Benefits of the Keto Diet

Today we have Mike Mutzel on the Collective Insights podcast to talk with us about a very popular diet-the keto diet. He turned his life completely around after experiencing addiction in his adolescence, and is now the founder of the very successful content site High Intensity Health, author of “The Belly Fat Effect”, a podcastor, and a Youtuber who shares complex science made understandable on topics covering metabolic health, gut health, and Functional Medicine. He has a bachelors in Biology, masters in Clinical Nutrition, and is a graduate of the Institute for Functional Medicine’s (IFM) Applying Functional Medicine in Clinical Practice (AFMCP). Today we’re diving into ketosis, fasting, and much more. We discuss:

• Reframing your motivation: Giving your gifts in the service of others
• Is keto for everyone?
• Does it matter if you eat ham, cheese and bacon vs. avocados, egg yolks, salmon and almonds?
• Fasting and keto
• Ketosis and its link to movement 
• Guidelines for testing ketones, glucose, heart rate variability and sleep
• Hormesis: About positive stress that leads to growth
• Most common mistake people make when switching to keto
• Should you stay keto forever or switch up your diet?
• Interpreting labs when adapting to ketosis
• Sleep tips

Movement in general is hardwired, it’s indelibly inked into our humanity blueprint. -Mike Mutzel

Mike has an amazing philosophy for what keeps him going in his work. His motivator is to do what makes him the most capable of giving his gifts in service of others. The reason taking care of our health matters so much is so that we’re equipped to give back. Tune in to find out how to optimize your life with the keto diet, movement and a positive mindset.

Guest Bio:

Mike earned his B.S. in Biology from Western Washington University in 2006 and completed his M.S. in Clinical Nutrition from the University of Bridgeport in 2015 and is a graduate of the Institute for Functional Medicine’s (IFM) Applying Functional Medicine in Clinical Practice (AFMCP). He is a Functional Medicine consultant in the natural product industry and has worked as a nutritionist with Gerard Guillory, MD of the Care Group, PC in Denver, CO. Mike has lectured alongside Dr. Guillory to large patient-groups in the Denver area and they have been featured on local T.V. programs discussing the power of Nutrition and Functional Medicine.

In April of 2014 Mike published his first book, Belly Fat Effect: The Real Secret About How Your Diet, Intestinal Health, and Gut Bacteria Help You Burn Fat.

To continue his quest for knowledge Mike attends many Continuing Medical Education (CME) events held by various organizations around the country, learning from top researchers in the field through groups like AACR, ACAM, A4M and IFM. He has currently completed four of six Advanced Practice Modules (APMs) to earn the only board certification in Functional Medicine through IFM.

Mike regularly conducts workshops for health care practitioners, teaching leading-edge science in a concise format that can be utilized by progressive clinicians for the prevention of chronic disease. Often termed Translational Medicine, this bench-to-bedside approach is key to ensure the application of pioneering research and concepts in systems biology a preventative health care setting, optimizing patient outcomes.

Mike lives in Kirkland, WA with his wife Deanna Arnill– a Doctor of Chiropractic- with their daughter and two dogs Shasta and Rainier.

Learn more at highintensityhealth.com

Full Episode Transcript:

Jacquelyn:Hey, Qualia community. Welcome to episode number 48 of the Collective Insights podcast. My name is Jacquelyn, and I've been doing the intros on this podcast for several months now. I wanted to finally introduce myself. I'm the one behind the scenes of the Collective Insights podcast, helping to make all of these episodes happen. I want to thank all of you guys for listening. We're coming up on our two-year anniversary of the podcast this month, and we have over a quarter of a million downloads now.

Jacquelyn:The Qualia community is so brilliant. Yes, that means you. We love when you guys leave us comments on social media or contact us through our website. There are so many brilliant minds amongst our community of 90,000 people. Do you know how big of an impact we can make if we come together and share about this amazing episode with Mike Mutzel? I'm setting a goal for us to get 100 reviews on iTunes, and also to share this episode with a friend.

Jacquelyn:In this episode with Mike, we're talking about the keto diet and also his awesome journey of growing up believing he would be a failure, going through addiction in his younger years to now creating this beautiful community around his site, High Intensity Health, and changing people's lives by making valuable health information super accessible and understandable.

Jacquelyn:After you listen to this episode, go to iTunes to leave a comment. I want to get 100 meaningful reviews. This episode contains awesome content, but we believe that real learning happens when minds get together, when you participate, so let's do it. We want these episodes to be shared because they have the power to transform people's lives. If you know someone who's struggled with their weight or struggled with dieting, will you please share it with them? Also, if you or your friends that you share it with have questions about this content, please leave them on our site at qualialife.com/keto, and we'll work to get those answered by Mike on a future episode.

Jacquelyn:I'm really looking forward to reading your reviews, So without further ado, let's jump into the show. Here's Heather and Mike.

Heather S.:Welcome back to Collective Insights. I'm your host Dr. Heather Sandison, and I'm so excited to be joined today by Mike Mutzel. Thank you so much for being here.

Mike Mutzel:Hey, my pleasure. Thanks for having me on.

Heather S.:Mike has been interested in health and nutrition since he was young, all the while going through deep struggles in health and emotional challenges throughout his adolescence. He is now the founder of a very successful content site called High Intensity Health, author of the Belly Fat Effect, a podcaster, a YouTuber who shares complex science made understandable.

Heather S.:I have to just let everyone know that I got a chance to meet Mike about six or seven years ago when I was a student at Bastyr. What happened was that my roommate came home, and she's like, "I met this guy. He's working for Zymogen right now, and he is so smart. You have to come and meet him with me and talk to him because he just has so much to share. I wish that our instructors talked about the science like this because it's so easy to get when he breaks it down."

