at me and said, but I might be dead by then.

Kelsey: Right.

Patricia: I totally get that. Some people are just, they really have nothing to lose. Some people have, in my case, it wasn’t life threatening at that stage. I didn’t have metastatic melanoma, but I was at risk of losing my eye. That was obviously also for me a huge thing. And then for some people it’s literally a matter of life and death and they say okay, I can’t wait another two or three years. It might be too late.

Kelsey: I think probably a lot of our listeners have heard some variation of this, I say quote, but I don’t really know where it comes from, but where cancer is or isn’t a metabolic disease.

Patricia: Yeah.

Kelsey: So what’s your opinion on that and what does that even mean either way, whether it is or isn’t?

Patricia: Yeah, exactly. This is an ongoing debate where okay, genetic versus metabolic disease. What that means is basically what we develop all our treatments, or what they’re based on, all the treatment approaches at the moment is cancer is a genetic disease. So cancer starts with one single cell that has mutated and that has some DNA damage for whatever reason, that can be environmental or it can be genetic, and that from there on then once we have six to eight mutations in a cell we can start talking about a cancer cell. Then obviously it starts to do this uncontrolled cell division and growth. That’s basically what we’ve always assumed. So we have to just go in and really damage that cell so much with chemotherapy. It’s basically killing off the cells, inducing so much DNA damage that the cell dies off and that’s the goal of the chemo and radio therapy basically.

Now more and more researchers in cancer research are interested in metabolism. It’s a bit of a chicken and egg situation. The best research to follow at the moment is probably Professor Tom Seyfried. He basically does these nuclear transfer experiments. It’s very interesting and I have it in the book as well. When there is DNA damage in a tumor nucleus and you put that into a healthy cytoplasm, so whatever the whole cell around the nucleus, that’s the cytoplasm, when that cell then divides, we actually have normal cells.

Kelsey: Wow.

Patricia: So what does that tell us? I mean, that’s amazing that if there is a nucleus with DNA damage and it replicates, and it’s still replicates, it’s a normal tissue. It’s not a cancerous tissue.

Kelsey: Right.

Patricia: Whereas if you transfer a cancerous mitochondria into a tumor with a healthy nucleus without any DNA damage, so if its cytoplasm and the mitochondria are cancerous, and then a healthy nucleus is transferred, when that cell replicates it becomes a totally cancerous cell. So the nucleus becomes cancerous as well.

Kelsey: Wow.

Patricia: It’s really experiments and studies from very, very reputable institutions that have been funded by government or by really reliable sources. This research has just never really come to the surface because I guess nobody really knew what it meant or how it could be used in practice.

Kelsey: Right. That’s what I was just going to ask you. That’s really cool, but what does that mean for cancer patients?

Patricia: Exactly and that’s I think that’s the thing. That’s why I say it’s chicken and egg. Does it start with DNA damage? Or does it start with mitochondrial, so metabolic damage?

Kelsey: Right.

Patricia: It could be that it’s the mitochondria that gets sick first and then that affects the DNA in the nucleus ultimately as well. Or does it start with the DNA and it’s the other way around? So that’s the big question at the moment where we really need solid evidence. And obviously if cancer is a metabolic disease, then the mitochondria especially for prevention I think as well is super interesting. How do we mind our mitochondria best and what can damage mitochondria? And we have a tiny bit of DNA in our mitochondria as well. It’s just so fascinating, this whole thing, okay, do we just go after the metabolism of the cancer cell? I think it’s probably a bit of both and that’s why I think we need a ketogenic diet in combination with conventional treatments.

Kelsey: Right, right. So when we’re talking about mitochondria being damaged, when you hear that statement, cancer is a metabolic disease, that’s what that’s referring to, correct?

Patricia: Yes. It’s a mitochondrial disease. That’s pretty much synonymous as far as I know.

Kelsey:  Got it. Yeah, I just want to make sure everybody understands that when we start to talk.

Patricia: Yeah, it’s probably a bit geeky.

