Blood Sugar

#237: John Limansky, MD: Keto & Fat Adaptation Beyond Macros

by Mike Mutzel


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John Limansky, MD a board-certified physician of internal medicine. As a clinician, he's see's patients throughout the world at


Show Notes:

04:35 Ornish protocols take away smoking and add exercise and meditation, but claim that it is the low fat diet that causes benefits.

06:02 Most doctors do not have the time to read the detail of studies to garner the truth. The average primary care doctor will see about 25 to 30 patients a day. The majority of studies in medical publications are drug studies. There is no money in doing nutritional studies.

07:43 Medical professionals still believe that saturated fat causes heart disease.  Saturated fat is the concern of the medical community with keto.

08:22 A small percentage of our population cannot tolerate high saturated fats. They can generally tolerate monounsaturated and polyunsaturated fats, a more Mediterranean dietary fat.

09:09 Do the ketogenic diet then measure your lab values of NMR LipoProfile against baseline. This will tell you if you should shift to primarily monounsaturated and polyunsaturated fats.

09:56 MCTs can be beneficial and are burned preferentially as energy and make ketones. If MCTs are your primary source of fat, there may be issues.

11:17 Dr. Limanski’s most valuable biomarkers to track: fasting glucose and fasting insulin. A 2 to 3 hour post prandial insulin challenge has many variables.

12:36 Nutrition is about 70% of the answer to our health issues. Stress levels, mold exposure, working late at night and eating late at night will be reflected in the CRP and make it harder for you to lose weight.

13:42 NMR LipoProfile is important because of the influence of cholesterol in overall health. Dr. Limansky looks at triglicerides, LDLp (particle size and number) to guide small changes in diet.

15:06 Exogenous ketones are not for everyone and are not a substitute for nutrition. Exogenous ketones help transition into 5 to 7 day fasts.

17:24 Hypo or hyperthyroidism is systemic inflammation, driven by some sort of antibody. Often, nutrition is the underlying process that drives the antibodies.

19:02 Dr. Limansky finds that people with autoimmune thyroid do better on a keto diet. Antibodies will decrease precipitously. Keto allows your gut to heal by eliminating grains and processed food.

19:51 Some people who are hardcore keto for an extended amount of time and restrict calories may stress their bodies with cortisol and thyroid production. This is simply remedied by introducing a few healthy carbohydrates.

20:12 Micronutrient dense foods support hormones. Many of our enzymes needed to make ATP energy production in the mitochondria require micronutrients.

24:59 The carnivore diet is good for an elimination diet. It allows the gut and gut lining to heal. Then begin incorporating things into your diet. There are no long term studies. Carnivore dieters who are successful tend to have already had a lean body mass, so they can utilize excess protein more.

26:43 You can be in ketosis and not lose weight because of the calorie expenditure equation weighted by exogenous fat intake.

30:30 If you are keto and not losing weight, decrease your fat intake and try to fast. This fires up the enzymatic reactions needed to burn through your fat source.

32:29 If you are insulin resistant, it will be more challenging to convert fat into ketone bodies. You may not get the satiety or brain boost right away.

36:24 If keto didn’t work, it is often something as simple as using artificial sweeteners, keto products or too much MCT oil.

36:53 Weight loss on keto should not be used as a barometer or focus. When you become healthy, you will lose the weight. Lean does not mean healthy.

39:49 Checking just the hemoglobin A1C does not reflect pre-diabetes, which can occur for years, damaging your microvasculature. Obesity is more of a symptom of a dysfunctional metabolism to insulin resistance. Fat cells produce hormones that drive it, creating a loop.

40:49 50% of people who come to the hospital with heart attacks are skinny. They are thin on the outside and fat on the inside.

42:02 Fructose and high fructose corn syrup drive much of fatty liver disease. Eating seasonally keeps fruits and berries to one specific time of the year when, evolutionarily, we would want to put on weight for the winter. We eat fructose all year.

44:33 If you have a metabolic disease like seizure, cancer, or insulin resistance, you should be hardcore keto. Check your levels and focus on food quality. Paleo with intermittent fasting works for many healthier people.

48:42 When Dr. Limansky experimented with a carnivore diet, his glucose went up and he did not feel as well. Ketones dropped and mental clarity slipped.

52:11 Doctors need to follow guidelines to prevent liability. He/she may agree with you, but they cannot prescribe or recommend something. The guidelines must change in order for us to change as a society.

56:35 Dr. Limansky keeps an electronic archive of the studies and research that support his recommendations. There is still liability but one must consider the ethics of doing harm with outdated recommendations.

01:00:01 Biohacking will have great impact only when the diet is dialed in.

01:00:45 Sleep is the most important biohack. Poor sleep elevates cortisol, raises insulin and increases hunger for carbohydrates. The cortisol boost lasts as long as 48 hours.

01:01:46 Eating late at night, even if it’s keto, suppresses melatonin production from your pancreas. You won’t sleep as well and the next day you will have higher cortisol levels.

01:02:13 Exercise: A high intensity 30 minute session can mobilize glycogen stores. You build muscle mass, increasing your BMR. If you are fat adapted, you preferentially use fatty acids as your energy source.

01:03:19 Fasting allows gene expression to happen so you make enzymes to break down your fat source more efficiently.

01:03:58 Sauna, especially infrared, lowers cortisol and boosts energy expenditure. It increases the density and amount of mitochondria you have.

01:04:30 Cold thermogenesis (the cold bath) increases resilience, energy levels and sleep levels.

01:08:04 Light therapy: The Joovv light doubled Mike’s testosterone. Hormones are influenced by the seasons. Light therapy increases your amount of mitochondria, burns more energy and decreases inflammation.

01:10:20 Turn off your cell phone and Wi-Fi at night. EMFs are a low signal, which is showing in research to stimulate your cells that produce massive amounts of calcium. Men who have cell phones in their front pockets heat their testes all day. Sperm counts are down by 50%. Fertility rates are down. EMF blocking underwear is available from Faraday’s.

01:15:08 Many of today’s biohacks are what our ancestors did.

01:22:35 Dr. Limansky is inspired by his wife and kids. He wants to pass down knowledge to his children. Mike inspires as well.

01:25:37 Autism rate is 1 in 8 children. In the next two generations, it will be 1 in 4. 50% of all dollars spent by Medicare are spent on diabetes and diabetes related issues. 50% of applicants for the military are rejected because they cannot pass the physical.

01:29:02 Dr. Limansky gets up early. He does 5 minutes of meditation and then light exposure and grounding for 10 minutes. He checks his HRV, fasting glucose, ketones and then does a fasted workout, weights and intervals. Then he does a sauna session and the ice bath. He does social media and emails only twice a day.

01:34:49 Community/Social connection: If you are disengaged from what you’re doing, you will eat 50% more food.

  1. This was a wonderful and well done Health piece! Thank you for sharing and getting this out there for us!

  2. Would love to get a list of the tests to ask my doctor to order from Dr. Limansky. My doctor is classic internal medicine: low fat, statins, testosterone replacement, etc. So, I am going to need to guide him on what tests I want.

    Kind regards,

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