Brain Health: Keto, Cycling Keto, and Fasting – Oubre Medical

Brain Health: Keto, Cycling Keto, and Fasting

We decided to sit down and have a chat with our practice owner and MD, Dr. Philip Oubre, and functional nutritionist, Aubree Steen.

We're diving into another 4 part series focusing on brain health. We're diving into part 4 here, following with:

1. How Indoor Air and Mold Affect the Brain
2. How Butyrate Helps Power the Brain
3. How to Test Your Brain Function
4. Keto, Cycling Keto, and Fasting



Dr. Philip Oubre (00:00):
Hey everybody. Today, we're going to continue our brain health series. This is the last video, and then we're going to be talking about fasting and keto.

Aubree Steen, FNTP (00:07):

Dr. Philip Oubre (00:08):
I know, right? Hot topic. I'm Dr. Philip Oubre and this is-

Aubree Steen, FNTP (00:12):
I'm Aubree Steen.

Dr. Philip Oubre (00:12):
So we're going to be talking about fasting and ketogenic. So a lot of people already know about ketogenic, so we'll save that for after you turn off the video. But first, we're going to talk about fasting. And fasting, when I first started learning about fasting, how hard can it possibly be to start fasting? You just stop eating, right?

Aubree Steen, FNTP (00:27):
You have no idea. You have no idea the mental and emotional attachment you have to food. You have oral fixations that you need to suffice. You always, you eat when you're stressed, you eat when you're happy, and they're like, "Oh, just don't eat." And you're like, "Okay, this is when I have my snack though." And it is a mental willpower. But one thing I really love, I know that we're already kind of diving into this, is that a therapist was always like, "If you have the need to eat, sit there and go what emotion is this in my body." So you sit back and go, "Okay, maybe I'm hungry, but let's see." Push the hunger away and go, "What else is going on? Am I happy? Am I anxious? Am I sad? Is there something I'm avoiding too?" So it's kind of cool, whenever you can take that energy into food and channel it somewhere else.

Aubree Steen, FNTP (01:10):
Then there's a difference between hunger and a craving. If you're sitting there and you're craving a food like sugar or crackers or chips or something snacky, that's a craving.

Dr. Philip Oubre (01:23):
Do you really need that?

Aubree Steen, FNTP (01:23):
Right, that's something that you don't really need. If you're truly hungry, think of, now, this is if you're a carnivore, or omnivore. Think of would you eat grilled chicken and broccoli and veggies and anything right now? And you're like, "No, not really." Then you're not hungry.

Dr. Philip Oubre (01:36):
You're really not hungry.

Aubree Steen, FNTP (01:37):
Then that's a craving. So kind of A, seeing-

Dr. Philip Oubre (01:41):
And that's okay.

Aubree Steen, FNTP (01:41):
Yeah. That's okay.

Dr. Philip Oubre (01:43):
First step is to identify.

Aubree Steen, FNTP (01:43):
Yeah, right. So just see where you're at. Are there underlying emotions? Do you need to work on something else in the meantime? Are you actually hungry? I don't really like the whole, "You just need to drink water." I think have a glass of water, but there is a difference between being hungry and just being thirsty.

Dr. Philip Oubre (01:58):

Aubree Steen, FNTP (01:59):
I think that's a little demoralizing to tell someone, "You just need to drink some water."

Dr. Philip Oubre (02:02):

Aubree Steen, FNTP (02:03):
No, I'm actually hungry.

Dr. Philip Oubre (02:06):
Yeah. The growling does not want water.

Aubree Steen, FNTP (02:07):

Dr. Philip Oubre (02:10):
So in addition to the mental aspect, because that's a big part of it, especially because we're American and we've been taught that breakfast is the most important meal and we eat all the time. And if we're not eating, we have snacks.

Aubree Steen, FNTP (02:20):
And then there's the fourth meal, the late night meal that we've been bombarded with.

Dr. Philip Oubre (02:23):
Second breakfast. And so there's also biochemical dependence on food when you've been accustomed to eating all of the time.

Aubree Steen, FNTP (02:30):
Right. So there are things like MSG, which are known neurotoxins, but also cause addiction in the body. They're sugar, cane sugar, which does cause addiction in the brain. So there's all these different chemicals, preservatives which can cause addiction as well. So you've been getting used to eating all the time, but necessarily are you hungry? No. You more so have this addictive property of like, "I'm craving these foods." They have a dopamine release. They hit really well. Like when you eat a ton of sugar, that is a happy, happy thing, right?

