Deconstructing Keto and Paleo Diets by Brenda Davis, R.D.

good morning everybody thank you so much here this green ism start tell I’ll start telling stories while we’re waiting so this morning I’m going to be talking about keto and paleo diets and I can remember first becoming really aware of these diets probably about 10 years ago especially the Paleo diet about 10 years ago because at the gym I was going to it was the diet everybody was on I think every single fitness instructor at the gym was doing paleo and I can also remember when keto started to gain some favor in the you know just we saw more and more people switching to taquito and I see people at the gym all the time on the keto diet and and I can also remember one of my very favorite instructors probably about five years after he started paleo switching to a more plant-based diet and he told me that the reason he was making the switch was because so many of his colleagues had it’s the several of the most well-known leaders in the fitness world had developed cancer and I thought that was so interesting and so he said and they shared this book that they’re starting to use and it was called how not to die of [laughter] course I got a big smile on my face I thought isn’t that interesting so there they were starting to understand that there was a connection between what they were eating and the risk of these chronic diseases so I thought to myself it concerned me to see so many people moving in the direction of a more meat heavy diet especially in the early days of paleo and so I thought I need to learn more about this and find out enough to be able to talk with with with some authority on the subject and so that’s why I am going to be talking about that today

and so I’m going to just give you a little bit of an outline so the first thing we’re going to talk about is a little bit about the history of low carbohydrate diet so we’re talking about keto and paleo which are kind of the two extremes of low carbohydrate diets so we’ll talk a little bit about the history then I will define keto and paleo diets talk a little bit about the similarities and the differences between these types of diets then we’ll dig a little deeper into some of the claims that are made by both camps the keto and paleo camps and then we’ll compare a little bit about plant-based versus low carb diets and how people do long term on these diets and we’ll finish finish off talking about the good the bad and the ugly of low carbohydrate diets so a little bit about the history and this is just a couple of slides I think maybe three slides that goes through at the time it’s sort of timeline of the beginnings of these diets and and so ketogenic diets first we started using them in the 1800’s to treat type 1 diabetes and this made a lot of sense because at that time of course there was no insulin so diabetes was a death sentence in fairly short order and so a ketogenic diet would provide an alternative fuel for people that couldn’t use sugar and then in 1921 ketogenic diets began to be used to treat epilepsy and and the way that happened was there was some evidence that fasting could help reduce epileptic seizures and of course fasting causes ketosis and and so because you start to use your body stores and you produce this other energy source and so the thinking was well we can’t obviously starve these little kids who who have epilepsy but could there be another way of producing ketosis to reduce epilepsy and so that’s how they started using these diets back in 1921 and then in 1958 we started to see interest in using ketogenic diets for weight loss and there was a book that came out or not ketogenic here it was just a low-carb diet for weight loss and this was a weight loss book back in 1958 and then the reason I put this one on is I just thought it was really funny it’s a low carbohydrates up to 60 grams of carbohydrate which is like two apples a day that’s it that’s all the carbs you’d be allowed and daily alcohol so it was called the drinking man’s diet and funny [laughter] and then in 1967 many of you may remember this I sure do but it was the Stillman diet another low carb diet and then in 72 really we have we had the release of the book that launched the low carb craze and that was the dr. Atkins diet revolution and everybody knows about dr. Atkins and then in 1975 the first kind of Paleo style diet appeared and it was called the Stone Age diet and then in 78 the Scarsdale died at another low carb diet and then in 92 Atkins revised his stuff a little with the dr. Atkins new diet revolution and then in 2002 the sort of king of paleo dr. Loren Cordain put out his book called the Paleo diet and that made paleo quite popular and then in 2003 the South Beach and then all of the books and articles by Gary Taubes and then in 2013 the paleo diet actually reached number one in the Google in Google search as the most popular diet and then in 2018 keto diets actually snatched the crown and became number one in the search for the most popular diet so they’re the reigning king

so what is a ketogenic diet well it’s basically a diet that forces your body to shift away from using glucose as the primary fuel to using more ketones and so why does the body shift well number one could be starvation fasting or very severe food restriction so you’re eating either nothing or maybe six or 800 calories a day and your body needs to find some other form of fuel so it relies on ketones and the second thing that can cause the shift is a diet that’s mostly fat so you’re not getting enough carbohydrates to fuel your body so your body has to shift over to using something else and so it starts to use ketones so what are key tones well ketones are the acids that are produced by the liver from fatty acids so instead of using carbohydrate you’re using fat and when you use fat we first of all we constantly produce ketones everybody produces ketones there in our bodies all the time but in very tiny amounts we use it as a as a small bit of our total fuel when you’re deprived of glucose however ketone your body’s ketone production just ramps up and you reach a metabolic state called ketosis meaning that you’re using a lot of ketones so does ketosis equal ketoacidosis many people get the two confused and in fact in ketosis the amount of ketones in your blood is higher than normal but it’s not high enough to cause acidosis in ketoacidosis and remember ketones are acidic okay so they’re acidic when in ketoacidosis the ketones go so high that it causes your blood levels of acids of ketone as acidic ketones to be so high that it’s dangerous to your life and in fact people who develop ketoacidosis about two to five percent actually die so and it’s most common in in type 1 diabetics who don’t give themselves their insulin injections and so that your body levels of ketones just go through the roof but we’ve also seen interestingly some case studies of women who are lactating so they’re breastfeeding so their energy needs are really high they go on a super low carb or ketogenic diet and actually go into ketoacidosis so it’s it that can happen as well that’s more rare most ketoacidosis is in people who have type 1 diabetes so is ketosis now we know ketoacidosis is not safe but is ketosis safe well it’s generally thought to be relatively safe in the short term but I think it can have some fairly negative consequences in the long term and we’ll talk later about some of those but just as an example think about your body being acidic for a extended period of time your body has to buffer the acid and of course we as we have this amazing storehouse of buffer called our skeleton and so we use the calcium from our skeleton as a buffer for the acid so long term it could actually injure our bones so how long does it take for the body to shift from using glucose to using ketones well it usually takes about one to three days of not eating like fasting or eating a very low carbohydrate diet first what happens is we use up our stores of sugar which are called glycogen then once our glycogen stores are gone we make glucose via a process called gluconeogenesis so Genesis is the generation neo new and then gluco for glucose so creating new glucose and we what do we use to create glucose well when we break down fatty acids and