Kelsey: It’s confusing, yeah. Okay, so when we say it’s either a mitochondrial disease or a metabolic disease, we’re talking about there being actual damage to mitochondria. When that happens, why do you feel like a ketogenic diet is then useful in that regard? What does a ketogenic doing to the mitochondria itself?

Patricia: Once somebody is fat adapted, the whole metabolism then is different. So a cancer cell, and we know that very much relies on…now I’m getting geeky again…glycolysis, so splitting glucose in the cytoplasm, so outside the mitochondria. It’s basically that’s what cancer cells like to do.

Kelsey: Okay.

Patricia: They have more glucose receptors and also more insulin receptors than healthy cells. That science basically forms the basis of a PET scan as well. We know that if somebody has a PET scan, they inject radioactive glucose and then you can see which cells become metabolically more active and where the uptake of that glucose happens very rapidly. That’s basically where those areas basically can light up. If it’s like a Christmas tree, it’s sort of, okay, there’s a lot of concern there. If it’s a little bit of lighting up, okay, we need to investigate. So basically oncologists know the areas that light up are metabolically more active. Why? Is it possibly because it’s a cancer cell? Then they have to obviously then investigate further to see if this is really the case.

But the science, the splitting of glucose, and cancer cells do that as opposed to healthy cells. They usually just do that when they don’t have oxygen. We know that from exercising as well. When we don’t have oxygen, we split glucose and we have a lot of lactic acid production.

Kelsey: Right.

Patricia: So that’s what cancer cells do all the time, whether they have oxygen or not.

Kelsey: I see. Okay. So that’s why the ketogenic diet is useful because it sort of diverts that process from happening.

Patricia: Yeah, and also basically cancer cells, they don’t really know what to do with fatty acids and ketones. They quite often have faulty mitochondria, or very inefficient mitochondria, or some of them lack mitochondria completely.

Kelsey: Okay.

Patricia: So that’s sort of the main premise at the moment, okay, because they have those faults, or because they’re not there, they just can’t use fatty acids and ketones as efficiently, or some of them not at all as the healthy cells.

Kelsey: Okay. So it’s more of like a starving of the cancer cells themselves.

Patricia: It’s weakening them, yeah.

Kelsey: Weakening them.

Patricia: I mean that’s what I see for some people, I mean starving. Yeah, I mean in my case, I had a tumor outside the eye as well and that completely disappeared on the ketogenic diet.

Kelsey: Wow.

Patricia: It didn’t respond to radiotherapy. It just stayed the same size. It stopped growing, but it never sort of shrank or anything. Then on keto it just completely disappeared. So I assume it was just starved.

Kelsey: Wow.

Patricia: Again, that depends on tissue, it depends on the tumor. We know that the eye, the retina is one of the most mitochondria rich tissues in the body. So, yeah, it obviously worked very well in my case.

But then there’s cancer cells that also rely on glutamine, an amino acid. There are metabolic tests now that they do in Germany. I learned that at a conference in Germany where they can actually test the metabolic preference of a tumor. Is this mainly glucose? Is this mainly glutamine? Is it a mix of the two? Or not at all?

Kelsey: Wow. Interesting.

Patricia: That’s where we have to go, I think.

Kelsey: Right.

Patricia:  Yeah.

Kelsey: So I guess if you can tell what source or what a cell is feeding off of, for example, if you found out that your cancer was feeding off of glutamine, would you then do a diet that kind of restricts glutamine as much as possible? Is that sort of where all this is leading?

Patricia: Well, that’s the tricky thing. We don’t know, in terms of the glutamine, we know that most cancer cells can switch over from glucose to glutamine and that’s why it’s so important to restrict protein. But glutamine is obviously, it’s not an essential amino acid. The body can make it no problem itself. So how do you block that?

Kelsey: Right, right. That’s a good question.

Patricia: Yeah, exactly. That sort of ongoing debate how you best do this, and I guess we just need lot  more research at the moment. The only thing we can do is just generally making sure that we don’t overdo it in the diet with glutamine.  

