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Hey everyone, Mikki here. You're listening to Mikkipedia. This week on the podcast, I'm stoked to bring to you a conversation I had with one of my BFFs, Dr. Cliff Harvey. Cliff is a fan favourite. He is a PhD naturopath strength and conditioning coach. And today we have a great conversation around the myths associated with a ketogenic diet. We talk a little bit about diet trends.

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energy expenditure, calories, and a whole lot in this clinical nutrition space. So basically we just riff, have a conversation, and share a ton of practical and, I guess, scientific information in our conversation. And to be honest, whenever Cliff and I get together, we really discuss it the way that we would if it was just us in a room. So it's a little bit like a fly in the wall conversation, but you guys know how I feel about Cliff and I know how you feel about him as well.

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it's always great to get his insights. For those of you unfamiliar with Cliff, he is, as I said, PhD, is New Zealand's expert on the effects of a ketogenic diet in a healthy population, but he is so much more than that. He's been helping people to live healthier, happier lives, and to perform better since starting his clinical practice way back in the late 1990s. Over this time, he's been privileged to work with many Olympic professional, Commonwealth, and other high-performing athletes.

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in amongst the general population and he has also worked with many people to overcome the effects of chronic and debilitating health conditions. Along the way he has founded or co-founded many successful businesses in the health, fitness and wellness space including Nutrition Store Online and the Holistic Performance Institute, New Zealand's leading certification and diploma for health nutrition, health coaching and performance that has many of the world experts teaching on the course so students are learning from the best.

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and the faculty includes the likes of Eric Helms and yours truly, has over 20 years experience as a strength and nutrition coach and in addition to his PhD research, he's a registered clinical nutritionist, qualified naturopath and holds a diploma in fitness training and health coaching in patient care. You can find Cliff over at cliffhavi.com, the Holistic Performance Institute and Cliffy Dog on Instagram. So...

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Just a reminder though, before we crack on into the interview, the best way to support this podcast is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of the podcast out there and it makes literally thousands of other podcasts. So more people get the opportunity to learn from the guests that I have on the show, like Dr. Cliff Harvey. All right team, enjoy the conversation.

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But also, I mean, this just a good opportunity to have a chat, basically. I reckon it was about time. Yeah. And so I'll kick this off, Cliff. Great to see you back. I've hit record, by the way. essentially, I mean, you and I sort of connected last week and you were like, hey, I saw your paper like I was, like it's my paper. And you missed a fundamental myth in the keto world. And I thought, oh, this is an

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excellent opportunity to touch base with Cliff, New Zealand's expert in ketogenic diets, to chat about some of these myths. But also actually Cliff, one of the reasons why I think this is, or could potentially be quite timely, I mean, I guess it's anytime, is that keto often gets lumped in with fad diets. Anything related to keto still gets lumped in with fad diets. And I know that

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at least in the sphere that I sort of look at. Like I follow a lot of sort of evidence-based practitioners, quote unquote, macro style people, they're constantly, they seem to be dismantling the idea that a ketogenic diet is a good approach. So I don't know. Yeah, I think that's absolutely fair. And I think nowadays a lot of people are lumping keto in with carnivore, just like... Yes.

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Back in the day, people lumped keto in with paleo, which wasn't really fair to either diet style. And I think the same is happening now with, know, carnivore and, you know, maybe that's an even more distinct case because there are a lot of people in keto, well, not a lot. There are some people in keto who are also of the opinion that carnivore is a fad diet. Yeah. This is, that's true actually. And do you follow Dr. Ids? Is that his name?

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Sort of. know who I'm talking about? Yeah, I've seen, you know, he puts out mostly really good information from what I've seen. There's a few things obviously I disagree with. But I don't really follow a lot of, I guess, influencer doctors, mainly because I just limit my time on social. Even though, you know, people see my posts and they think that I'm on there all the time. I'm obviously not. Totally. Whereas, as you know, I live and die by social media.

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I'm super happy to be on there answering questions, looking at monkey memes and whatnot. I like to keep abreast of what messages people are exposed to, I suppose. And in fact, one very recent one that Dr. Ids did was a bit of a takedown on the carnivore diet study that was a case study, or think series released, published, I think, with Nick Norwitz actually late last year, looking at the impact of

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carnivore approach. believe it was an IBD, but you may know better than I. And essentially, basically dismantled this idea that a carnivore carnivore was a good diet for anyone. And I just think that I get a little bit frustrated where people don't see a use case for different scenarios. And of course, then I do the stupid thing and I read the comment section and you've got a lot of people saying, hang on, I thought Harvard was a great university and you know, just, you know,

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Yeah, I thought Michaela Peterson was out to lunch and you know, all of these different personal comments sort of come up about the people who might promote carnivore and the rest of it. And it just, I think it just misrepresents where the value of these particular diet approaches are. And it's a real shame because I feel like an avenue of therapy for some people will immediately, that door will be closed to them. Yeah. And I think the

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The approach that is most consistent with science, you know, as a broad category, in my opinion, is to always say we need further research. We need more research on carnivore. There are a lot of things that need to be teased out as far as, you know, are the claims around its nutrient sufficiency actually correct or are they somewhat flawed? they contextually correct?

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And as you say, are there use cases for any particular diet? Now, I think that's even more true within keto because keto is a much more expansive diet. know, carnivore is incredibly restrictive. And I guess one of the questions that I ask and many others ask is that while it appears to have benefits for people based on case evidence, number one, we need to explore that further and see whether that is an aberration.

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uh, there is consistent use, you know, case for those types of diets, but more importantly, doesn't need to be that restrictive. And, know, I, I'm not, as you know, one of these people who's like, you know, moderation is the key to everything because behaviorally and psychosocially that may not be consistent with the person, but there's also a case to be made for a wider compendium of food. Generally being.

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more helpful for a lot of people. Yeah. Now, I think one of the interesting things is that for those use cases, we really need to explore why it might be working and then, you know, do the proving if you will for that. And interestingly, it's an area of research that I'm just kickstarting now in the, in the realm of, as you know, it's a sort of pet project of mine, systemic nickel allergy syndrome.