triglyceride form part of that molecule is a glycerol backbone which we can use to make glucose we can use lactate which is byproduct of glucose metabolism to make glucose we can even use certain amino acids to make glucose so we have a number of things we can use to do this process of gluconeogenesis and then as glucose reserves are depleted the body just ramps up the ketone production as well so can all our cells and this is really important can all the cells in the body use ketones the answer is absolutely not so up to 50% of our basal energy needs and up to 70% of our brain energy needs can be supplied by ketones however the balance will have still have to come from glucose now the other thing to know is that their cells need two things to be able to use ketones they need mitochondria and they need certain enzymes for the process of producing ketones some cells actually don’t have them and one of the cells that doesn’t have one of the types of cells that that doesn’t have them is red blood cells red blood cells actually lack mitochondria they must have glucose or they will not survive that’s their energy source and the other is surprisingly our liver cells lack the necessary enzymes for the conversion so liver cells can’t use ketones for energy either those cells absolutely must have glucose so [snorts] are there any physiological benefits to ketosis well in fact there are and and particularly we have a number of studies looking at using fasting or modified fasting such as the fasting mimicking diet and they’ve reported a fairly favorable effects like reduced blood pressure cholesterol blood glucose levels we’ll of course when you’re not eating you get those those kinds of results but this is the one that I think is most interesting when you’re fasting your body is trying to survive so it gets rid of deranged cells cells that aren’t working properly that could be cancerous even it just tries to get rid of those cells and something happens that your your stem cells actually get boosted and new growth of new cells start to starts to occur which can be very very healing in some cases so that’s important of course you get weight loss and you get reduced visceral fat and you get lower igf-1 levels as well which as you know can cause the growth of sometimes unwanted cells and and so these are you know we also get reduced inflammation and so you’ve heard if you’ve heard about True North for example in some of these places that use fasting therapeutically they have really quite wonderful success so there may be benefits in in those regards but our focus today is going to be on high-fat low-carbohydrate diets and the these diets and they’re producing ketosis and is that good or bad and why or why not so the keto diet has really become just wildly popular as a weight-loss diet and and it’s gaining ground as a diet that could be used therapeutically to treat disease so we’re gonna address those

so let’s look now at at the macronutrients in a keto diet this is a keto weight loss diet so it’s generally about 75% of calories from fat about 20% protein and about 5% carbohydrate or less so you can see it’s a very very low in carbohydrates and we see a range you know it can go up to 80% of calories from fat a little less in protein but what really sticks no matter what is it is not more than 5% of calories from carbohydrates now this is the classic ketogenic diet that was used for epilepsy and still is used for epilepsy it’s 90% fat only six to eight percent protein and only two to four percent carbohydrate okay so this is a diet that is extremely high in fat and low in both protein and carbohydrates so it’s stricter than the ketogenic weight-loss diet it would produce more ketones than what what the weight loss diet would so what foods are actually permitted on this diet well you can see the base of the pyramid is meat poultry and fish then eggs and dairy then fats and oils and then green vegetables and some non green non starchy vegetables and then at the top you’ve got a few nuts and seeds and berries what’s not allowed as you can see is all the high carbohydrate foods like bread and pasta and sugar and and fluid milk I mean we do allow some they do allow dairy but it’s the high fat dairy like cheese and and cream and butter and no corn or beans or rice or any of the non-sterile any of the starchy vegetables either and the basic you know theme would be eat fat eat meat poultry eggs and fish the fattier the better and eat non starchy vegetables so that’s kind of the diet in in a sentence here’s a sample recipe to give you a flavor I got this from one of the popular keto websites and you can see here this recipe has three pounds of ground fati ground beef 2 cups of pepper jack cheese 4 cups of Colby and Monterey cheese Jack cheese and then 2 cups of frozen pepper strips and that’s that’s that’s it so 1/8 of the recipe has almost 800 calories 61 grams of fat about 70% of calories from fat 30 grams of saturated fat 7 grams of cholesterol are behind rate 49 grams of protein 250 ml of 205 milligrams of cholesterol and less than half of a gram of fiber so there’s almost no fiber there at all

so let’s look at the Paleo diet and how it compares to this so the Paleo diet is essentially a pattern of eating that attempts to mimic the diet of our Paleolithic ancestors other names you see our caveman diet Stone Age diet primal diet and the basic premise is that what humans a DIN creator cultural times is the diet best suited to our genetic makeup the shift from a hunting-gathering diet rich in wild meat and wild plants to an agricultural diet rich in grains and legumes gave rise to our obesity and chronic disease epidemics so that’s what’s believed in the paleo world so what do the Paleo macronutrients look like well it’s about 50% fat about 30% protein and about 20% carbohydrate so it’s a low carbohydrate diet but not nearly as low as the ketogenic diet so what foods are permitted well you can see it looks really similar to the keto diet pyramid here’s meat at the bottom then fruits and vegetables in the middle and then nuts and berries at the top and of course there’s no beans there’s no there’s no grains there’s no one of the differences of course there’s no dairy here as well and here’s a sample recipe it’s very similar half the recipe is 643 calories 37 grams of fat 54 of protein so it’s even higher in protein but it’s got more carbohydrate about 24 grams 147 milligrams of cholesterol and it’s got more fiber about 8 grams so let’s compare the Paleo and the keto diets so the similarities are in blue the differences are in pink here so let’s look at the similarities first meat poultry fish and eggs are high in both of these diets nuts and seeds are included in both diets green vegetables are included in both diets legumes are excluded in both diets grains are excluded in both diets okay so here’s the differences so in the Paleo diet there is no dairy whereas in the keto diet there’s quite a bit of dairy mostly cheese and very high fat dairy products other non starchy vegetables are included in the Paleo diet pretty generously and they’re included but limited in the keto diet which I’ll show you in a minute starchy vegetables are limited in paleo and they’re excluded in keto there is no there are no potatoes or squash or any of those kinds of vegetables in a keto diet but in a paleo diet they’ll fit in a sweet potato here or there something like that and then fruits are moderate in the Paleo diet and they’re minimized in a keto diet because they have a lot of carbohydrates and then concentrated fats and oils are fairly moderate in a paleo diet and they are extremely high in a keto diet so again the macronutrients in keto about 75 percent fat 20% protein 5% carbohydrate whereas paleo is 50 percent fat 30 protein 20 carbohydrate so let’s talk a little bit about the carbohydrate restriction and what we’re really talking about here so keto diet is less than 5 percent of calories from carbohydrate other low-carb diets are about 6 to 20 percent of calories from carbohydrates so paleo is actually at the highest end of low carb diets whereas keto is at the lowest end of the range of low carb diets so how many grams of carbohydrates are we talking about well keto diets are 20 grams for most keto diets some will go as high as 