Heather S.:I cannot overstate just how good you are at doing that, and it's really thrilling for me to have you here because when I met you, you had just had your first baby, and life was just getting started in these different directions. Now, to circle back and see you again thriving is just ... It's really, really fun. Again, thank you for taking the time to chat -

Mike Mutzel:Yeah, my pleasure.

Heather S.:... share your insights.

Mike Mutzel:That is so funny. What a small world, right? I guess that goes to show that for those of us that pursue advanced degrees in this and we've lived this lifestyle, we try to make it a career and try to help other people because there's so many sick people out in the world. Super funny that, yes, we come back full circle years later.

Heather S.:Crossing paths again. You went on to study with IFM, Institute for Functional Medicine, and get the AFMCP, the Applying Functional Medicine in Clinical Practice. You have a biology degree, a master's in ... It's clinical nutrition, right?

Mike Mutzel:Right.

Heather S.:Where'd you do that?

Mike Mutzel:Yeah, that was University of Bridgeport in Bridgeport, Connecticut.

Heather S.:Oh, cool.

Mike Mutzel:Yeah. They have a good program. They have an ND school as well there, and that program's a little bit more, not so much dietetic focused. When people hear about nutritionists, they think about registered dieticians, and that's a little bit more kind of hospital-type care, a little bit more conventional shall we say.

Heather S.:Right, and you took more of the functional medicine path, which is so fun. We love that, obviously.

Heather S.:Mike, after going through your struggles early in your life, you now have created this successful brand. You've written a book that everyone loves. You're an inspiration. How did you get there? Can you tell me a little bit of your story?

Mike Mutzel:Yeah, great question. Well, there's many ways that I got here, but it came through a lot of self-doubt, struggle, suicidal ideations. Long story short, I had a great upbringing, and my parents got split up when I was about four years old. Lived with my dad in kind of an affluent area here in Washington, in Bellevue, went to a private school, did really well, then moved to California with my mom and my stepfather, and my older stepbrother was going through some challenges. I got exposed to drugs and alcohol at a very early age when I was nine.

Mike Mutzel:So, I went through this. I did book reports and all this sort of stuff as a young kid to basically flunking school, skipping school, getting involved in drugs, getting arrested twice before I was 15. I knew I [inaudible] liked the brain. Then, I knew first-hand what it was like to have a terrible brain and feel like I couldn't remember anything, couldn't focus, couldn't relate with people. I was emotionally stunted from exposure to these things.

Mike Mutzel:I was like, "You know what? I've been healthy before." I couldn't quantify what health was when I was 15. I was like, "I'm going to get back to that state, and I'm going to start with my body and start working out." I realized that I was able to build self-confidence. I was able to then talk to girls. I was super shy because the only way before between ages nine and 15 that I could communicate with people was when I was under the influence of drug or alcohol, right?

Mike Mutzel:Anyway, long story short, I think a lot of people have ... They were overweight, or they were depressed, or they had anxiety or whatever. Mine was totally self-inflicted. Yeah, I got exposed to these things, but it was totally self-inflicted. I realized that no one's going to have a pity party for me. No one's going to come save me. The only person that's going to get me to be the person that I want to be is me. So, I realized that my health is in my own hands.

Mike Mutzel:I know some of us are dealt a bad genetic hand, and we're predisposed to cancer at the young age or autoimmunity or something like that, but I think a lot of us, sometimes we stay in this rut of disease or depression or lack of vitality because we think that someone doesn't understand me. My parent, my spouse, my teacher, my brother, my whoever, my boss, they just don't get me. They didn't have my struggles. But I just realized that feeling that way, killing myself is not going to solve the problem. The only way that I'm going to solve my problem is to do the work.

Mike Mutzel:I saw instant changes. Changing my diet, back then my stepmother was actually into Atkins. She was getting these low-carb bars, and we started cutting out carbohydrates. I'm not in any way saying that I've been keto since the 1990s, but she influenced me. She introduced me to a chiropractor who got me lifting weights. He was like, "Back when I was 15 after I got arrested the second time, I cleaned my life up." He was like, "Look. You got to do lunges. You got to squat. You got to do these full body weight exercises."

Mike Mutzel:Over 20 years later now, I'm like, "That's what I preach to clients because we see so many people in ... " Especially women in their late 30s, their bodies change after kids, and they kind of panic and do more and more cardio. It causes the adverse response that they want. They want to burn fat, and sometimes catabolizes muscles and so forth. Anyway, long story short, it comes from self-doubt, feeling like crap, honestly wanting to kill myself, to, "Okay, the only way I'm going to get out of this is if I make continuous, small little improvements every day."

Heather S.:I want to go a couple directions with that. One, I really want to dig into the keto diet with you today. But, before we go there, we've all experienced struggles, right? I think you're very relatable in that way. You've also built a business, a very successful business. You've written a book. Those are big things to bite off. What keeps you going? What are the tools that you've used that really get you through the struggles and onto the other side so that you could become successful?

Mike Mutzel:Yeah, so that's a brilliant question. One of the tricks that I play on my own mind is I realize that if I'm tired, or I'm fatigued, or I'm feeling lazy, I realize that other people are hurting. What I mean by that, I feel like we're all on this planet to serve other people. We all have this unique gift, and everyone's gifts are so different. That's what makes the world so unique. I feel like that we need to act on these gifts to get more gifts.

Mike Mutzel:I hate to relate this to money, but if you look at you see sometimes rich people get more rich and more wealthy, and people that are out there giving, serving people in our own space, Mark Hyman, other people, it's like, "How did they write another book? How are they in this docuseries? How are they starting this other business?" I know these people. They come from a place of giving and serving, and they feel compelled or called to do something.

