Denise has been a Registered Dietitian (RD) for 29 years. She administered the Ketogenic Diet to children and adults with epilepsy and other conditions at the University of Michigan CS Mott Children’s Hospital for 11 years and now runs her own Private Practice for Ketogenic Diet Therapy (KDT).
She is a Certified Diabetes Educator (CDE) and a Certified Specialist in Pediatrics (CSP).
Denise received her BS in Dietetics from Michigan State University and completed her Dietetic Internship at the University of Arkansas for Medical Sciences.
Denise speaks and trains nationally and internationally on the administration of KDT. She is one of “Charlie’s Angels”, a group of vetted professionals that provide KDT through the Charlie Foundation for Ketogenic Therapies.
Hey welcome everyone to another episode of Keto Chat. I am your host, Carole Freeman, Certified Nutritionist, Keto Diet Specialist. I am here today, I’m so excited, finally I get to talk and interview Denise Potter of Potter Dietician … oh, wait, I’ve got the … Potter Dietician Consulting. She’s somebody I’ve been sending referrals to for quite a while and I’m so excited we finally get to connect and I get to share with you her expertise. Let me give you a little background on Denise.
She’s a Registered Dietician for 29 years. She administered the keto diet to children and adults with epilepsy and other conditions at the University of Michigan, CS Mott Children’s Hospital for 11 years and now wants her own private practice for Ketogenic Diet Therapy, KDT. She is a certified Diabetes educator, she’s a certified specialist in pediatrics. Oh man, this lady is credentialed, I’m telling you.
Denise received her Bachelor’s in Science and Dietetics from Michigan State University and completed her dietetic internship at the University of Arkansas for Medical Sciences. She speaks and trains nationally, and internationally on the administration of the Keto Diet Therapy. She is one of Charlie’s Angels, a group of vetted professionals that provide Keto Diet Therapy through the Charlie Foundation for Ketogenic Therapies.
Welcome. Welcome, Denise Potter.
Hi, thanks so much for having me.
So glad to be here.
Just to start out with, I gave your professional bio, but can you just give us a little sneak peek of who you are as a person in this world?
Wow, as a person I’ve been married almost 30 years to an awesome husband, Terry. I have four children of various ages: 13, 16 … wow, I forget because there’s so many, 22 and 24. Four awesome kids. I am just so excited to be, as far as professionally, working with Ketogenic Diet, but on a personal level. My family loves to be active, run, do little baby triathlons. When I say triathlon, it means a lot of things, so little baby ones, and stay active and always learn new growing.
Excellent, well I’m so excited you’re here. I have so many questions for you. I’m really curious, it sounds like probably pretty much out of high school, you got on the dietician track. How did you get interested in that? How did your path start to getting all the credentials you have?
It’s kind of a stupid story, but I’ll tell it anyway. When I was in college, and this happens to a lot of high school kids, everybody’s asking you, “What are you going to do when you go to college? What are you going to do?” Because it was always a given I’d go to college, but to do what, I didn’t know. So I started telling people business just to get them off my back. I went to school my first year and took all those basic classes. By the end of my first year, all of a sudden one day in a conversation with my mom, I said, “I like nutrition, I think that’d be really interesting.” She said, “Oh, well then you should go to Michigan State,” because I was at Calvin College, a small private college.
And she’s like, “Well you should go to Michigan State.” I said, “Okay, then I will.” Then I did. I transferred the next year, went into the Dietetics Program and never looked back. Never had that, “Oh my gosh, I’m in the wrong major,” type issues. I spent three years there and then when I’m down to Arkansas to do my dietetic internship down there, which was really great. We loved it down there. And spent an extra three years in Arkansas because we just loved it. Then ended up coming back to Michigan from there.
I just always, I guess … I don’t know, like a lot of people, nutrition was just interesting to me, kind of exciting, and I had no idea where I would go with it. But it started out, like a lot of people typically in a small hospital. I was the only dietitian and working with any type of patients because you’re the only one there, so you saw everyone which was a really great experience, and then moved from there into different specialties. I’ll just keep going if you want, because over time I transitioned for Diabetes because I realized, “Wow, instead of just going to see someone in the hospital today and no one really cares,” and those of you who are familiar with hospitals, the credentialing agency is joint commission.
So it’s all about joint commission. The dietician had to have been there. Made a note, seen the patient in some way. Or at least screen the patient. I felt like sometimes no one cared I was there except joint commission. I leaned over into Diabetes because I could do education, I could teach people, and I could actually make a difference in their life because I showed up today. So leaned into that and then over time transitioned … keto was just kind of an accident, how I started out with that. Then like I said, if you want that whole story, I can give you that too.
But anyway, just … yeah go ahead. I’m kind of on a tangent. Sorry.
Well it’s great, yeah.
I wanted to pause for a moment. Most of the people listening to this are just going to be general public. Can you explain what does Registered Dietician mean and the steps to get there?
Oh wow. That is a great question. Thanks for asking that because there’s a lot of confusion. Registered Dietician or … so you’ll see RD or RDN, it means Registered Dietician or Registered Dietician Nutritionist. Anybody that has that credential means they’ve gone through a four year degree program and they usually have either done an internship in addition to that, or sometimes those clinical hours are included in the program, like in a Nursing Program you would do your clinical hours inside the Nursing Program. Sometimes, again, you do Bachelor’s degree and then you do a separate internship, which what I did.
So there are few different routes to get to that, but you can’t even take the test to be an RD unless you have gone through the proper credentialing. There can be a difference between Nutritionist and Dietician, and then there’s licensing in a lot of states where the dieticians have licensure and then you have nutritionists. So it can be a different thing. I think it’s important when people are working with someone, it’s a question you can ask, what are your credentials? Do you want to work with someone that has that RD or RDN, or a specific certification for a nutritionist, which is a little different.
Excellent. The RD then is a national credential that has standards across all states-
And then each individual state has different credentials that they may issue as well. So the RD is kind of gold standard nutrition credential that people can get.
Right, exactly. Then yeah, different states have licensure. For example, I’m in Michigan and we don’t have a state licensure for dietitians, again which is fine, it gets into who can practice and such. When you go into that, if say you’re in a hospital say, or you’re in regular, many health clinics if the dietician comes to see in the hospital it’s going to be a Registered Dietician because that’s who is allowed by the joint commission to do the nutrition assessments.