30 grams but it’s usually they try to keep the lid at 20 grams so they try to eat less than 20 grams of carbohydrate whereas for Paleo it’s about a hundred grams so it’s much more generous so let’s take a look at the percentage of calories from carbohydrates in plant foods so fruits are about 92% starchy vegetables about 90 legumes about 70 non starchy vegetables about 60 58 or so and nuts and seeds are about 12 ok so so think about these numbers and then remember a keto diet is less than 5% of calories from carbohydrates and a paleo about 20 well the vast majority of plant foods range from about sixty to about ninety percent of calories from carbohydrates how many of those foods can they afford to eat if they’re trying to get less than five percent or even less than 20% of calories from carbohydrates not a whole heck of a lot so we really need to understand that plant foods are predominantly carbohydrates with one exception and that exception is nuts and seeds that’s where we get our essential fats from okay and and otherwise they are predominantly carbohydrate so how much carbohydrate in non starchy vegetables so a lot of people say oh keto diets we can have lots of non starchy vegetables but if you look at it an avocado has 12 grams of carbohydrate if you’re only allowed 12 20 grams of carbohydrate for the day how many avocados can you have maybe one turnips twelve for a cup Brussels sprouts eleven for a cup and and then we’ve got sort of the medium non starchy vegetables like eggplant cabbage carrots asparagus broccoli peppers with somewhere between six and nine and then the lower carb vegetables like the leafy greens which might only have 1 gram of carbohydrate per cop so you could eat more of those but you certainly couldn’t eat a lot of the other non starchy vegetables just so you know that there really is a limit on how much they can consume now if you look at the carbohydrate content of other foods and remember the lid is 20 grams for a keto diet you know take a look at any of the grains or starchy vegetables a serving of a cup of granola 66 grams of carbohydrate a bagel is 56 a cup of beans is 41 Apple is 30 the limit for keto diet is 20 these people ought to say I heard somebody at the gym the other day say I just realized how bad apples are for me you know can you imagine and and so this is the thinking that these foods are bad because there’s this black and white thinking if a food contains carbohydrates it’s bad you know if it doesn’t it’s good so that’s the thinking so what are they eating while they’re eating a lot of this stuff down at the bottom of this of this chart here they’re they’re eating cream cheese sour cream cheese butter meat chicken fish eggs those are the things that don’t have carbohydrate so by definition this diet is a diet of this stuff ok so just just so you get that so which is more healthful a keto diet or Paleo diet well a paleo diet is definitely healthier than a keto diet because a keto diet is the most extreme of low carb diets it’s mainly fat on meat plant foods are heavily restricted whereas a paleo diet is the least extreme of the low carb diets it allows a much more liberal intake of plant foods about 5 times more than a keto diet so it has more of the protective nutrients that we need to protect our health like like fiber and phytochemicals and antioxidants and pre and probiotics and plant sterols and all of those things it’s about five times higher in a paleo than than keto diet

so let’s dig a little deeper into each of these diets so we’ll begin with the keto diet so the common claims are that it will reduce epileptic seizures that it will induce rapid weight loss said it will improve brain function it will fight cancer it will improve endurance performance it will reverse diabetes it will reverse heart disease or reduce heart disease risk and it will increase longevity so we’ll take a look at these are there it first of all is there any truth to the claims well yes there’s some truth to the claims but to varying degrees so we’ll examine the weight of the evidence fairly briefly first there’s convincing evidence that ketogenic diets work for epilepsy and the evidence is this it is first of all there’s probably 20 percent or so of children who are epileptic who do not respond to the very powerful epileptic seizure medications and in these children they seem to respond to a ketogenic diet they actually over 50 we see in over 50% reduction in seizures in about half of those who do the diet and about 10 to 15 percent of the children become completely seizure free when they go on a ketogenic diet now this seems to happen most if the children have an epileptic syndrome such as something called Luke 1 deficiency and glute 1 deficiency is a rare genetic mutation that results in insufficient production of a glucose transport protein called glute 1 so in other words these children can’t transport the glucose into the brain to be used for fuel and so when all of a sudden they can use ketones the brain can function and it stops the or slows the seizures so you can see them therapeutic value in in that for this particular population so switching to this alternative fuel can be very life-saving for these children so we have moderate evidence for weight loss and and basically the evidence is mainly short-term there are many reports in the literature of significant weight loss in trials of three weeks to four months on a ketogenic diet we see favorable changes in body composition and markers of inflammation on this diet so the evidence long-term is a little bit different in 2013 there was a meta-analysis of 13 randomized control trials and people on the keto diet actually did lose slightly more weight than people on a low-fat or under 30% of calories from fat diet they lost about two pounds more over a year they had lower triglycerides they had higher LDL and HDL cholesterol and they had no differences in blood pressure fasting glucose insulin a1c or c-reactive protein and these are mainly measures of our blood glucose regulation and and our inflammation however weight loss was similar to the low fat after two years so there were really no detectable differences now there was actually an interesting metabolic Ward study in 2016 you know what a metabolic Ward study is it’s a study where people are actually kept in the hospital and so what they eat is really controlled they can’t sneak anything extra they get what you feed them period and and this was 17 overweight men were put on either a baseline they were put on a baseline diet and then I think it was one of these where they do the the baseline and then and then go to the keto diet and and so the body fat loss was no greater on the keto than it was on the 50 percent car bhai great diet but this was what was most important is they actually lost more fat free mass with the keto diet which fat free mass is what it’s muscle exactly so you don’t want to lose muscle so that was the disadvantage of the keto over the over the the 50% carbohydrate the take-home message here is keto diets do promote weight loss and actually appear more effective than many other diets for accelerating weight loss short term however they don’t really seem to offer very significant weight loss advantages over other diets long term and they have some serious downsides and we’ll be talking about the downsides in a minute but I just want to make this point there are lots of ways to lose weight anything that promotes an energy deficit will promote weight loss you could eat 800 calories worth of Twinkies and lose weight you could go on you know he could smoke cigarettes and lose weight you could go on chemotherapy and lose weight this was back in the 1920s there was a huge campaign for sorry there was a yeah there was a huge campaign for using cigarettes for maintaining your slim figure you know just because something promote promotes weight loss doesn’t mean it’s a good idea so we need to remember that and this I think is really important every year US News ranks the best diets every single year and they they do that with a panel of the leading experts on health and weight loss and and in the 2018 rankings out of 40 diets in the best diets overall category keto diets tied for last place in the best diets for healthy eating keto diets ranked number 40 out of 40 they were in the very last place why well because the diet is extremely high in total and saturated fat and it’s very high in fatty animal products which will increase risk of disease it has a high potential for nutritional deficiencies deficiencies of fiber and potassium and folate and magnesium and vitamin C and it has multiple adverse side effects and so it ranked number 40 it’s not a diet that we should be promoting or people should be following