Kelsey: Right.

Patricia: That can be a pretty tricky thing to do.  

Kelsey: Yeah, right. Of course.

Patricia: Yeah.

Kelsey: Okay. I do want to jump back to talking about the ketogenic diet itself. But before we do that, I wanted to know if you feel like there are, and just from your personal research or what you’ve seen, do you feel that there are certain cancers that do very well with the ketogenic diet, and then certain cancers where maybe it’s not as useful? Like who should be doing a ketogenic diet?

Patricia: Very good question. The main thing, and the most research we have is into brain tumors. If somebody comes to me with a brain tumor, I really don’t think twice, especially if the PET scan, and it is usually an indicator of a brain tumor. It’s usually pretty clear and they tend to be the ones that respond the best. I guess in my case, the eye is such a part of the brain as well and that’s what really then motivated me to really start as well because that’s where the evidence was the strongest.

Kelsey: Right.

Patricia: But it’s for really any solid tumor. If somebody has a PET scan, that’s always great because then you know you can ask do you know the glucose ability of a tumor? So how much it relies on glucose and how much it basically was lighting up during the procedure, and that can give a bit of an indication as well. Eugene Fine is a cancer researcher. He has quite a bit of information on that whole PET scan, and he also said in a recent interview if the PET scan shows up very clear, then it’s definitely worth a try. Any solid tumor it could be.

I also go with otherwise other symptoms of a patient basically, so a bit of history. And if somebody has already been on a low carb diet but then got cancer, you obviously have to see how they implemented a low carb. Some people think they’re low carb but it’s probably not quite what we understand as low carb for cancer. I always look at the history a little bit as well to see how appropriate it is and the amount of support somebody has. Some people get so stressed out by implementing, and we know cortisol drives glucose and the other way around. So it’s no point really getting super stressed out. I think you cancel out the effect of whatever you do on the nutrition side as long as you’re stressed like mad.

Kelsey: Right.

Patricia: It’s really important to look at the full picture.

Leukemia, it’s a little bit mixed. So if there’s not a solid tumor present. So leukemia, it’s a bit mixed, I’m sort of not quite convinced. I keep looking into research. There is a study from 2010 that says leukemia can really proliferate on fatty acids.

Kelsey: Oh, interesting.

Patricia: But then again, I’m sort of thinking, okay, if somebody has a very high carb diet, usually triglycerides can go up. My fatty acids, my triglycerides are a very, very low on the ketogenic diet and that’s what it should be. So what should we do? I don’t know if we have a clear answer when it comes to  cancers that don’t have solid tumors.

Kelsey: Right. Okay. Alright. So definitely if you have some sort of solid tumor, definitely a brain tumor, the ketogenic diet is going to be a good choice. For other types of cancers, there’s just not quite as much research, as definitive research I should say. Right?

Laura: Yeah, exactly. We just know sort of the underlying mechanisms. We know all the pathways, not all of them, but we know some of the pathways the ketogenic diet affects and they obviously apply to solid tumors in general. That’s when it can make, I think for any cancer patient, there’s so much research into hyperglycemia, how it really can affect certain oncogenic pathways. And also hyperinsulinemia, that’s really not a good idea for cancer patients to have, especially also when they go through treatment because high insulin and high glucose can rescue cancer cells from the effects of radio chemotherapy. They can fix free radical damage from the treatment with glucose. We know that as well. I think for anybody, it’s just still even if they can just keep their glucose and their insulin at bay, that’s a big step and that already has a good effect.

Laura: I have a potentially controversial question. We, on this podcast, like to talk to about the diversity of diets that would be appropriate for different people and how carbohydrates can potential be helpful for certain health conditions. What are your thoughts about how glucose intake without cancer would affect the risk of getting cancer? Do you think that a ketogenic diet can be considered a preventative diet for cancer? Or do you think it’s just a therapeutic diet once somebody already has cancer.