Excellent. Yes. I know my state in Washington, every state’s different. All I know about is my state. We have a separate credential, it’s called a Certified Nutritionist, that you have to have a Master’s degree or higher to be able to get that, and that’s the standard for that. That’s my credential. I’m not a Registered Dietician, I don’t have the national credential. I just have my local one here, which is … yes. I’ll just add right here that I am adamant that if somebody is using a therapeutic Ketogenic Diet for any medical condition, you need to be supervised by somebody, I would say the Charlie’s Angels, but somebody who is definitely a Registered Dietician.
Another clarification too, in my state anyone can call themselves a nutritionist. You can say you’re a nutritionist with no training whatsoever. That’s another interesting thing. I just want to try to educate people just a little bit because it can get so confusing and people don’t know who is helping them with what and what credentials they have. Nutritionist doesn’t mean anything. What’s protected in our state is the word “certified” and the nationally Registered Dietician or Registered Dietician Nutritionist, is protected so anyone who is calling themselves that knows that they can use that under only specials conditions, or they have to have special credentials for that.
But be weary. If somebody is calling themselves a nutritionist out there in the world, it doesn’t necessarily mean anything. So like Denise said, ask their training, ask their credential, ask licensure, certification, what is it that they actually have. They should provide you with that too.
That’s a really fair question because the same in Michigan, that’s why it’s taken so long. We can get licensure through in this state, and I won’t say … I haven’t been super active with that, but because there are groups that are nutritionists which have a whole different level of training, or no training, again because yes you can be a nutritionist, anybody can hang that banner up in Michigan and say that they’re a nutritionist, go out and charge any amount of money. The general public doesn’t know that, so I really appreciate you bringing that up.
Of course, you have a Master’s degree. I fought long and hard for my education and credentials, and experience. You do really want people to at least what they’re getting when they’re out there seeking out a professional. I’m also going to just say yeah, thank you for the plug that we hope a Registered Dietician would be the person to work with for a therapeutic Ketogenic Diet because there are lot of concerns where the diet could be absolutely safe and not a problem, but there are many things to look for.
One of my concerns is a little bit where a lot of people started working with Ketogenic Diet yesterday, last week, last month, and we all have a first day. I get that. But you really … you might want to think about those who have been working with for a long time. I’ll tell you, I’ve learned something new every single day since I’ve been working with this diet, something odd, something strange, something different comes up all the time. The Registered Dieticians, we have a great network of dieticians. So if something comes up that I don’t know, I’ve got 100 buddies that are also working keto that I can go to and say … you know of course an email will serve and say, “Man guys, I’m not sure what to do with this.”
And we all have those every single day, and this all people that have … most of have been doing it a long time but then also we’re bringing along the young dieticians that haven’t been working with this so long. So the network’s pretty good. It’s pretty tight because it’s small. It’s a pretty niche field, but yeah I just can’t tell how much a little bit of experience can make a big difference with this.
Yeah, oh that’s to hear that you have that network of support because you’re right, especially the categories of people that you love working with, that you’re really good at working with, those people absolutely need somebody who’s clinically trained, and experienced, and has resources to go to when they don’t know what the answer is.
I’ll add to that too that there is a lot of … people that are following a Ketogenic Diet because they think they want to primarily follow it for weight loss, but anyone whose on any medication at all, I am adamant too that they need somebody who is a credentialed healthcare provider and familiar with that, or at least has referrals resources they can refer to because there are so many different things that can compound upon each other when somebody has any medication for any reason. Even if they’re just doing keto for weight loss, there’s a lot of things to watch out for.
Those of you watching out there, if you’re on any mediations, a therapeutic application of any reason for the keto diet, please, please reach out to your trained and experienced healthcare provider.
Yeah, and I like to, on any patients that I work with, I do require … they need to let their doctor know that they’re on the Ketogenic Diet. Usually of course, because I require lab work as well. They kind of have to ask their doctor because they need their lab work. It gets a little scary because things happen and then people can land in the hospital and the doctor is going to say, “If I had known you were on this, maybe they could have done something different.”
But there is a big unfamiliarity with the doctors because this is … even within neurology where they are administering the diet, there’s still definitely a little level of, I’ll say, discomfort in a bad, but they were really reliant on the dieticians to manage these patients. And I’m talking in critical situations in the hospital, in the intensive care unit. Honestly, the dieticians are working very closely with the physicians for the care of these patients. You can’t undercut that importance.
Let’s talk about what areas of a therapeutic application of the Ketogenic Diet. What conditions do you specialize in treating? We can’t use “treat” for a dietician, right? We have to say “support nutrition for”.
We’ll it’s Medical Nutrition Therapy.
So therapy treating … I think we can get into this play on words and if it really came down to a court room, what are we going to do, you know? So I don’t know, I’m treating people. One specialized [inaudible 00:15:01] I’m going to start out with the diet and I’m sure you’ve addressed this, but the diet 100 years ago became proven and known for pediatric epilepsy and adult epilepsy as well. So it’s been used for 100 years for this application, and that’s where I started was pediatric epilepsy. I’ve seen just absolute miracles with this. One of my favorite things, and I’ve gotten this quote … I’m probably going to cry in a minute.
I’ve heard this from parent several times where they say, “I’ve got my kid back.” And they look at you like, “I’ve got my kid back.” And I want to throw names in there and I can’t, but it’s just beautiful. Maybe that doesn’t mean they’re seizure-free. Maybe it means they used to have 10 seizures a day and now they have one seizure a day. They used to last five minutes, now they last 30 seconds. I mean there are all different levels of how well the diet works, but there is a greater than 50% chance that the diet’s going to work in pediatric epilepsy for these kids. And this is after they’ve tried two, to three, to four, to 10 medications.
These kids, when they come in, and unfortunately when they come in sometimes and are referred for the diet, sometimes they have gone through up to 10 or more medications. It’s well-researched that the diet … and there’s a new consensus statement out if anybody wants great details, a 2018 consensus statement put out, Dr. [Passab 00:16:33], would be one of the first authors on there. Anyway, that has recommendations for who should use the diet. That any person with epilepsy that’s failed two medications that were appropriately prescribed, is definitely a candidate for the diet.