there’s a limited or mixed evidence for brain disorders cancer and diabetes so the evidence in terms of brain function for Alzheimer’s there are possible benefits for people who are Apple II for allele negative so you know this particular app oe4 increases your risk for Alzheimer’s so for people that don’t have that have that particular problem they seem to respond better to ketogenic diets than people who have a pony for and then for cognitive function we’ve seen some benefits in a few animal studies for migraines there was a couple of case reports one observational study suggesting benefit there was one study suggesting improvement in motor and non-motor symptoms and in Parkinson’s disease so very very limited amount of research nothing very convincing as of yet for cancer the theory it for cancer is that sugar feeds cancer and so cancer cells can’t use fat so a keto diet will cause apoptosis or cell death in cancer cells so that’s the theory so let’s take a look at the evidence in favor of this theory so there was a pilot study in 16 humans in 2011 that reported some improvement in the quality of life and blood parameters but no increase in longevity in cancer patients there were a few rat studies in 2012 2013 that showed rats with human brain cancer that that they had been given achieved remission or greater longevity with a Aikido diet there was a human study base I think based on the findings of the rat study that used a keto diet and they found it improved the effectiveness of a chemo drug for glioblastoma which is a type of brain cancer but people who just used the keto diet and did not use the drug did not have any benefit and then in 2015 there was a review of 32 case studies and the keto diet prolonged remissions but only one patient used just the keto diet so that’s that’s the evidence Pro the evidence con 2017 people with this genetic mutation called BRAF v600e they found that that a keto diet actually allows or this particular mutation allows cancer cells to use ketones to grow faster and and so the mutation is actually present in a hundred percent of hairy cell leukemia 50% of melanomas and about 10% of colon cancers and 5% of multiple melanomas so er sorry multiple myeloma x’ and so this is very interesting because in these particular cases ketones accelerate the growth of the cancer so that was 2017 and then in 2018 there was a study that showed that the keto diet plus chemo slowed tumor growth in mice better than the drug alone but the keto diet alone actually accelerate the progression of the cancer so that was of just a brand-new study and then another new study from 2018 showed that slow dividing brain cancer cells are actually fuelled by fat not glucose these cells are more invasive more resistant to chemo and radiation than the fast dividing cells so when they’re fueled by fat that’s bad news because they’re less responsive so and then there were some there was some further evidence in 2018 there was a comprehensive review of keto diets and cancer and they reported that studies fail to show increased survival in advanced cancer patients with a keto diet they also reported not all tumors respond favorably to keto diets but they also reported that keto diets may have potential if combined with keto and early stages of the disease but if we look at low-carb diets and cancer mortality there was a 2018 study that reported that people who ate the most low-carb diets had or the the lowest carb diets had a 35% increased risk of dying of cancer compared to people eating the most carbohydrates and cancer rates are lowest in people eating plant-based as we talked about yesterday so and diabetes the evidence is that there’s some short-term benefits with keto diets weight loss improved glucose control reduced a1c lower triglycerides fewer medications but the downside is this keto diets do not reverse insulin resistance so if you have you’re on a keto diet you get reductions in glucose and weight and all of that and it looks like your insulin resistance is reduced so you have a load of carbohydrate the load of carbohydrate you get this huge spike in glucose because you remain so insulin resistant long term there are no long-term studies using keto to treat diabetes in humans but we have a lot of low-carb studies and they consistently show favorable short-term less favorable long-term results we have a systematic review of studies that are over 12 weeks in length and there were really no differences in weight loss or a1cs with with the longer term treatment but there are a number of red flags and unfortunately we don’t have long term studies in humans are they’re quite rare we have very few of them but but the red flags are that we found that ketogenic diets are associated with fatty liver systemic glucose intolerance insulin resistance insufficient insulin secretion reduced beta and alpha cell mass disappear and inflammation and as I mentioned although human studies are fairly limited and the contrary evidence is for athletic performance heart disease and longevity and for athletic performance the claims are big that it will improve your athletic performance but we only have about seven studies they were done between 2014 and 2018 and between five and forty two participants each so they’re pretty small duration about four days to ten weeks and despite consistent fat loss in the athletes most studies reported reduced performance not better performance and you can just see the summary here this first 2018 study reduced performance lower peak performance lower mean power less recovery this one didn’t find any change from 2018 and then reduced performance reduced reduced this one showed improved performance this one showed a little bit of both improved with moderate intensity but worsened with high intensity and the bottom line I think really is is that these diets fail because carbohydrates require less oxygen to power muscles than fats the faster you move the more carbohydrates muscles burn and so when your work at high speed and high intensity you can’t exercise as fast when because your energy needs or your oxygen needs are increased and you need the carbohydrates for that so [snorts] what about heart disease will the evidence for heart disease with a couple of early studies and in these studies basically showing that keto diets increase total LDL and HDL cholesterol but they decrease triglycerides of the 2006 study also reported improved particle size we have three meta-analysis looking at low carb versus low fat and when I say low fat it’s almost always just under 30% so it’s not really low fat but it’s it’s you know what what they label low fat so in 2012 twenty three studies in 2013 thirty two studies in 2016 11 studies and the findings were very consistent that low-fat diets lower total and LDL cholesterol and high fat diets lower triglycerides and increase HDL and increase total and LDL cholesterol and in children with epilepsy the findings are very interesting several studies between 2015 and 2017 finding that keto diets consistently promoted negative changes in lipid profile and particle size increasing you know they’re just atherogenic diets and and so what they reported was increased total and LDL cholesterol increased triglycerides increased oxidative stress unfavorable changes in particle size so all negative findings and then if we look at cardiovascular disease and low low carbohydrate diets in general the findings are so consistent when we have a low carbohydrate diet that’s mainly animal food diet in this study in 2010 it increased mortality 14 percent if the protein came from plants it actually reduced mortality 23 percent and then this study in 2012 the lowest carbohydrate eaters had a 60% increase in mortal so that’s huge they actually quantified the increase for every 20 grams of carbohydrate you