Patricia: No, I definitely think there is a place for low carb and keto in prevention. But we really have to look at the person. And again, in the book that I’m publishing next week, we have, it’s like a bit of a guideline questionnaire like where we just have certain points, okay if this is you, then you might consider low carb and keto. But obviously doing certain blood tests first as well. I’m quite conservative there. I don’t think anybody should just start doing low carb, especially keto, without having a baseline. And then checking, okay, do I actually thrive on this? Or do I run into problems? I think it’s always a good idea to, okay, before I start making major changes, I get a baseline.

Some people, they tolerate carbs incredibly well and they thrive on them, and especially people who are active, who are insulin sensitive. So they know what to do with the blood sugar and they know how to use it. But then there are people who are clearly very insulin resistant and they clearly don’t thrive on carbs. It clearly just causes more damage than anything else. It’s, as you say, it is so individual. But I definitely think some people they do incredibly well on carbs.

Actually for me, I never really, I have a very high carb diet and I don’t’ think I necessarily suffered from it. I was a triathlete and I did loads of obviously cardio endurance training, so 15-20 hours a week. I was on a very high carb diet and I performed very well. But then obviously when I was diagnosed with cancer and I had the relapse, I cleaned up my diet big time and I still had very high carbs. For me it was a big turnaround.

We also don’t know, could it just be very useful for the short term? I think for healthy people as well, I have some colleagues in the UK who used the ketogenic diet for 7 – 8 weeks to reset hormones and it works brilliantly. And then they go back to a more moderate approach. So I think you’re very right in that, and I know people hate that when you say it depends and it’s individual. It’s like no! Just give me one answer to one question. I’m always, no, I’m sorry. It’s just not possible.

Also we still don’t know should the cancer patient who is thriving on a ketogenic diet in terms of the tumor stay on it forever? What’s the story there? If somebody is thriving, and I for instance, I do blood tests all the time and check that everything is really okay. I have to do that anyway because my tumor is sort of susceptible to spreading to the liver. So I have to get regular blood tests. But I think anybody should really do that and check, okay, am I still on track? Is everything okay? How am I feeling? Whenever you change something in your life, you have to adapt. So I’ve started recently to workout a lot more again and to do quite a lot of strength training, weight training. I have to completely overhaul everything, and okay, what works now? I obviously can’t just do the same as I was before when I was not as active. I think, yeah, it defiantly has its place in prevention if it’s appropriate, if you know what I mean.

Laura: Yeah, and I think you have a really great perspective on it because one of the problems I tend to see in the low carb, ketogenic community is that, and this is the same thing for any diet approach, that it can become one of these one size fits all, like everyone should be doing X Y Z. And it doesn’t sound like that’s you’re approach whatsoever. But we always like to point that out because a lot of our listeners are coming from a little bit of like an orthorexic type background where if they hear people saying that, oh well, a ketogenic diet helps with cancer, it could be confusing to them if they are eating a higher carb diet. And then they may start worrying about, well is that going to cause cancer if I’m eating carbohydrates?

Patricia: No.

Laura: So I really like that you are looking at this as a therapeutic treatment for people with solid tumors who have a serious health issue that needs to be treated differently than just the a maintenance approach.

Patricia: I don’t think it does any harm for anybody to measure their glucose from time to time. I really think that has a lot of answers, glucose, and how we respond to also lifestyle, stress, lack of sleep, environmental stuff like toxins, or whatever. BPA drives your insulin up. Right? When you know these things, you sort of, okay, if my blood glucose all of a sudden tends to go up, okay, what’s going on? What have I changed? Am I more stressed? Am I eating something that affects the glucose? Quite often it’s actually not the food. It can be a lot of other things. In my case stress is definitely my biggest thing that I have to watch otherwise my glucose just isn’t quite the way it should be.

