Daisy’s latest extraordinary man, Richard, chats to Daisy about his university studies, how he surprised her with a visit a few months ago (which is quite some feat as she lives in the middle of nowhere in rural France!) and what exciting new projects he has up his sleeve.
Richard is a 53 year old software developer and technical speaker who built financial systems to expose risk on Wall Street and has worked on systems from industrial robots to payroll. At 38, he was the public-facing chief executive of a major software component company when he discovered he had type 2 diabetes. At 40 he retired, to devote his time into learning about type 2 diabetes and reversed his own with the ketogenic diet 5 years ago.
With Carl Franklin he founded the 2 Keto Dudes podcast (over 250,000 monthly downloads), and the international Ketofest event to help popularize the intervention as a treatment for type 2 diabetes.
Last year Richard went back to school to study Biochemistry, and he is currently producing videos debunking bad science journalism.
This transcript is brought to you thanks to the hard work of Karen Jones.
Welcome back, Jessica to the Keto Woman podcast. It’s lovely to see you again. How are you doing?
Thanks for having me for a second time. I’ve been thinking about coming back on because there’s so many things I’d like to talk about. So, I’m so glad you’ve had me on
Exactly, it’s a pleasure to see you. And as you said you’re back. You were on, I looked it up, you were on episode 35 back in June and you told us all about you and your story and what you’re doing and you teased us a little bit with the Type 1 research that you’re doing and you promised to come back and talk about that and all the other things you’ve been getting up with. I’ve seen pictures you’ve been putting on social media. You’ve been really busy on the lecture circuit this year as well, I think.
Yeah. Yeah. Well there was that recent series in Australia where we had Steve Phinney come over and Jake Kushner and a lot of other amazing speakers and they spoke in Sydney and then they spoke in the Gold Coast as well, and I was able to go to both of those. And, I was so lucky to be able to take Steve Phinney and Jake Kushner out for lunch in Sydney.
I know! I was super star struck and then they’re just so down to earth and I just got that sort of out of the way. But it was just lovely. We went to the 360 Bar and Restaurant. Have you been to Sydney? It’s in the center point tower.
No, never been that far. The furthest around the world I’ve got to is Thailand and Hong Kong, that sort of area. So no, never got that far.
Well, when you come to Sydney, I’ll take you there because it is beautiful. You just look around all of the city, and it was a perfect place for them to go because they wanted to sightsee but it was raining. So I’m like, okay, well this will do. So yeah, it’s been fantastic and I’ve obviously been lucky enough to be able to speak at some of those events as well.
Actually, when I was at the Gold Coast, I spoke about my personal story with distorted eating, which we spoke about on the podcast last time. So that was really good to actually get that out there into the conference space and get that out there to the doctors and other health professionals. A lot of individuals and the patients, they know all that happens because they’re the ones who live and experience that sort of disordered eating or negative relationship with food.
But I think a lot of health professionals are blinded to that or they just don’t see it or they don’t think about it. So, I was really happy that they asked me to come along and speak about that at the Gold Coast. So, I’m sure that’ll be on YouTube eventually. And apart from that, I’ve been really busy stuck into the PHD this year, so I’m sure we’ll get into more about that. But it’s a busy time, but it’s all very fantastic.
Oh, great. It’s nice, isn’t it? When you’re busy doing something you love it, it doesn’t feel, doesn’t feel arduous in the same way.
Yeah. Well I mean there are parts of a PHD that are kind of like “what am I doing”, that are lonely and tedious. But I’m almost out the other end of that section now. And you’re right, If I wasn’t super passionate about this, I don’t think I could be doing it. So yeah, I feel lucky.