Dr. Philip Oubre (03:02):
Or the opposite, if you've... Go on.

Aubree Steen, FNTP (03:04):
Yeah. No, go ahead.

Dr. Philip Oubre (03:05):
If you've ever come off of sugar for a significant amount of time and have you added back in, you quickly realize how dependent you are because you weren't dependent on it for a while.

Aubree Steen, FNTP (03:14):
Oh yeah. And it's an immediate rush. You're like, 'Oh sugar." You get so excited. You're happy. And I know and then when kids, when you have kids that are running around, no they don't like... Maybe they have ADD, but when they've just had an entire fruit kind of juice and gummy bears at the same time and they're sprinting around the parking lot, like this. Yeah. They're getting energy out, but that sugar it's an exciting kind of aspect.

Dr. Philip Oubre (03:40):
Okay. So you took that to a totally different place than I was expecting, but that's important too. As far as the biochemical dependence on food.

Aubree Steen, FNTP (03:46):

Dr. Philip Oubre (03:46):
I also want to talk about the biochemical dependence on fat and sugar proteins.

Aubree Steen, FNTP (03:52):
Oh yeah, go ahead.

Dr. Philip Oubre (03:53):
No, no, no. You're the nutrition, you get to talk about that. So switching from a non-fasting state to a fastest state actually requires some work. You can't just jump right into it. It feels miserable.

Aubree Steen, FNTP (04:02):
The first thing you have to do is to assess. So we're basically going to talk about, well, let me rewind because there's quite a few things that you can talk about this. So when we talk about going into a fasted state, I like to talk about the two types of people, a sugar burner, or a fat burner. This is not calling you a name or anything.

Dr. Philip Oubre (04:18):
She did, she totally did.

Aubree Steen, FNTP (04:20):
A sugar burner is when you're reliant on sugar and sugar comes in fruit, carbohydrates, you name it, for energy. And so sugar burning is if I were to utilize this sheet of paper, my homework for the day and light it on fire. So that's going to go rapidly, that's sugar burning, you're going to constantly need to feed that fire with paper over and over and over again. And usually when I say sugar burning, you're reliant on those external carbohydrates, you haven't tapped into your own storage sugars.

Aubree Steen, FNTP (04:47):
You haven't tapped into fat stores for energy. You're reliant on, oh, that cereal, that sugary snack, that high carbohydrate meal, the potato chips, the pasta for energy. You feel better when you eat food, not just you feel good from food, but you actually feel better when you eat. You feel bad between not eating. That's sugar burning. Fat burning is if I were to take, imagine this is made out of wood, like a log. I don't have a log here.

Dr. Philip Oubre (05:13):
I understand.

Aubree Steen, FNTP (05:13):
Okay. So imagine right a log.

Dr. Philip Oubre (05:16):
They can imagine.

Aubree Steen, FNTP (05:16):
A log is...

Dr. Philip Oubre (05:18):
Use your imagination.

Aubree Steen, FNTP (05:20):
Imagination. So a lot is going to be kindling. It's slow and it's burning. And that's when we utilize our own fat because ideally what happens, that we eat some carbohydrates, obviously. We have a little bit of that sugar stored through glycogen, which is stored in our muscles, but-

Dr. Philip Oubre (05:35):
Pause there. Because you're right, but there's a lot of detail there. So as far as sugar is concerned, your body can only store about six to eight hours of sugar burning. If you're doing a workout, you can only last for about an hour of working out with sugar. So, but fat you've got days worth of fat and protein. You've also got days worth of protein, but protein is muscle and function. So you don't want to burn protein for fuel too much. Although we do. So days worth of fat hours worth of sugar.

Aubree Steen, FNTP (06:02):
Yes. Yeah. So you want that low kindling energy and that's when you do eat low-glycemic vegetables and carbohydrates paired with healthy fats and protein, because what happens is now you're not having an abundance of sugar and carbohydrates to burn through you go, "Oh, okay. I actually need to access my fat because I'm not being handed that sugar." And you go through your storage sugar and you eventually access fat and you don't have to go into keto to do this. We'll kind of talk about how to go in and out of it. But that's kind of primarily sugar burning and fat burning. Where do we start? How did I get here?