Then there are some other conditions such as [GLUT-1 00:16:50] deficiency and PDHD that you also would put a patient on the diet immediately for. You wouldn’t wait until they failed two medications. So that’s the first place, my first love and first introduction to the diet. I’m just going to go on a slight tangent with that. The diet’s been around for 100 years. In 1994, I’m going to talk about the Charlie foundation briefly, is that okay?
Yeah, how could we not talk about that?
Okay, so in 1994 a family had a really just two or three years old, a little boy Charlie, who has having just hundreds of seizures, and hundreds of seizures. He had brain surgery, he had all kinds of issues, numerous medications and nothing was helping his seizures. The parents were just researching and researching and they looked and they found in a book and it said Ketogenic Diet would be a treatment for his epilepsy. They went to their doctor, their doctor said, “No, that’s not-” and I don’t remember all the details of why they said no, but they said no.
They didn’t take that no for an answer, and they took him to Johns Hopkins, which was one of the few places in probably the world that was using the Ketogenic Diet still. It had been used in the 20s, 30s, 40s, but it had kind of fallen out of favor because many new seizure meds kept coming up, so why try a diet when seizure meds work? Well even in spite of all the new seizure meds, 30% of the patients with epilepsy won’t be helped by the meds. No matter what you do, three out of 10 needs something else.
So Mr. Abrams took, and his wife, they took Charlie to Johns Hopkins, they put him on the Ketogenic Diet, and a week later, he’s seizure-free. [inaudible 00:18:33] he’s seizure-free. They were suffering with this for, I think, up to a year at that point. Thousands of seizures her child had had, and now he’s seizure-free after one week on a diet therapy. Thankfully, they were mad. They were absolutely angry, a righteous anger. They took it, you can get the Dateline interview on YouTube with Jim Abrams, and then they formed the Charlie Foundation and they created a movie with Meryl Streep called First Do No Harm, I don’t know if you’ve ever seen that.
But it’s grab a box of tissues if you haven’t seen it yet. It tells a parallel story about a family who had a similar situation and got their child on the diet. Anyway, they wanted people to know. They said, “You’ve got to be kidding me. This therapy is available. There are children who need to be helped, and adults, and what’s going on?” The Charlie Foundation, honestly almost single handedly just brought the diet to the forefront and the spotlight, and they started with training.
As soon as when all these things were coming out, they prepared and they had training available, and they started new centers, okay? So they went from one center in the US, and again, there may have been other centers that were offering the diet in small scale. Now we have about 104 centers. I haven’t counted in the last few months, but 104 centers. Now, 104 is great, but imagine how many hospitals we have in the US. Imagine how many hospitals.
So there are five places in Michigan you can go to get the diet. I can name you eight or nine states that do not have a place for someone to go to put their child or adult on a Ketogenic Diet. Eight or nine states in our country where it’s just absolutely not available and you’d have to travel across state lines to have a professional put your child on the diet.
I forget where I was going from there. I was talking about the Charlie Foundation. So anyway, so the Charlie Foundation and there, of course, you can find them easily if you Google them, they have a list of professionals, I am one of them obviously, people that are vetted, who’ve been working with the diet for length of time and really have great credentials and can help patients with the diet. It’s a lot of people like me who I started out in a clinical setting and working with the diet over time, working with that in private practice, I came to the point of, “Wow, I can’t do both. I can’t run both of these.”
There are so much unmet need on the private side that it made more sense to jump over here and say, “I think I can make a bigger impact over here. I’ve done all I can there, and that was amazing, but I think now over here, I can hopefully expand my impact.”
Yeah, okay so then pediatric epilepsy was your first foray into the Ketogenic Diet-
Thank you [crosstalk 00:21:31].
What other therapeutic applications are you in love with in your practice?
Okay, thank you. I needed to be re-routed so I’d remember where I was. Adult epilepsy is the next thing … adult epilepsy is a very huge unmet need, because these people, many of them should be on the diet, should at least give the diet a try. I’m going to give you super quick numbers. In Michigan, there are 100,000 people with epilepsy.
That means 30,000 of them, 30%, have uncontrolled seizures. That means 30,000 people should at least give a try to the diet, okay? And then half of them, a little lower odds for adults, 30-50% for adults, let’s say half of them have some benefit. So 15,000 people could have great benefit from the diet. Let’s say I’m half wrong. Okay, 7,000 people should have great benefit from the diet. But I’ll tell you the last time I counted grief numbers, six to eight months ago in Michigan, probably got about 500 people on the diet that are being monitored by dieticians in a center.
So we’ve got less than 1% of the population for the treatment that has Class One clinical trials that we know it works, there’s no question of whether or not this diet is effective for this condition of epilepsy. So there’s that. That’s a pretty big soap box that I like to stand on because I really want that to change and I want it to change now, not 25 years from now, because the Charlie Foundation started 25 years ago, but I hope it’s exponential what they can do, and everybody in this arena can do, in the next three to five years.
As far as other conditions, obviously it’s getting pretty … the diet is getting pretty well known for cancer treatment, and thankfully even since four or five years ago when I started this, I feel like the acceptance level is really improving and increasing with that among physicians because at first, there was a lot of pushback from physicians, but the studies are there, the research is there to say that this is a very reasonable treatment to try in conjunction with … I heard that in conjunction with other treatments.
I don’t encourage people with cancer to use the diet as a standalone treatment. We know definitely from mouse models that the diet helps to make the chemo more effective. It helps to make the radiation more effective. It kind of opens things up to where the treatments can get to on the cellular level where it can be more effective. So that’s pretty exciting. It’s more studied in glioblastomas, but yet I don’t pay to use the diet with any type of cancer that doesn’t have a contraindication because we don’ know that information yet. We just don’t know. It’s going to take time and research to know exactly what cancer healed.
Maybe we’re going to come out and say, “This exact cancer, it doesn’t work,” and then that’s fine. But what I do know, and the reason why ethically I think [inaudible 00:24:36] get out here and do this, is it’s been 100 years with pediatric epilepsy and there are just thousands and thousands of kids that aren’t being treated. Knowing that makes me think I will be dead and gone before this diet is well accepted for cancer. So I’m just jumping in trying to make a difference.