eliminate from your diet and for every 5 grams of protein you add to your diet you increase risk of cardiovascular disease by 5 percent that’s incredible and then in 2014 this study showed this is a US study and they showed that a low-carb high animal protein diet increased risk by 51 percent and that’s mortality risk the low carbohydrate plant diet there was no association with increased mortality so [snorts] the last is is longevity and the evidence in favor of longevity is just to 2017 studies that reported increased midlife longevity using ketogenic diets in mice it improved their memory and health spend their their their strength and speed and all of that and and so what we have no human studies so when they say that it helps with longevity the studies are very limited and they’re not based on humans but we do have some strong studies on longevity and low carbohydrate diets in people in and this is these aren’t randomized control trials but these are studies that we’ve been following people for a long time people eating the low-carb animal diets it increased mortality 23% and and with low-carb plant it reduced mortality 20% and in in 2014 low-carb animal diet increased mortality 33% and then the newest study they the 2018 study the lowest carbohydrate intake was associated with a 32% increase in mortality risk the last ones I was talking about were cardiovascular disease mortality and I don’t know if I made that clear so this is total overall mortality this study was really interesting because again if you look at it this is a graph showing the lengthy – in carbohydrate intake and mortality and you can see the highest mortality is with consistently with the lowest carbohydrate intake and then you see the lowest mortality at around 50 to 55% of carbohydrates and then you see mortality going up again and so you think what is with that because this is you know diets that are fairly low fat plant-based diets there are like 75 or 80% carbohydrate because they’re about 10 percent protein and about 10 percent fat right so why are we seeing this well actually the the low carbohydrate intake what we saw was a 32 percent increased mortality with high carbohydrate intake we saw 23% increased mortality so not as much as the low carbohydrate diet the lowest risk as I mentioned 50 to 55 percent and this part here mortality increased 18 percent when the carbohydrate was exchanged for animal derived fat or protein and it decreased by 18 percent when the substitutions were plant-based but here’s why they think the association with the high carbohydrate intake was it’s because high carbohydrate diets in that in these studies were associated with refined carbohydrates so the populations were mainly people eating white flour and white rice and they thought they wouldn’t have seen that increase if the carbohydrates were actually coming from whole foods so the authors concluded these data provide further evidence that animal-based low carbohydrate diets which are more prevalent in North American and European populations should be discouraged so then we have to say how much carbohydrates do the world’s healthiest people eat the people who live the longest lives like the people of the Blue Zones who live to be a hundred and are still productive what do what do they eat to be able to achieve that kind of longevity well actually their carbohydrate intakes sorry I shouldn’t have switched that so fast their carbon you can see range from about 40% to over 80% but they average about 62% can you see the difference here here’s the longest healthiest people on the planet here’s what their diet looks like about 25% fat about 12% protein and about 62% carbohydrate this looks very different than ketogenic or paleo diets right or at least what people call paleo diets so if we look at the main e in Bolivia in South America these are the people that live a sort of a hunter-gatherer lifestyle they have the lowest reported rates of chronic disease of any population on the planet what is their diet it’s 14 percent protein 14 percent fat and 72 percent carbohydrate so the verdict is I think can be summed up fairly well with this quote from Michael Pollan eat food mostly plants not too much that’s the key to longevity so in summary keto benefits are reduction in epileptic seizures decreased energy intakes weight loss improved blood sugar decreased triglycerides increased HDL the risk short-term increased LDL cholesterol impaired glucose tolerance worsening kidney function reduce reduced athletic performance bone loss vitamin mineral deficiencies constipation weakness fatigue bad breath and muscle cramps through n headaches and in the short term in the long term increased all cause mortality increased exposure to persistent organic pollutants that induce metabolic disorders and increased birth defects persistent organic pollutants are things like dioxins and PCBs because they move up the food chain impaired artery function increased total and LDL cholesterol kidney stones nutritional deficiencies and non-alcoholic fatty liver disease and hepatic steatosis which is worse than non-alcoholic fatty liver disease

so now let’s dig a little deeper into paleo diets so the claims are this came from a paleo website when people start eating paleo they often lose weight feel less hungry and have fewer cravings for sugar their skin clears up they have more energy and they find that muscles start appearing where there had been flagged for years this way of eating can literally reverse diabetes reduce your chances of getting cancer and reduce inflammation in your joints it can help you avoid heart disease the theory of course is what humans ate in pre agricultural times is really what’s best suited to our genetic makeup and as with on other animals the diet we would eat in the wild is really the diet we were intended to eat and so you know what what we know is that our native diet supported early humans through a two to four decade life people lived an average of 20 to 40 years regardless of that let’s assume that it is a good idea to eat like our ancestors what’s the first question you would want to ask what did our ancestors eat right that’s the first question we need to ask pre agricultural people ate wild plants animals fish and insects the balance of those foods varied with the time frame during the Paleolithic period with the location on the planet these people were at with the season with gathering and hunting skills with tool with with with tools and culture and there were changes over time during the first 80% of the Paleolithic period humans were vegetarian because we didn’t have any ability to hunt we might might have eaten some insects but that was about it during the last 20 years humans started to hunt and and so some meat was added to the diet so what didn’t people in the Paleolithic period eat well they didn’t eat any packaged foods there was nothing from a box or bag there were no deep-fried foods there were no fast foods there were no refined that’s oil sugar salt there were there was no added salt I should say there were there was no milk of other mammals or products that were made from the milk of other mammals there was certainly no bacon ham salami sausage or any other processed meat and there was no alcohol so dude new paleo diets equal true Paleolithic diet and this is a question I asked myself and I’ll tell you what what really got me interested in looking at this question I went to the nutritional anthropology research and I found two studies one from 1997 and one from 2010 and these studies are the best studies we have that estimate the intakes of Paleolithic man so they did a the first study in 97 and then 25 years later their second study came out and basically what they said is early ancestral diets were overwhelmingly plant-based with some insects and very small amounts of animal flesh reliance on meat increased in later ancestral diets as hunting skills improved however much proof points to continued significant if not predominant dependence on plant foods so here we have this is the DRI so this is our recommended intake for macronutrients this is the Paleolithic estimates of what people actually ate in Paleolithic times from 97 and this is their revised estimates from 2010 and so what we know is people probably ate