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And one of the hypotheses that I'm starting this research off with is that perhaps a carnivore diet works for some people, particularly for gastrointestinal or cutaneous expressions, because it's by nature a low-nickel diet. When we consider that the prevalence of systemic nickel allergy syndrome might be a lot higher than what we previously thought, it's a compelling hypothesis. It doesn't mean I necessarily believe it yet, but it would make sense that someone who did have a

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systemic nickel allergy, if they're going on a carnivore diet, it's going to be low nickel. So they're going to see improvements. I think we could probably say that based on the research already. Um, but it is something that needs further exploration to see whether that is just one of the reasons it could be effective or the primary reason. Like if it were the primary reason for showing effect, even into some people, then they wouldn't need to necessarily be that restrictive and only eat, you know, meat or these sort of modified carnivore diets that are emerging now only eating meat and dairy sort of thing.

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You could include a lot of vegetables, could include a lot of fruits, you could even include some other carbohydrate sources. So I think we really limit ourselves when we immediately come down on diets. But by the same token, man, on social, the people that are the most vociferous in attacking my positions are the extremes. It's hardcore vegans and hardcore carnivores.

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Yeah, I know. because you're, unfortunately, you're in that camp of let's figure out the best approach, rather than coming at it with some sort of diet bias, you're almost looking at what's going to suit the individual in front of you. Cliff, I sort of feel like you need to explain a little bit more about your nickel hypothesis, because I know it is something that you've been thinking about and we've discussed a little bit, but I think that it will be something that a lot of people will be curious about, because it's actually not out there so much in that sort of public sphere.

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Yeah, it's not. I'll explain it sort of by way of an analogy because it's or an anecdote, I should say, because it's kind of interesting. So the background is that around 20 % of people probably have a contact nickel allergy. And a of people already know that because they wear, you know, cheap jewelry and they get dermatitis, eczema type symptoms. But nickel is ubiquitous in foods. So it's very commonly found in foods. And some proportion of people with a contact nickel allergy

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have a systemic nickel allergy where they're actually getting hypersensitivity reactions to the nickel that's present in foods. Now we don't know exactly how many that is. It's up to 20 % of the 20 % who have contact nickel allergy. So that's not nothing, right? That's up to 4 % of the population, probably not that many, but let's say somewhere between one and four based on the extent research. Now nickel is predominantly found

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Mostly in seeds, nuts and grains, but it's mostly in the brain and germ of grains. whole, whole grainy. Exactly. And so given that I'm not currently following keto or low carb or anything, I, a little while back thought, well, I'll, I'll shift my diet a little bit just to lean up. Right. Got this conference in the States coming up or so. This was a while back now though. And, um, I started just tightening up.

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my diet a little bit by just removing some of those ultra processed foods that had kicked in. It's not that I was getting too overfed or anything like that. It's just that I wanted to lean up a little bit. So just a few subtle shifts in nutrition. You got rid of that chocolate bar after dinner? Well, I didn't get rid of that actually, but instead of having more of a treaty kind of thing where I was quite happy as if it's my macros kind of thing to have some milk chocolate.

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I'd go for dark chocolate and have just less of it. Shift from having maybe some of those white carbs that had crept in to whole grains, eating some legumes to bulk out the meat and whatnot because things are expensive at the moment. And some of the symptoms that I experienced started getting worse. Such as? Gut symptoms, more bloating, frequency, looseness of stool, and some cutaneous symptoms because I get a little bit of dyshidrotic eczema.

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Not bad, but just a little bit on my feet. And that started getting a lot worse. Now these are not uncommon comorbidities, obviously with Crohn's disease. So I thought, well, that's interesting because I have suspected in the past that I might have a systemic nickel allergy because I have contact allergy to nickel. So I did a little self experiment where instead of eating, you know, a very healthy low nickel diet, I just ate a low nickel diet, including a lot of foods that we would typically not consider to be the best.

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day in, day out use. Obviously, I don't think any food's bad. But eating a lot of refined white flour products just to really get the nickel down and found that within days really, the frequency of using the bathroom was down from sort of six to 10 a day down to one or two. Gastrointestinal symptoms way down, cutaneous symptoms way down. More importantly,

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Some other things that I hadn't really thought were linked and they may not be, but cognition improved, headaches reduced, because I typically haven't had headaches, but I started getting quite bad headaches. And also neck and back pain went down a lot. So there was enough there that I thought, this is basically the approving because typically with a nickel allergy, it's indicated by contact and then sort of confirmed by

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implementation of a low nickel diet, does that improve symptoms? Often you go to the next step clinically, we might provide a challenge at some point of high nickel foods or even nickel sort of in solution to see whether there's a response. But anyway, that was interesting because it was a really good example that the shift to a healthy diet, while it would work for most people or a healthier diet, didn't work in this particular instance, because there were certain things within that diet that weren't working. The shift to what ostensibly a lot of people might think is an unhealthy diet,

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actually helped a lot of things. Now, would I keep eating just a whole bunch of refined wheat flour all the time? No, but it meant that that was a really good proving. And then I could basically go back to eating sort of what for me, at least as a healthier version of that low endical diet. Anyway, that's the anecdote that sort of explains where I came to this point. And because I'd had some interest in it through the years, just

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hands-off sort of way. thought, this is really interesting. I want to explore this a little bit more because I started to see in the research as well comorbidities between nickel allergy and IBS, nickel allergy and IBDs, right? Which is why I started also thinking in the light of these case studies coming out, well, this could be an interesting thing to look at. So we're currently working on some research where we're modeling diets initially to like put together a best practice carnivore keto

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maybe Mediterranean vegan diet and quantify how much average nickel people would be getting from those diets. Then hopefully we'll go on and do some RCTs in that space. That's a super interesting cliff because I imagine a diet like the Mediterranean diet. Did you say nuts and seeds had a higher level of nickel? Yeah. So typically nuts, seeds, legumes and whole grains are the things that are highest. Chocolate, really high.

