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Only 12% of U.S. adults are considered metabolically healthy. So most of us have some room for improvement when it comes to blood sugar, lipids, and blood pressure. And one (very easy) thing you can do to sway your health for the better is to eat more protein—specifically whey protein powder.
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Some of those taking Ozempic or Wegovy are learning that too much of a good thing is never good.
Semaglutide, the medication prescribed under the brand names Ozempic, for treating Type 2 diabetes, and Wegovy, for weight management, works by mimicking the hormone GLP-1, which is released by the gut after eating. The hormone has several effects in the body, such as stimulating insulin production, slowing gastric emptying and lowering blood sugar.
It has been hailed for its weight-loss benefits, most conspicuously among celebrities. Oprah Winfrey recently said she uses weight-loss medication and lauded “the fact that there’s a medically approved prescription for managing weight and staying healthier, in my lifetime.” She said it felt “like a gift.”
But between Jan. 1 and Nov. 30 this year, at least 2,941 Americans reported overdose exposures to semaglutide, according to a recent report from America’s Poison Centers, a national nonprofit representing 55 poison centers in the United States.
California accounted for about 350 of the reports, or around 12%, according to Raymond Ho, the managing director of the California Poison Control System. Ho said the number roughly corresponds to the proportion of California’s population to the rest of the country.
The nationwide number of semaglutide overdoses this year is more than double the 1,447 reported in 2022, which was more than double the 607 semaglutide overdoses reported in 2021.
There were only 364 reported semaglutide overdoses in 2020 and 196 in 2019, less than 10% of the number that occurred so far this year.
America’s Poison Centers released the data with a disclaimer that the figures likely represent an undercount in the number of cases involving semaglutide, as the center only included those voluntarily reported to poison control centers.
“It is an alarming trend from a poison center perspective,” Ho said. “We get the usual dosing error calls, and all of a sudden there’s an explosion of people calling much more regularly about this.”
The use of semaglutide and other GLP-1 imitators has surged in popularity over the last year as a quick and effective way to manage weight loss. More than 4 million prescriptions for semaglutide were issued in the United States in 2020, according to federal data, and usage of the drug has continued to grow since then.
Dr. Stephen Petrou, an emergency medicine physician and toxicology fellow with California Poison Control, said there were multiple factors contributing to the increase in overdoses.
“Not only is there rising social popularity” of the drug, Petrou said, “but there’s also wider FDA indications for use.”
Semaglutide was patented by the Danish pharmaceutical company Novo Nordisk in 2012 and has been available in the United States since the FDA approved it in 2017. The drug was originally released as Ozempic for Type 2 diabetics to manage blood sugar levels. Moderate weight loss was found to be a common side effect of the drug, and the FDA approved a different formulation of semaglutide, called Wegovy, for that purpose in 2021.
Ho and Petrou said the different formulations of semaglutide could help explain why it has led to so many more overdoses than other drugs of its class. Both are administered via weekly injections, with Wegovy in single-use pens and Ozempic in needles that can vary in dosage. Standard dosages range from 0.25 mg to 2.4 mg for weekly injections, depending on the prescription.
“Someone who is unable to get Wegovy can resort to using Ozempic instead, because it is the same medication, but they may start to [adjust] their dose” upward, Petrou said. “That’s when they might encounter problems.”
Ho and Petrou said the vast majority of semaglutide overdose reports are accidental, either due to patients not waiting a week between doses or by misunderstanding dosing instructions. Unlike the GLP-1 hormone, which is rapidly metabolized by the body, semaglutide and similar medications have much longer half-lives, meaning the medication can build up inside the body if not enough time elapses between doses.
Furthermore, semaglutide can also be taken orally as a daily pill — sold under the name Rybelsus — but overdoses are rarely reported.
“We’re not seeing cases of mis-administration or toxicity or overdose with that medication,” Petrou said.
Ho and Petrou explained the signs of semaglutide overdose can resemble those of hypoglycemia, also known as low blood sugar. Symptoms can begin with increased heart rate, sweating, dizziness and irritability. More serious cases can cause confusion, delirium and coma.
“If they have hypoglycemia, the good majority of them will have to be admitted to the hospital and monitored and watched closely, because of how long these drugs last,” Ho said.
Ho encourages everyone who is prescribed semaglutide to thoroughly read the medication’s label and follow the dosing instructions listed.
“We always say this: The dose makes the poison,” Ho said.
Anyone who needs emergency poison assistance or has other poisoning-related inquiries can call the national Poison Helpline at (800) 222-1222 or visit the Poison Help website.
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Jeremy Childs
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Ketogenic diets are put to the test for diabetes reversal.
As you can see at the start of my video Does a Ketogenic Diet Help Diabetes or Make It Worse?, ketogenic diets can lower blood sugars better than conventional diets. So much so, in fact, that there is a keto product company that claims ketogenic diets can “reverse” diabetes. However, they are confusing the symptom (high blood sugars) with the disease (carbohydrate intolerance). People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Clearly, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse at the same time.
We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket within just two days. Below and at 0:46 in my video, you can see a graph from the study showing the blood sugar response two days after eating sugar. On a high-carb diet, blood sugar response is about 90 mg/dL. But, the blood sugar response to the same amount of sugar after a high-fat diet is about 190 mg/dL, nearly double. The intolerance to carbohydrates skyrocketed on a high-fat diet.