about 3000 calories they got close to 30% of their calories from protein and this is the later part of the Paleolithic that lasts 20% of the Paleolithic period carbohydrates range from probably about 35 to 65 percent of calories 35% for the hunters very far north who had limited plants 65% for people closer to the equator range from probably 20 to 35% of calories saturated fat somewhere six to 12 percent of calories depending on how much meat they were having cholesterol around the 500 milligrams omega-6 to omega-3 around the two-to-one and fiber around the hundred to a hundred we round 70 to 150 grams so when you look at all of that is there anything there that just pops out at the page at you the fiber it’s absolutely crazy a hundred and four that was the original estimate and then they you know they increased the range from 70 for the hunters way far north to a hundred and fifty to two hundred in the people near the equator so where does fiber come from plants exactly so when I saw this I thought to myself holy smokes these people were eating a truckload of plants so I don’t see people eating a paleo so-called Paleo diet today that are eating anywhere close to 70 to 150 grams of fiber even vegans don’t eat you know often a you know they might get 70 if they’re eating a really good vegan diet but even most vegans don’t get that so then I looked at the micronutrients and again the estimates really were shocking so vitamin C to five to six hundred milligrams most vegans probably get two or three hundred where does vitamin C come from yeah fruits vegetables exactly that’s where vitamin C comes from what about calcium one to two thousand milligrams they weren’t drinking any milk where did they get their calcium leafy greens you know plants potassium seven to ten thousand milligrams what’s the recommended intake of potassium 4700 does anybody need it probably ninety ninety-five percent of the population doesn’t get that much potassium it vegans do the best but even vegans often don’t get the 4700 these guys were eating close to 10,000 where does potassium come from plants right so then I thought to myself I wonder what is closer to a true Paleolithic diet a paleo diet or a vegan diet so I thought I’m just gonna do some math here so I went to a paleo the probably the most popular paleo website and took three days of recommended menus and analyzed them to see what they were actually eating then I did the same with a recommended plant-based menu which is a hundred percent plant-based or vegan and then I compared the amount of nutrients this is the macronutrients in the true Paleo diet with those of what people who are calling themselves paleo are actually eating with those people on a plant-based diet we’re eating to look at I wonder what comes closer the vegan diet or the hundred percent plant-based or this thing they call a paleo diet and here’s what I found out and and of course when I did the analysis I adjusted the menus so they all provided the same number of calories so it was a fair comparison so they all provided 3000 calories so the protein was actually closer on the new paleo diet about 30% 32% of calories on this what they call the Paleo diet very close whereas vegan diets only about 15% but carbohydrates were much closer on the plant-based diet a fat was closer on the plant-based diet saturated fat was closer on the plant-based diet cholesterol was closer on the new paleo diet the ratio of omega-6 to omega-3 was actually closer on the plant-based diet and of course the fiber intake was closer on the plant-based diet and and the you know you see the 31 grams of fiber in the new Paleo diet but that’s at 3,000 calories so at 2,000 calories like most people would be eating they might yet 20 if they’re doing a good diet so then let’s look at the micronutrients who comes closer well for riboflavin thiamine vitamin C and E the plant-based diet came closer vitamin A and zinc the Paleo diet came closer iron calcium sodium and potassium the plant-based diet came closer and here’s the summary the Paleo diet comes closer to a true Paleolithic diet for for nutrients protein cholesterol zinc and vitamin A the plant-based diet comes closer to a true Paleolithic diet 413 nutrients and you can see them listed there in other words a plant-based 100% plant-based diet is actually nutritionally closer to a true Paleolithic diet than what people are calling a Paleolithic diet or a paleo diet today so why the macronutrient discrepancies if you think to yourself the Paleo people are eating meat and plants like vegetables and and that’s what people ate in Paleolithic times why aren’t the numbers matching better for nutrient intakes well let’s look at what the differences were first of all total fat they eat twice as much fat as people during the Paleolithic period they two to three times more saturated fat and two and a half times more cholesterol they eat only about 1/4 to 1/2 the carbohydrates and they eat only about 1/3 of the fiber so what’s going on well why the discrepancy well a paleo today the people trying to do paleo are focused on achieving the protein intakes of the Paleolithic period 30% protein that’s what their focus is getting that protein they’re less concerned about getting the same amount of fiber vitamin C or potassium as people during the Paleolithic period did so their emphasis is on meat as opposed to plant foods and we have to recognize that wild foods do not equal farmed foods meat and vegetables consumed today were you know we’re not available in Paleolithic times and they bear little resemblance to those eaten by pre agricultural populations if we compare wild meat to domestic meat what we see is meat from wild animals is much lower in fat about 6 to 16 percent of calories from fat compared to 30 to 60 percent of calories from fat in farmed animals it was much lower in saturated fat higher in omega-3s it was free of antibiotics of added hormones and in Paleolithic times of environmental contaminants and even the wild versus domestic plants cultivated vegetables and fruits have been bred for appearance palatability transport ability digestibility and yield wild plants deliver over three times the fiber of commercial plants and are [snorts] more concentrated in vitamins and minerals and protein so there were big differences so the Paleo diet of today does not equal the true Paleolithic diet and what about the claims about reduced disease risk because we have all sorts of little trials that show reduce body weight increased Tidy improved lipid profiles improved blood glucose better insulin sensitivity less inflammation decreased blood pressure in people going paleo versus people eating western-style diets so why are we seeing these favorable results well we’re seeing the favorable results because the Paleo diet of today removes refined grains refined sugars refined fats and oils are they’re supposed to fast foods fried foods processed meats high fat dairy and alcohol that’s what they remove in these studies and so of course you’re going to get some improvements compared to a Western diet however is it really short term gain for long term pain and this is something I would argue while many paleo diets do induce weight loss and favourable lab results in the short term they’re really significant concerns about adopting such diets in the long term paleo diets are high meat diets that’s what they are they’re high in animal protein they’re high in agro chemicals they’re high in carnitine which is converted to TMAO by gut bacteria which is highly atherogenic they’re high in endotoxins which is the outer cell membrane of gram-negative bacteria that can cause that can leak into the bloodstream and be very inflammatory they’re high in environmental contaminants all the persistent organic pollutants they’re high in heme iron which is a pro-oxidant they’re high in nu v GC which is a pro-inflammatory molecule and nitrosamine Ziff they’re processed they’re high in products of oxidation they’re high in saturated fat and cholesterol and they cause an upregulation of cancer promoting genes so that’s what we’re doing when we boost meat intake how much meat are people eating paleo actually consuming well the typical recommendations are for 30% protein so in a 2,000 calorie diet that’s a hundred and fifty grams of protein in a 2800 calorie diet it’s 210 grams of protein so assuming that 80% of their protein comes from meat and 20% from plants we’re talking about 16 to 22 ounces of meat a day 16 to 22 ounces how much meat is actually safe to eat well according to the most cited nutrition expert in the world dr. Walter Willett from Harvard if you step back and look at the data the optimum amount of red meat you should eat you eat should be 0 in 2016 the Mayo Clinic put out a study a analysis of 6 studies 6 studies with over 3 million participants they said there was strong consistent evidence that increased intake of red meat especially processed red meat is associated with increased all-cause mortality and we see that in meta-analysis after meta-analysis red-meat is consistently linked with all cause mortality with cardiovascular disease with cancer and with diabetes and in 2015 the World Health Organization actually declared processed meat a group one human carcinogen and red meat a group to a or probable human carcinogen a group one human carcinogen is in the same category as cigarettes and asbestos so this we know um