And then if we go from cancer and then ALS, Lou Gehrig’s Disease, I haven’t seen the diet well utilized for this. There are a few studies, some mouse models, that suggest that it could be a good idea the way that the energy is being provided, because you’re talking about with the Ketogenic Diet, you’re providing ketone bodies to provide energy versus carbohydrate metabolism. So everything’s changing and in some of these conditions, in Parkinson’s Disease, and ALS, perhaps in MS, the carb in Alzheimer’s, the carbohydrate metabolism’s not functioning well in Diabetes to say the least.
Things aren’t functioning properly and we change that cellular metabolism we can make an impact at, potentially again, the research isn’t fully there for all these conditions but it makes sense that we can make an impact with these conditions. It’s going to take years and great people to say, “Yeah, I’m going to try this in a very safe way, in a safe environment, with laboratory testing, with supplementation, to see if this has an impact on my condition.
So much good stuff.
I didn’t put a list in front me, but I’ll name off a couple of other conditions that are so exciting with the diet, Ketogenic Diet, because I don’t think it’s snake oil, I don’t think it’s going to fix everything. It’s not … remember vitamin E a few years ago? Oh my gosh, you could fix anything with vitamin E. Anyway, but these are things that, again that I researched to an extend and feel strongly. Migraine headaches. I started believing this when one of the nurses I met at a keto conference, she came back and she said … six months later, I ran into her at the same conference in Phoenix that you and I suddenly were at this similar conference.
This nurse said, “Yeah, I haven’t had a migraine since Beth cured me,” and Beth’s the Charlie Foundation consultant dietician. She said, “That cured me of my migraines.” I said, “What are you talking about?” She said, “Well at the conference you can’t find the carb. This keto conference two years ago in [inaudible 00:27:09], you couldn’t find a carb unless you went out looking for it.” So she came out of there in a mild state of ketosis and she got on a plane. She has a migraine every time she gets on an airplane, every time without fail, horrible migraine.
She flew home and she didn’t have a migraine. She thought, “Wow, that’s pretty cool.” So she continued to eat low carb, pretty strict keto. She had one migraine over the course of a year and a half. Actually two years now since she did that. Now she eats a little looser. She basically feels like she’s cured. She can have a little flexibility with carbohydrate now. She doesn’t have to be as tight, and she was having three to five migraines a week, including every time she flew, and she flies a lot for her job.
So that kind of sold me on migraines. Wow. That’s awesome. I’d like to see, and as a matter of fact, I spoke to a physician about this the other day. I’d like to see for status … I forget what they call migraines, when you’re … we have so many patients in the hospital with a migraine that no one can stop. No one can stop. Why are we not making them ketotic immediately and using this even as a short term treatment for migraines? Wow. Okay, so that’s one thing.
Another cool thing is Bipolar Disorder. Again, this is a really loose one person impact on this, but I met somebody who had heard me talk about keto and he called me back a few months later and he said, “Hey, I want to talk to you about this,” and so I chatted with him. Actually, this person was a medical student, and long story short is he already was doing a Ketogenic Diet to an extent, or a high level modified Atkins Diet, had Bipolar Disorder, and nothing was working. None of his meds were really acceptably working for him.
He has had the best results of any of his medications with this dietary change. I don’t know if he’s still on some medication, or [inaudible 00:29:17] he tells about that, so I really truly don’t know. But his doctor was very happy with his success. What’s interesting is just from hearing me talk for 20 minutes about keto and how we administer it at the hospital, etc. etc., he came on and said, “Wow, this works similar to how some of these medications work. So think I’m just going to give that a try.” Boom, his life has been much improved since then.
Yeah, other stories, examples of that are actually, I interviewed Kerry Brown, I don’t know if you’re familiar with her, but she’s out publicly. She’s does ketogenic cooking, she’s a chef. So I did an interview with her where she talked about how keto was instrumental in conquering her Bipolar.
Wow, that’s great. In another area, and it’s just starting to researched now, is Schizophrenia. Dr. Chris Palmer out of Harvard, who is working with some patients with Schizophrenia and seeing good results with that. It can be a challenging population, but he’s really seeing some good benefits with that, and he had a poster at the last keto conference a couple of weeks ago in Korea, and is working on new research, so that’s really exciting too, that that area … and just amazing that some of these people, he has a brief case study written up.
These people were on 20-30 medications and had failed. And [inaudible 00:30:45] measure terrible, but wow, look what they’ve gone through. Interestingly enough, with the Schizophrenia, a lot of the meds are also anti-seizure medications. There’s a lot of crossover with the brain chemistry and how those things work.
Wow, so much exciting stuff, too. Any examples you can share of people you’ve worked with? I know you can’t say specifics about people, but any case studies that you can share about a remarkable recovery that you’ve supported?
Yeah. A couple of different things. One patient I think of real early on that I worked on with a diet, and I remember the doctor saying, “Oh, [inaudible 00:31:32] the diet. He’s always going to need medications, but I think the diet is going to help him, so we’ll get him going.” So we put this child on diet, and I remember if her mom was just absolutely over the top stressed out. It’s hard. It’s hard to do when we’re talking about the level that we’re doing some of these in pediatrics.
She’s texting me at 10:00 at night and I’m thinking, “Oh my goodness, how is this going to go?” Anyway, but again, long story short, this child within a few weeks is seizure-free. We keep him on the typical for a kind of typical standard of two years. He continues to be seizure-free. We weaned him off the diet very gradually, which is typical of a lot of keto programs. We’ll wean very slowly, we don’t just pull people off the diet quickly in epilepsy.
He remained seizure-free for years. I saw him not too long ago, and here he is, still seizure-free. Then it was kind of cool because they didn’t even think that it would work that well for him, but we had to try it because we didn’t know. That was real exciting. Not everybody … less than 10% of the patients in epilepsy will become seizure-free not on the diet. I think that’s important for people to know because you don’t want parents coming in with this false hope that they’re going to be seizure-free. There are a few conditions that is very more likely than others.
Like Glut-1 efficiency and [Do 00:32:55] Syndrome. Those two specifically are more likely to promote seizure freedom. In other cases, I’ve had quite a few cancer patients with glioblastomas, with breast cancer, specifically just that I think of, that have had good long term results. I follow people for as long as they want. I may follow them for only three months. Some people extend out to six-12 months, and so there’s [inaudible 00:33:23].