Mike Mutzel:That's what I leverage. I don't know if I'm called to do this, but I know that I really enjoy this and people benefit. If I'm ever feeling unmotivated, tired, fatigued, whatever, I just think about how many people are not benefiting from that. I write it down in the morning. I use Brendon Burchard's planner. He has a great planner. It's on Amazon. His name is Brendon Burchard. He wrote the Motivation Manifesto, a bunch of other great books. That's just one thing that I leverage, and I do the same thing as it comes to health, right?

Mike Mutzel:There's times that I don't want to meditate. There's many times I don't want to exercise. There's times I don't want to eat healthy. There's times I'd rather drink alcohol than not, right? I think, "Okay. Well, what would the person that I want to become, my future self, what would that person do?" Because we all should be continuing to grow. Also, I think about my daughter is the most important person in my life, and think, "Well, would my daughter want her father to be drinking or sleeping in or doing whatever?"

Mike Mutzel:It's a way to just reframe. I think a lot of us struggle sometimes with motivation, with drive, just part of humanity, and we need to constantly have all these backup plans in our mind to trick ourselves. I think the biggest thing, again, is just realizing that all of us have this gift. We need to use it to help other people, and when we're being lazy, playing video games, whatever, watching TV, we're not helping other people. So, that's what drives me.

Heather S.:What a fantastic toolset. One of the really big topics that you talk about in your podcast, on your YouTube videos, in your book as well, and the number one question we probably get, is around ketosis and fasting. I just want to dive deep into that. Tell me everything.

Mike Mutzel:Sure, yeah. I mean, there's so much to it. One thing that got me really excited about the ketogenic diet, and we kind of talked about my past, was how it affects the brain. I know all of you are very interested in neurophysiology and some of the metabolism within the brain and neurotransmitter profiles, but as someone who was [inaudible] alcohol, got in a lot of fist fights and stuff like fights with my older siblings, I'm concerned about my brain health and mild cognitive impairment and CTE to a certain extent.

Mike Mutzel:When I started to really dive into the neuropharmacology of nutritional ketosis and some of the epigenetic and neuroepigenetic effects, meaning ... A lot of us know that we have genes, but we sometimes forget that there's this software that's really governing the hardware of our genes. That software is the epigenetics. We can influence this. Just like we open up our iPhones or our computer and it says, "Hey, you need an update," well, we can update the epigenetic software that control which genes are expressed or not expressed.

Mike Mutzel:It turns out that the main keto metabolite, beta-hydroxybutyrate, people know this as exogenous ketones, the BHB, and so forth. That is an epigenetic modifier. It affects histone acetylation, which really at the crux of how genes are turned on or turned off, has to do with this cellular wheel called the histone. The acetyl groups control the relaxation of that, and therefore, gene expression. Long story short, the ketogenic diet is not just swapping out one macro for another in your bloodstream like, "Well, you're just cutting out one." It's a little bit more than that.

Mike Mutzel:That is what got me very excited. It has to do with the signaling pathways, the sirtuins, brain-derived neurotrophic factor, and all the downstream metabolites that occur through the signaling imparted from ketones, namely beta-hydroxybutyrate, but we're finding ... I shouldn't say we. Scientists are looking more at how acetoacetate, so-called the mother molecule, the mother ketone molecule, how that also affects gene signaling. And, I will say, just acetyl-CoA, or acetyl groups in general, which are the kind of intermediary between free fatty acids that are lipolyzed from either our fat stores or from our diet, and then those in themselves have signaling properties as well.

Mike Mutzel:It's not that glucose is inherently bad. It's all a matter of proportions. Even if you're fasting for four days, you're still utilizing glucose, right? Gluconeogenesis is occurring. It's just a matter of proportions. When we start to become a little more fat-adapted and pivot more and we get less hangry, we're going longer between meals and able to feel okay and thrive on that, that's associated with a metabolic signature that's characteristic of these epigenetic and metabolic signaling pathways that are very favorable.

Mike Mutzel:I think, particularly when it comes to brain health and neuropharmacology, mood and affect, I think that's the big thing that is really important because a lot of us don't realize that even in depression, there's glucose changes and different glucose utilization within the brain and neurotransmitter profiles. I think this is a great metabolic, nutritional therapy that has these translative effects, particularly beneficial for the brain.

Heather S.:Do you think that this question is fully answered? Do you think the science has completely answered that going into ketosis and being keto-adapted is positive for the majority of people, or are there questions that you would still like to see scientists asking and getting answers to? You're really good about presenting the science in a lot of your videos. What lingers for you, if anything?

Mike Mutzel:Yeah, that's a brilliant question. I think there's some bio-individuality, particularly in the rate-limiting enzymes, HMG-CoA reductase, HMG-CoA synthase, involved within the liver that are responsible for taking dietary fat or body fat and then packaging that into a ketone. So, we know individual-

Heather S.:I'm just going to say. Those enzymes might be familiar to people because that's where statins act, right?

Mike Mutzel:Exactly. On the very similar ... These are these downstream pathways that are basically responsible for ... They're involved in lipid synthesis and cholesterol synthesis. There's different, what we call, single ... There's different polymorphisms or variability. There's flavors. Everyone has a different, unique flavor. I think for some people, it can be challenging. We do hear people say, "Well I tried intermittent fasting. I tried ketosis, and I ended up in the emergency room." You're like, "Really? How could that possibly be?"

Mike Mutzel:If we don't get a concomitant rise in ketones associated with glucose reduction upon fasting or eating a low-carb, high-fat diet, then basically, we don't have enough energy in the system. It's like trying to drive your car through the Alps with no gas. You're just not going to be able to do it because the brain needs either glucose or ketones because we can't directly ... It's interesting how this works because the brain could use fat. It just can't directly utilize free fatty acids from the bloodstream. They need to be packaged in a ketone payload and converted [inaudible] the brain kind of [inaudible 00:16:18].

Mike Mutzel:Back to your question, there's definitely individual characteristics here in terms of the metabolism, but also, it's not like all keto diets are the same, right? We can measure ketones by eating ham, cheese, and junk, or we-

Heather S.:Bacon.