I think keeping an eye on glucose, and for those who want to geek out, sometimes to check ketones. I think being in ketosis part of the year, or some people part of the day, or do it intermittent fasting, it can work really well for some people. But others, they don’t do well on it. It’s having a few tools and then checking in as well, what works and what doesn’t.

Kelsey: Yeah. I love that approach. I think that makes a lot of sense. And it’s sort of Laura and I’s approach too is just like what works for you personally, because you are different from everyone else, and your individual health circumstance is different from everyone else. I think it’s important to really think about that. That’s when it can be useful to work with someone who can kind of look at you individually because as yourself, I think it’s easy to identify with a lot of different things that are going on for other people, and read about their success, and just sort of think you should be in a million different baskets at once doing all these different things. That can not only be overwhelming mentally, but it’s just kind of I feel like it can be like a little confusing for your body too to just be doing a million different things at once. I like that you are very focused on the individual. That’s a really great approach I think.

Patricia: Oh, yeah. Totally. I mean it’s a functional medicine approach, it’s very close to my heart.

Kelsey: Yeah.

Patricia:  I try to sort of convey that to people as well. I know I always say I know it’s very frustrating that I can’t have a whole group and do the same thing with all of you and you all have the same results.

Kelsey: Right. We wish we could do that.

Patricia: Yeah, exactly. Unfortunately that’s not the way. But it can also be a fascinating thing. It depends on the individual. Again, some people, they thrive on it and others find it incredibly frustrating.

Kelsey: So let’s jump back to the ketogenic diet itself for a moment here. So we talked about what that means exactly. What you were saying was that it just sort of starts with that lowering of carbohydrate intake. Now is there a sort of general guideline for how low you should go? Or what kind of things are you monitoring to determine how low someone should go with carbohydrates, or any other macronutrient for that reason?

Patricia: Yeah. Carbs, normally we count net carbs.

Kelsey: Okay.

Patricia: So take the fiber off. So net carbs are, that’s what I work most clients towards is 12 grams per day. If somebody has 3 meals, it’s 4 grams per meal. It’s incredibly low.

Kelsey: Right.

Patricia: But again, I’ve been in ketosis for about 4 years now and I can eat pretty much any amount of vegetables I want at this stage, and I’m not getting thrown out of ketosis, and it doesn’t affect me as much as it did in the beginning. I think it depends where somebody’s coming from. Again, insulin resistance plays a big role, several other factors, age, how advanced the cancer is, so if they have metastasis, how much they exercise. That all sort of influences how many carbs somebody has. Actually the big the problem with some of the patients that I have is they just lose too much weight.

Kelsey: Yeah.

Patricia: Then I need to go up with the carbs as well. I mean, starchy vegetables and obviously not refined carbs. Mainly sort of the starchy ones and sometimes some legumes as well when somebody loses too much weight.

But that’s sort of what I work towards, 12 grams. And then it’s very important to keep monitoring them. I have a whole list of blood tests that I require and that ideally they monitor on an ongoing basis, ort of every three to six months. Then obviously then the tumor markers, and then we know, okay, does it work, or is it not worth all the the effort?

Kelsey: Right.

Patricia: That’s sort of what I usually do. And if somebody responds really well, and they go through treatment a lot better as well, some people who are in ketosis, and we know that irrespective of blood glucose, if ketones levels are high, then the response to treatment is better as well and side effects are reduced.

Kelsey: Interesting.

Patricia: Yeah. Adrienne Scheck, she was involved in a research study that was 2012-13, I think, that came out and it’s a very interesting study where they show even just the administration of exogenous ketones can actually help treatments.

Kelsey: Wow.

Patricia: Yeah. If somebody does well on all those levels and feels well especially as well, and it’s not overwhelming, then yes, we just keep going and obviously adjust as we go. Usually people get really, I’ve got some cancer patients, they’re incredible geeks and they really know anything and everything. I said you can actually take over for me soon. I just have to keep reminding them, okay, just keep adjusting. It’s a dynamic process, and keep experimenting, testing, functional testing once somebody has recovered a bit. Digestive function obviously is huge, and feeding the microbiome, and that’s why I’m in promotion of having vegetables as well on the ketogenic diet. I know there’s other approaches, and again, each to their own and for some people it can work incredibly well. But I just, I’m a bit suspicious still.