I don’t always know the long term results unless I go back and contact them later. Sometimes I do that, and it’s always great to hear. So I have some people with glioblastomas who, well over two years, three years, so that’s always going to hear because the survival rate on a glio, I believe, and I hope I’m saying the right number, but it’s 5%, the likelihood of living past 18 months is 5%. When you start seeing people having clean scans at two years, something’s happening. Something’s happening that’s way outside the realm of normal treatment.
As far as other … wow, just so many cases of people feeling better, having better cognitive abilities, having more energy, feeling less bloating. Just basic things that feeling better in general, I think, because our diet can be sometimes so terrible, sometimes we just slide off into so many carbs. Honestly, some of these are just flat out too calories. When we pull that back and we get the calories in line, and we get the carbohydrates down, I think just in general that promotes such a feeling better wellbeing.
Let’s talk about the different types of Ketogenic Diets. In the side of things that I’m working where people argue over macro percentages, we’re not talking about that. Therapeutic applications of the Ketogenic Diet that are different names, types, extremities you might think of that way. So share with us the different types of Ketogenic Diets that you may be supporting people with.
Okay. Okay. I’m going to tell you, but I’m also going to refer to … there’s a really cool description of the five types of Ketogenic Diets on the Charlie Foundation page, if someone wants in writing where they can look at it and really see it off. The first type of Ketogenic Diet that’s very strict would be considered traditional Ketogenic Diet, where I’m going to help someone calculate out exactly and see … you say people say macros, but I’m looking at a ratio, a ratio of how much fat … and it’s the ratio of the macros, right? So how much fat compared to how much protein plus carbohydrate.
A very high strict Ketogenic Diet might be a 4:1 ratio. So four grams of fat to one gram of protein and carb, plus carb. So 90% [inaudible 00:36:04] pretty hard to do, typical oral diet. But you’ll see that a lot of the pediatric or adult formulas that are calculated that the 4:1 ratio, you virtually have an adult 4:1 for a long period of time unless they have a real high caloric intake because you can’t even get enough protein in for an adult on that ratio. So we’re not doing that.
Typically, when someone says Ketogenic Diet, and you say it someone with a background like me in pediatric epilepsy, they are thinking of 3:1 or 4:1 ratio, everything’s weighed and measured. Very specifically. That’s one side. The next level down would be a modified Ketogenic Diet. That would be still strict, still measured out. When I’m talking about 50 grams of chicken and 180 grams of broccoli and 40 grams of butter. Okay, very strict meal, measured out. But at a lower level ratio. So at a 2:1 ratio, or a 1:1 ratio when you’re looking at that. Again, that’s just another way to look at your macros. The ratios, macros, it’s the same thing put into two different categories.
Then we have MCT diet, which is medium-chain triglyceride oil, and that tells people on keto now, or using MCT oil, it’s used routinely in the hospitals with all of the patient populations in the hospitals using that. And the MCT oil helps get a higher level of ketosis. Sometimes you can get away with more carbohydrates. On the MCT diet, it might be strictly calculated, or it might be more with household measures. But same idea, we’re trying to get to a certain level of macros or a ratio to get to ketosis.
The next layer down would be modified Atkins Diet, which honestly quite frankly that’s what most people are doing, that are saying, “Okay I’m keto,” pretty much they’re doing a modified Atkins Diet, which is probably a 1:1 to 2:1 ratio with the macros. Again, that [inaudible 00:38:13] carb, and somewhere in that vicinity, probably even moreso 1:1.5 to 1. In a lot of the recipes that you see in the recipe books, not for fat [inaudible 00:38:24] and such, but just typical meals, a lot of them are hitting in that 1:1 level, which is really an easily attainable level.
I mean, you could eat 1:1 and not even feel like you’re missing anything if’s well done. But that’s not so strictly calculated, and that’s more of saying, “Hey, I ate eight to 10 ounces of protein a day,” and then just eat … keep your carbs and it depends. You’ll see 10 to 20 grams of carb a day as a recommendation there, but I’ll tell you that even in the therapeutic hospital world that every center has a different take on what [inaudible 00:39:04]. It’s hard to tie it down. Hopkins, they wrote the book, they wrote the Ketogenic Diet guideline book basically. So they start people on 10 grams of carb.
That’s super low, so a lot of places are doing different modifications and saying, “Man, if you eat 200 grams of carb a day, maybe we’d drop to 100. And then we drop you to 50. And then-” you know? And then we talk and we see what your level of benefit is. It depends what you’re seeking with the diet. Are you seeking seizure control? Are you seeking cancer cure? Are you seeking weight loss? How do you apply these different diets into what level and to what extent, very much matters with what your goals are because I’m not going to put someone on a real loosey goosey diet who needs to cure cancer.
I’d like them to be strict, but we’ll do whatever they’re able to. I’d like to be pretty strict because we’re playing with fire here. We’re playing with rattlesnakes, so I want to get serious. Anyway, so yes, modifying that can mean a lot of things, but I’d say that’s basically what most … the typical trend of what people are doing that’s considered keto now and it’s kind of hard because there are so many different definitions. I was doing a lot of research this summer, or this fall, for a talk, and then I was looking through the research. You have greater role carbohydrate diets, and low carbohydrate diets, and all these different definitions.
I don’t have them right in front of me, but all variations of what’s consider low carbohydrate. So it’s really muddy right now. I think you were mentioning earlier before we turned on the recording that wow, we need to come together on a little bit of this and have some set standards on what’s what, which on one hand that’s great, on the other hand it’s difficult because at least the way I like to work with patients, every single person is dealt with as an individual.
What works for you doesn’t work for them, and to get someone into ketosis, I can have one person in a 2:1 ratio and have great ketones, and then the next person have very few ketones at the 2:1. So what’s it mean for each person. It’s hard to tie that down, but I like to measure the ketones in the blood. That’s my favorite to measure them to really know how people are doing, and to have good solid numbers and good solid evidence so that’s more important to me really than the ratios, and also what are the outcomes. Are we seeing the benefit? Are we seeing the results? The results are more important than the numbers.
Yeah, you touched on something that’s so important, too, because people get so confused and conflicted. They wonder why is there so much disagreement about one person says, “This is what a keto diet is,” and the other person says, “No, this is what it is,” and I always explain to them it’s because you’ve got those keto coaches out there, right? They’ve lost some weight on it, they’ve figured out what worked for them, so then they say, “Well this is the way to do it,” but exactly what you said, and especially in the therapeutic realm, is that it is so different for each person, and that’s part of what your expertise is, is knowing how to modify and change it, and adjust it to get to work for each individual.