so let’s talk about plant-based vs. paleo keto diets briefly we have very clear consistent evidence that whole plant foods are protective to health heavily processed foods fast foods fried foods with added fat sugar and salt are damaging to health and meat especially processed meat increases risk of disease we know that and because we know that national and international dietary guidelines are starting to reflect this reality what you need to understand is these diets are taking out some of the most protective foods on the planet foods that are consistently associated with disease risk reduction and the evidence is so strong for that now that national and international Dietary Guidelines are starting to reflect this the World Health Organization in the 12 steps to healthy eating step number one is to eat a nutritious diet based on a variety of foods originating mainly from plants rather than from animals number one the FAO the Food and Agricultural organization in plates pyramids and planets they they highlighted international leaders that are lard that are promoting largely plant-based diets because they have advantages for health and the planet in Germany choose mostly plant-based foods in Brazil eat foods mainly of plant origin in Qatar emphasize a plant-based diet in the UK eat more plant-based foods we’re seeing this over and over and over again cancer organization eat a healthy diet this is the American Cancer Society with an emphasis on plant foods and and the World Cancer Research Fund eat mostly foods of plant origin the American Institute of cancer research choose mostly plant foods such as vegetables fruits whole grains and cut sugary drinks we look at the Dietary Guidelines for Americans scientific advisory committee in 2015 they say that a dietary pattern that is higher in plant-based foods such as vegetables fruits whole grains legumes nuts and seeds and lower in animal-based foods is more health promoting and is associated with lesser environmental impact than the current US diet then we see this brand new eat Lancet Commission from 2019 and they basically say universal healthy reference diet is one that increases the fruits vegetables are vegetables fruits whole grains legumes nuts and seeds and decreases unhealthy foods like red meat sugar and refined grains so this is universal and now in Canada I’m for I’m a Canadian and I was rejoicing very recently we put out our new food guide and our new food guide is reflecting this knowledge as well we did not listen or allow input from industry on this food guide and so the guide is mostly flat half the plate vegetables and fruits 1/4 the plate whole grains a quarter of the plate your protein sources whether that be beans nuts and seeds or some animal products dairy is nowhere to be seen except for as part of the protein group so now summing up let’s talk about the good the bad and the ugly of low carb diets first of all the good low carb diets tend to eliminate refined carbohydrates the white flour products and the sugars like soda they eliminate many highly processed foods which are damaging to health that’s good the bad they’re high in fat saturated fat and cholesterol they’re high in proactive ants and chemical contaminants they’re low in fiber phytochemicals and antioxidants they have many potential nutrition shortfalls especially with keto diet like minerals and vitamins and they well low carbohydrate diets are high animal food diets they are both ecologically unsustainable and ethically unjustifiable so let’s talk about ecological sustainability low carb diets essentially downplay the ecological crisis that makes eating lower on the food chain and ecological imperative if our entire population ate a low-carb diet our planets dwindling resources would very quickly run dry David Katz estimated that if we all ate paleo we would need 15 planet Earth’s to sustain the current population with the amount of meat that would be required in 2016 a study from the Proceedings of the National Academy of Sciences estimated that of green by 2050 greenhouse gas gas emissions would be reduced by 29% if everybody followed the global dietary guidelines keep more fruits and vegetables and eat less meat sugar and calories they would be reduced by 70% if we all ate a vegan diet their recommendation a global shift to a plant-based diet there was another study that I thought was kind of interesting that showed a typical steak and shrimp cocktail dinner would burden the atmosphere with 816 kilograms of carbon dioxide emissions this is the same as what would be produced by driving a relatively fuel-efficient automobile from LA to New York City and finally I want to end on this note we need to as human beings think about the consequences of our food choices beyond ourselves we need to think about the consequences for our fragile planet but we have got a responsibility to also think about the ethical consequences of our choices you know when we think about it in terms of people if everyone ate plant-based the global calorie supply would be increased by an estimated 50% which could effectively wipe out hunger for animals that’s the thing that we often don’t talk about and it to me makes no sense for us to cause incredible pain suffering and death and other living beings when it is not only unnecessary we’re destroying our own health and the health of the planet in the process we slaughter 70 billion animals every year for food most of those animals are raised in Capo’s or confined animal feeding operations probably in the United States it’s close to 90 percent of them now I don’t know about you this isn’t including anything from the ocean nothing from the ocean at all so this is just land animals 70 billion is almost ten times the human population every single year we raise and slaughter for our food and you know I’m not sure how we make the distinction but when you think about is it intelligence how do we pick the animals that are going to be our food you know if we think about dogs and cats most people are repulsed by the thought of eating them but in fact pigs are smarter than dogs so it’s not intelligence pigs are the estimated intelligence of the pig is is about a three-year-old child that I remember studies being done in California that that we’re looking at the pigs ability to play a game on a computer where they used their snout to move a joystick and they said pigs they couldn’t teach dogs to play that game and they said the pigs could actually could actually not only play the game but they never made a mistake what they had to do was match two things on each side of the computer if they got it right they got a treat and they said no Pig ever made a mistake they said they tried to train a chimpanzee to do it and and the and and the the researcher actually looked at the chimpanzee and said if you were a pig he would have had this by now so these are very very intelligent animals that would live what 12 to 15 years they live six months in hell they live six months in in these little stalls that are so small they can hardly move the dust and dander in the place the smell is so reprehensible that we have to wear a gas mask to go inside