Diet & Weight Magazine

Diet Doctor Podcast #5 – Dr. Michael Arata & Stephanie Kennedy

By Dietdoctor @DietDoctor1

It's very high-pressure intense work. But like a lot of physicians he realized he wasn't really affecting the problem in a good enough way to prevent it and that's when he transitioned. Plus with some of his own health challenges which we'll talk about. And what they've developed is a functional medicine lifestyle practice and as part of that they focus on a low-carb ketogenic diet.

But they focus on it from a plant basis, so primarily a vegan ketogenic diet, but here's the key - with cycling. And that's something that's going to keep coming up over and over again, because the more we learn about it the more we realize how important cycling is. And that means cycling with intermittent fasting and cycling with meat.

And we're going to talk about that. We're going to get into some of the controversies about plants versus carnivore diet versus a balance of all that, talk about their philosophy of how they approach their patients and some of the concerns with a vegan diet, what you need to be careful monitoring for, and of course talk about their book that's coming out, Keto With Plants.

So I really enjoyed this interview, I like their perspective a lot and their approach to the patient and their sort of balanced way of approaching people to help them not only understand the science, but understand how to implement it and how to make the changes last. So I hope you enjoy this interview as much as I did.

If you want to learn more about us you can visit us at DietDoctor.com or you can visit me at lowcarbcardiologist.com. Thanks a lot and enjoy the interview with Dr. Michael Arata and Stephanie Kennedy. Dr. Michael Arata and Stephanie Kennedy, thank you so much for joining me on the DietDoctor podcast.

So you're an interventional radiologist, you spend like all day in a cath lab like suite sticking catheters and needles in people and draining things and opening arteries and yet you transitioned to wanting people to work on their lifestyle. So give us a little bit of background on how you got to that point.

So that was very satisfying but as I got more into limb salvage most of the patients typically would be either diabetics or renal failure or both, and those patients you could get a good result in the short-term, but unfortunately most of those patients... it's not a long-term solution. You could spend three, four hours on a case basically vascularizing someone from their abdominal area all the way down to their toes and actually get blood flow back to their feet, that could heal their ulcer, but three months later they're back.

And, you know, when you are doing one of these cases wearing 30 to 40 pounds of led and you know it gets really hot in it and really it's actually quite fatiguing in those long cases, so at the end of it you're gratified by the fact you've helped the person, but then you're really disappointed when they come back.

And it just got me thinking, "There's got to be something better. How can we allow this to happen?" is really what I would start to question. And I didn't have the knowledge base, the experience, the exposure to understand what got people to that point to the degree I needed. Fortunately I started working with other patients who had naturopaths as part of their care team.

And my interactions with them really started to basically plant the seed that there is something different. And I think a key part of this for my story is I was a biochemistry major as an undergrad. So when I started discussing things with naturopaths, they often talked about the biochemical aspect of it. That really resonated with me.

And fortunately one of the naturopaths I worked with suggested I should go to a functional medicine conference. When I went, my life changed, it literally just flipped a switch. And I was just like, "Oh my gosh, this is it." And it really is a biochemical based aspect, you know, there's a lot of different overlapping specialties, integrative medicine, functional medicine, and these things are not that different, I mean there's a lot of overlap, but one of the key things about functional medicine is it's more systems biology and biochemistry based.

So I think I needed that. I don't think I would have made this transition without that science core to it. Well, with this knowledge I was learning I experimented on me. And being someone that was working 90 to 100 hours a week, I was a typical American. I had all the conditions that you see in middle-aged, now actually younger adults.

So I was not sleeping, I had sleep apnea, I weighed 230 pounds, I had gastroesophageal reflux, I had skin conditions, you know, eczema would flare up all the time.

That started getting better and I actually was getting off medication. So it was an incredible experience just seeing what happened to myself when I did something that was not what I've been basically brought up in the system.

So an incredible journey and then you opened up a practice where now you're treating people holistically, you're treating not just one problem in the IR suite, but trying to treat them in the whole person focusing on nutrition and ketosis as a cornerstone of that treatment.

So we're focusing on nutritional ketosis and while I did obviously jump right into the ketogenic diet for my first go-round, I also found that plants really make me feel well. And it was kind of a revelation for us both because we did it together. The first time we did wasn't quite a vegetarian diet, but it was very plant heavy and we both felt tremendous. And Stephanie had been vegetarian before, so she had more experience with- I was a carnivore, I would go and have a big steak and just leave the plants.