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And obviously the darker it is, the more nickel there is, which is kind of interesting because often with that health halo effect and you know, not without reason, we would tend to default towards darker being better. But as a practitioner, one needs to realize that that's, well, that might be true for most people, even almost all people, almost all the time. It's not true for every person. Yeah. And for what it's worth when it comes to chocolate, my

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go to for most people that I work with, which is in sort of fat loss space, is eat what you like because you're not going to be getting a lot of it anyway. if you really love that caramel chocolate, then have those couple of pieces of caramel. Of course, depending on how that might trigger for the eating behavior, but you know, a lot of people are like, Oh, I just have dark chocolate because it's so healthy and I have eight pieces or whatever. I'm like, hmm, there's an issue there. Oh, a hundred percent. that, I always ask people, well, do you enjoy that?

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Like, oh, not really. Why do it then? But there are so many nuances within people's psychosocial approach to food. That's something that we also miss when we're really into a diet, you know, that others might call a fad diet, because we think that it's all about the food. But it's not really much about the food, to be honest. You know, it's about food environment and it's about how we interrelate with that.

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And, you know, as you know, when we looked at this was our research, wasn't it? Yeah, it was the research that we did together for my masters. You know, the qualitative paper that we put together where it seemed like we had those quite distinct behavioral approaches to nutrition, where some people tended to be moderators, others abstainers. Yeah. Like to put it in this context, your moderator probably could

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Be happy and completely satisfied with four squares of dark chocolate after dinner. Great. Whereas the abstainer type, they're probably not going to be satisfied by that, but it might also trigger, you know, additional eating. They might be better off just abstaining most of the time and then having it as an occasional trade and maybe an occasional trade where they really freaking go for it. You know, neither approach is good, bad, better, worse. Right. And this is one thing that I think comes into the whole keto low carb Mediterranean.

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At the end of the day, if one's energy intake is appropriate, they're getting enough protein, they're getting enough essential fats and enough micronutrients, it actually doesn't matter all that much, I believe. For sure. I feel like you and I are on the same page with diet. Largely speaking, there may be a few things that we might have fisticuffs over, but ultimately, blood sugar balance, muscle mass.

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but also what makes you feel good, what gives you good energy. And looking beyond just protein, carbs and fat are really sort of like the fundamentals of what makes up someone's most awesome diet. Yeah, and looking beyond really arbitrary, thou shalt nots or thou shalt that people have. It drives me up the wall when I see these articles from newspapers and pop science type outlets where it's

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Something like I saw one the other day, the headline was, this is the time that you must eat to be healthy according to a dietitian. And it was basically saying you have to have breakfast before 8.30. It doesn't matter if that's great. And that sets up good dietary patterns overall. If you don't feel hungry in the morning and maybe not having breakfast helps you to sustain an appropriate energy intake.

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then fast through the morning, who cares? And people will debate about the nuances of early versus late feeding based on clinically meaningless effects that aren't translatable to individuals. And we'll it all the time for every hundred percent. Right, small changes in timing, frequency, all this kind of stuff. It just doesn't matter when people are getting what they require and not too much over a timeframe. You know, I...

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You'll know my beef with what fasting can do for some people, because you might see this in your practice as well, is that people think they're using it as a bit of a calorie control tool, not recognizing that they're overeating later in the day comes from the fact that they're not eating early in the day. Like this is, that's something that I see, but not in everyone for sure. And I do feel that sometimes some people, dare I say it,

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like to go to the micro level detail of what they should or shouldn't do and really sort of get a little bit worked up on it because it allows them to be distracted from the really big things that they could just focus on that are actually much more important. Like, I don't know, I do get people who ask the most nuanced questions where they haven't even sort of got their foundations sort of set in their diet. And sometimes I feel like that's a bit of a distraction. Yeah.

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You know, I had this discussion with Dr. Joe Kamczewski at the last Sports Nutrition Association conference because he brought up a very good point that behavioral strategies have actually not been very effective for eliciting weight or fat loss. So with that defined output. And he was completely right when you're talking about the sort of intuitive eating, healthy at every size type movements. They have

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very positive outcomes for people's psyche, psycho-emotional state, et cetera, but they typically don't help with the progression of, disease. But there was one exception that I brought up, and that's in the research looking at mindfulness. And there are a number of studies where they compare a weight loss intervention, dietary weight loss intervention, to mindfulness. And the mindfulness group tends to do pretty damn well, sometimes achieving greater weight or fat loss than the diet group.

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I would say maybe the diet groups intervention wasn't all that good, but I would say that if it's a calorie restricted diet, it's designed for weight loss. doesn't really matter what else is involved with it. It should elicit fat loss. Now, did they stick to it? Adherence is always an issue, but the fact still remains that people doing something that is non dietary to have a better psycho emotional state, having a better

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capacity to create a psychosocial environment that is more conducive to health. That's a really important finding. And it goes to show that it's not just all about the food. It's about the psyche and the environment in which we have our interrelationship with not just food, but other elements of health. I will say that a lot of the obesity literature is pretty underwhelming when it comes to results.

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But I do, but I agree with you actually, because what they are, you know, if it's a randomized controlled trial and they're supposed to be in a calorie deficit and they might be getting some small sort of measure of, of fat loss, but maybe not that much over like, you know, six months or 12 months or whatever, then really you're right. Like if it is, if the problem is, that it's not well tested because they can't really adhere. But I think that's an outcome anyway, to your point, like.

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Whatever they're doing in that trial is not going to be successful, not because the calorie deficit itself didn't work, but there was something about the way they designed it that made adherence nigh on impossible, which is actually one of the major things. Absolutely. And I think that also speaks to the importance of in a clinical one-on-one setting, we can't be applying cookie cutter approaches because the key is how is that person going to sustain a calorie deficit if they need to lose body fat?

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Or if they're looking to just be healthy, happy, perform well, how are they able to elicit an appropriate energy intake? Now there are so many tools that people can use, but they need to understand that they're just tools. And so a lot of the meaningless debates about whether fasting is healthy or unhealthy should really be switched into for whom is fasting appropriate and why. Similarly for low carb keto and a lot of the junk.