Mike Mutzel:Yeah, bacon. Or, we can have free-range eggs, egg yolks. We can have almonds, avocados, salmon, right? I think the public feels that the ketogenic diet is just this one thing. The only thing that matters is having high ketones. I think we're going to learn a little bit more over time about the nuances of that because there's many people that are in ketosis trying to lose weight, but they're gaining weight, or they're not losing weight like they think.

Mike Mutzel:I think there's a lot of nuances here that scientists over time will be able to help us better figure out, I don't know if that's going to be a new testing technology or looking at real-time insulin, but the take-home message here is I think everyone needs to experience some sort of self-induced food restriction through time-restricted feeding or intermittent fasting. That's a natural way that lends itself to the neuropharmacology and the metabolic signatures that are characteristic or synergistic with a ketogenic diet.

Mike Mutzel:A lot of us have autophagy deficiency from just eating all the time, right? We're just constantly eating every three hours, and that's not good for brain health. I think a lot of us can benefit. You pick your fasting plan du jour. Is it 16:8? It is 20 hours fast, four hours eating? Whatever it is based upon your history, your metabolism, your goals, your lifestyle, but I think a lot of us need to start there. Then, it's like, "Okay. Well, how much carb-restriction do I need? Am I overweight? Am I pre-diabetic? Do I have diabetes in my family? Am I an athlete? Do I have concussions?"

Mike Mutzel:There's a lot of variability there, and I think that's where working with nutritionists, doctors, naturopaths, things like that, help people to really customize this because it's not just like, "Oh, you're in ketosis. Okay, you're good to go," right? There's a little bit more to this story.

Heather S.:Yeah, so do you recommend that people get a ketone meter? I have in my clinical practice, lots of people interested in this, and I struggle to decide what's the best way to approach it for each person. Absolutely, I couldn't agree with you more. I think there's a lot of variability. I have those type A patients who are like, "I want every metric I can possibly get." They're going to order the ketone meter. They're going to be looking at blood glucose, and track all of it and send me the Excel spreadsheet.

Heather S.:Then, the other people who are like, "Just tell me what to do. I don't want to know anything else." Do you have a place that you start or resources that you can point people in the direction of in terms of just where to get started?

Mike Mutzel:Yeah, that's a great point. I think checking your glucose and ketones together periodically, and I like people to do this first thing in the morning right after a meal. So, you finish eating, check where things are at, then follow the glucose tolerance test, but instead of eating a bunch of crap, you're eating your normal meals. What you're doing is you're testing your diet in real-time, and obviously, there's some imperfections to just looking at glucose and ketones, but if you look at them together, I think it gives you an insight into how your body is processing the food that you're eating.

Mike Mutzel:Because we know that cardiovascular disease, atherosclerosis, cancer, these aren't phenomena of fasting, they're phenomena of the post-meal or postprandial window. We need to see how our body is processing food. I think it is a good idea. I think, maybe I'm biased here, but I think part of the success of the ketogenic diet is because, for the first time, people are then acutely aware of what is affecting their ketones and their glucose. Because, often times, these ketone meters also test glucose, and now, more and more people are becoming aware of this.

Mike Mutzel:I think people are realizing like, "Wow, even though that was a gluten-free cupcake or whatever, it tanked my ketones." They're curious, like, "I wonder why that is?" What if I have an avocado instead next time?" for example, or, "When I stayed up all night on Friday night partying, drinking wine, my glucose was 130 the next morning. What the heck?" I think there is some insights to looking at the quantified self, but I don't think that we can make total extrapolations about this. Yeah.

Heather S.:Yeah, in my practice I've had a husband and wife will decide to do it together, which I think is a fantastic idea. If you have a partner who's doing this with you, especially if you tend to eat your meals together, to be doing it together makes it so much more accessible and easier to implement. There are even nuances between them. I had a classic husband, wife came in, and he would be kicked out of ketosis when he had zucchini and she wouldn't. She would stay in ketosis. So, there's all this individuality in terms of how people respond, and is there a way to understand what's going on for you personally without the ketone meter or the glucometer that, each of those pieces?

Mike Mutzel:Yeah. That's a great question there. What I look at is heart rate variability as well, and quantifying sleep with the OURA Ring. That's something we've been doing for a number of years now. That's what else we look at. There's other tests you can use. For heart rate variability, there's the Firstbeat. There's the Polar unit. There's Elite HRV. For a while, I was doing that first thing in the morning, my heart rate variability, but now I just rely upon the OHRA Ring because the Elite HRV, as much as I like it, sometimes it wasn't syncing with my phone and things like that.

Mike Mutzel:Then, the other proxy that I look at that is free is strength. That's why I encourage people to have some sort of recreational activity that they really enjoy that's quantifiable. That can be Pilates. That can be yoga. That can be weight lifting, CrossFit, powerlifting, whatever. Because you know that if you're in that downward dog when you're doing yoga and it's really tough and your shoulders are shaking, somethings wrong. You're undereating. You didn't get enough sleep. Something is wrong, right?

Mike Mutzel:Or, if you're trying to do a bench press and you can normally do 200 pounds, but now you can only do 180, to me, that means something is wrong. That's why I like to encourage people to figure this stuff out. That's why I'm not a huge fan of just going on the treadmill or going on the elliptical and watching TV and moving around because there's really no way, unless you're looking at the wattage, which is a direct power output that you're putting into that exercise, you can't really directly quantify that. That's another proxy that I use frequently.

Mike Mutzel:It's like if my strength is going down, something is wrong. It gives me a good insight. It's like, "Okay. Well, maybe I need more carbohydrates. Maybe I'm over-training. Maybe my diet, I ate too late and didn't get good enough sleep." There's a lot of different things, but that's just one really accessible one that you don't need any tools for.