their smeller’s are 200 times more sensitive than ours they go crazy in these places so they sometimes to one another’s tails off because they’re going insane and what so what do we do to prevent that we just we cut their ears off with Doc their tails we remove their genitals with no anesthetic when they’re about three weeks old and and all of this so we can eat them when they’re about six months of age and they get transported to slaughterhouses and it’s estimated that 10 to 30 percent are inappropriately stunned and are actually skinned and boiled alive these creatures are smarter than dogs you know how do we as human beings justify this I don’t get it it’s you know I think the only way that we justify it is we put a halo on it because it’s tradition you know think about the things that we’ve justified under the banner of tradition for so many centuries that have been so wrong and we have to stand up and be counted when tradition is wrong we need to change it it’s up to us and so we need to be leaders in this regard this is so important the ultimate question is this how can humans best adapt to their current environment to sustain a growing population on a shrinking planet we as human beings have a choice when we consider the consequences of our food choice not just for ourselves but beyond ourselves a plant-based diet becomes an ecological and an ethical imperative and I think this sums it up as well as anything the keys to a long life avoid fatty meats eat your veggies and get your daily exercise and with that oh and these are some of my books my most recent one is actually the kick diabetes cookbook and because I have a minute I’ll just tell you I’m in the midst of a sequel to that book that’s more in information a larger book with a lot of information fewer recipes but about overcoming diabetes and and I will end with that just a very quick mention of a program I’m teaching at living light as well so this is a more intensive nutrition program and thank you very much for your attention [applause] thank [applause] you so much yeah [applause] I’m very happy to take questions of course Rita your crown of crowns fabulous [snorts] slice you have left not for a chance and as my colleague I want to share this with you excellent slice thank you [applause and cheering] thank you very much that means a lot to me coming from you Rita who’s a not only a colleague but a fellow of the Academy of Nutrition and Dietetics and I’m honored that you’re here thank you so much for those kind words thank [applause] you I’ve been watching you on YouTube for about 15 months I went plant-based 15 months ago and the movie what the health got me but thank you for what you do what do you say to somebody it says oh everything in moderation what do you say to them thank you for that question you know what I say to people who say everything in moderation is everything in moderation is is reasonable if if everything you’re eating is relatively healthy but everything in moderation if you’re eating things that are all killing you will still kill you just a little more slowly you know it’s it’s a you know I can remember and I’m meaning no disrespect but for years our national nutrition campaigns were built around the moderation message you know all foods can fit into a healthy diet there are no good foods no bad foods everything in moderation and and I remember thinking to myself here we are dying 70% of us are dying of a chronic disease and we’re trying to you know tell people that oh deep-fried pork rinds are just fine just so long as you eat them in moderation that was not the met it’s not the message people need to hear the message people need to hear is eat more vegetables eat more whole grains eat more you know eat healthy foods eat less deep fried foods eat less meat those are the messages people need to hear we need to be very careful of the moderation message even though moderation generally makes sense in your life if most of what you do is killing you it will still moderation will still kill you so I wanted to ask you about fasting because from your data it seems that it’s beneficial so I was wondering because I know that intermittent fasting is very big it’s probably just as big in the workout community as keto and paleo so what are your feelings I know that like it’s a bit and fasting in the gyms they always talk about like you could you know do it because you said the benefits if you stayed on a fast for like three days you can get so renewal and so what are your feelings in terms of maybe doing a three-day week what a fast and then eating you know vegetarian based diet for the balance of the week so for three as they would say in the gym yeah there’s a for three there’s the five – there’s a six one there’s all kinds of ways of doing these intermittent fast some people even do them where you’re only fasting for a certain number of hours each day so twelve or fourteen or sixteen hours something like that these have become quite popular and I think you know generally do what works for you what feels you know I mean we need to have some science base but generally the evidence is fairly strong that sort of fasting or fasting mimicking diets could be of benefit especially for people who are over consuming it reduces your level of consumption and so whatever helps you to reduce your level of consumption may be of some value now the thing that I would be concerned about is is simply doing extended water fasting because there are a lot of risks to water fasting and I would prefer if somebody who’s doing water fasting that they do it under the supervision of a a place like TrueNorth fort for example I think maybe what would be a reasonable compromise would be to do a juice fast or something where you’re just limiting your calories pretty significantly big Sal that kind of thing and doing at what they call a fasting mimicking diet which is low-calorie or just doing the overnight or maybe something not quite as three-four but maybe 5:2 and on those to do some green juices because what I’d like to see is I’d like to see your body loaded up with antioxidants during that time of reduced food intake so you just be giving yourself quite an antioxidant loose you also have to be a little conscious of preserving your muscle mass and so I think to do something that’s a little more modified would be a reasonable compromise but definitely some some significant therapeutic advantages to using those kinds of diets for diabetes for example they can be quite powerful yes just one quickly I don’t really know what it’s four to five to and all that is but the general criticism I’ve heard about fasting by a doctor is that it’s misguided because you need nutrients to drive the phase one phase to detox and deliver and if you don’t have it in fasting the body tends to sequester those so they’re not available for the liver detox yeah so the concern is well what about all the nutrients you need to detoxify the body and that’s one of the reasons why I think especially if you’re doing it on your own that you do some of the juicing to provide or at least something to provide those nutrients especially if you’re you know incorporating sprouts and such in your juices you’ll absolutely boost those kinds of phytochemicals that are really important for the detoxification pathways but also I think with pure fasting with water fast I think the evidence and dr. Fuhrman is a quite an expert in this areas while he’s speaking later today so you may want to ask him as well but we have some studies that are show some very powerful therapeutic healing with fasting and and so but my feeling is it does when it’s used you need to be really monitoring your blood levels of everything to make sure that your body can can handle it and that you go off the fast if your body’s not responding well but I’ve seen some some really dramatic improvements in in people’s health with fasting from a place like TrueNorth um that’s see where you do four days of eating three days of fasting or the five to is five days of eating two days of fasting some people don’t completely fast they just do a very low calorie diet or a juice fast during those two days exactly oh I guess I’m sorry we have to end but I’m gonna be outside doing signing books and I’m very happy to answer any questions