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science that we see around keto and low carb doesn't help the debate because people just default back to it. Yeah, yeah, I totally agree. It's interesting Cliff with what you said about that, you you're not, you wouldn't be considered or you're not keto right now. Would you be low carb? That's a really good question because probably according to, you know, especially as I'm ostensibly an athlete, according to what

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My carbohydrate requirement supposedly is according to the position stands. I probably would be, you know, uh, I don't know exactly how many grams of carbs I'd have in a day, but it's probably only, I'll do some quick calculations. It's probably in the region of, I mean, a hundred to 200 grams. Yeah. I mean, I'd probably be like, no, that's not true because I often. Eight to add lib item as much as I desire after dinner. So I might have some fruit. might have some chocolate, you know,

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white chocolate now, those types of things. So that probably bumps things up a little bit. So I wouldn't be low carb or keto, I'd probably be getting in the realm of 250 odd grams of carbs a day. But again, probably lower than what would be recommended to me. Absolutely, because what would that put you at grams per kg body weight? I'd probably consistently eat about three grams per kilo. Yeah. And I imagine for your sport, is the recommendation sort of five to six or something? I would say so, yeah.

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And that's, you know, to me, so fundamentally flawed because having a recommendation of grams per kilo based on what sport or activity someone does is, just entirely arbitrary. You know, it, it isn't the carbohydrate requirement is entirely dependent as you and I both discuss a lot on the frequency, volume, intensity of the exercise. And that's another area where, you know, one of the things that winds me out more than probably anything else.

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are these throwaway guidelines like to perform at your best, you must have carbohydrate before training, which is not an evidence-based statement. People claim it is because hey, but people having carbs or exercise perform better. Well, you could say that, but it depends on the duration and intensity of the exercise. For a lot of people, it makes zero difference. And the evidence is clear on that. I don't know if you listened to podcast with

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myself, Danny Lennon and Eric Alms, we talked very much about the, the utility of carbohydrates and that peri exercise window. know, anyone who is abreast of the research understands completely that it's not an absolute, you know, conversely though, it's interesting because you'll have a lot of the low carb people will say, well, the body produces all the glucose it needs. You don't need to have anything, which is not consistent with the research either, because even

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for those athletes who are habitually low carb, performing really well, maybe at the top of their sport, the evidence still points towards them getting benefit from carbs taken during exercise, especially if it is a duration, obviously, that would usually indicate having carbs as a supplement. And it seems to be pretty much exactly the same as those athletes who are higher carb habitually. So that's kind of cool because that makes sports nutrition a little bit simpler.

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Like be low carb if that works for you habitually, be high carb if that works for you habitually. But you know, you're out there cycling hard for three hours, have some carbs during the event. Yeah, it's interesting, isn't it? So we, because we recently did the Southern Lakes Ultra and listeners will know because I, prior to this one coming out, I chatted to Philip Prinz about his most recent trial with Tim Noakes on the 10 grams of carbs per hour to prevent hypoglycemia.

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showing that there was no performance difference when you compared that to a higher carb approach as sort of stipulated by guidelines. was either 60 or 90, I think. And so in the Southern Lakes Ultra, had maybe our nutrition, we had to account for all of our food. We probably had around 25 grams of carbs an hour and we're running from about, I think the shortest day might've been three and a half hours and the longest day was about 13 hours. And we

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consumed most of our calories outside of the actual training itself, because we had to have daily bags of all of the food we were going to have on a certain day, all sort of prepped and ready to go. And a lot of it was Dehigh food, it was other things, but carbs and calories, most of them were consumed outside of the training, because the gut, for us particularly, because I'm speaking on behalf of Hubster as well, just feels so much better when you have

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a lot less on board when you're running and we don't really need it. I can easily go out for a couple of hours, even up to three hours, with not even really having that much, not noticing an appreciable change in my blood glucose level or my energy level or anything like that. Beyond that, I need something, but it's just so individual, Cliff. Equally though, you know that we've been in this low carb space. Like, Hubster's been in the low carb space since after he met me.

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Uh, in 2017 and then prior to that, we were sort of like hanging out in 2012 doing a similar thing. And of course you before that back in 1893, you were low carb. So we've been in the trenches for a while. And I mean, I still did low carb, but it's for me a targeted thing. It's the easiest way for me to lose body fat because the easiest thing to do to preserve protein, central fatty acids, micronutrients, et cetera, is just to cut out the carbs. And so it's a nice, easy way for me to lean up.

30:55
I'm one thing that you mentioned. I was just looking on my slides actually for this talk I'm giving in a couple of weeks in Texas. bring up a really good point because you know you're saying you're eating most of your calories outside of the event. Now research has suggested that up to 80 % of endurance athletes are under fueled right if that's not corrected for in research that's a really big confounding influence because if we're then saying that you know athletes benefit from X amount of carbohydrate during

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exercise, are we just making up for a fuel shortfall? And you know, this is why the context of how and why people are supplementing is really important. Yeah. And I don't think it's, it's typically taken into account enough. you know, again, we sort of default to that position of what is your total energy intake, like across the board? Are you getting enough protein? Are you getting enough central patios? Are you getting enough micronutrients? Then in terms of the fuel provision,

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man that differs per person or per athlete a lot. And as you know, when I'm now, you know, if I'm coaching anyone and they want to track, apart from a few like really high level athletes I have, I don't even worry about carbs versus fat. I say beat this protein intake per day, be within 10 % or so of this energy intake. How you get there, I don't care. Yeah. Do you find that the people you work with are

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like initially unsatisfied with your loose recommendations because people want numbers and they want targets, even, sort of thinking about actually what a challenge it could be for them to actually do that, you know, macro tetris? Mostly no. And that could be a function of, well, exclusively no. And I think that might be a function though of the clients that I have typically know and understand how I work.

32:52
And they like to have, like me, enough structure to get results, but within that enough freedom to not have to stress too much about it. And so some of them don't even track calories. mean, they don't track calories. They don't even follow a diet plan per se. They just have in their mind an idea of that modular approach. And we can adjust that too, because we're talking via email about the calculators I've developed. The latest ones.