Dr. Philip Oubre (06:35):
That's a great one. The next step is really just talking about how do we convert from sugar burning to fat burning? Because that can be a difficult process. One of the ways is just to stop eating and suffer through it and go through the keto flu and all that. That's not what we recommend. So if you are a sugar burner, if you're burning your paper really quickly, then the first step is just to start cutting down the number of carbs you're eating, the amount of carbs per meal or another way to look at it because too often in medicine and in health, we say, "Cut this out. Don't eat that." Instead of looking at it that way, eat more of this. So in order to become more of a fat burner, then you need to eat more fat. And if you eat more fat than you will naturally eat less carbs.

Aubree Steen, FNTP (07:13):
Yeah, you want to start shifting your plate. So I like to think about gradually reducing carbohydrates while you're increasing fat and protein. So if you have your full plate right, before let's say three fourths of it was a pasta. Even if it's a gluten-free pasta, it's still a pasta and a little bit with some chicken, a little olive oil in there. Now what we want to do is over time, cut that down to a third of the plate. As long as you can start to add in high fiber veggies in there, start to add in more fat, like avocado, more olive oil, you'll start to naturally change the balance of that plate. And what happens is you're slowly reducing those carbohydrates that your body is reliant on externally. And then once you start doing that, it's a nice gradual transition because you'll start transitioning into fat burning much easier.

Aubree Steen, FNTP (07:54):
Now you want to keep that kind of carbohydrate count lower over time. Like if you're only eating, we don't quantify calories, I actually don't even know how people track calories. But let's say if you're eating like 1800 to 2000 calories a day, just naturally, you don't want like 300 grams of carbohydrates, even if you're just increasing a ton of fat. So you still want to be mindful of, "Okay, am I eating now 75% of pasta? And I'm just adding like 600 calories of oil on there." Oh it's not the healthiest thing to do.

Dr. Philip Oubre (08:21):
Sweet fat.

Aubree Steen, FNTP (08:21):
Yeah. Sweet fat. You want to just start to transition naturally. So that's how you can do it with diet. And then over time, you'll start to reduce some of the starchiness things. Again think about this as like, even if you have balanced meals, thinking about those snacks, if you're like, "Oh, I'm a treat myself with a Coca Cola or I'm a treat myself with a bag of candy."

Aubree Steen, FNTP (08:38):
You knock yourself almost immediately out of that fat burning for quite a while. And it takes a little bit of time to get in there. There's different ways to do it outside of food itself too. And kind of like how Dr. Oubre said, if you cut everything out at once, you're going to go through that keto flu, something similar happens with exercise. If you want to burn through that sugar pretty immediately, you can do a ton of high intensity interval training and that will burn through any of that sugar that's readily available. Or you can take it gradual. When you start shifting your plate and you're like, "You know what? After I eat, I'm going to go for a 45 minute walk to burn off some of that sugar that's circulating in the system." Something like that.

Dr. Philip Oubre (09:14):
Yeah. And never eat a carb without fats, or we're if you're going to eat the apple, even a fruit or something. If you're going to eat an Apple, try to pair it with some sort of nut butter or some other nuts. I don't know what kind of food plan you're on, but that's one of the things I think Americans frequently miss is, I'm eating this snack. Always pair it with a fat that makes it better. Another way to kind of transition it to more fat burning is just to start with a fasting window and start extending it over time. So naturally most people don't eat overnight. I laughed because I did have a patient that would literally set an alarm to wake up and eat ice cream in the middle of the night. She just couldn't control herself. And eventually we worked through that, poor thing. So most people do not eat overnight. And so you already start off with an eight hour fast. Hopefully you're getting around eight hours of sleep.

Aubree Steen, FNTP (09:56):
I would say a lot of people do eat right before they go to bed because of sleep. And that's a whole different topic.

Dr. Philip Oubre (09:58):
Yeah. So, but whatever it may be whenever the time you naturally stop eating. And whenever you naturally start eating, count that as a fasting window. So if you stop eating at 10:00 PM and your first meal was at 6:00 AM, then that's already an eight hour fasting window. So the very next thing you can do is try for a nine hour window. So say you're either going to stop eating at 9:00 PM or if you're going to stop eating at 10 then say, "I'm going to wait till seven." Most people in the beginning do better with delaying when to start eating than to stop eating earlier. So you already have your pattern, a bedtime snack, whatever it may be, allow yourself that, but whatever time you stop, then extend it one hour and wait until you're comfortable with that. Once you're calm. And so if that's two or three days, great, and you're ready to go to the next one.