But the few clients I've gotten to do it, have said the same thing. Them and their husbands were like, "Oh, my gosh, I feel so amazing!" And I felt like euphoric, just like this clean energy buzzing through. It was pretty amazing but yeah, it's a lot of work.

And one of the hard questions is, "Is there one that's better? Or if you're feeling great it doesn't matter?" I know you've had some experience with a little bit of all of this. So tell us about not just your own personal transition to a vegetarian based keto, but with your clients. Why you have felt that's the better way to go?

And so I think that is true with how we eat. And the other aspect of it is that when we look at how the body repairs itself and heals and grows, it's response to a stimulus, so the stimulus is a change. So I think that's an important element to eating. So I guess what I would say is there is no perfect diet.

It's a continuous exposure to something and our bodies are not meant for that, that's not how we're built. So I think that that's where we came to the idea, let's combine ketosis with plants and make it in a way that we actually incorporate cycling. And so I think in order to make that work and be practical, you have to fast. I don't think you can do this without fasting.

And I'm regularly having patients well into their 70s using ProLon and finding it quite doable. And that again kind of fits in because it's plant-based, so it's just a nice fit for what we're trying to do with the patients. And then the population that's on the other end of the spectrum is I see young patients with dysautonomia and POTS.

So for that population this approach, this lifestyle actually helps them too, which is really fascinating, it has actually surprised me. Because you have patients that wouldn't think that fasting would help and it really does.

So we're organizing our foods into columns like that, so you could just, "I can eat all these foods in the green list, all these foods", so that's kind of easy, but then if you don't cook or whatever it's just a list of ingredients too, so I have written a lot of recipes and I hate cooking and I am busy and lazy. I hate to say lazy, but I am, I admit it.

So I'm trying to cook with that in mind because I hate doing it. So it has to be something that can be like prepared in 10 minutes, I don't like all these gadgets in the strainer and then then you end up with a huge pile of dishes at the end of the night. So they are simple and they are really tasty. I would say the key is we treat our food as a vehicle, with olive oil and MCT oils. So just anything... I make really good dressings and sauces and spices to try to get that in there and then I like to start the day with a smoothie.

This would be the first thing I'd help people add actually, rather than say, "Okay we got to cut this and cut that". I say, "Let's add to what you're already eating a green smoothie in the morning." So a couple of strawberries, a bunch of spinach, some hemp and avocado and MCT of course, so it's really fat full and veggie full. And it sort of feels a lot of voids...

You know, you could eat like a ton of pizza but you can't sit down and eat like buckets full of kale salad, because all the nutrients that your body wants have been met and it's like, "Ah, I'm good", and it shuts it off. But with pizza it's still like, "I still don't have it, I still don't have it." So you could just gorge.

So starting your day off or a lunch whatever you prefer for the green smoothie sort of ripples out and it kind of naturally has them cut back on other things, so it's just a nicer start to, "We'll meet and add something to your diet instead of take it out." So I try to do little twists like that to make these changes a little easier and we try to incorporate it a little bit more slowly rather than...

He can just turn on a dime and transform everything, but most of us can't do that. So I tried to be like, "Let's prioritize the changes, let's do them slowly and incorporate them and once it's like working in your life then we'll look and add the next one." And so I kind of slow everybody down and keep it very realistic.

And so it's great to have someone like you who can coach people along and really help them prioritize the process to understand what needs to change first and then what can follow after that. So people need to keep that in mind when they're trying to make lifestyle changes, because if you try and do too much at once you can end up frustrated that it's not all working.

We will be the first to tell you, it's difficult. If you're more of a vegetarian plant-based it's certainly much easier to do, but the way we eat is actually to have some meat. And the way we do that is we try to eat meat in a 24-hour period roughly once a week. Now we don't always stick to that.

Certainly things like conferences and traveling, it gets a little bit more challenging and so we're flexible and pragmatic about it, but ideally we would say, "Go through your weekly cycle", which we do a five-day plan and we try to encourage people to do three days of time restricted feeding in that five days and then have a meat up day. And for that day you have meat with each meal. Now it's not necessarily gorging on huge steaks.

We're talking small serving sizes, but you're having animal protein with each meal. And the way I like to think about that and the way I explain it to patients is that we are omnivores and to think there were omnivores that had access to animal meat every day is not realistic. You can just look around the environment and what would happen is you would have a kill. You would capture some sort of animal, whether it's a fish or bird, a rabbit or whatever it is and you would eat a lot of it.