33:18
sort of semi quantified down from the energy and macro intake, what that means in terms of the average body size that is sort of indicated by the measures we've put into that calculator. So it will sort of automatically quantify what that means in terms of the sizes of vegetables, palm sizes of protein, et cetera. And so for a lot of them, it's just a semi quantified approach where they're just using those portion sizes. The next stage is having a quantified diet plan and the sort of final

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stage if they really want to go there is with the tracking. And again, I try and the tracking as simple as possible. And I think that just, you're just going to get more sort of adherence. It's interesting actually, because of course, when we caught up and I was like, let's talk about this paper, I'm only actually just going to mention it now halfway through our interview. But on the whole carb, the, you know, what determines a low carb diet? Because when this paper was going around the

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86 different authors that managed to get their names on it. There were groups of people who had a varying opinion on what constituted low carbohydrate. It landed at, I think, maybe less than 130 grams a day, or was it 25 % intake, or something like that. But there were people who were very adamant initially that we must be advocating for 50 grams of carbohydrate or less as being the best approach for metabolic health and things like that.

34:45
Whereas people like me were sort like, well, you can get a lot of good metabolic health benefits. You don't necessarily have to push it down that low. And that might be an approach for someone who is severely insulin resistant or who indeed has type two diabetes. But for the average person wanting to improve their metabolic health, just have a better lipid profile, know, lean out a little bit, not even lean out, they just lose weight actually. If I'm thinking about people who you'd sort of put this on, like it's unnecessary to

35:14
have such a low carbohydrate intake. And I do feel this is where some of the contention lies with a low carbohydrate approach is that people think that it must be 50 grams or below and that's where people get their knickers in a twist. I agree. think that, you know, we always need to think about in terms of utility. And is that a helpful approach to have these arbitrary guidelines? And I don't believe it is in most cases. But further than that, if we take

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our scientific lens to it, that this has been studied because I did it. We did it. looked at, we were the first study to look at different low carbohydrate diets that had never been done before with the exception of the paper by Sears. But that is almost like you've got to consider that's almost like a designed to prove study for, um, what do you call it? The zone diets. So that, that sort of low carb diet, wouldn't necessarily consider to be low carb either, right?

36:13
So we compared obviously a 5, 15 and 25 % calories from carbohydrate diet. And I think that's really illustrative because it still seems to be seldom done where people are using the energy of portioning rather than arbitrary gram amounts. Because once we get to anyone outside of a fairly small band around the medium, median calorie intake, we're looking at quite different gram amounts.

36:42
If you have, I've had endurance athletes who are achieving nutritional ketosis consistently eating 250 odd grams of carbs a day. It's because they have such a high calorie intake generally, plus they're usually metabolically efficient and insulin sensitive and all sorts of that, achieve ketosis very easily. So I think that those debates about where

37:11
keto dieters, we're a low carb dieters are not helpful, they're not scientific. And at the end of the day, any diet that elicits ketosis is a ketogenic diet. 100 % ketogenesis is a physiological state, it's not a diet. Exactly. And to your point as well about what is going to be of benefit to the average end user.

37:36
I would seldom have people measuring like carbohydrate and say, cap, they want to be on a low-carb keto diet. Initially, we just avoid obligate carbs. Like it's easy, right? And I don't get them worrying about it because I feel that where people do, now this is where I get in trouble with the carnivore crew. I don't want people to be worrying about it to the point where they begin to exclude green vegetables or, you know, maybe having some berries with.

38:03
Salad or something like that you really want to have as much nutrient density. What is possible and i'm quite the advocate for vegetables. Please you know if people can. Tolerated or not even tolerate it but if it's appropriate for the diet fruit. And then it's gonna begin to expand from there i guess it's to some degree it's like the carbohydrate carbohydrate appropriate diet redox right it's the new one. Add a ration of that we are.

38:32
There aren't any bad foods, they're just what's appropriate for you. And most of that's psychosocial, not physiological. And it's interesting when you mentioned, you know, get rid of the obligate carbs, because even if someone were to say, have some potato at lunch, have, you know, some sweet potato at dinner, maybe have a piece of fruit with some, and then they've got like green vegetables or whatever, actually across the board, that's still a pretty low carbohydrate diet. If you were to do the numbers on that, because...

39:00
those types of carbohydrate foods are also fairly water-based. They've got a bit of fiber and it's actually hard to get the bulk carbohydrate from things like that as opposed to say a cup of rice has 60 grams of carbohydrate, cup of cooked rice. Yeah. And that's a really good point because a lot of my clients and myself, you know, as well, don't eat a lot of carbs during the day because they simply don't want to and they don't feel as good, I guess, if they have a

39:29
carb heavy meal, say at lunch. Like I say, know, myself included, a lot of my clients will have mostly protein based meals through the day, maybe few of them. And then that allows some carbs at night. Now how much that kind of allows depends on whether the person is better suited, usually again, behaviorally to low, moderate or high carb. And it's quite nice. No, it doesn't work for everyone either because some people would have the carbs in the morning. That's great. But for a lot of us, I feel that having that bigger meal at night,

39:58
with some of those carbs, it is relaxing. It is very satiating. does, you know, as compared to after lunch, where maybe you don't want to too heavy and maybe want to go and have a lie down. You want that at night, so why not? Where, Cliff, where in terms of sort of like the ketogenic diet space, I suppose, and low carb space, which areas are you, if you are, like particularly interested in exploring? Like, what is any of the research coming out that you're...

40:25
or that you've already sort of got in your head that you think is sort of the next step in this. Because I feel like, you know, albeit it moves slowly, it's things, people are in societies are shifting towards it being an approach for people with metabolic disorders, you know, like, and it is more accepted and people are more interested in it. We've had a lot of information over the last year looking at

40:51
the neurological benefits of a ketogenic diet and even a low carbohydrate diet. Is there an area where you feel hasn't really been targeted, which you feel that a ketogenic diet or a low carb diet could be interesting to know how it might impact? Yeah, there is one that I'm really interested in and we're actually kickstarting some research, which you may want to be involved into, which is to look at ketogenic overfeeding.

41:20
because we would default to the research that shows that irrespective of whether excess calories come from carbs or fat, that deposition is pretty much the same. Even though in terms of a sort of closed system mass energy balance equation, it doesn't actually work. It does within the human body because of inefficiencies and efficiencies within substrate use of fuel. But

41:50
I wonder whether that is the same for a truly ketogenic diet. Now it probably is. And my hypothesis for these studies would be that it results in exactly the same amount of fat gain. But just anecdotally, we do hear quite a lot that people say, look, I can't put on weight when I'm on keto. Now that might be because they're so satiated, they're almost insidiously changing their dietary habits. And I kind of know what that's like. You you're eating

42:20
Plenty of protein, plenty of fat, plenty of vegetables, and you're just very satiated. You actually end up auto-regulating energy intake, which we've seen in the research. But where people have actively tried to put on mass eating a keto diet, they tend to struggle. Now, again, that might be behavioral and it might be because they're averse to loading in those calories, right? But maybe there's other stuff going on as well. So that's something that really needs to be explored. And, you know, like I say, I'm really hopeful that we'll get cracking into that.