Kelsey: Right. Yeah. I would think that you would need some vegetables and especially the more fibrous kind of stuff. Once you’ve been in ketosis for a while like you were saying, you just tend to do perfectly fine with more vegetables. It doesn’t kick you out of ketosis or anything.

Patricia: Yeah.

Kelsey: I would imagine that makes little bit more sense than not eating vegetables, personally.

Patricia: Yeah. I guess we need more research into that, and the whole microbiome, and how keto effects the microbiome. Yeah, exactly.

Kelsey: Yeah. Okay. You mentioned ketone levels before and sort of measuring that. Is that how you determine that you are in ketosis?

Patricia: Yeah. Exactly. At the very beginning when somebody just starts off on a ketogeinc diet, they can do the urine strips, and they’re much cheaper than the blood strips. But at first, sort of 2 to 3 weeks you can use those. And then some people then they get a shock from one day to the next and say my ketones disappeared. I got kicked out of ketosis. What’s wrong? And it’s mainly just because different ketone bodies are being produced after about sort a transition phase of 2 – 3 weeks.

Kelsey: Okay.

Patricia: So some people they still have purple, so high ketones in their urine. And for other people, they just completely disappear, the urine ketones. Then you need to go over to measure beta-hydroxybutyrate in the blood. There’s different ketone levels depending on what you measure. When you measure them in the blood, you usually do the combined ketones and glucose. We call it the metabolic range where we want ideally a cancer patient to be sort of between 1 and 2. So if you measure glucose and then divide that by ketones, then so for instance if somebody has somebody has a glucose of 4 and ketones of 2 that would be a ratio of 2. So that’s good to be between 1 and 2.

Kelsey: Okay.

Patricia: But it’s incredibly hard. Some people get to be stressed out with the testing and all of that. For some people it makes a lot of sense. They thrive on testing and geeking out, and other just get completely stressed out.

Kelsey: Yeah.

Patricia: I was in 3 today and my cancer’s growing!

Kelsey: Right.

Patricia: It can put a lot of stress on some people, and for others it can be reassuring.

Kelsey: Yeah. And that brings me to another question that I have which is you’re doing a dietary restriction like this that really is so much of a total lifestyle change as well just because it is not an easy diet to follow. Nobody would accidently sort of fall into ketosis. It’s something you really have to purposefully go try to do.

I imagine that when you’re facing an intense diagnosis like cancer, a lot of people can kind of feel like almost what’s the point, or this is too difficult, this is stressful. Where do you draw that line? How can you determine if it’s going to do more harm than good for someone? Where’s that stress level sort of have to lie in someone implementing a diet like this for it to become not useful anymore?

Patricia: If somebody starts treatment and they have the full shebang with chemo, radio, surgery, all of this, then I always sort of try to calm them down and say look, let’s just get you through treatment as best as we can without any major interruptions and breaks from the chemo. Just make sure your immune system keeps up and the white blood count doesn’t fall, which is sometimes that’s the one thing I struggle most with, with people. That’s really my main focus and I keep saying to them just don’t worry too much at the moment.

But I emphasize clean eating if possible, but not sort of counting or trying to go into ketosis. That’s where I think sort of exogenous ketones can have their place. I’m actually in contact with a German company at the moment. They have developed those ketone drinks and they’re already using them in hospitals. It’s basically just a drink that people have during chemo that brings them into light ketosis. Apparently it’s very useful for people because they sort of have this sense of control that, okay, I am doing what I can, but it’s not overwhelming.

Kelsey: Right.

