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EVIDENCE-BASED KETO DIETJULY 2021The End Goal isMetabolic HealthTONY HAMPTON, MD, MBARoberts, T. (2021) Dr. Tony Hampton: TheEnd Goal is Metabolic Health. EvidenceBased Keto Diet Research. SpearheadCertifications.1Department of Community Research, ThePaleo Foundation2Department of Standards, SpearheadCertifications, Encinitas, CACORRESPONDENCE1Email: tobias@paleofoundation.org2Email: karen@paleofoundation.comKEYWORDSMetabolic HealthCommunity SupportBio-individualityCulturally-Familiar foods
Paleo FoundationEvidence-based Keto Diet ResearchCOMMENTARYThe End Goal is Metabolic HealthMedical Director and board-certified obesity specialist Dr. Tony Hampton discusses theimportance of a diet support system, culturally familiar foods, and bio-individuality withSpearhead Director of Community Research Tobias Roberts.With well over four out of every ten adults in thePart of the popularity of the Keto diet is that it doesUnited States overweight, it should come as noseem to offer a quick pathway towards practical weightsurprise that interest in weight loss diets has never beenloss. However, many popular Keto advocates encouragehigher. People want to lose weight and want to do itnutritional practices that fit the Mayo Clinic's definitionquickly. One recent CDC poll found that 49 percent offor fad diets. The strict requirement of limitingAmericans said they would like to lose weight.carbohydrate intake to under 20 grams per day oftenUnfortunately, the vast majority of Americans look to fadleads to complete abstinence from certain food groupsdiets as a quick and easy solution to meet their weight losssuch as grains or legumes.goals.Within the "low-carb community," however, moreThe esteemed Mayo Clinic says that "when it comes tocoherent and reasoned voices seek to combine aweight loss, we'd all like a quick fix. And plenty of dietsnutritional program focused on lowering carbohydratepromise that advertising results that sound too good to beintake with a more holistic healthier livelihood plan. Dr.true Fad diets are attractive because they seem toTony Hampton is a board-certified obesity specialist whopromise something we all want: an easy way to lose a lotworks with patients individually in the clinic and withof weight." The clinic equates fad diets with nutritionalsmall groups enrolled in the diabetes preventionprograms that promise rapid weight loss via eliminatingprogram (DPP). As one of only just over 3,000 board-entire food groups, require strict and rigid rules, andcertified obesity medicine specialists in the Unitedseverely restrict calories or other nutritional parameters.States, he's been able to use his knowledge to helpdevelop and support programs that reduce the obesityThe Keto Diet is easily one of the most popular diets in theburden, especially amongst marginalized communities inUnited States. Besides regularly being the "most GoogledSouth Chicago.diet" on a yearly basis, the global ketogenic diet marketsize was valued at USD 9.57 billion in 2019 and isDr. Hampton is also especially passionate aboutexpected to expand at a compound annual growth rateremoving barriers to health and equipping patients and(CAGR) of 5.5% from 2020 to 2027.his colleagues with the education and resources theyneed to take charge of their health. 2021 The Paleo Foundation1
COMMENTARYMuch of his work has focused on identifying socialdeterminants of health among at-risk patient populations.This work has allowed him to develop education aroundnutrition and weight loss that helps patients set realisticPaleo FoundationMuch of Dr. Hampton's work is focused on addressingthese social limitations and constraints that contribute tounhealthy diets and obesity. He has also beeninstrumental in the launch of the Food Farmacy (that'sand attainable goals based on their life experiences.FARM-acy with an "F") at Advocate Trinity Hospital. ThisWe recently chatted with Dr. Hampton about his work andpatients and community members who live in urban foodhis perception of the current state of the low-carb ketodiet craze.program aims to increase access to fresh, healthy food fordeserts."The purpose of the Food Farmacy was to help bridgethat gap with the Chicago Food Depository since somany of the food options are limited in the community Iserve (predominately African American)," he tells us.Similarly, the healthy living program helps educatepatients about the benefits of lifestyle interventions with afocus on nutrition, stress reduction, sleep, and exercise."The program includes large educational sessions with75-200 people where clinicians teach these principles in alive setting. Research was done in the community to alignwith what food is available with the foodrecommendations while also attempting to partner withgrocers to increase access to fresh foods," he explains.Many nutritionists, doctors, and other medicalprofessionals who see patients dealing with obesity,metabolic disease, and other nutrition-related issues findthat too often, certain marginalized communities simplydo not have the cultural and structural supports that helpDR. TONY HAMPTONthem make the necessary dietary-related changes for theirhealth.THE IMPORTANCE OF CULTURAL AND STRUCTURALSUPPORTS FOR ANY WEIGHT LOSS PLANHelping people realistically meet their weight loss goalsgoes far beyond a simple meal plan or carbohydrate orcalorie restriction parameters. Not everyone can jump intheir car and visit their local farmer's market to purchaseRather than simply bringing in the latest diet guru, Dr.Hampton makes an effort to help the community heserves to understand that healthier nutrition and lifestylesare not a privilege of the wealthy but fully accessible andattainable to their community and reality."I make sure our speakers (in the Healthy Living Program)look like the communities we serve, but not to exclusion. 20/pound of grass-fed beef. Nor do many people havethe time to prepare three meals from scratch daily. 2021 The Paleo Foundation2