After one week on an 80 percent fat diet, you can quintuple your blood sugar spike in reaction to the same carb load compared to a week on a low-fat diet, as you can see in the graph below and at 1:12 in my video. 
Even a single day of excessive dietary fat intake can do it, as you can see in the graph below and at 1:26 in my video. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. Just one meal high in saturated fat can make carbohydrate intolerance, the cause of diabetes, worse within four hours.
Given enough weight loss by any means, whether from cholera or bariatric surgery, type 2 diabetes can be reversed, but a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire.
I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever instead of antibiotics. However, a keto diet for diabetes is worse than that because it may treat the symptoms while actively worsening the disease. It may be more like curing the fever by throwing that pneumonia patient out into a snow bank or “curing” your amputated finger by amputating your hand. One of the co-founders of masteringdiabetes.org suggested it’s like a CEO who makes their bad bottom line look better by borrowing tons of cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole.
Do you remember The Club, that popular car anti-theft device that attaches to the steering wheel and locks it in place so the steering column can only turn a few inches? Imagine you’re in a car at the top of a hill with the steering wheel locked. Then, the car starts rolling down the hill. What do you do? Imagine there’s also something stuck under your brake pedal. The keto-diet equivalent response to this situation is who cares if you’re barreling down into traffic with a locked steering wheel and no brakes—just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! The longer you go, the more speed you’ll pick up. If you should hit a dietary bump in the road or start to veer off the path, the consequences could get more and more disastrous over time. However, if you stick to the keto straight and narrow, you’ll be a-okay! In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem instead of just whistling past—and then into—the graveyard.
The reason keto proponents claim they can “reverse” diabetes is they can successfully wean type 2 diabetics off their insulin. That’s like faith-healing someone out of the need for a wheelchair by making them stay in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone. Their diabetes isn’t gone. In fact, it could be just as bad or even worse. Type 2 diabetes is reversed when you are weaned off insulin while eating a normal diet like everyone else. Then and only then do you not have diabetes anymore. A true diabetes reversal diet, as you can see below and at 4:58 in my video, is practically the opposite of a ketogenic diet: getting diabetics off their insulin within a matter of weeks by eating more than 300 grams of carbs a day! 
The irony doesn’t stop there. One of the reasons people with diabetes suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal, which forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products (AGEs), which are implicated in degenerative diseases—from Alzheimer’s and cataracts to kidney disease and strokes, as you can see below and at 5:31 in my video.
You get AGEs in your body from two sources: You can eat them preformed in your diet or make them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein, but we would expect less internal, new formation due to presumably low levels of methylglyoxal, given lower blood sugars from not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal! As shown in the graph below and at 6:11 in my video, a few weeks on the Atkins diet led to a significant increase in methylglyoxal levels. Those in active ketosis did even worse, doubling the level of this glycotoxin in their bloodstream.
It turns out that high sugars may not be the only way to create this toxin, as you can see below and at 6:24 in my video. One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests, “feel queasy and light-headed, and develop what’s been described as ‘rotten apple breath.’” Acetone can oxidize in the blood to form acetol, which may be a precursor for methylglyoxal. 
That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. The irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences.
This is part of a seven-video series on keto, which you can find in related videos below.
I also recently tackled diabetes.
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Michael Greger M.D. FACLM
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Ketogenic diets have been found to undermine exercise efforts and lead to muscle shrinkage and bone loss.
An official International Society of Sports Nutrition position paper covering keto diets notes the “ergolytic effect” of keto diets on both high- and low-intensity workouts. Ergolytic is the opposite of ergogenic. Ergogenic means performance-boosting, whereas ergolytic means performance-impairing.
For nonathletes, ketosis may also undermine exercise efforts. Ketosis was correlated with increased feelings of “perceived exercise effort” and “also significantly correlated to feelings of ‘fatigue’ and to ‘total mood disturbance,’” during physical activity. “Together, these data suggest that the ability and desire to maintain sustained exercise might be adversely impacted in individuals adhering to ketogenic diets for weight loss.”
You may recall that I’ve previously discussed that shrinkage of measured muscle mass among CrossFit trainees has been reported. So, a ketogenic diet may not just blunt the performance of endurance athletes, but their strength training as well. As I discuss in my video Keto Diets: Muscle Growth and Bone Density, study participants performed eight weeks of the battery of standard upper and lower body training protocols, like bench presses, pull-ups, squats, and deadlifts, and there was no surprise. You boost muscle mass—unless you’re on a keto diet, in which case there was no significant change in muscle mass after all that effort. Those randomized to a non-ketogenic diet added about three pounds of muscle mass, whereas the same amount of weight lifting on the keto diet tended to subtract muscle mass by about 3.5 ounces on average. How else could you do eight weeks of weight training and not gain a single ounce of muscle on a ketogenic diet? Even keto diet advocates call bodybuilding on a ketogenic diet an “oxymoron.”