42:50
in not too distant future. Yeah, that's nice because I know, think, it Jose Antonio has run a few protein overfeeding studies to see what impact that has on weight gain and it's quite favorable as I remember. Yeah, I think the sort of balance of evidence is that overfeeding with protein, all things remaining equal doesn't really predispose to fat gain. So that's a cool finding, right? Because that's a really important thing when it comes to

43:19
not just the physiological but behavioral side of nutrition. And it goes to show that, you know, on one level, a calorie is a calorie, and that calories and calories out is immutable, you know, as it relates to the first law of thermodynamics and how that affects mass gain, mass loss, but it then speaks to the nuances within that we're substraight endpoints, storage versus use versus excretion, etc. are really important when it comes to what actually

43:48
makes impact for people. And so, you know, for that reason, I've always been a big advocate for probably higher protein intakes than most people have suggested, especially in the keto realm. Yeah. There was probably, I'm going to say three to six months where I got swayed the other way because people were saying, you know, protein's bad. I, it never sat right with me. And it was sort of an aberration when you consider I

44:17
been an advocate for a higher protein, I guess, version of ketogenic diet for 20 odd years and have been again for probably the last 10 or 15 years. And I understand that looking at carbohydrate overfeeding initially in the studies that have measured it, like it was short term overfeeding with carbohydrate, it should just increase your thermogenic rate and you increase energy expenditure. I can't recall the

44:44
timeline with that. So it might only even be like 24 hours overfeeding or something like that. Cause ultimately like if you do that too many days in a row, that is not going to end well. No, it's not. But you know, again, it provides the context of how does the body seek to modify its activity. And you know, obviously we've got a real interest in feeding kids. Right.

45:13
It's really interesting in that area because we really do see the impact of externalizing control versus having intrinsic motivation and autonomy, whether that is conscious or more, more so autonomic and physiological. Because the more we remove that autonomy, the more likely it is that we will develop poorer habits around food. What I'm really getting at there is that

45:41
If, for example, you have kids able to eat what they want when they want, but it's from a compendium of good healthy foods, they'll get what they need over time. The more we try and externally control that food, the more they almost doubt those signals they're getting. And I think a lot of us as adults have developed those sort of patterns.

46:03
where it's all about a sort of top-down approach and we're not paying enough attention to the bottom-up physiological drivers. Now that's a little bit different to intuitive eating because I think that's somewhat flawed because it's not as if, hey, I feel like eating ice cream every day, I'm going to do that. We still need to create structures. But let's say we've made ourselves like kids and just had most of the time, especially in the home, just good...

46:28
healthy foods, meat, vegetables, the area, cetera, they're available. And we kind of just went for it. Maybe we'd end up eating pretty much what we want, sorry, what we need because we're going to auto-regulate pretty effectively. Well, it's interesting because I've been having conversations with people in my group and they're like, we're coming at the end of our sort of eight weeks of sort of coaching together and they're like,

46:56
I've been focusing so hard on my food and diet and I've seen really great results, but how am I going? I don't know how I can continue to have such a focus and be really rigorous around what I do. And I'm like, I 100 % understand that because you've had decades of this auto regulation you haven't even been aware of, of a different way to eat. And so some of the skills you've learned over the last eight weeks, they are still skills that you need to actually put in place. But ultimately,

47:23
you will get there. Like it just takes time. Like it takes time to be in this place where you don't have to think about what you're doing in food because actually you've developed those skills to shop for food so you've got good healthy food available. You sort of know what cues that your body is giving you with regards to your appetite and your energy. And you have a whole heap of resources that you've gained from the sort of the learning experience of doing the program.

47:51
to sort of put together a meal that you know is going to support your goals. But it just takes time to trust that. And that's not going to happen over eight weeks or 12 weeks or maybe not even six months. But you do get there because at some point in our lives, we've gotten there. And just for us as, I guess, professionals and as people who are interested in the area, probably just happened like, I don't know, 10 years earlier than everyone else that I'm working with. So it just feels second nature now.

48:20
Absolutely. I think it comes down to finding those tactics that work enough so that you can have freedom within structure. Because I think that's the, you everyone craves freedom, but the idea of a fairly arbitrary and absolute freedom we all know is just non-existent. You know, most of us would, I think, agree that we need to have some constraints on freedom for the greater good, whether that's societally or within our own physiology.

48:48
And that's why I love ideas like, you know, that modular approach to creating meals. It's just so easy for people to conceptualize. It's why I have no problem with people having a treat meal. Because if that's the thing that allows them to be consistent the rest of the time, great. You know, if people are more moderators, then they can probably do those things more frequently. It's just all about finding whichever tactics work. It's why I've got no problem if someone wants to drop a meal out because that's the way that they achieve energy balance. Fantastic.

49:17
Conversely the under eater who's been doing it because they've been told the fasting some magical panacea for everything and They're under eating and a meal bacon. Yeah, you know Yeah, yeah, and I mean it's Once you reach this place, then you're far less likely to hit, know by now for these Ridiculous supplements that keep people keep sending me on sort of the next big thing when it comes to weight loss like hops extract Someone just asked me about that today where there was like

49:45
pay $300 every three months for these drops and your appetite's suppressed and you get to lose weight. people who feel like they haven't yet reached that approach that really suits them, there's a bit of desperation. This is why these things kind of work because people will buy them. Yeah. And I mean, that's an interesting example too, because there are clinical trials on it. It does seem to be somewhat effective. I don't know about the...