Heather S.:Ways to get some feedback without it being a meter that you have to order, and then have strips for it and all that. You were talking about exercise here. Is there a way to get benefit from ketosis, from a ketone diet, and not exercise? Can you do one or the other and still get benefit, or do you really need to do both diet and exercise?

Mike Mutzel:That's such a great question because there's a lot of people that are not low-carb or keto at all, and they have high ketones because they exercise. It doesn't mean that doing one obviates the need to do the other. I think we all ideally. If you look at hunter-gatherer people, unindustrialized humans, they walk, they garden, they work with their hands. I think exercise is built into our DNA. I should say movement, in general, is hardwired in. It's indelibly inked into our humanity blueprint.

Mike Mutzel:So, we need to be moving, and, I think, exercise ... I don't think, I know exercise can enhance and augment ketosis in fasting. If you're going to do, say, a 24-hour fast and you do a hike in the morning, for example, you're going to be in ketosis right away. You're going to deplete your glycogen. It's going to accelerate all the benefits of fasting. A lot of people are trying to enhance autophagy through fasting, but actually, there's a ton of data in humans showing that exercise is a much better autophagy-enhancer than fasting is, much more quick-

Heather S.:Okay. I'm going to stop you and have you tell us about autophagy. What is it?

Mike Mutzel:Yeah, so it literally translates into self-digesting in Greek. Autophagy is a cellular process that it's very nuanced. There's glycophagy, nucleophagy, mitophagy. There's all these different subtypes of autophagy, but a lot of us are interested in this as a way to get rid of damaged organelles, damaged tissues, particularly for people that are optimizing brain health. Our brain, our neurons can accumulate proteins and protein adducts, and that can lead to neurodegeneration. So, we want to be able to snip up those damaged proteins, recycle them, reuse them, or get rid of them as waste.

Mike Mutzel:This is a really hot topic. I feel like autophagy now is where keto was back in 2016. It's just growing like crazy, and it's all linked and interconnected with fasting. Long story short, there's a lot of different ways we can enhance autophagy. We can take rapamycin, which is an mTOR inhibitor. mTOR, when it's activated, suppresses autophagy, so if you inhibit mTOR, it's thought that you can upregulate autophagy. Long story short, basically, there's a lot of different ways that we can undergo or enhance autophagy.

Mike Mutzel:Part of it is glucose-restriction. So, we can drive down our glucose with things like metformin, with berberine, with a low-carbohydrate, high-fat diet, with exercise, with fasting. Those are ways to drive down glucose and kickstart fatty acid utilization, and part of that fatty acid utilization is mediated through autophagy. What's interesting is when we go to yoga, when we go to Pilates, when we lift weights and we get sore, that sore feeling, these so-called adaptations that enable us to be stronger for that [inaudible] workout are autophagy. [inaudible] your sore muscles, literally are an indirect proxy of autophagy.

Mike Mutzel:That's what's super exciting. There's been a lot of different studies in humans that have looked at different autophagy-initiating proteins in the serum and in white blood cells, and they found that exercise is a reliable way to enhance autophagy. Now, a lot of people say, "Well, wasn't there that guy in 2016?" I think, the Japanese man, I'm forgetting his name at the moment. He published studies on fasting, and so a lot of people think that fasting is the only way to enhance this protective process that's associated with longevity, but, again, there's many ways to go about this. That's why I think fasting's great, but also you need to exercise as well.

Mike Mutzel:Because if we look at the amount of data we have on exercise in humans compared to the amount of data we have when it comes to enhancing autophagy through fasting, it's weighted in favor of exercise. Not to say that fasting's bad, it's just if you want to be really evidence-based about this, exercise is a wonderful way to enhance autophagy.

Heather S.:Yeah, and so one of the things that Daniel, who's here at Qualia, we talk about this model of medicine where thinking about any dysregulation really stems from too much or too little of something. You can have too little stress. If you don't have enough movement or stress on the system in that way, then you're not going to have balance. You're going to have a dysregulated system at some point. Having these stressors at either end of calorie consumption or of movement or even of oxygen consumption can really create a body that can adapt to the environment. That resilience is what's equated with health.

Heather S.:It sounds like this autophagy is ... and, senescence is another word that I think is related here that you hear more and more lately ... this process of killing off the cells that maybe aren't serving you anymore and making room for those youthful, good, healthy, well-communicating, well-functioning cells. Am I understanding you correctly?

Mike Mutzel:Yeah, as I understand it, the same thing. If you think about just what you said, people have some unmet need ... For example, if I just sit on my couch all day, order Uber Eats and pizza and everything like that, there's no real demand to make my muscles stronger. There's no real demand to get rid of excessive protein accumulation in my brain. There's no hormetic stress. That's the thing where people hear and associate or confuse stress as being bad, but exercise, like doing a podcast like this, getting up on a stage in front of people doing Toastmasters, whatever it is, that's positive stress that leads to growth and adaptation and positive change.

Mike Mutzel:I think ...

Heather S.:Right, this concept of hormesis.

Mike Mutzel:Hormesis, yeah, like a low-dose poison. If we look at all the "superfoods," the polyphenols, the blueberry proanthocyanidins ... We look at rosemary, garlic, ellagic acid, sulforaphane. A lot of people think, "Oh, they're so protective." But, you're like, "Well, how are they protective?" They're inducing mild hormetic stress within the cell that induces an NRF2, which is an antioxidant response element.

Mike Mutzel:It's funny how exercise, you're like, "Well, wait. Exercise increases interleukin-6. Isn't interleukin-6 linked with cancer?" You're like, "Well, yeah, but in a chronic upregulation of interleukin-6 drives inflammation, but short-term, adaptive leads to favorable changes." I love that analogy that too much or too little ... I learned from Sid Baker, and he always talked about how some people have this disease like some unmet need or something they need to get rid of. That can be too much of something, too little of another thing.