What about bone loss? Sadly, bone fractures are one of the side effects that disproportionately plague children placed on ketogenic diets, along with slowed growth and kidney stones. Ketogenic diets may cause a steady rate of bone loss as measured in the spine, presumed to be because ketones are acidic, so keto diets can put people in what’s called a “chronic acidotic state.”
Some of the case reports of children on keto diets are truly heart-wrenching. One nine-year-old girl seemed to get it all, including osteoporosis, bone fractures, and kidney stones, then she got pancreatitis and died. Pancreatitis can be triggered by having too much fat in your blood. As you can see in the graph below and at 2:48 in my video, a single high-fat meal can cause a quintupling of the spike in triglycerides in your bloodstream within hours of consumption, which can put you at risk for inflammation of the pancreas.
The young girl had a rare genetic disorder called glucose transporter deficiency syndrome. She was born with a defect in ferrying blood sugar into her brain. That can result in daily seizures starting in infancy, but a ketogenic diet can be used as a way to sneak fuel into the brain, which makes a keto diet a godsend for the 1 in 90,000 families stricken with this disorder.
As with anything in medicine, it’s all about risks versus benefits. As many as 30 percent of patients with epilepsy don’t respond to anti-seizure drugs. Unfortunately, the alternatives aren’t pretty and can include brain surgery that implants deep electrodes through the skull or even removes a lobe of your brain. This can obviously lead to serious side effects, but so can having seizures every day. If a ketogenic diet can help with seizures, the pros can far outweigh the cons. For those just choosing a diet to lose weight, though, the cost-benefit analysis would really seem to go the other way. Thankfully, you don’t need to mortgage your long-term health for short-term weight loss. We can get the best of both worlds by choosing a healthy diet, as I discussed in my video Flashback Friday: The Weight Loss Program That Got Better with Time.
Remember the study that showed the weight loss was nearly identical in those who had been told to eat the low-carb Atkins diet for a year and those told to eat the low-fat Ornish diet, as seen below and at 4:18 in my video? The authors concluded, “This supports the practice of recommending any diet that a patient will adhere to in order to lose weight.” That seems like terrible advice.
There are regimens out there like “The Last Chance Diet which consisted of a low-calorie liquid formula made from leftover byproducts from a slaughterhouse [that] was linked to approximately 60 deaths from cardiovascular-related events.” An ensuing failed lawsuit from one widower laid the precedent for the First Amendment protection for those who produce deadly diet books.
It’s possible to construct a healthy low-carb diet or an unhealthy low-fat one—a diet of cotton candy would be zero fat—but the health effects of a typical low-carb ketogenic diet like Atkins are vastly different from a low-fat plant-based diet like Ornish’s. As you can see in the graph below and at 5:26 in my video, they would have diametrically opposed effects on cardiovascular risk factors in theory, based on the fiber, saturated fat, and cholesterol contents of their representative meal plans.
And when actually put to the test, low-carb diets were found to impair artery function. Over time, blood flow to the heart muscle itself is improved on an Ornish-style diet and diminished on a low-carb one, as shown below and at 5:44 in my video. Heart disease tends to progress on typical weight-loss diets and actively worsens on low-carb diets, but it may be reversed by an Ornish-style diet. Given that heart disease is the number one killer of men and women, “recommending any diet that a patient will adhere to in order to lose weight” seems irresponsible. Why not tell people to smoke? Cigarettes can cause weight loss, too, as can tuberculosis and a meth habit. The goal of weight loss is not to lighten the load for your pallbearers.
For more on keto diets, see my videos on the topic. Interested in enhancing athletic performance? Check out the related videos below.
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Michael Greger M.D. FACLM
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It’s not just in your head—managing your weight during menopause (and in your postmenopause years) is just harder. Declining estrogen levels create an internal landscape that favors fat accumulation (especially in the belly), muscle loss, and even unfavorable blood sugar and cholesterol levels.
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If anything defines America’s current obesity-drug boom, it’s this: Many more people want these injections than can actually get them. The roadblocks include exorbitant costs that can stretch beyond $1,000 a month, limited insurance coverage, and constant supply shortages. But before all of those issues come into play, anyone attempting to get a prescription will inevitably confront the same obstacle: their body mass index, or BMI.
So much depends on the simple calculation of dividing one’s weight by the square of their height. According to the FDA, people qualify for prescriptions of Wegovy and Zepbound—the obesity-drug versions of the diabetes medications Ozempic and Mounjaro—only if their BMI is 3o or higher, or 27 or higher with a weight-related health issue such as hypertension. Many who do get on the medication use BMI to track their progress. That BMI is the single biggest factor determining who gets prescribed these drugs, and who doesn’t, is the result of how deeply entrenched this metric has become in how both doctors and regular people approach health: Low BMI is good and high BMI is bad, or so most of us have come to think.
This roughly 200-year-old metric has never been more relevant—or maligned—than it is in the obesity-drug era. BMI has become like the decrepit car you keep driving because it still sort of works and is too much of a hassle to replace. Its numerous shortcomings have been called out for many years now: For starters, it accounts for only height and weight, not other, more pertinent measures such as body-fat percentage. In June, the American Medical Association formally recognized that BMI should not be used alone as a health measure. Last year, some doctors called for BMI to be retired altogether, echoing previous assertions.