It’s pretty full on, isn’t it? I mean I know to a certain extent you can pace your own PHD, can’t you? You can decide how long it takes you to complete it
Potentially. So, the minimum amount of time is three years. And then I think you can do up to, I don’t know what the maximum amount of time is, but generally they don’t want you to go for longer than four years. Right. And it’s usually your supervisor who doesn’t want you to go longer than four years because they want to get on to the next thing. And if you’re going for longer than that, it either means you’ve been too slow and you haven’t been dedicating time to it, or something went wrong or you’re doing too much for your thesis. So any of those things could be applicable if you’re going for longer than three years or four years even.
But my PhD is a continuation of my Master’s work, so it is on low carbohydrate diets for Type 1 Diabetes. I can’t remember if we spoke about that at all last time, I would’ve said that. I know we touched on it. Okay, cool. So, yeah, in my master’s degree for dietetics, I did a systematic review looking at all the available literature on low carbohydrate diets for Type 1 Diabetes. And you know, we found what we expected, which is that there’s hardly anything out there. That’s the whole reason we did the review because we knew that the evidence was scarce, but we thought, “Well, you know these people out there living with Type 1, and it’s essentially a disease of carbohydrate intolerance, so we need to figure out which level of carbohydrate is appropriate for these people. We can’t just keep reverting back to the national dietary guidelines to give advice to people with Type 1 Diabetes”.
We have to make a change, and that’s going to take years, but we need to do that systematic review so other researchers go “Wow, this is an area we need to investigate”. And so we pulled together all the studies we could find. The studies we did find, though they weren’t large randomized control trials, they were decent studies and they all show that low carbohydrate diets had a positive effect on Type 1 Diabetes clinical outcomes in at least one of the outcomes – an HbA1c reduction or reduction in insulin or a reduction in severe hypoglycemic events, or just average glucose levels. So, if it was a reduction in any of those outcomes, then we classified it as effective and so the research was promising and that’s what we saw. But certainly the biggest conclusion of our systematic review was that more research needs to be done. And so that’s why my PhD is delving into this same exact topic and we planned to do a couple of primary clinical trials where we are investigating a specific low carbohydrate diet protocol for people with Type 1. So, I’m in the very early stages of my PHD, but those are the things that are to come over the next few years.
Wow, fantastic. It seems to be something that I’ve often seen the arguments against using a low carb diet for Type 2/Type 1, and I’ve seen infographics and all sorts of things which basically say it’s a great way of eating for both, but quite often people who are familiar with Type 1s, maybe Type 1s themselves or have friends or relatives who are Type 1s, say “Oh but hold on, you know you can’t treat them in the same way” and “you have to have carbohydrates and you have to have this minimum amount”. And they quite often quote something that’s quite high. And it to me that logic doesn’t work.
I would have thought having the carbohydrates lower is the best possible thing because it’s all about trying to keep that insulin as stable as possible. And I know you’re not producing any insulin at all when you’re a Type 1, you have to be putting in, but surely the least you need to be injecting the better. Can you just maybe address that a bit and get rid of or debunk some of the myths that are out there. Because I’m sure you know very well how to contradict some of those.
Well exactly what you’re saying is the rationale for why we want to do this type of research, why we even looked into it in the first place. You would think logically that if you reduce your carbohydrate, then you can reduce the requirements for insulin so you don’t have to have excessive insulin injections, and then you can expect more stable glucose levels
Because, of course, there are problems aren’t there. There are problems associated with injecting insulin and presumably the more and more you use it, there are side effects to that.
Yes. So that’s a big thing that we’re learning. Before the discovery of insulin, which was in the early 1900s, they were managing Diabetes with a low carbohydrate diet, and it had to be very, very low, basically it was almost no carbohydrates with periods of fasting. That’s how they extended the lives of people with Diabetes because otherwise they would have died in a few days, and they extended their lives from a few days to a few months or a few years. They obviously weren’t going to live full lives without insulin, but it was the best they could do at the time. And then when insulin was discovered, it was an amazing discovery, we can be so grateful for that discovery and the use of exogenous insulin when it came into the medical system.