50:12
the meaningfulness of the effect, like is it big enough to actually justify? Probably not. But is it going to help someone to, over the long term, develop habits of health and or performance that are really effective? And I highly doubt that. And you know, I've really, I think we even talked about this last time, I've really cut back over the years, I guess, on the supplements that I take. Most of it was because I just enjoyed, you know, trying to

50:41
muck around with stuff and see whether it gave an effect. But I think I'm getting to a point now where, especially with how expensive everything is, I kind of know what works and it's more about the all of those various foundations of health of which food is just one part and supplementation obviously is only a small part of that as well. For what it's worth, I dived into the literature after looking at that hops extract and pretty underwhelming on the human side.

51:10
Preclinical trials looked sort of promising, but ultimately, I agree with you, actually Cliff, if spending $300 every three months was enough of a motivator for you to also get into the gym, look at your protein, moderate your meals, and develop these other skills which are long-term, amazing, and you've got that money, spend it because, you know, that could be worth it. I personally would prefer to spend $300 every three months on actual hops.

51:40
as in craft beer. That also makes me adhere to my other diet skills and behaviors. So I then get to enjoy beer as part of my moderate diet approach. Oh, definitely. Absolutely. I follow an LC plus B diet, like low carb plus beer diet. Hey, that was a running joke years and years ago. Especially when I moved up to Canada, we would say that all the time we get our carbs from beer.

52:10
It wasn't just a joke. We kind of did. We ate meat and salads and stuff like that. And then had a couple of beers every day, which I wouldn't do now. I don't think a couple of beers every day is conducive to health, but hey, we were young. Hey, well, for what it's worth, that's exactly what we do in the weekends. When we go out, we long run and then we have more carbs. But also those carbs do mostly include one and a half craft beers, which I love actually. I feel like that's a real balance.

52:38
in terms of everything else that I've got that I do in my sort of diet and exercise. Well, yeah, it's, aside, it's an interesting idea too, because there's so much vilification of particular foods, right? And let's take sugar as the prime example. Sugar is bad for health, right? But let's assume that someone is getting the protein, essential fatty acids and micronutrients they need and they're getting plenty of fiber. If

53:07
Even more than the recommended amount of the daily energy comes from sugar. Is that necessarily a problem? Like I would say based on the evidence now and based on based on experience, I would say no. Maybe something else is going to come out, which will tell us that it's uniquely dangerous, whatever, but I just, can't see that based on what we know right now. There's an interesting conundrum in there though, because you'll see a lot of the evidence bros posting, you know,

53:35
Sugar is not inflammatory, sugar is not addictive, sugar is not bad for health. Those things can all be justified with research, but conversely, the idea that sugar is inflammatory is based on the research. Now, why is it inflammatory? Probably not so much just because it's present in the diet of an athlete who's eating an energy-appropriate diet and getting all the other stuff, more so that it is driving for a food behaviors in people who

54:05
are eating ultra processed foods and it's not very satiating and the sugar containing foods are driving the consumption of more, cetera, et cetera. So I don't think we can ever have these, you know, throw away sort of comments that are almost like a gotcha. Here's, well, sugar's not inflammatory and here's three studies that support my contention, you know.

54:27
look at the context and look at the nuance because we need to look at dietary patterns and habits of health rather than just the isolationist, this is bad. Same thing that could be said for saturated fat. You know, a lot of these people who are sugar apologists will also say within the same breath, but limit your saturated fat to less than 10 % of your calories. It's not a, and even if we have meta-analyses suggesting that saturated fats are independently associated with X or Y,

54:57
I don't believe it's strong enough because the evidence is so inconsistent. Right. We even, don't know if you remember this, but I reanalyzed data from one of our studies and there was no effect on LDL cholesterol, anything from fairly large increases in saturated fat across 12 weeks in the context of a low carb diet. Now, does that mean there's no effect? No, but

55:26
It does show that these inconsistencies in the research and we haven't yet teased out what the impact of saturated fat in the context of an otherwise healthy diet is. Um, we haven't teased out necessarily. Well, we, we kind of have the long-term effects of low-carb ketogenic diets, you know, which is something that you and I have discussed before. A lot of people will default to the idea that, well, studies show.

55:53
that low carb diets are associated with increased mortality risk. They're not low carb diets. They're diets that have 35, 40, 45 % of the calories from carbs. And when population data is adjusted for dietary quality, we don't see any effect. So what we're basically showing with all of these studies is that shitty diets are shitty diets.

56:17
And good diets are good diets. And it doesn't really matter whether it's a keto diet, replete with vegetables and healthy stuff, or a Mediterranean diet that's replete with vegetables and healthy stuff. It's pretty much all the same because it's filled with healthy stuff. I've sort of landed on, and I think you're probably here too. I don't mean to put words in your mouth though. So the final thing I just want to ask you is, are you a proponent of actually the most toxic thing in the diet is likely the calorie? And if you eat in excess of your calories, this is where a lot of the

56:47
foundation or poor health sort of starts from equally, you're about to do a study on overfeeding. So it'll be interesting to see whether that is true in the context of a keto diet. I think it's probably the biggest factor because I think what we consistently see is that most of the reason why diets or interventions work is because they help people modify their energy intake, know, including like fasting and which we've talked about a lot on this podcast.

57:17
So I think it's probably fair to say, but there is one wrinkle that I would throw in there is that I do believe again, based on the evidence that we do have an underlying epidemic of nutrient insufficiency that's under recognized. You know, when we consider that, I'll pull up that, um, rezo again, if I have it, it's pretty.

57:44
Interesting, especially when we look at athletic populations, but I think it goes a lot further than that. We can even just look at population data where half of Kiwi males are not getting enough zinc. More than a quarter of Kiwis are probably not getting enough vitamin B1, B6. Three quarters of women not getting enough calcium. Half of Kiwis not getting enough selenium. These are not

58:14
They're not nothing, right? And when we consider like athletes, I'll go back to the endurance athletes, because that's really interesting. Probably over three quarters not getting enough omega-3 fatty acids. Nearly all not getting enough vitamin D. Over three quarters not getting enough vitamin E. Over half not getting enough vitamin K. You know, it goes on and on.

58:41
We can't expect for the body to either perform at its best or even just be healthy in the face of challenge if it's not getting the essential micronutrients, right? Essential being the key word, which people don't pay enough credence to. Because the underlying narrative, and again, you and I have talked about it before that we hear from academics all over the place and public health organizations, government dieticians, et cetera, is that just try to eat a healthy diet and you'll get all that you need.