The thing is, BMI can be an insightful health metric, but only when used judiciously with other factors. The problem is that it often hasn’t been. Just as obesity drugs are taking off, however, professional views are changing. People are so accustomed to seeing BMI as the “be-all, end-all” of health indicators, Kate Bauer, a nutritional-sciences professor at the University of Michigan, told me. “But that’s increasingly not the way it’s being used in clinical practice.” A shift in the medical field is a good start, but the bigger challenge will be getting everyone else to catch up.
BMI got its start in the 1830s, when a Belgian astronomer named Adolphe Quetelet attempted to determine the properties of the “average” man. Using data on primarily white people, he observed that weight tended to vary as the square of height—a calculation that came to be known as Quetelet’s index.
Over the next 150 years, what began as a descriptive tool transformed into a prescriptive one. Quetelet’s index (and other metrics like it) informed height-weight tables used by life-insurance companies to estimate risk. These sorts of tables formed “recommendations for the general population going from ‘average’ to ‘ideal’ weights,” the epidemiologist Katherine Flegal wrote in her history of BMI; eventually, nonideal weights were classified as “overweight” and “obese.” In 1972, the American physiologist Ancel Keys proposed using Quetelet’s index—which he renamed BMI—to roughly measure obesity. We’ve been stuck with BMI ever since. The metric became embedded not only in research and doctor’s visits but also in the very definitions of obesity. According to the World Health Organization, a BMI starting at 25 and less than 30 is considered overweight; anything above that range is obese.
But using BMI to categorize a person’s health was controversial from the start. Even Keys called it “scientifically indefensible” to use BMI to judge someone as overweight. BMI doesn’t account for where fat is distributed on the body; fat that builds up around organs and tissues, called visceral fat, is linked to serious medical issues, while fat under the skin—the kind you can pinch—is usually less of a problem. Muscularity is also overlooked: LeBron James, for example, would be considered overweight. Both fat distribution and muscularity can vary widely across sex, age, and ethnicity. People with high BMIs can be perfectly healthy, and “there are people with normal BMIs that are actually sick because they have too much body fat,” Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association, told me.
For all its flaws, BMI is actually useful at the population level, Fitch said, and doctors can measure it quickly and cheaply. But BMI becomes troubling when it is all that doctors see. In some cases, the moment when a patient’s BMI is calculated by their doctor may shape the rest of the appointment and relationship going forward. “The default is to hyper-focus on the weight number, and I just don’t think that that’s helpful,” Tracy Richmond, a pediatrics professor at Harvard Medical School, told me. Anti-obesity bias is well documented among physicians—even some obesity specialists—and can lead them to dismiss the legitimate medical needs of people with a high BMI. In one tragic example, a patient died from cancer that went undiagnosed because her doctors attributed her health issues to her high BMI.
But after many decades, the medical community has begun to use BMI in a different way. “More and more clinicians are realizing that there are people who can be quite healthy with a high BMI,” Kate Bauer said. The shift has been gradual, though it was given a boost by the AMA policy update earlier this year: “Hopefully that will help clinicians make a change to supplement BMI with other measures,” Aayush Visaria, an internal-medicine resident at Rutgers Robert Wood Johnson Medical School who researches BMI’s shortcomings, told me.
Physicians I spoke with acknowledged BMI’s flaws but didn’t seem too concerned about its continued use in medicine—even as obesity drugs make this metric even more consequential. BMI isn’t a problem, they said, as long as physicians consider other factors when diagnosing obesity or prescribing drugs to treat it. If you go to a doctor with the intention of getting on an obesity drug, you should be subject to a comprehensive evaluation including metrics such as blood sugar, cholesterol levels, and body composition that go “way beyond BMI,” Katherine Saunders, a clinical-medicine professor at Weill Cornell Medicine, said. Because Wegovy and other drugs come with side effects, she told me, doctors must be absolutely sure that a patient actually needs them, she added.
But BMI isn’t like most other health metrics. Because of its simplicity, it has seeped out of doctor’s offices and into the mainstream, where this more nuanced view still isn’t common. Whether we realize it or not, BMI is central to our basic idea of health, affecting nearly every aspect of daily life. Insurance companies are notorious for charging higher rates to people with high BMI and lowering premiums for people who commit to long-term weight loss. Fertility treatments and orthopedic and gender-affirming surgery can be withheld from patients until they hit BMI targets. Workplace wellness programs based on BMI are designed to help employees manage their weight. BMI has even been used to prevent prospective parents from adopting a child.
The rise of obesity drugs may make these kinds of usages of BMI even harder to shake. Determining drug eligibility by high BMI supports the notion that a number is synonymous with illness. Certainly many people using obesity drugs take a holistic view of their health, as doctors are learning to do. But focusing on BMI is still common. Some members of the r/Ozempic Subreddit, for example, share their BMI to show their progress on the drug. Again, high BMI can be used to predict who has obesity, but it isn’t itself an obesity diagnosis. The problem with BMI’s continued dominance is that it makes it even harder to move away from simply associating a number on a scale with overall health, with all the downstream consequences that come along with a weight-obsessed culture. As obesity drugs are becoming mainstream, “there needs to be public education explaining that BMI by itself may not be a good indicator of health,” Visaria said.