Mike Mutzel:I think a lot of people need to think about that root cause because even in the context of autophagy, too much fasting is problematic. Certain cancer cells thrive on autophagy. Certain viruses and different immune stressors and things like that inhibit autophagy, or upregulate autophagy, to evade the immune system. It's not like even if we think about this cool thing that everyone's excited about right now, having that chronically elevated is problematic, so context matters.

Heather S.:Yeah, and Sid Baker, that's great. Stress, he is somebody who has popularized introducing parasites into the system as a way to balance the immune system. I can't think of really another therapeutic, controversial therapeutic treatment that would be a little bit counterintuitive kind of like what we were talking about. It's this stress on the system, but that ultimately leads to more regulation and balance.

Mike Mutzel:Yeah, and for people that are super interested in that, the great book, Epidemic of Absence, Moises Velasquez-Manoff. It's a complex thing, but his whole thing is we were exposed to all these parasites and stuff growing up in rat feces and everything like that, so our immune system became tolerant of that. Now that we've taken that out of [inaudible] our system doesn't know basically where [inaudible 00:31:25]. It's [inaudible 00:31:25], so it turns on to our own self tissue.

Mike Mutzel:That's a great way to reframe this and understand that we're living our life out of balance. A lot of us, just like we evolved with parasites and bugs and everything like that, we evolved to move. A lot of us are not moving, so, therefore, we're getting these cardio-metabolic aberrations that manifest really and affect our brain, which is pretty scary.

Heather S.:Yeah, that is a fantastic book. He takes sort of a journey around the world-

Mike Mutzel:Yeah, he's so good.

Heather S.:... looking at all this epidemiological data about how parasites are good for us, which is so counterintuitive. We spend so much time thinking that bugs are bad, and it's entertaining. It's well-written, and I think a great idea to share.

Heather S.:The biggest challenges that people typically face when changing their diet, what do you see come up?

Mike Mutzel:I think the biggest thing is meal frequency. A lot of people come at this from hearing about the 1990s, 2000s dietary advice. If you don't have protein every two to three hours, you're going to basically fall apart, and you need to stoke your metabolic flame with food. I think because fat is digested a little bit differently than carbohydrates and proteins, we need bile, there's just much more time. There was one study ... you would find this super interesting ... these Canadian scientists radioisotoped palmitic acid in some food. I can't remember with fatty food.

Mike Mutzel:They were able to see how it was metabolized and so forth, and how long it was taking to metabolize. They found that this palmitic acid from just one ... I can't remember what type of food. It was in the enterocytes of the gut for 24 hours after the meal. Other radioisotope-labeled carbohydrates are long gone. They're in the muscle. They're in the fat. They're long gone after 24 hours. So, the take-home message is if you're switching to a ketogenic diet, you need to understand that you need to compress your feeding window and not eat so much frequently.

Mike Mutzel:It's going to be a one or two meal a day, maybe three at most, but it can't be keto breakfast or keto coffee, keto breakfast, keto snack, keto lunch. That's not going to work. That will lead to weight gain, indigestion, issues related to gall bladder or bile functions. I think that's the biggest hiccup is when you make this switch, it's like you're implementing some aspect of time-restricted feeding, and you're changing your diet all at once. Because I made that mistake, and I was having an avocado and nuts for a snack. Then I was like, "I just feel bloated." Deanna and I were looking at each other back in 2015 like, "This keto thing kind of sucks."

Mike Mutzel:Then, we started to think about it. I started to dive into the research, and I found this lab that was talking about the second meal effect, and all this, how fats take so much longer to break down. For me, that was a light bulb moment. Then, I started to interview all these people at that time and so forth, and everyone was like, "Yeah, I'm just doing one meal a day. I'm just doing two meals a day." I'm like, "Wow, they're doing it unknowing of the scientific data from these Canadian scientists." That's, I think, the biggest takeaway.

Mike Mutzel:I would say trying to eat a little bit seasonally and not be too dogmatic about it. As people listen to this, it's probably going to be early, middle summer. Look, if there's butternut squash is coming in season, or blueberries, or whatever, you don't need to be a hero. You don't need to be, "Oh, I'm keto all year round." I think we need to have a little bit of flexibility. From animal model data, hibernating bears, and different animals, our microbiome and our metabolism changes with the season, so I think having a little bit more flexibility is key. People are naturally up longer. They're more active in the summer and the spring and so forth. It makes sense you can afford a little bit more carbohydrates, but those are the two things that I think are the biggest.

Heather S.:In my practice, I typically tell people that I don't want them to be stuck in ketosis forever. I want them to go back and forth and have this dynamic ability to respond to the environment, again, this hormetic effect, and be able to burn both fat and burn sugar when that is reasonable for whatever's going on. Can you speak for or against that? Do you think that's a reasonable recommendation to make, or is there literature that says otherwise that maybe people should be in ketosis forever?

Mike Mutzel:That's a great question. You know, I don't think anyone really knows, but it certainly makes a lot of sense to me based upon the changes of the seasons and so forth. I mean there is this interesting data coming out about metabolic flexibility in that we lose that ability to pivot back and forth. If you are in ketosis for a long time, it doesn't mean that you're going to be unable to utilize glucose for fuel, but I think that it just ... It's so new in a sense, even if we ... Let's just take a step back and just say the power went out. We live north of California. How are we going to get avocados and nuts and seeds and all these keto foods during certain times of the year?

Mike Mutzel:I think part of it is we need to be a little bit more flexible with that, but that being said, I think if someone has a disease, someone has autoimmune [inaudible] has [inaudible] someone has [inaudible] CTE, Alzheimer's, then that's where it's like maybe you limit that flexibility a little bit and consider this a medical diet. Then, hopefully, you can remediate things and then introduce more flexibility over time. I think I'm on to your point. First of all, it can be boring. With any diet long-term, it gets boring. I love avocados, but there's days where I'm like, "Oh, man. I can't have another avocado."