Dr. Philip Oubre (10:40):
That's okay. If you want to do it over a week, remember that you're doing this for longevity, so you don't need to be there tomorrow. Don't go for the fast win, because if you go for the fast win, it's a fast loss. Go for the longterm benefit. So start with an eight hour window or whatever, meet yourself where you are and be honest about your goals. And I would say at least a one hour extension on your fast once a week, that would be a reasonable goal. I think for most people and your goal we talked about in there in our butyrate video, the goal is to get to a 16 hour fast. That may seem daunting. Okay. When I first started getting into fasting, I had already done some fasting just because I was lazy in the mornings and I'd run out with coffee and I actually wouldn't eat anything until lunch. So we call that unintentional fasting, unintentional intermittent fasting, or when you run out of food as a bachelor, that's another unintentional fasting, or one of the power goes out in a winter storm.

Aubree Steen, FNTP (11:30):
No, we just had so many snacks. That's burrowing.

Dr. Philip Oubre (11:35):
So as you extend that fasting window, it may seem daunting, but I've done 72 hour fasts before that's currently my longest fast. And that even coming out of my mouth, that sounds completely unbelievably hard to do, but trust me, your body is made to fast. It is designed to fast. And so it's also a wonderful exercise. As Aubrey mentioned the beginning, if you want to break some of your food habits, that's one of the easiest way, it's not easy, but that's one of the most powerful ways to break food cravings is to separate that entirely and give yourself permission to say, "well, I don't need to eat anything for 72 hours." Not immediately, you're going to work your way to it. I'm kind of jumping the gun, but giving yourself permission to not eat, gives you control over the food instead of food controlling you.

Aubree Steen, FNTP (12:20):
Right. And you can use it simultaneously. It's easier to fast when you're fat adapted.

Dr. Philip Oubre (12:24):

Aubree Steen, FNTP (12:24):

Dr. Philip Oubre (12:25):
So you don't want to get into those 24 or 72 hour fasts until you are fat adapted, until you can... Yeah don't.

Aubree Steen, FNTP (12:32):
Don't do it after you've had it... Yeah, you can. Yeah. You'll feel pretty terrible. But once you start getting into that habit-

Dr. Philip Oubre (12:40):
FPT. FLC sounds better.

Aubree Steen, FNTP (12:43):

Dr. Philip Oubre (12:43):
FLS, take it up a notch.

Aubree Steen, FNTP (12:45):
Okay. So, but one thing that-

Dr. Philip Oubre (12:47):
You can figure that one out.

Aubree Steen, FNTP (12:47):
Yeah, feel the sauciness.

Dr. Philip Oubre (12:50):
I don't [inaudible 00:12:51].

Aubree Steen, FNTP (12:50):
Feeling saucy. So one thing also is that once you become adapted and you get into that rhythm, you will feel like, "Okay, well I'm doing my fasting and I'm fat adapted, but I do want to have maybe a gluten-free pasta night or do something like that." There's little tricks that you can do to actually ease yourself to where you're not spiking from the blood sugar. What you can do is try to burn all the glycogen in your system before you eat that.

Aubree Steen, FNTP (13:10):
So do like a 15, 20 minute HIT exercise, then eat. And then you can go on a long kind of walk for 45 minutes, that has been proven to be the best way of utilizing those carbohydrates. And we tracked it on a continuous glucose monitor with myself and with patients, my brother, you name it. And we've been able to prove this as well, that the blood sugar spike is like just normal after that. So you burn through as much as you can before the dinner. This is, of course, if you just want to exercise around food, but it will help. And you're not going to have that immediate knockout.