In another 200 years, surely BMI will finally be supplanted by something else. If not much sooner: A large effort to establish hard biological criteria for obesity is under way; the goal is to eliminate BMI-based definitions once and for all. Caroline Apovian, a professor at Harvard Medical School, gives it “at least 10 years” before a comparably cheap or convenient replacement arises—though any changes would take longer to filter into public consciousness.” Until that happens, we’re stuck with BMI, and the mess it has wrought.
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Yasmin Tayag
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What does the science say about the clinical use of ketogenic diets for epilepsy and cancer?
Blood sugar, also known as blood glucose, is the universal go-to fuel for the cells throughout our bodies. Our brain burns through a quarter pound of sugar a day because “glucose is the preferred metabolic fuel.” We can break down proteins and make glucose from scratch, but most comes from our diet in the form of sugars and starches. If we stop eating carbohydrates (or stop eating altogether), most of our cells switch over to burning fat. Fat has difficulty getting through the blood-brain barrier, though, and our brain has a constant, massive need for fuel. Just that one organ accounts for up to half of our energy needs. Without it, the lights go out…permanently.
To make that much sugar from scratch, our body would need to break down about half a pound of protein a day. That means we’d cannibalize ourselves to death within two weeks, but people can fast for months. What’s going on? The answer to the puzzle was discovered in 1967. Harvard researchers famously stuck catheters into the brains of obese subjects who had been fasting for more than a month and discovered that ketones had replaced glucose as the preferred fuel for the brain. Our liver can turn fat into ketones, which can then breach the blood-brain barrier and sustain our brain if we aren’t getting enough carbohydrates. Switching fuels has such an effect on brain activity that it has been used to treat epilepsy since antiquity.
In fact, the prescription of fasting for the treatment of epileptic seizures dates back to Hippocrates. In the Bible, even Jesus seems to have concurred. To this day, it’s unclear why switching from blood sugar to ketones as a primary fuel source has such a dampening effect on brain overactivity. How long can one fast? To prolong the fasting therapy, in 1921, a distinguished physician scientist at the Mayo Clinic suggested trying what he called “ketogenic diets,” high-fat diets designed to be so deficient in carbohydrates that they could effectively mimic the fasting state. “Remarkable improvement” was noted the first time it was put to the test, efficacy that was later confirmed in randomized, controlled trials. Ketogenic diets started to fall out of favor in 1938 with the discovery of the anti-seizure drug that would become known as Dilantin, but they’re still being used today as a third- or fourth-line treatment for drug-refractory epilepsy in children.
Oddly, the success of ketogenic diets against pediatric epilepsy seems to get conflated by “keto diet” proponents into suggesting a ketogenic diet is beneficial for everyone. Know what else sometimes works for intractable epilepsy? Brain surgery, but I don’t hear people clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity with electroshock therapy can be helpful in some cases of major depression, so should we get out the electrodes? Ketogenic diets are also being tested to see if they can slow the growth of certain brain tumors. Even if they work, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you can just go chemo?
Promoters of ketogenic diets for cancer are paid by so-called ketone technology companies that offer to send you salted caramel bone broth powder for a hundred bucks a pound or companies that market ketogenic meals and report “extraordinary” anecdotal responses in some cancer patients. But more concrete evidence is simply lacking, and even the theoretical underpinnings may be questionable. A common refrain is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer is like saying Hitler breathed air so we should boycott oxygen.
Cancer can feed on ketones, too. Ketones have been found to fuel human breast cancer growth and drive metastases in an experimental model, more than doubling tumor growth. Some have even speculated that this may be why breast cancer often metastasizes to the liver, the main site of ketone production. As you can see below and at 4:59 in my video Is Keto an Effective Cancer-Fighting Diet?, if you drip ketones directly onto breast cancer cells in a petri dish, the genes that get turned on and off make for much more aggressive cancer, associated with significantly lower five-year survival in breast cancer patients, as you can see in the following graph and at 5:05 in my video. Researchers are even considering designing ketone-blocking drugs to prevent further cancer growth by halting ketone production.
Let’s also think about what eating a ketogenic diet might entail. High animal fat intake may increase the mortality risk among breast cancer survivors and potentially play a role in the development of breast cancer in the first place through oxidative stress, hormone disruption, or inflammation. This applies to men, too. “A strong association” has been found “between saturated fat intake and prostate cancer progression and survival.” Those in the top third of consumption of these kinds of fat-rich animal foods appeared to triple their risk of dying from prostate cancer. This isn’t necessarily fat in general either. No difference has been found in breast cancer death rates based on total fat intake. However saturated fat intake specifically may negatively impact breast cancer survival, increasing the risk of dying from it by 50 percent. There’s a reason the official American Cancer Society and American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommend a dietary pattern for breast cancer patients that’s essentially the opposite of a ketogenic diet. It calls for a diet that’s “high in vegetables, fruits, whole grains, and legumes [beans, split peas, chickpeas, and lentils]; low in saturated fats; and limited in alcohol consumption.”