And so, the treatment for Type 1 Diabetes changed significantly. And then the sort of understanding that came from there was that “Well, you know, Type 1s or people with Type 1 already live with this difficult thing” or I guess their life is so tough that why would we then go and put them on a restrictive diet, like a low carbohydrate diet. You know they already have to go through so much, let them eat what everyone else eats. And so that started being the thought process. And particularly, I know that’s how dieticians are taught, we don’t want to put them on any restrictive diet because that’s unfair to them when they’ve already got this unfair condition. So that’s the way that they manage it basically, well we know they’re going to eat a diet just like everybody else because that’s what we want them to eat, so then we have to give them a set amount of insulin. That’s how it came into practice that we need to have carbohydrate regularly. We need to have the insulin regularly which can be an okay way of doing it.
I know a lot of people out there can manage their Type 1 Diabetes with more moderate levels of carbs or even slightly higher levels of carbs, but it’s not easy. And it depends what sort of health outcome you as the individual want do you want those really, really stable blood glucose levels so you can really minimize any risk of disease? If you do, then maybe you will need to have or find those other approaches, and find those other interventions like a low carb or a ketogenic diet. But the individual needs to be aware of the different interventions out there as opposed to just some random dietician coming to them in hospital when they’re diagnosed and saying “you must eat x amount of carbs this many times a day and if you don’t, you’re at risk of having a Hypo, you could die”, because that’s what they’re doing in the hospitals at the moment.
I’ve seen it and you know, I wasn’t impressed at all. I was actually very frightened by the way that it was all going on so happy and bubbly, like there was no issue. Just dosing all of these people, and very young people as well, up on all these carbohydrates when that could lead to really negative consequences and potentially a really low quality of life if they’re unable to manage their Type 1 Diabetes. I guess, the thing we should say as well, is that a low carbohydrate diet for Type 1 isn’t necessarily evidenced based practice yet but neither is a high carbohydrate diet.
So there hasn’t been adequate evidence to support a high carbohydrate diet in the practice of Type 1, but people are doing it anyway and that’s the best practice guidelines at the moment. And you have to sit back and you have to go “Why, why, why are we just reverting to the guidelines for this population?” So that’s really the crux of my PHD. I’m asking why.
Yeah, amazing. It’s that fear factor. And that’s the thing I’ve seen cited often “You know, you don’t understand, we have to predict, protect against hypos because they can kill us”. And you can hear that the fear, and very understandably because it must be something probably most of them have experienced, and it must be terrifying. And, but, but again, with my logic, it seems that that you can predict much more what those peaks and troughs are going to be with the blood sugar when your carbohydrates are down. It seems to me that they get more wildly erratic when you throw the carbs in and it’s less predictable. Presumably the thing that would help most is predicting much more accurately how much insulin you’re going to need.
Yeah. Well, Dr. Richard Bernstein says that big inputs lead to big mistakes and small inputs lead to small mistakes, the input being the carbohydrate amounts and the mistake being the mistake in calculating insulin. So, you’re exactly right in what you’re saying there are, at least that’s what we would expect. And we have seen that in those few trials that are looking into low carbohydrate diets for Type 1. The other thing I want to highlight that people don’t talk about a lot in the “Type 1 Space” is that it’s really, really hard to estimate or calculate the amount of carbohydrates in food. So, even if you say, “Okay, well, I am eating two pieces of bread and I know exactly how many carbohydrates are in there. All is well, I’ll give my insulin”.
The nutrition label on that bread is not accurate, it’s an estimate. And then if you go to something like an apple for example, well how ripe is that apple, what’s the exact size, how many bites did you take? How much did you leave leftover in the end, did you eat the skin, did you not, what type of apple, what season was it grown? All of those things affect the carbohydrate content. So even though we go onto Google and we search the carbohydrate content in apples, that is just a big estimate. And as you can imagine, the more people are eating carbohydrates when they have Type 1 and the more they have to figure out how much insulin to take, the more risk there is for error.
Because that’s the variable isn’t it? That must be the biggest macro that you’re using to calculate how much insulin you need to compensate.