Patricia: Sort of my gut feeling tells me that that’s the way to go. If somebody feels they get a lot, a big sense of control and they can really do it, and it’s absolutely no problem, they have a lot of support as well, so people who literally cook for them, by all means they can, under supervision, they can try, and they can try lowering their carbs and being in light ketosis. But again, it’s incredibly hard during chemo because most chemo drugs are glucose based. Most people get steroids, so that drives their sugar up as well.

It’s just trying to really, it’s more working on the stress levels, to be honest, for somebody at that stage. Then once they’re done, we can really look into implementing it properly, doing some testing as well, working on their gut is always sort of the first thing, and really then just take it from there and just try to really calm them down during treatment and see.

Yeah, if it gives them an immense sense of control, and they feel it really helps them a lot, and they have the support, then it’s possible. But otherwise, I wouldn’t necessarily recommend making, on top of all the other overwhelming changes, making a huge amount dietary changes.

Kelsey: Right. So sort of waiting until you get through that very stressful period on intense treatment.

Patricia: Exactly. Just make very small changes, if they have a really very, very poor diet obviously, try to do something there. Give them some substitutes, and sometimes it’s very simple stuff just to make sure their glucose doesn’t…you know not having Coke during treatment for instence.

Kelsey: Right.

Patricia: Which a lot of people do.

Kelsey: Yeah.

Patricia: Some people have looked at me, wow, why would you do that.  A lot of people do that actually. Even just simple things. So instead of binging, we have some much research now getting up and exercise, even if it’s just going for a bit a walk. There’s so much research into this and it’s amazing actually how it can enhance the effects of treatment and just get someone through treatment a lot better. I think exercise is important during treatment.

Kelsey: Right. So it’s more of like the lifestyle stuff during treatment to get you through it a little bit easier, focus on your stress level, maybe do a little bit of movement, that sort of thing. And then once you’re through that part, more focusing on the dietary changes because I think for a lot of people, an intense change like this is such a huge process. And sometimes people are not focused on eating for health until they get this diagnosis. It’s not something they’ve ever thought about before.

Patricia: Exactly, yeah. I always say, doing treatment, to be honest, chemo should really do its trick. Chemo should really knock those cancer cells on their head, and not a diet.

Kelsey: Right. Right.

Patricia: Exactly.

Kelsey: Makes total sense. Okay. So you brought up the gut a little bit ago. That sort struck a chord with me because when you do a ketogenic diet, that’s a lot of fat, for most people it’s going to be a very high fat diet. How does digestion play a role when it comes to the ketogenic diet?

Patricia: It is important to balance it. Usually at the beginning, I have to support digestion and the liver because the liver obviously has to work a lot more as well because the liver has to convert fatty acids into ketone bodies, and it has to produce a lot more bile as well to emulsify all the fats. There’s a lot going on in the digestive tract, also for the pancreas, the stomach, and producing different amounts and kinds of enzymes.

Having digestive support is usually a very good idea for most people, unless they really take their time and ease into it over weeks, then it’s totally possible. There are several gastrointestinal problems that can arise when you initially start. Like constipation can be a problem, and also some people get more bloated, and then it really depends a bit on the symptoms as well. Generally with supplements, it helps just short term, just at the beginning. And then incorporating probiotic foods is absolutely no problem. Once you ferment vegetables, they actually have a much lower carb count.

Kelsey: Yeah.

Patricia: So carrots, they go down to something like 8 grams to 2 grams per 100 grams when you ferment them.

Kelsey: Right.

Patricia: I eat a lot of fermented vegetables and I make kefir with a little of a mix of cream and milk. I have a bit of miso as well. I mean it’s not the best always, but still. I make bone broth as well. Again, we have the glutamine problem.

Kelsey: Right.

Patricia: Small amounts. But it’s certainly good. Sometimes somebody needs more or less at the beginning when they come out of treatment. It’s always a matter of priority really.

Kelsey: Yeah. Okay. This brings up to me that when you start a ketogenic diet, especially if you’ve been diagnosed with cancer, can be a lot of things going on at once. Even once you’re through, if you are doing chemo, radiation, all that sort of intense treatment at the beginning, even once you’re through that, it probably is very helpful to work with someone. Or at least sort have some guide or resource to have as a go to as you start this process. I know you have, well actually you have 2 courses and a book coming out. So can you tell us a little bit about the resources that you have available for people that are interested in this?