“To date, not a single clinical study has shown a measurable benefit from a ketogenic diet in any human cancer.” There are currently at least a dozen trials underway, however, and the hope is that at least some cancer types will respond. Still, even then, that wouldn’t serve as a basis for recommending ketogenic diets for the general population any more than recommending everyone get radiation, surgery, and chemo just for kicks.
“Keto” has been the most-searched keyword on NutritionFacts.org for months, and I didn’t have much specific to offer…until now. Check out my other videos on the topic in related videos below.
For an overview of my cancer work, watch How Not to Die from Cancer.
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Michael Greger M.D. FACLM
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When you think of blood sugar (aka glucose) levels, does your mind jump straight to how much sugar you eat? If so, that’s completely fair. Your carb intake does play a significant role in your blood sugar levels. Carbs (no matter if it’s fruit, grains, or candy) are eventually broken down and metabolized into glucose. Eating a lot of carbs, especially foods with added sugar and no fiber, floods the bloodstream with glucose and can cause a dramatic increase in blood sugar.
But it’s not the only thing that impacts your glucose levels. Other habits that have nothing to do with who or how much you eat also influence how your body regulates its sugar.
So if you’ve recently had bloodwork done or are using a continuous glucose monitor and notice higher than desirable glucose levels, or if you’ve been feeling a bit haywire energy-wise, it may be because of one (or more) of these four sneaky culprits.
Being stressed releases a cascade of hormones like adrenaline and cortisol. In the right stressful situations (say you’re being chased by a bear), the release of these hormones increases your alertness and energy production—meaning your blood sugar will spike. But in these short-term situations, that energy spike is actually desirable.
You need to be alert and energized to deal with whatever the situation at hand is. And once that stressor is removed, levels of these hormones go back to their resting state and everything is balanced again.
The problem arises when stress doesn’t go away. Stress from work, financial concerns, relationships, parenting, and daily inconveniences, also trigger these hormones. Chronically high cortisol levels can also chronically raise blood sugar levels.
What can you do about this? Eliminating stress isn’t necessarily the goal here, but rather try to incorporate science-backed ways that can help manage the stress in your life. This could be through the use of meditation, yoga, aromatherapy, or adaptogens like ashwagandha.
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Molly Knudsen, M.S., RDN
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Depending on your goals and the type of fast you’re doing, drinking beverages with a small number of calories (such as lemon water or coffee) should not interfere with your progress. In fact, taking a “dirty” fasting approach to beverages can make fasting easier to stick with for beginners and help keep your body properly hydrated.
As Varady explains of her clinical experience with fasting, “Many of our studies run six to 12 months, and we want our subjects to feel comfortable while doing fasting. If we ask them to change their eating habits too much, they often drop out.” Plus, she adds, if weight loss is the goal, “these additives only contribute a very small amount of calories, so it does not upset their progress.”
That said, high-calorie or high-sugar options like smoothies, soda, or broth will likely do more harm than good and should be avoided during your fasting window.
And despite the health benefits of fasting, it’s definitely not for everyone. For example, some experts warn that intermittent fasting is trickier for women because fasting is a type of stressor, and women process stress differently than men.
Amy Shah, M.D., a double board-certified physician specializing in hormones, previously told mbg that overly stressed women should skip intermediate fasting, as it can negatively impact female hormones (though more research needs to be done on the subject).
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Julia Guerra
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Like so many of us, LeVeque was taught that overnight oats, chia pudding, and egg scrambles are the epitome of healthy breakfast foods.
While these dishes can be nutrient-dense and delicious, she notes that most of them don’t hit the 30-gram threshold she’s looking for to activate muscle protein synthesis and get her on her way to her goal of consuming 1.2 to 2.0 grams of protein per kilogram of body weight a day (upward of 100 grams daily). A large egg contains around 6 grams of protein, for example, so she’d need to eat at least five of them to hit this breakfast target.
It’s a lot easier to make a high-protein breakfast using complete animal-based proteins like steak, chicken, salmon, turkey, bison, and lamb, she notes. Bioavailable animal proteins also contain important fat-soluble vitamins and tend to be higher in leucine—an essential amino acid that kick-starts muscle building and repair.
Another nice thing about these proteins is you don’t need to do much to make them taste good. Case in point: The morning LeVeque and I connected for this piece, she said she’d just consumed some ground beef straight out of a glass container in her fridge for breakfast. And after the call, before running to her next appointment, she’d probably have some leftover chicken from the night before with carrots, cucumbers, and whatever condiments she had on hand.
Eating this type of breakfast might sound a little weird but, she explains, “When you eat enough protein, you really don’t care what the other stuff you’re eating is. You’re so satisfied that the cravings hit the floor.”
Since introducing more protein to her breakfast—in the form of whole animal proteins and her go-to smoothie (which also features a serving of protein powder)—she’s noticed that her strength has skyrocketed, her digestion has improved, and her cravings and mood have steadied. “I feel stronger and lighter than ever,” she says, noting that some of her celeb clients like Jennifer Garner and Halle Berry have had similar results on a higher-protein diet.
Here’s the breakdown of how LeVeque fits in at least 30 grams of protein each morning using whole-food ingredients.
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Emma Loewe
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To do so, they used data from over 1,000 people who’d participated in the ZOE PREDICT 1 study, which focused on how and why people respond differently to the same foods.