Heather S.:I don't have that problem.

Mike Mutzel:Right.

Heather S.:The labs, so one of the other things that's come up for me clinically is that the labs go haywire. If somebody's seeing a conventional physician and that cholesterol level, that total cholesterol level, starts to creep up over 200 as they're adapting, their doctor wants to put them on statins. Is there some nuance to the way to interpret lab work while you're going through this, while you're starting to get into a keto-adapted lifestyle? Even years into it, how do we interpret these labs?

Mike Mutzel:Yeah, this is a great question. Dave Feldman is an engineer who's come at this from a beginner's mind basically, and has some really compelling data, has thousands of people submitting their cholesterol levels and all that. Yeah, people are going to look like they're going to keel over of congestive heart failure, but he's actually uncovered a lot of the raw data. The interesting thing about medicine is we see a study, we see the pretty statistical analysis and the charts, but we don't see the raw data. He actually has uncovered the raw data from the NHANES data, so thousands of data sets, and stratified them for age and all this.

Mike Mutzel:Even looked at there's only seven centenarians in NHANES data set, but the six out of seven had high LDL cholesterol by the way. It's interesting the should we be so scared about the high total cholesterol or high LDL if and only if these criteria are met and that triglycerides are low, HDL is high. In those context, is LDL problematic? Again, so if you have low triglycerides, like triglycerides under 80, I think, is his cut point, HDL over 60 I believe. It could be around there, but higher HDL, lower triglycerides, then it's like high LDL is not necessarily problematic because it's this whole metabolic symphony.

Mike Mutzel:I've interviewed him. He's got some great YouTube videos if people are interested in this, but yeah. You know how allopathic doctors like to look. They like to look at one little mechanistic biomarker, and then their toolbox is intervention, drugs or surgery. I think people need to be a little bit less skeptical of that, and take into consideration how they feel, how is their energy, how is their body composition, how are the other biomarkers in context of this so-called atherogenic marker. Yeah, it's going to look different.

Mike Mutzel:Then, also, I think, it's interesting for people to, instead, start to do postprandial bloodwork and start to look at how are their lipid levels in the postprandial window. I think that's where I've been following this research since 2009, I think. There was a consensus paper that said, "You know what? Heart disease is not this ... " Like I said earlier, it occurs in the postprandial window. Atherosclerosis, the hardening on the coronary artery occlusion, is from damage after a meal, so why are we doing fasted lipid tests?

Mike Mutzel:I think even my mom, she got her bloodwork through Kaiser the other day. She was like, "Mike, you wouldn't believe it." She's like, "The doctor told me not to fast." She's like, "It's the first time in 20 years they've ... " And, I was like, "Really? That is so cool." So, it's actually becoming more mainstream-

Heather S.:That's great.

Mike Mutzel:... that we're realizing that, "You know what? We're getting false positives from people fasting for 12 or 14 hours." They're looking squeaky clean when really, they're metabolism could be a train wreck, so keep that in mind as well.

Heather S.:Yeah, I think we call that the milkshake study. I remember reading about people who consume a milkshake, so high fat, very high fat, very high sugar, that you can see the tightening of the arteries. You can see occlusion, and the diameter of where the blood is meant to flow gets smaller. That's essentially what leads to a heart attack or a stroke is not getting blood flow through the capillaries. Right after, having high fat, high sugar, that's exactly what happens to some degree in everyone. If you have that atherosclerotic plaque there, then it's even more dangerous, right?

Heather S.:How fascinating that somebody at Kaiser is starting to look at those postprandial lipid levels. Sugar, insulin, of course, we've been looking at that for a long time wondering how the body is reacting with certain inputs. I think both are probably relevant, both fasting and postprandial, but putting them into context and having enough data and enough information so that we know what that means. I don't know that we do right now.

Mike Mutzel:Yeah, well, you're right. Maybe it's a conversation for another time, but they were talking about the cutoff point for triglycerides, postprandial triglycerides. You don't want them north of 200.

Heather S.:Oh, [crosstalk 00:41:43].

Mike Mutzel:That would give you an idea that ... If that person with the high LDL, when they go keto if they're like, "Well, okay. Maybe it is a little bit high fasting, but what do I do after, say, 90 minutes of bulletproof coffee or some sort of keto meal?" If there's not this so-called post-meal hyperlipidemia, then maybe it's not so much of a problem. I think that's interesting.

Heather S.:Oh, that's really helpful. I hadn't heard that. Thank you. That's super helpful. What if somebody falls off the wagon? Parties, birthdays, summer, trips, these things happen. The holidays, oh, my goodness. I've got so many patients that come in in January like, "All right, I fell off. I enjoyed Christmas. What do I do now?" What do you suggest?

Mike Mutzel:Yeah, that's a great, great point. A friend of mine, Mark Bell, he just talks about putting points on the scoreboard. Look, this all happens to us. Sometimes we stay up late and watch Netflix, and we feel terrible the next morning like we screwed up our sleep and all that. Look, just get some small wins. Go for a walk. Just try to do something, and put some points on the scoreboard. Then, over time, all those small points will add up to a big win.

Mike Mutzel:I think that's the thing. We're going to make mistakes. We're going to fall off. We're going to go be with people that are not on the same wavelength, and we'll be tempted. Look, it happens. It's part of being human, but just try to do something like we talked about earlier like reframing when you're fatigued, or you're tired, or you don't want to build your business or whatever. You have to have little tricks and little tripwires built in.