Yeah. Some people will also calculate insulin requirements based on fiber intake and protein intake, but then starch can also delay the release of glucose into the blood so it can change your insulin requirements. Again, that is more related to the timing of the insulin dosages and so on. So, I mean it’s so difficult.
I was going to say it just a nightmare thing to have to try and calculate all the time.
That’s the thing – even when we find strategies that are shown to be more effective, it’s never going to mean that managing Type 1 Diabetes is easy, it’s always going to be such a difficult condition to manage. And all those people out there that I see on social media that are absolutely killing it with Type 1 Diabetes and they’re sharing all their progress online, all their ups and downs? I think that sort of social media support is incredible for Type 1 Diabetes because I know a lot of people can feel quite alone. And I think partly it’s because there is so little evidence on appropriate dietary management of Type 1 Diabetes that the health professionals actually don’t even want to see people with Type 1 Diabetes or they just want to send them to somebody else, or they just want to wrap up the conversation.
I mean we do have the health professionals out there, but do we actually have those health professionals that really know what they’re doing when it comes to Type 1? I think there’s only a handful of them. So I really just hope that with the research that we’re doing, we can spark the interest of more researchers to investigate this as well. Because it’s just my study on its own, we need way more than that. Yes, we’ll be able to more securely and efficiently answer the question “Are low carbohydrate diets effective for Type 1 Diabetes?”. But we’re going to need more for the guidelines to change and for those standard practice recommendations to change.
Yes. And I think also that groundswell of what the public are doing, as you mentioned social media groups like the Facebook Group Type 1 Grit. they are doing amazing, amazing things in helping push and encourage that research, aren’t they? As well as just the day to day familiarity with talking to other people who are going through a similar experience to you. I mean that really helps when you’re making any kind of change or dealing with anything. To talk to somebody who’s going through the exact same thing is so helpful isn’t it?
Yeah, definitely. And that kind of brings us to what I’m doing at the moment, which is trying to figure out the features of an effective low carbohydrate diet. I could do this for any dietary intervention. I imagine they’ve done it for plain old weight loss guides – what features of those diets are the most effective. But you bring up a specific feature there which is group support or group sessions.
We could have two low carbohydrate diets that are exactly the same level of carbohydrate but one of the interventions will use something like group support and the other one doesn’t. And the one that doesn’t may not be effective whatsoever then people will be signing it going “Look, low carbohydrate diets suck. They don’t work”. But was it just because the intervention was no good? Whereas the other intervention using more rich methods and methods that are really supporting the individuals is helping them stay compliant to their diet.
I think a big part of staying compliant as you say, is that support, the peer support, whether it be other people going through the same thing or just regular sessions with the health professional. And then also education, I would expect that the more education someone gets behind why they’re making these changes in their diet, why is it carbohydrate they’re reducing, why is it fat or protein that they’re increasing and which types of fats and why are those types of fats healthy?
All of these really deep questions are so important for the person that’s going to hopefully sustain that lifestyle long term.
Yes, absolutely. It’s certainly been something that’s helped me immensely making changes. The difference with the weight loss surgery I had the first time where there was just no support whatsoever and the second time finding the online groups and just getting that peer support, it made a vast difference and that’s actually how I got into low carb and Keto in the first place. It had a very important impact, it’s really, really important.
Yeah, I think it’s interesting you say that because the low carb Keto space has a very strong community behind it. I haven’t necessarily delved into or looked for Vegan communities or whatever, I’m sure they’re strong as well. But I know in the low carbohydrate community we put on these regular conferences, like what we were speaking about at the beginning, and we have so many podcasts like this one that is spreading the education and spreading the knowledge. I haven’t ever seen a low-fat conference going on with heaps of people that are attending for 10 hours on a Saturday out of choice.
I don’t think it would be as much fun.