And based on their analysis, quality and timing are the two big factors to consider when reaching for a snack. Namely, snacking on higher quality foods (options that are nutrient-dense, as opposed to “empty calories”), was linked with better blood fat and insulin responses.
Further, in terms of timing, snacking during the day is also better for blood sugar levels. Late-night snacking, on the other hand, was associated with less desirable blood sugar and fat levels.
And these findings on snacking were independent from other dietary factors like full meals, which the study authors point out means healthy snacking is one simple, modifiable change people can make to improve their health.
“Our study showed that the quality of snacking is more important than the quantity or frequency of snacking, thus choosing high quality snacks over highly processed snacks is likely beneficial,” explains study co-author Kate Bermingham, Ph.D. in a news release, adding, “Timing is also important, with late night snacking being unfavorable for health.”
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Sarah Regan
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Whey protein is beneficial for more than just muscle gains.
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Molly Knudsen, M.S., R.D.N.
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Blood glucose, commonly known as blood sugar, is a key health indicator. It acts as the primary fuel source for our cells, especially those in the brain.
Derived mainly from the foods we consume, particularly carbohydrates such as grains, fruits, vegetables, and sugars, glucose is broken down and released into our bloodstream. It is also created by our liver in a process called gluconeogenesis.
The balance of glucose in your blood is controlled by an intricate system involving several hormones, chiefly insulin and glucagon, both produced by the pancreas. After eating, our blood glucose levels increase, signaling the pancreas to produce insulin. This insulin then functions to facilitate glucose absorption by our cells, where it is used for energy or stored for later use.
When blood glucose levels diminish, the pancreas releases glucagon, which prompts the liberation of stored glucose back into the bloodstream.
Persistent high blood glucose levels, a state known as hyperglycemia, can lead to health complications such as diabetes, heart disease, kidney disease, among others. Conversely, hypoglycemia, or exceedingly low blood glucose levels, can result in a slew of symptoms including weakness, confusion, and in severe cases, loss of consciousness.
Monitoring blood glucose levels is especially important for individuals with diabetes. This is where CGMs are instrumental, as they provide real-time data on glucose levels, aiding individuals in better managing their health.
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Amanda Lundberg, RN
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These findings come as good news to anyone who wants to lower their risk of diabetes or gain more control over their blood sugar. The researchers hope new technologies that allow for the safe alteration of brain waves during deep sleep could even be a promising health intervention for blood sugar control.
But until those kinds of tools become more available to the everyday person, the findings also highlight the importance of prioritizing deep sleep.
As such, one of the best things you can do for your overall sleep hygiene is to maintain a consistent sleep/wake schedule—that is, going to bed and waking up at the same time every day.
Research also shows that exercising regularly is a good way to prime the body and brain for deep sleep. In one analysis of existing exercise and sleep studies2, researchers write, “Exercise promoted increased sleep efficiency and duration regardless of the mode and intensity of activity” in middle-aged and elderly adults.
And of course, to make sure you’re getting the most out of deep sleep, you might want to consider trying a quality sleep supplement with ingredients that are research-backed to help people fall asleep faster and stay asleep longer, such as magnesium and PharmaGABA®.
Here’s our full guide on how to get more deep sleep for more information.
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Sarah Regan
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Eating in alignment with your circadian rhythms means that you’re taking advantage of this natural period of higher metabolic activity.
Current studies on meal timing show that early fasting in particular can help lower blood sugar (glucose) levels, manage weight, and improve body composition. Some research indicates that frontloading your calorie intake 2for the day before 3 p.m. is linked consuming fewer calories daily and eating a higher-quality diet, whereas eating a higher percentage of your daily calories after 8 p.m. is associated with having a higher body mass index (BMI) and body fat.
So there’s pretty well-established (and growing) evidence behind eating earlier in the day. What’s still emerging though is comparing intermittent fasting eating window times. What the data currently show is that early time-restricted feeding may reduce fasted blood sugar levels and insulin sensitivity—meaning your cells are more responsive to the hormone that helps the body better utilize glucose. And late time-restricted feeding may increase blood sugar levels.
But in terms of fasting, intermittent fasting in general is considered a beneficial therapeutic approach to managing type 2 diabetes3.
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mindbodygreen
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Vitamin D, which can be synthesized in our skin in response to sunlight and is also found in small amounts in certain foods, has receptor proteins located in neurons and certain brain cells. It plays a crucial role in protecting the nervous system, maintaining critical brain functions, and preventing oxidative damage to the brain.
Yet, an astonishing half of the population is affected by either vitamin D deficiency or insufficiency, and rates can vary widely based on race and ethnic origin. Vitamin D deficiency is particularly concerning, as it has been associated with cognitive impairment and dementia. Plus, there’s emerging research to suggest adequate vitamin D levels may ward off glucose regulation concerns, including the onset of diabetes.
A recent review of studies focused on vitamin D insufficiency and cognitive function in adults. The review included nine studies involving 69,643 participants with an average age of 53.6 years. It found that individuals with vitamin D deficiency or insufficiency had reduced executive function, processing speed, and visuoperceptual ability. What’s more, five of the studies linked vitamin D deficiency to an increased risk of dementia.