Mike Mutzel:If you know you're going to go to a friend's house and there's going to be a lot of alcohol, a lot of junk food, maybe have a little bit of whey protein shake beforehand. It will improve your satiety. Have some MCT oil potentially. Figure out what's going to work for you to help blunt that, and then also keep in mind your long-term goals. Why are you doing keto in the first place? Try to link that with something big like I'm doing this for my business. I'm doing this for my grandchild. I'm doing this to prevent whatever. Then, you think about, "Okay, well, is eating this cheesecake or pizza or drinking three bottles of wine, or whatever it is, is that going to ... How's that going to effect this big goal that I have?"

Mike Mutzel:Often times, the short-term gratification of whatever that food or alcohol is is not greater than this big goal or big dream we have. Again, it's all these little tricks you've got to play with yourself all the time.

Heather S.:I love all these little hacks that you're sharing. Thank you. Any other hacks that you use to improve your metabolic health? You've talked about diet, ketosis, this mindset, about exercise. What's your relationship with sleep like?

Mike Mutzel:Yeah, so I just got the Gravity Blanket. Are you familiar with this?

Heather S.:I'm not. Clue me in.

Mike Mutzel:Oh, my gosh. This has been a game changer. Yeah, so me, I notice for whatever my brain, how it works, if I get bad sleep, I totally notice it. It comes through in my articulation, my speech, my word retrieval totally tanks. So, sleep's very important to me. Mouth taping is a big one. The neuropharmacology, the physiology of that is when we're in REM sleep, all of our muscles become paralyzed, including your tongue. If you're just hanging, your mouth is wide open. Your tongue collapses in your airway. By taping your mouth with some 3M Micropore tape or SomniFix, basically, you're entraining your brain to learn to breathe through your nose, and so that when you're in REM sleep, you're not becoming paralyzed and hypoxic. That's unique.

Mike Mutzel:The Gravity Blanket's amazing. I have no financial affiliation with this company, but basically, it's this 25-pound blanket, and you feel like you're in your mom's womb, I guess, is the biology of it. Man, my REM and deep sleep has been off the charts. That's huge. And, just good old fashioned sunlight. We have chickens and pigs, so the first thing I do in the morning after waking up and having some salt water is go out and let them out and feed them barefoot. Then, we have a little just cold plunge. It's only $100, like a 110-gallon trough. It's for feeding animals or whatever. You can go to Tractor Supply Store and just ask them for 110-gallon trough. So, I just jump in that, and it sucks every day. It doesn't get better.

Mike Mutzel:Like this morning, I really, really didn't want to go, and so that's just another thing. You mentioned the mental trick is like if I can jump ... Because it's been really cold here in Seattle recently for some reason. If I can get into this freezing-ass, cold water right now, the rest of my day ... There's no email. There's no phone call. There's no podcasts that's going to be more challenging than that. These are all inexpensive things. Backyard chickens, they cost six bucks a chicken. It's super inexpensive. You can walk barefoot. It's cheap. Jump in the cold water.

Mike Mutzel:Those are the things that I like to do. As many of your listeners probably know, a good night's sleep really starts with what you do in the morning, your sunlight exposure, and then I walk my kid to school every day. We're the only parents [inaudible 00:46:29]. It's like all these [inaudible] drive, and I know them feel guilty because they don't even wave anymore. They're just like, "Oh, here's the Mutzels walking their kid to school in the rain." You're like, "You should be walking too." Yeah, those are just a few of the things that we do.

Heather S.:All right, and on that note, I think you need to go. Are you walking or biking?

Mike Mutzel:Pick her up.

Heather S.:You got to go pick her up.

Mike Mutzel:I'm going to bike. Yeah.

Heather S.:You're going to bike, nice.

Mike Mutzel:I have a bike race in 10 days, yeah. So, I've been bike.

Heather S.:Oh, so, you're training?

Mike Mutzel:I just train commuting, yeah.

Heather S.:Love it. Love it.

Mike Mutzel:Yeah, but thanks so much for having me on. This has been a lot of fun.

Heather S.:Hey, any takeaway that you want to leave our audience with?

Mike Mutzel:Yeah. You know what? I know a lot of people that probably listen to your podcast care about their brain, and I just want everyone to know that your brain is changeable. If anyone is living proof of that, it's me. People I pal around with when I was 10, 11, 12, and stuff like that, some of them are living in motorhomes and jail and all that. I totally transformed my brain with nutrition and with lifestyle, and I continue to transform my brain over time.

Mike Mutzel:People need to realize wherever they're at, I think the brain is one of these organs just like our muscle tissue. It's really plastic. It's malleable. It's adaptable. Just put, as Mark Bell says, put some points on the scoreboard every day. Brush your teeth with your opposite, non-dominant hand. Do different things all the time. Not just nutritionally, but for your brain. If you're watching Netflix, try to remember the characters' names, and quiz yourself at the end. There's all these little things you can do that, over time, have sweeping effects on your body and brain, which I think are cool.

Heather S.:Mike, it's been such a pleasure to have you here. I've learned a bunch.

Mike Mutzel:Thanks so much.

Heather S.:I know our listeners have as well, and we can't wait to have you back-

Mike Mutzel:Absolutely.

Heather S.:... because you have so much to share. You are so inspiring. Thank you. Thank you. Enjoy your race.

Mike Mutzel:Will do. Alrighty. Have a good one, guys.

Heather S.:All right, you too.

Mike Mutzel:Thanks.

Heather S.:Take care. Bye, Mike.

Mike Mutzel:Bye.

Jacquelyn:Thank you for being with us for this conversation with Mike Mutzel. Don't forget to leave a review on iTunes, and if you have any questions or comment, leave them on our site. We can work to get those answered by Mike in a future episode. Also, check out our free ebook that offers a well-rounded approach to brain health, The Foundational Guide to Neurohacking at qualialife.com/guide. Make sure to subscribe to Collective Insights wherever you listen to podcasts, so you don't miss an episode. See you next time.