Right, yeah because some people come in, it’s interesting now, now versus two or three years ago, people came to me two, three years ago and said, “Oh my gosh, I don’t know what to do. I can’t find any information.” I’m like, “Cool, I’ve got it.” And now people come and they say, “Oh my gosh, I don’t know what to do. There’s so much information.” It’s such a 180 in such a short period of time. It’s laughable. I mean it’s great, but it is a lot for people to wade through to figure out, which again goes back to really making sure you have somebody who has a little experience, and who has the education and training to know that there is more.
Hopefully, we’ll [inaudible 00:43:14] through, as a Registered Dietician, hopefully pretty soon we’ll have something through that layer to have a keto certification there within our organization. Because we don’t have that yet. We have a position paper talking about the Ketogenic Diet when we don’t yet have a credentialing as we’d like with Diabetes or with pediatrics. I that needs to come soon, where we have that additional credentialing because that will help people also to understand that yes, this person has been vetted and trained.
Yeah, that will be exciting. Hopefully, might just be a little political here too, hopefully it’s actually the therapeutic keto diet, because I know with the Diabetes education, they encourage a very high carbohydrate. Maybe higher than what would be optimal for somebody with Diabetes for that. So anyways, I’ll tuck that under the rug for now.
Well, I don’t know, pull it back out. Let’s talk about Diabetes. I’m almost … I’m very [inaudible 00:44:19] old patients of mine come in and say, “Oh my gosh, you gave me 60 grams of carb a meal.” I’m sorry. I’m sorry. It’s all [inaudible 00:44:28], that’s what we did then. It’s not what I would do now, okay? Absolutely unequivocally no. It’s funny, and the ADA still, they aren’t specifying the amount of carbs other than, “Oh, you need more than 130 grams,” is their position, 135 grams of carbohydrate. You don’t. You can function very well on many fewer grams of carbohydrates.
So if someone says [inaudible 00:44:55] diet for Diabetes, please don’t do it without your doctor and dietician. Please, please, please, because now you’re getting into dangerous. Now you’re getting into dangerous and you talked about medications and that’s the first application I think of with meds where you really can hit a danger level. So you want someone who’s positioned, who knows what meds to reduce before you start the diet, how to monitor that, and to be very strict. But man, with Diabetes, we have to get on that too. I mean that’s … it’s crazy. It’s honestly probably crazy that it’s taken us this long to wake up. Again, I apologize.
But let’s start here and move forward and say, “Let’s be serious about this, and let’s decrease the medications, let’s decrease the blood sugar.” If I can tell this super quick, a doctor at the conference, the Keto Symposium, two years ago … no it wasn’t, I’m sorry. I think he was down in Tampa at the Metabolics Conference. I don’t know if you were at that one.
He had Type I Diabetes. He wanted to do a triathlon, and I mean a real triathlon, not like what I do. Then run a marathon, bike a million miles and swim two miles. Well he is having low blood sugars three and four times a day, and devastating low blood sugars where if you have Diabetes, you understand. You just crash, you can even get confused. It’s a real serious implication, and dangerous if you’re driving. So he’s having this three or four times a day, but now he wants to start training for marathons. How do you do that?
He said he put himself on a Ketogenic Diet. He went down to 70 grams of carb a day, which is pretty liberal, really, for Ketogenic Diet, but he wasn’t ketosis. He cut his insulin needs down by 50%. Again, he’s Type I Diabetes, so how much better just to not need as much as [inaudible 00:46:45]. His blood sugar was well controlled, and now at the time he spoke, he had had four or five low sugars in a period of months versus four or five a day.
So his quality of life, let alone … and this is with intense training. He did do a couple of triathlons too. With intense training, and this gentleman, he had every blood sugar from he was eight years old. He had everything. He was quite detailed. But it was amazing, the results he had on that. And this is nothing about even his athletic performance or anything. It’s about quality of life, it’s about glucose control, and about safety.
We would say, “Oh, it would take two. It’s more important,” etc. etc. but man, I would argue that with Type I it can also be a very critical option. Again, I don’t think it has to be 20 grams of carb. I know there are some programs that that’s where they’re saying, is 20 grams of where you have to go with Diabetes, but oh my gosh, if you’re eating 250 to 300 grams of carbs, or we get down to 1:1 50, may not really help keto, but holy cow, you’re going to be in a lot better shape. You’re going to live longer and live better by doing that.
Sorry. You mentioned Diabetes and I couldn’t help it.
No, that’s great. I’m glad we went there. It’s interesting too because I came out of, a Master’s degree in Nutrition, and we got this simultaneous psychology degree where I was trained that restricted diets cause eating disorders, and they don’t work, and there’s no way … it’s not sustainable. So instead of helping people follow restricted diets, that we should help them learn to love themselves and give up on dieting because it just made people feel bad if they dieted, then they were going to regain the weight and they would just feel even worse about themselves, right?
It took me going through a horrific car accident, brain injury, chronic pain syndrome, for me to have the experience so desperate that I was willing to try it, risk giving myself an eating disorder and feeling bad about myself. It’s been transformative. Like, experiencing it and how amazing I feel and the inside out and every which way of my health and body transforming, totally gave me a different perspective and it took that for me to open my eyes to that.
I’m the black sheep of my class and cohort at the school that I went to because that’s what I found with clinicians, is that unless they’ve used it clinically, like you have, and seen the amazing transformations that people have gone through, and the power of it, and how it’s not cruel and in fact it’s actually a gift of freedom for them, or they’ve tried it themselves. If they haven’t had either of those experiences, they’re still very much on the … I want to call it the myths of a Ketogenic Diet about how it’s dangerous and unsustainable and we shouldn’t be doing that.
I’m really glad that you’ve had the experiences you’ve had and you can speak out and say, “It’s not only safe, it’s going to save these people’s lives for Diabetes.” It’s not dangerous to eat less than 130 grams of carbs a day and in fact, you’re seeing these people having amazing health outcomes and quality of life.