59:09
People are on the news saying that, like, yeah, no, you can get everything you need from diet. And I think that you can, but it's an example. It probably lends itself to the reverse causation. I'm sorry, to the circular reasoning fallacy. Because if what we're saying is eat a diet that's healthy, and by that we mean eat a diet that contains all the essential nutrients and the amounts we require, we'll get all we need from diet. Of course, it's circular reasoning.

59:37
But if we're looking at it in a different way where it's the attempt to eat a healthy diet and it's people are doing most things right most of the time, we're not sure that that does actually lead most people most of the time to eat all that they need. in clinical practice, I've only seen one person in the last decade who was achieving sufficiency for everything. In their actual food intake? Wow. Even food and supplements combined because a lot of our

01:00:07
long COVID cohort, lot of our COVAX AE cohort, they were also attempting to supplement to improve the health outcomes. Now, whether they were supplementing effectively is a whole different topic, but they typically weren't achieving sufficiency of many nutrients. You know, and I'm talking usually between, you know, six and 10 nutrients not achieving sufficiency for. So, you know, it's, I agree 100 % that that energy

01:00:36
balance and the calorie being the most damaging thing in health, think that's entirely true. But I also think that we also need to have that eye on nutrient sufficiency. It's so important and people just don't recognize it enough. I love that. And I totally agree. And for what it's worth, this is one of the reasons why I'm such a fan of good green vitality, actually, like because it does, it really does fill the gaps and the amounts aren't

01:01:04
like the extreme amounts that you might find in some sort of poorly put together multivitamin capsule that you can just purchase from the pharmacy or the supermarket. And for what it's worth with athletes, I think that the inclusion of those adaptogens are just, and the antioxidants and things like that are just super helpful for the overall metabolic health and nervous system and all of it. Yeah. And for the same reason, know, that's one of one of the

01:01:32
reasons why i'm such a big advocate for vegetables and having those. What is in there because they're providing a secondary nutrients that while they're not essential. The evidence you know obviously shows time and time again that they are likely beneficial for health. And it's one of those things that i know we're running out time but it's one of the things that i still can't get my head around when advocates for extreme approaches to keto or carnivore diets. Claim that vegetables are.

01:02:00
bad for us because there's simply no evidence for it. But on the other hand, we have a lot of evidence showing that they are now they might point to the fact that a lot of that evidence is observational and therefore it's methodologically weaker. But in the absence of evidence to show harm, we can't conclude harm when all we see is benefit. And we also need to think about, know, I think when people are looking at research, they should always be thinking about

01:02:30
it is a bit of a continuum from plausibility into what we actually say. Because a lot of evidence is limited into one of those categories. Well, it's plausible that this happens, but we don't actually see it in real life. So it probably isn't happening. On the other hand, we're seeing certain things in real life. Is it plausible that that would be happening? Probably or maybe not. You know, it's like the correlation causation arguments where what is it, you know,

01:02:58
ice creams are associated with shark tanks or something like that. Yeah, it's not plausible. All right, Cliff. So to finish up, you mentioned a presentation you're giving in a couple of weeks time and I will link to the conference because I believe that people can attend virtually and so we'll make sure that this comes out with enough time for people to hit their purchase ticket for a virtual ticket and also

01:03:28
Are you doing strength-based training on an app? Are you doing, what's the go? Can people sign up to train with Cliff? They can, yeah. I got back into some online coaching probably a year or so ago, just because I really enjoy it and I was missing, I'm compulsive about writing strength plans. I love doing it. So I thought, well, I'll write one a month, put it up there. And it's basically the program that I'm using at the time.

01:03:56
So it's very much based around a minimalist approach to strength, you know, for the time poor sort of person. So effective, minimal time, and then it has, you know, nutrition guides and lifestyle advice around it and stuff like that. So yeah, I've got my own little app and I do that and it's a cool little group of people who are part of it. And like I say, I kind of do it for fun. It's just great to have some people wanting to get stronger and healthier. That is awesome. Well, I'm going to put, I'll put a link to the

01:04:24
Sports Nutrition Association Conference plus to your app in the show notes. So can you just let people know where they can find you? mean, people know, but let's remind them. Yeah, to find my stuff, it's at cliffhavi.com and they can go to cliffhavi.com forward slash coaching to find out how to get online coaching and whatnot. And then obviously our institute is the Holistic Performance Institute at holisticperformance.institute where people can study nutrition. Amazing.

01:04:54
and health coaching. And in fact, I'm talking to Dr. Sarah Hancock, actually, soon, who is, as I believe, right now going through HPI and she's just singing the praises of the course. So we're to have a bit of a chat about that and amongst the other sort of dental hygiene stuff that we'll be talking about. Well, interestingly, I just spoke with Sarah this morning. We're possibly going to co-write a paper on sort of that interplay between dental and metabolic health. I love it. I just cannot wait to dive into that with her.

01:05:23
Cliff, as always, such a joy to talk to you. I love it. Like this has been the highlight of my Tuesday. So thanks for all your wisdom and knowledge and we'll talk soon. Thanks boss.

01:05:47
Alrighty, hopefully you enjoyed that. Love chatting to Cliff and this really is just a great excuse to jump on and chat to my mates. And in fact, when I started the podcast, one of the friends that I have in Dunedin, is I think one of the best lecturers out there, Aidan Summerfield, said to me, Mickey, you just want to do this to chat to your mates. And he is not wrong. Speaking of experts.

01:06:12
Next week on the show I speak to cardiologist Matt Boudoff about the effects of a ketogenic diet on heart health. is one of the researchers in this space. Super interesting. I also have my vegetarian webinar coming up next Wednesday. That's Wednesday April 16th, 7pm New Zealand time. If you're a vegetarian, if you want to optimise your protein intake,

01:06:39
and also learn about other nutrients that are super important. This is the webinar for you. Put a link in the show notes to that. But if you've got any comments or questions, as always, hit me up. I'm on Instagram, threads and X @MikkiWilliden, Facebook a@MikkiWillidenNutrition, or head to my website, MikkiWilliden.com, where you can sign up to that webinar. All right, team, you have the best week. See you later.