Patricia: Yeah. The book is coming out next Tuesday on the 19^th of April. It’s called The Ketogenic Kitchen, and I’ve written it with Domini Kemp, who is a chef and a food writer here in Ireland. She was actually my client back in 2013.

Kelsey: Oh, wow.

Patricia: Yeah. She’s in the media here quite a bit. She used to write for the Irish Times, which is the national paper. She had a recipe column there. She said, “Patricia, you just need to get this information out. You can’t just keep it to yourself.” Okay! How do we go about it? So we decided to write a book together. She focuses on low carb and that’s basically what she does, she had breast cancer, and how to really embrace the fats. I like that expression. It is all about embracing fats and not being scared. But that doesn’t mean you just go and drink olive oil or some people eat half a jar of coconut oil. That’s not the ketogenic diet that I promote.

Kelsey: Right.

Patricia: I think in terms of fats, I still try to get them from whole foods as best as I can instead of just using loads of fats and funny oils and stuff. So trying to have avocados, and coconut products, and just the whole food thing.

Kelsey: Right.

Patricia: That’s very much what her part is. It is really how to incorporate those. The protein would still be a little bit higher than on keto, and the carbs as well. It’s more moderate, but it’s good for people to get a taste of it and ease into it, or ease out of it, of the ketogenic. And mine is meal plans actually, because that’s what I found, people need meal plans. Recipes alone don’t really do the trick because you’re sort of, okay, I had this for breakfast now, now how we go on, and how can we make it really balanced, and avoid food intolerances? Some people, they just keep eating the same foods over and over again until they can’t tolerate them anymore. Other people they go nuts on nuts. And oh, there’s so many things actually.

Kelsey: You’ve got quite the experience to draw upon.

Patricia: So it gives people really clear sort of structure and then they can obviously make some ….. if they want because each recipe has the exact macronutrient breakdown and also calories. So it’s a really good start, a guide. Lots of other information, not just recipes. It’s really about the science behind it, what we just talked about. What to use to test, contraindications, very important as well.

Kelsey: Right, right. That’s awesome.

Patricia: Yeah. It’s very comprehensive. It’s 450 pages.

Kelsey: Oh my gosh. Wow!

Patricia: Then my courses. I recommend looking at the book, or I have e-books as well, looking at them first and really gathering your information. If you’re ready to go, I do have online courses for practitioners and nutrition geeks, so people who really want to go in depth. And I have a bit of a mix on that and it’s quite in depth in terms of foods and science as well. Then I also have one for patients. It’s less science-y. It’s really more about the practical knowledge.

Kelsey: Right. Well that’s fantastic, Patricia. I mean, I’m very happy that you have these resources for people because this is an intense thing to experience and then to have to feel like you’re in over your head trying to implement a ketogenic diet can be very, very overwhelming. We know that stress is not good for anyone, but never mind a cancer patient.

Patricia: Yeah.

Kelsey: So anything that you can do to make it easier on yourself to implement this stuff is great. Thank you so much for creating these resources for patients because I think it’s going to help a lot of people.

Patricia: Yeah. I really hope so. The feedback has been great so far. I have 25 people on the big practitioner, the geeky course. And the other one is only really just launching and I’m hoping to do a lot of live, sort of month long live courses where people can ask me questions.

Kelsey: Thant’s fantastic! Well, thank you so much for being on our show today, Patricia. This was a really great episode and I hope our listeners got a lot out of it. I know I certainly learned a lot today. So I think they probably did too.

Patricia: Yeah. It was great talking to you. Thanks a lot for inviting me.

Kelsey: Absolutely, our pleasure. Alright. You take care, Patricia.

Patricia: Thanks. You too. Thanks a million.

Kelsey: Thank you.