Dr. Philip Oubre (13:40):
It doesn't need to be exercise, a simple walk burns calories, pulls sugar directly out of the bloodstream. So in order to work towards those 24 hour fasts and longer, the first step you want to get to is you want to be able to get to a 16 hour fast and you don't necessarily need to do it every day. That's not the goal. If you can fast for 16 hours and not feel totally miserable, you are definitely fat adapted. Okay. So the goal is, before you try one of these longer fasts, you want to get to 16 hour fast three days a week. If you can tolerate 16 hours, three days a week, then you're most likely, fully ready for a 24 hour. So what I would usually do for our patients is focus on at least 12 hour fasts per every day, but doing a 16 hour, three days a week, and now you're ready to do a 24 hour and I would get them to do a 24 hour every other week or so.

Dr. Philip Oubre (14:24):
And if they can do two or three 24 hour fasts without feeling completely miserable, then we would have pushed it to the next level of saying, "Well, now you're going to do a 36 hour fast and now you want to do that maybe every other week." And this is if we're really trying to get, but once again, the whole topic is brain health, you're trying to regenerate brain health quickly. And then once you can tolerate a 36, obviously go to a 48. By the time you get to a 48, you're pretty well ready to jump to a 72.

Aubree Steen, FNTP (14:49):
It's that 40 that's hard to hit.

Dr. Philip Oubre (14:50):
It is.

Aubree Steen, FNTP (14:51):
And [crosstalk 00:14:52].

Dr. Philip Oubre (14:52):
That's a total mental block. 24 is actually not as hard as you think.

Aubree Steen, FNTP (14:57):
Breakfast to breakfast or dinner to dinner.

Dr. Philip Oubre (14:58):
Right, so if you think about it. You eat dinner at night, you finish it at 8:00 PM or whatever it is. That means you just don't do breakfast or lunch the next day, you get to eat dinner the next night, and we say 24 hours, we say 48 hour. Your body doesn't know whether you made it 47 hours. Like there's no benefit that happens at the magical 48 hour window.

Aubree Steen, FNTP (15:18):
[crosstalk 00:15:18] crying at 47 hours because you have one more hour to go, just eat.

Dr. Philip Oubre (15:22):
So normally what I do is I do mine by dinner. So if I'm doing a 24 hour, I will eat dinner. And if I finish eating dinner at seven and the next day I eat it at 6:00 PM.

Aubree Steen, FNTP (15:31):
Its okay.

Dr. Philip Oubre (15:32):
Right, give yourself a little credit. And if you need more help, there's actually a fasting app that Peter Attia made it, that's the most ridiculous thing ever.

Aubree Steen, FNTP (15:41):
But it works, sometimes you need structure.

Dr. Philip Oubre (15:44):
If you need some app to tell you how long you've not eaten, then you just download the app. It's free. It's called Zero.

Aubree Steen, FNTP (15:49):

Dr. Philip Oubre (15:49):

Aubree Steen, FNTP (15:50):
Way to you make you crazier.

Dr. Philip Oubre (15:53):
And you hit the button when you're fasting and you hit the button when you eat. And it tabulates how long you fasted, how many times you did and all that.

Aubree Steen, FNTP (15:58):
Sometimes it's good to see the number you're like, "Oh my God, it's like 15 hours. Okay. I can do another three. If I want to." I don't know.

Dr. Philip Oubre (16:06):
So anyway fasting is powerful, being fat adapted is the tool for everyone. Everyone should be fat adapted, no one should be a sugar burner. So if you are a sugar burner, then one thing you need to do is get more fat adapted. Even if you never decide to play with the fasting. But if you want the brain benefits and you don't want to fast, you have to do keto. And if you're going to do keto, we always like the cycling keto. So five days on keto, two days off, we kind of talk more about keto and our butyric acid. We were going to talk about keto in this video, but we ended up talking a lot about fasting and how to get fat adapted. So we'll just end it there. It's amazing how long you talk about something, meaning just don't eat.

Aubree Steen, FNTP (16:42):
But what we can do is I'll put a link in the bio to kind of like a cyclical keto PDF that I've made. It's nice. We'll just give you a little guideline on how to do it if you want to, if you're interested.

Dr. Philip Oubre (16:51):
So there's more information about nutrition and being fat adapted on our nutrition course. Go to our website, click the learn button, hit the courses and you learn more about being fat adapted, more about nutrition and getting better. And of course, subscribe to our channel, like our video, share it with friends and we'll see you next time.

Aubree Steen, FNTP (17:08):
Bye guys.

Dr. Philip Oubre (17:08):
Keep that brain sharp.

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