In two of the studies, the severity of memory and cognitive impairment was found to be directly proportional to the degree of vitamin D insufficiency.
One study found that vitamin D supplementation can increase cognitive and memory function, pointing to the potential of this vitamin to combat cognitive decline.
However, it’s important to note the research had some limitations, including the underrepresentation of certain populations, such as people from Africa, Asia, and of Hispanic heritage. The authors also noted that larger randomized controlled trials will be needed to explore the full range of effects of vitamin D deficiency and supplementation, as well as their connection to cognitive health in the aging brain.
Another new study1 looked into the effects of vitamin D on glucose regulation and diabetes risk. It found that adequate vitamin D levels lowered participants’ risk of developing the condition.
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Jenny Fant
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While these numbers are shocking (and honestly, quite terrifying) there’s some optimism to be shared: Type 2 diabetes is preventable.
That said, we’re dealing with a metabolic health crisis in the United States and around the world. So, accepting the “obesogenic way our environments are designed and the inequitable way we organize our resources and societies,” as researchers from the Lancet review so eloquently put it, is not an option if we’d like to optimize the metabolic well-being of humanity moving forward.
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Morgan Chamberlain
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You can buy hibiscus tea in ready-to-use tea bags or as a loose-leaf tea. If you like a richer, more flavorful tea drink, consider purchasing loose-leaf hibiscus tea in bulk. Using loose-leaf tea allows you to add more tea to your tea strainer to make a more concentrated beverage.
If you prefer a lighter tea, steep your hibiscus for a few minutes. For a stronger tea, steep loose-leaf hibiscus tea and hibiscus tea bags for 10-15 minutes.
Registered dietitian Lauren Manaker, MS, RDN, LD recommends making a large batch of hibiscus tea and keeping it in your refrigerator to enjoy throughout the day.
Most traditional hibiscus tea methods, such as Egyptian Karkade, a hibiscus tea drink made with sugar, are sweetened. However, you can enjoy your hibiscus tea unsweetened or with a squeeze of lemon or lime. Sugar alternatives like monk fruit can also be used to counter the tart taste of hibiscus tea.
Keep in mind that f you’re using a lot of sweetener in your tea, it may take away from hibiscus tea’s benefits. “Of course, we have to consider what we are adding to our tea when assuming we will reap the benefits of this cozy sip. Adding loads of added sugar may work against some of these health goals,” says Manaker. For example, while regularly drinking unsweetened hibiscus tea may promote heart health, a diet high in added sugar has been shown to negatively impact heart health15 by increasing blood lipid and body fat levels.
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Jillian Kubala, MS, RD
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You know the saying “You are what you eat?” Well, the same goes for your metabolism. If you want to keep your blood sugar balanced and optimize your metabolism, being mindful of foods and dietary patterns in relation to their impact on blood glucose control is key.
LeVeque recommends first focusing on incorporating foods from what she refers to as “The ab Four” into your diet: protein, fat, fiber, and greens/vegetables deep in color. “These foods provide essential amino acids from protein, essential fatty acids from fat, fiber, and nonstarchy produce that has little to no effect on blood sugar.”
Next, it’s important to be cognizant of foods that could cause a spike in blood sugar. These include simple carbohydrates(as opposed to the complex, fiber-laden types of carbohydrate you receive from whole grains, legumes, vegetables, etc.), sugary treats, and added sugars. (Generally, the more processed and refined a food is, the less it resembles the original plant source, and the faster and higher the blood glucose spike.)
“When you look at sugar and starches that have been removed from their fiber cell and are considered acellular carbohydrates (aka processed carbohydrates), they have an exaggerated effect on blood sugar,” LeVeque notes. “Think things like orange juice, sugary condiments, and baked goods.”
However, this isn’t to say you can’t enjoy these types of foods in moderation—or modify a recipe to make it more blood-sugar-friendly. To be on the safe side, LeVeque advises enjoying fruit in its whole form, using condiments without any added sugar, and enjoying homemade baked goods so you can use higher-fiber flour and lower amounts of unrefined sugar.
There are also different ways of eating that lower and/or maintain an individual’s blood sugar levels. These include low-carb, high-protein ketogenic patterns, as well as vegetarian, vegan, and Mediterranean diets that are rich in plant-based proteins and natural fiber sources. (See an example of what a metabolic scientist eats in a day here, for reference.)
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Morgan Chamberlain
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Over 90% of the diabetes cases in the United States are Type 2 diabetes, which is the type of diabetes linked to lifestyle factors like the standard American diet, a sedentary lifestyle, and obesity and metabolic syndrome.
It’s possible to prevent and sometimes even manage Type 2 diabetes through lifestyle factors like diet and exercise, and many clinicians already recommend these interventions. In fact, study participants in the afternoon exercise group also had the highest chance of being able to transition off their diabetes medications.
As one of the co-authors of the study, Jingyi Qian, Ph.D., explained in a news release: “We’ve known that physical activity is beneficial, but what our study adds is a new understanding that timing of activity may be important too.” So while it takes a lot of willpower to roll out of bed and straight into the gym, a fitness class, or onto the Peleton, afternoon exercisers now have something to tout.
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Gretchen Lidicker, M.S.
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