You made me think of something. Let me see if it will come back to me. Oh, I know what I want to just touch on really briefly because I’ve struggled through this thought of when you mention causing eating disorder and having this restrictive diet, and yes let’s just let it go, and yes, love me and big is fine. And yada-yada-yada. And we don’t want to pick on anybody but we know the health outcomes of obesity. We know it’s horrible. We know America continues to go up and up and up, and wait. But I think it was sometimes, it was like a budget. I know there have been many different diet plans that look at food like a budget.
But I think it’s not a crazy way to look at it, because I would like to look at my finances and just say, “Why should I have to not spend? Why should I not be able to buy whatever I want? Why should I not have a new car? Why should I-” you know, name it, name it. Why can’t I do that?” No, I’m sorry, I have a budget that allows me to buy everything I basically could ever want. Really, you know, within reason. I have a budget. I have to follow it. If I don’t follow my budget, I have a lot of trouble. Things happen. It doesn’t go well if you just ignore your budget. So I can pretend that I should be able to get through life without a budget.
It shouldn’t matter. But it really doesn’t work that way. Sometimes I have to look at food that way because I would love to just eat whatever I wanted, and do whatever I want. Actually you don’t really feel good when you eat whatever you want often. But I would love it if it wasn’t that way. I would love it if it was just easy and it didn’t matter, and we could just move on. But it’s not [inaudible 00:51:55] need a budget. We need to [inaudible 00:51:59] budget can be just like diet. I just think to get into that mentality that it’s not a dirty word to have to have some control. We’d like in our culture not to have to have control to do whatever we want because everybody’s okay.
It doesn’t matter what you are, who you are blah-blah-blah-blah-blah, okay. And sure that’s true but if you want good health outcomes you might need a budget.
Yeah, yeah. The work that I’m doing, I found that following a what we’d call a modified Ketogenic Diet, or modified Atkins-type approach, it allows people to follow that budget much easier, right? Because they’re experiencing that reduced appetite and I’m working with them on behavior change and the psychology of cravings and appetite and all that. So this ends up being the sustainable diet whereas just generic calorie restriction ends up being … it doesn’t have all the same benefits of being a sustainable way of eating or living, so yeah it helps. The keto diet helps people follow their budget.
I love that. So as a dietician, Denise, people probably wonder what you eat, right? I’m curious, because I know when you went to school … I actually, right of high school I went to … I was going to be a dietician. I got to my first nutrition class and this would have been back in like 1990-91, and they were teaching the four food groups. That was what nutrition was. You had iceberg lettuce on Wonder bread with Velveeta cheese and spam. That was a healthy meal, right.
I’d done my own studying before that about … I was really on the train of we needed whole foods to get vitamins and minerals and when things are really processed they’re missing a lot of stuff. So I just got to that first class and I’m like, “What? This doesn’t make any sense. I can’t believe we’re so behind the times here.” And then other stuff in life happened. I never completed that, I just dropped out of school. I started my other life.
How, going through all the training you have, and your experience with the keto diet, I’m really curious, how has that influenced what you eat and what works for you?
That’s a good question. What’s been interesting is when I first started keto it was just this is what you do with your patients. You put your patients on this and they’re going to eat low carb, and etc. etc. it never really occurred to me that I should eat lower carb. Then just over time, I just started thinking, “Hm, maybe I should [inaudible 00:54:50],” and we’re talking quite a few years ago when it really wasn’t … Keto wasn’t wasn’t really cool yet, right?
[inaudible 00:55:00] when you’re eating low carb they think, “What’s wrong with you?” Also, there was, going back, the Atkins had … as a dietician, I saw a lot of people that came in that had done a lot of weight fluctuation with the Atkins Diet so I didn’t have a very good opinion at that point because a lot of people have lost a lot of weight and then regained more weight. That had happened, [inaudible 00:55:23] the ones that were unsuccessful.
At the same time, what I was doing for them wasn’t working either for weight loss, just typical calorie restriction. It wasn’t very successful either. Anyway, so the influence on me just continued to realize that you don’t have to be a dietician to know you really shouldn’t eat a ton of sweets, but we have this attitude of, “Oh, anybody can have whatever they want and we’ll all be happy in the end, but it’s really not that way.” So it’s definitely influenced me to continue to cut back and back.
I have [inaudible 00:55:55] two sets of kids ages, and I always … I warn my kids not to have eating disorders and eating issues, and food complexes because mom’s a dietician. So I tried to be more loose and maybe a lot more things than I would have because I didn’t want to create at a really young age, and when I provide a healthy diet, but not have them have all kinds of food craziness. The further I come along, so the older two are out of the house. With the younger two it’s more, “Sorry guys, you don’t need all that sugar.” And we’re cutting back and it’s not coming in.
It’s a struggle, featured around my house just like it is for everybody else. If anything, I feel like a very human dietician. To be transparent, always trying to stay the healthy weights, always been something that I’ve had to work hard for. It’s not something that … I don’t trust skinny dieticians. Sorry all you guys. But I just feel like if you’ve been through the struggle maybe you can help people better. Exactly like what you’re doing.
You’ve been there, done that. Wrote the book, made the video, and you get it. So anyway, so just yeah, again, to keep answering, so I just continue to cut more carbs out of my diet as the years have gone by. So I don’t have an exact … [inaudible 00:57:17] times where I may feel like … like right now, honestly, I have some inflammation, I have tendonitis, and I’m trying to get my ketones as high as I can right now to hopefully help that inflammation. I’m trying to get ready for a triathlon, you know.
Other times, again, I like Beth [Zubakeni 00:57:37]. I think she calls herself a fluxaterian. Don’t tie me down into this exact ratio, but low carb is definitely my lifestyle, where I’ve moved to. But if catch me with a potato, don’t fry me. But I also say, and I don’t have epilepsy, thank God, or cancer, or some of these other conditions that would warrant the diet on a strict level. Does that help?
Yeah, no that’s awesome. That’s my position is that we all should have this metabolic flexibility that a lower carb diet for most people is very healthy and occasionally having some carbs in our body should be able to digest those and process those and not spiral out of control. Some of us are farther away from that, and because of generations of maybe Diabetes and things like that, we may have a harder time where we may need to do something more extreme, longer term.
But somebody like you that’s been active and fairly healthy your whole life, you’re going to have a lot more flexibility there. We’re all different.