You would eat it for, you know a day or two, while it's still fresh. And I think that's how our bodies are designed and so that's how we style the plan is to do that. And what it's doing is providing nutrients that you don't necessarily get from plants. I don't think that necessarily animal products are bad in that sense that some people do think they are as far as health goes, but I think the problem is that the meat that we have readily available is bad.

And my approach is kind of beyond macronutrients so we can talk about sugars and fats and things like that and that's important but I think even more important are the fatty acids that are present in the fats. And if you look at the meat supply in this country, not only is the Omega 6 - 3 ratio really poor but you have really elevated levels of palmitic acid.

Palmitic acid is very inflammatory, it activates TH1 and TH17, so you not only have inflammation but you have revved up immune system and that's what causes atherosclerotic plaques. So I think that if you have really good quality wild game it's completely different than the hot dog that you get in your grocery store.

And in fact if you look at people who are ill, who are going to try to incorporate ketosis, they are going to struggle if they have mitochondrial dysfunction. So if you're going to do a more plant-based ketogenic style diet on someone with mitochondrial dysfunction, they are going to struggle without carnitine. It's essential. So meat is a great source of carnitine.

And with B12 I actually prefer methylmalonic acid. I think the B12 levels get falsely elevated with dysbiosis, which is an abnormal mix of bacteria in the gut which actually produce B12 levels artificially. So I don't necessarily find that a B12 level itself is very helpful. Methylmalonic acid I think is more telling.

And certainly if you have meat once a week I think you're going to be okay, assuming there are no chronic illness. The things that I think that can be helpful in terms of supplementation on the mineral side, I think applies to most people is magnesium. I think most of us walk around magnesium deficient, so that's one that I give basically to everyone.

And the other thing with that is there's not a good test for it. So I don't have a way to titrate it, so I just kind of give it to everybody. And generally it makes people sleep better and when people sleep better, they feel better. So that's kind of just an automatic one for me.

And then if you look at the other aspects of the minerals, I think the food tastes better when you season it and so certainly just having them add salt to the meals, which most people are okay with and tolerate. I don't think you need to get to the point where you're using supplements. We just haven't seen that to be a need.

I think all of the herbs a really good but one of my favorite mixes, I like to get mixes too, because I like to be quick, I'm trying not to use the word lazy, but Trader Joe's, they have an organic herb salad mix, so you get kind of random bits of herbs in each of them, just kind of different, like dill, all kinds of stuff in them, so we try to use fresh herbs as much as we can in things that are so high on antioxidants and flavor let's face it.

And what else do I put in there? I guess I don't really keep track of what I do in that.

So I definitely don't cut corners on dressings. But Trader Joe's does have a mixed salad, I think it's called the Green Goddess, and that's an olive oil based one. And I'll fit it out with a little olive oil, but it's a nice one to give you a quickie boost.

And so our main fat in our lifestyle is actually monounsaturated. Lots of olive oil, tons of avocados, nuts. So I don't think that our clients need a lot of Omega 3, because what Omega three they have, is more effective I think, based on the studies, and the fact that they don't have a lot of inflammatory Omega 6 that they have to balance out. So in general we're not using a lot of Omega 3 supplementation for that reason.

So an MCT has basically 14 g of fat per tablespoon. So if you add that tablespoon of MCT with your red plant, you basically get towards neutral, close to neutral on the fat - carb ratio. Now we would limit that to one serving a day but it allows you to have that sweet that people tend to crave. So it's a way to incorporate flexibility and really stick with the lifestyle. Those fats in general are not the same as the other fats, in particular MCT.

The MCT is absorbed directly across the endothelium. It does not go through lymphatic and drag all these inflammatory compounds like polysaccharide, which is the component of bacterial cell wall, which is extremely inflammatory. I personally think that's why saturated fats are unhealthy more than anything else. Is that they're dragging all these inflammatory products in the blood stream.

So MCT is a way to avoid that and increase the fat content in your diet. It also is more prone to generate ketones, so it's going to facilitate that process. So we're really big fans of both MCT oil and olive oil in particular. The other oils we'd really encourage you to completely avoid as much as you can. And as a practical product... I always mispronounce the name... Myiaka?