COMMENTARYPaleo FoundationThat way, we can talk about foods that are commonwithout the risk of offending (I can talk about cornbreadbecause I grew up eating cornbread and am AfricanAmerican). We talk about removing old belief systems thatdon't serve us anymore. Yes, it's okay to eat greens withoutcornbread because the extra 30 plus carbs don't serve meanymore. It's also important to remind them that most"soul food" is keto-friendly. Greens, cabbage, okra, etc.,are all keto-friendly if consumed without cornbread, forexample. And the greens can be cooked with fat andmeat. Once they realize we are not asking them to removeTo this end, Dr. Hampton's nutritional advice generallyfocuses on helping his patients cut out emptycarbohydrates from highly refined foods. Instead ofsimply focusing on dietary changes, however, he alsobelieves that exercise and other lifestyle changes areessential to ensure that weight loss is sustainable over thelong term."That's where exercise becomes the focus," he says. "Ieducate (my patients) that movement is key but remindthem that aerobic exercise is best for fat burning. I givesimple examples. If you areculturally familiar foods, theysprinting, you will need fast fuelunderstand how doable it is," Dr.Hampton says.“If their blood glucose respondsA FOCUS ON HEALTHIER LIFESTYLESfavorably, then there is no reason toFOR BETTER METABOLIC HEALTHavoid that food if they enjoy it TheDr. Hampton certainly believes thatgoal is metabolic health, not keepingre d u c i n g t h e n u m b e r o f e m p t ythe carbs at a certain level. I believecarbohydrates from highly processedpatients need to focus on settingand refined products is a central aspectof healthier nutrition and lifestyles.realistic goals, have a team to"Most diets that recommend wholesupport them, accept incrementalfoods are better than the standardchange, and celebrate theirAmerican diet," he believes. In hisopinion, randomized controlled trialssuccesses."(RCTs) have shown superior metabolicbenefits of low-carb diets. However, instead of instinctivelyrecommending a certain carb threshold or other aspects ofa low-carb diet, he attempts to look at the specific andcontextual elements of the individual patient."I do believe in bio-individuality, so if I have a patientthriving on a low-fat diet, there is no need to change. Butconsidering that most Americans are insulin resistant, it'smore logical to suggest a low carb diet as a starting point.Metabolic syndrome and its related conditions benefitfrom a low carb approach and include medical conditionslike PCOS, diabetes, hypertension, dementia, fibroids, andmany, many more," he says.like glucose. If you are walking,you have time to liberate "slowfuel" like ketones. Bonus, it'smuch easier to take a walk thanto sprint.”Although Dr. Hamptonadvocates for loweringcarbohydrate intake as part of aholistic approach to healthierlifestyles, he is also worriedabout some of the "Ketomyths" that are beginning totake hold given the currentpopularity of the Keto dietacross the world. Specifically, Dr. Hampton worries aboutthe role of drastically increasing the amount of fats thatmany Keto supporters advocate for."The major myth is the myth that we have to go crazyadding fat," he says. "I once recommended bullet coffeewith MCT oil as the standard. Now, I encourage mypatients to just get the carbs under 50 or 20 grams andallow the body to produce endogenous ketones insteadof depending on exogenous ketones. I also discourage"keto-friendly snacks" to avoid triggering patients if theyhave a processed food addiction. Snacking is generallynot needed when in ketosis, but if a patient doesn't havea processed food addiction, they fair pretty well with aketo-friendly snack.” 2021 The Paleo Foundation3
COMMENTARYPaleo FoundationDr. Hampton also believes that promoting total abstinencefrom food groups such as grains and legumes can also bedetrimental in the long run."I generally tell patients they are not lab rats, and eachperson is different," he says. "I ask them to consider usinga continuous glucose monitor and see how their bodyresponds to foods that are considered ones to avoid. Iftheir blood glucose responds favorably, then there is noreason to avoid that food if they enjoy it.”A focus on bio-individuality allows Dr. Hampton to help hispatients discover a personalized plan towards healthiereating habits. "If (a patient) decides that a cup of Quinoawith 39 carbs is something they enjoy that's areasonable approach. I also have some patients whobecome metabolically healthy, increase their daily carbs alittle, maybe to 75 grams if they seem to tolerate it. Thegoal is metabolic health, not keeping the carbs at a certainlevel. I believe patients need to focus on setting realisticgoals, have a team to support them, accept incrementalchange, and celebrate their successes."Tobias Roberts, BSc. Department of Community Research, ElSalvador. 2021 Spearhead Certifications4
The esteemed Mayo Clinic says that "when it comes to weight loss, we'd all like a quick fix. And plenty of diets promise that advertising results that sound too good to be true Fad diets are attractive because they seem to promise something we all want: an easy way to lose a lot of weight." The clinic