Yeah, and I think that’s super important too. Again, not putting everybody in a box. We were created, God created us to run on carbs and on fat. I think it’s important to look at when especially people are doing the diet for different reasons beyond a therapeutic implication, to think about that, that … I’ve had patients ketotic for well over 10 years, never out of ketosis, so I know that can be perfectly safe if monitored, okay.
At the same time, if you don’t have a medical reason for that, then I think that’s a discussion of do you need to be 100% there, and there are a lot of different camps on going in and out and how often, etc. etc. But I think there’s definitely a place for that, for some flexibility.
Yeah, excellent. Well I have one closing question but before I ask that, was there anything else that you were hoping that I ask about, or that you wanted to share with our viewers/listeners?
Wow. I guess, again, we kind of touched on this at the front end. It’s just as you’re looking for someone to work with to really consider people that are credentialed and people that have some experience, and if you’re looking for a therapeutic application, choose wisely. The Charlie Foundation has been around forever and ever. It has some great educational information on the Ketogenic Diet, that and Matthew’s Friends is another.
The Charlie Foundation’s initial focus was epilepsy but they’ve gone from there to the other applications for the diet. On there is a list of providers that can help, and there’s a list of centers if you were looking for epilepsy specifically. There is a list of centers in there where you find what you’re by if that was your desire.
Excellent. Okay, so my final question for you, Denise. The meteor’s coming at us today. We’re all going to be wiped out of this planet. What’s your final meal?
Oh, I don’t want to answer that. The meteor is coming really? Yeah.
It’s your final day. Come on, let’s hear it.
My last day, wow. I don’t know, probably a deep dish pizza, I don’t know. Yeah, I had to think about that. My grandmother Laura’s fried chicken. You know.
Oh wow, nice.
I haven’t really thought about what my last meal would be ever, but we’ll all have a last meal someday. But if you have the wrong last meal too many times, you should [inaudible 01:01:36]. You better hope [crosstalk 01:01:39]-
Only have the last meal when you know for sure. Like, “Oops, the meteor missed us. Oh, okay.”
Exactly, yes. Yeah, I could say [inaudible 01:01:48] but no, probably not.
Well you know actually I had one more question. I lied. I wanted to ask really quickly … oh, I’ve totally ruined my format here, but I wanted to also ask about your position on exogenous ketones.
Wow. That also is a good question. One, I don’t feel like there’s enough research to have a huge impact. I definitely have patients that are using that, and what I have them do is report back to me their results. I don’t like that a lot of them have … As a matter of fact, I was trying on some this morning, and I’m like “It’s got three grams of carb,” and with the ketones and some [inaudible 01:02:32] is focused on the carb it’s like, “Ah, how can there be three grams of [inaudible 01:02:36] be okay.” But it’s going to take your ketone levels up to a certain extent. I have a lot of people, I’ll say lot, it’s definitely some patients that say, “Oh my gosh, I feel so much better. I have so much more energy.”
So there’s that. Some of them have a whole lot of caffeine infused, so I don’t know if they have a lot more energy because that have a lot of caffeine and it’s just like they just took [inaudible 01:02:59] or had a big cup of coffee. To me, the jury’s out, but I think it’s really interesting, and there is probably a place, I’m not exactly sure where it is. I’d be cautious about someone, for some of these therapeutic applications that people are using them, I would want you to let your healthcare provider know, or your doctor or dietician know I’m using these, how often am I using these, and what impact is it having because we really just truly don’t know all that information yet. Again, so jury’s out. I kind of play with them a little bit myself just to kind of see what I think. But I’m not … yeah, I wish I had a better opinion, but I’m kind of hanging out and seeing what happens with them.
Yeah, I mean I love that very fair and balanced position. A lot of people don’t understand that in this country, anything labeled as a supplement does not have to be safety tested. It doesn’t have to be any clinical trials. Anybody can put anything out there and just start selling it, so we really don’t know, and especially the different combinations of what’s out there. We don’t know.
Right. And I’ll say the ones that I tried this morning, I’m not going to say the brand, but it said not artificial sweeteners, and Erythritol was the flavoring, and I think it had Sorbitol too. And yet on the label it said no artificial sweeteners. I thought, “Okay.” I mean I have a packet sitting out so I’m going to call the company and ask them about the labeling because I thought this is … it’s not truth in labeling but somehow they got around it. Yeah, it’s just interesting. Yeah, there are very few restrictions on what people do, and the cost is very high. I feel like for the price point, it’s pretty high for those. So if I’m going to recommend those, I want to know they work really well and do exactly they say and they’re not harmful because I won’t incur that cost on a patient without really good reason.
Yeah, yeah, and the other behind the scenes thing is there is no requirement for testing to prove that the label matches what’s actually in the supplement as well.
Make sure any supplements, people, you’re buying them from very reputable companies that have done third party assurance testing and all that stuff. But that’s a whole other topic.
All right, I think I’ll wrap this up. This has been fantastic, Denise. Where can people find you? Where can they find you? Find you? I said that like three times now. How can they find you?
Yeah, oh wow. You can find me one, on the Charlie Foundation list under the resource page for finding a provider. My website is potterketogenic.diet and then my email, I think you’ll probably attach to your show notes. So yeah, going to my website way. I have a contact form on my website. Yeah, I’d love to work with people, well I’ll talk with people first [inaudible 01:06:06] and then I say I just need a brief interview with them before they want to commit to something. I’m pretty flexible, but I love to work people on an individual basis. I also have some class group things upcoming to start the first of the year, that I’m kind of excited about, to try and hit more of these populations that really therapeutically need the diet, but it’s not so available. We need to get more going, so that’s up and coming first of the year.
Oh, excellent. All right, so yeah, we’ll put your contact information below. Hey, thank you so much for watching. If you enjoyed this, give us a thumbs up, subscribe and also a little tricky thing now on the YouTube is hit subscribe, but you actually want to get a notification when I’ve got new episodes coming out, hit the little notification. It’s like a little bell thing there. Click on that and that will actually give you notifications for every one of the new episodes we have coming out. Lots of great interviews still to come.
Thank you so much, Denise, for being here and sharing all that you’re doing in the world. Such great work.
Yeah, thanks so much for having me. I really appreciate it.
Yeah, you’re welcome. All right. Thanks for watching. We’ll see you next time.
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