My personal take on it is that individuals that are sick, that have a leaky gut, are more than likely to respond well to his way of eating, because those toxins are going to be much more toxic to a compromised individual, whereas a healthy individual with a very intact gut lining, with an immune system that's well-functioning, they're not going to have as bigger reaction to these things.

I mean, clearly they are toxins, nature is pretty fascinating and it's designed these seeds very well and there's a reason why these compounds are in them. Just like there's compounds in other aspects of plants that are very nurturing to humans. So I think it's something that is important to consider with individuals who are ill, I don't think it's as important for healthy people. So that's kind of our take on it. Am I speaking for you?

And Sean Baker being the king of the carnivore movement, because of just what a powerful and strong and imposing figure he is with the amazing things he's accomplishing but then even people like Georgia Ede who take a more maybe philosophical approach to it and she has seen all the benefits in herself by getting rid of plants and going perfectly carnivore. And what is your take on that when you see people feeling better and sort of thriving on a pure carnivore diet?

Michael: think it would go back to some things that are similar in the sense of the biochemistry behind meat, I would say, in the sense that mTOR is a fantastic thing to stimulate, but do you want to have it turned on all the time your entire life? I don't think so. Elevated levels of insulin growth factor, I mean these are things that have positive effects.

But like everything, if we really look at life, it's in spurts. And so I think that these types of styles of eating can make people feel well, but I don't think they're a good choice for the longevity of their life. And that's the thing, is we don't have a snapshot of 20, 30, 50 years of eating a carnivore diet. We have months, or maybe a year or two.

And most people have unhealthy microbiomes. And so if you eat meat only that is much easier on the gut to digest and you're to have less issues with doing that with an unhealthy microbiome than someone who jumps in and has 50 g of fiber a day at the gate. They're going to struggle.

Because when we talk about longevity sure we could talk about mTOR, but it's kind of hard to measure mTOR on a regular basis. We can talk about MP kinase and PAK but those are hard to measure, so we have to find our surrogate so we use CRP, we can use IGF-I, we can use blood sugar and insulin. But what you find as the best markers that you think we can follow to see if somebody's on the right track?

I really think the brain is tied to the muscle. And so in that individual we have to have periods of stimulation of mTOR. I think it's very important. That may be an elderly patient and you may say, well are you putting them at risk for shorter lifespan or are you putting them at risk for cancer. I don't know for sure, I don't think so when it's pulsed, and I think that's the key.

If you look at most hormones, most hormones are pulsed. So I think you're okay to periodically stimulate these things. I would be very hesitant to have someone like that be on a carnivore diet. I just would. On the other hand if you're in your 20s and you're trying to build a beautiful body, I mean that's what you're going to do. Who knows if that's a good choice long-term though?

If we're going to do that for ourselves in our practice we should make it available for everybody. And I think over the last year or two we've started to see more people become interested in this and start to go in that direction so I think it is a new trend let's say. But we feel that getting a book is a great vehicle for us to get this experience that we've had out to as many people as possible.

So it's like okay, I know you're tempted overall your lives, but let's not do that and just lay other foundation to make sure... to give people permission to take time to take care of themselves... and it's kind of a mixture of everything just to lay the foundations for a good start of a change that's going to become lasting. That was important too to us is that this change would be lasting for people.

I was obeying all the rules and the scale was just sitting there and I know I shouldn't like get on it all the time, because I don't like it, but I went on a five day meditation retreat and lost weight on the retreat and he kept telling me, "It's stress, it's stress", and I'm like, "You take your stress and you just shove it... somewhere. I'm tired of hearing about this stress nonsense." And it turned out he was right... whatever.

And then as women I think we don't give ourselves permission, because we're like we need to do this for everybody else and give, give, give, but you can't give from an empty vessel and you know that's just really true. So you actually owe it to your family to take time to take care of yourself, so that there's more of you to go around, so it's really your duty to take care of yourself first. So I think shifting the thoughts on that and then also the restriction thing, I try to shift the paradigm, you know, the thinking on that, that you are giving yourself nutrients rather than restricting the pizza, just kind of shift the-

So I really try to connect the mind and the body so that you are aware of what you're putting into your body, how it makes you feel and then that becoming a motivator rather than this long term goal like, "I'm trying to avoid cancer", or "Avoid dementia".

That's not motivating day-to-day when you're in the trenches. So we try to get immediate rewards in place and stuff like that. So it's a lot to pack into one book, and then there are recipes yes, you're right. So yeah, it's coming together.

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