No, I just, I wonder if they could even provide the rationale and the logic and the education for those other diets. Maybe that’s why they’re not holding full day events for them! But I think that is a huge reason people have found low carb or Keto or Paleo or whatever, because the rationale and the logic makes sense. Receiving that rationale and logic and knowledge is very crucial.
Yes. And I’m sure I’m biased, but it does just seem to be a really nice community. You know, all the people I’ve met, when I met people at Ketofest this year, they just seem to be a really lovely bunch of people
And I think they’re all empowered, aren’t they? Everyone has that sense of positivity about them. You know, even people that haven’t even, like you say, Ketofest -I went to the Ketofest in Canberra, in Australia in September – and I met quite a few people that hadn’t actually started a ketogenic diet. They didn’t know what it was before the conference, they had actually come with a friend or a family member, and even they were so empowered by the message and the community and the education and the cooking and the fun that was going on that day that they brought the same energy as everyone else was buzzing on.
Everyone was just bringing each other up. I think in a world where we are absolutely plagued by these epidemics of obesity and Diabetes and heart disease and cancer, where for the last 20, 30 years, we haven’t really gotten better, we’ve just been getting worse, and we haven’t had the tools to deal with those diseases, and now finally having something which makes sense that we can apply and we can enjoy that is just huge. And it’s no wonder people are buzzing from ear to ear at these events and there’s hundreds of podcasts talking about these sort of dietary tools. So, yeah, I think it’s a fantastic movement to be a part of.
It’s actually, and I think you mentioned that buzzing I think, then the whole thing is, people feel good eating this way so they’re naturally predisposed to be being in a good mood. I mean, I can just imagine being at a low calorie, low fat conference so you know, I’m going to be grumpy walking in, so it’s going to be very difficult to feel upbeat.
Imagine how many tea breaks you would need! You would need a break every two hours so people could go and have something to eat because they’d be lagging and low energy. And I actually thought about this the other night, I thought at the next low carb conference I really want to do a behind the scenes thing, like a video series or something, because I think capturing that energy is the most amazing thing and it would be a really good way to get other people on board I think as well. Because something that I’m really interested in doing is spreading this dietary information that I am lucky enough to have with people who don’t have it or they just haven’t had the access to it.
I always think back to my dad’s story, for example, where my dad ended up having a heart attack and was diagnosed with Type 2 Diabetes. But in the years leading up to that event, he was going to the doctor and he was trying to get some answers and he was trying to do something. He was always going on some sort of diet or doing more exercise or whatever it was, trying weight loss pills. He knew he had to lose weight and improve his health, but no one could help him do that, and I just feel that that’s an all too common problem.
We have all these people out there who are wanting to do something and that are trying, but all the strategies they’ve been given are ineffective or they haven’t worked for them or they’ve done them in the past and it’s not working now. And a lot of these people, when you tell them about this new strategy, this alternative, well, it’s not a new strategy but it’s an alternative strategy to what they’ve been doing.
So, let’s say for example, it is a reduced carbohydrate, high fat diet, and it works for them and they can sustain it, and they get the education behind it. Then they are just so grateful and they just think “Where have you been all my life?”! And that is just the critical thing, it’s not that low carb hasn’t been here, it’s all of a sudden new, it’s that people just aren’t being told that it’s there, they aren’t being offered it as a strategy. And whether or not people decide to use it forever or not, at least give them that dietary tool and at least offer it to them and let them know that it is there.
And I think that’s how we tie it back to Type 1, I think that’s important for them as well. You know, we can say to them “Okay, well this is a high carbohydrate diet, this is a moderate carbohydrate diet, this is a low carbohydrate diet. This is what we know about them. This is what your management’s going to look like on each diet. What would you like to do?”. If that’s how they treated people with Type 1, then I feel like that would already be better.
Yes, absolutely. And I do love that sense of empowerment. That’s part of what is so uplifting isn’t it? And I can see, especially in the in the Type 1 community when you feel you’ve lost that, you feel disempowered because you’ve got this thing going on that is really difficult to control. If you can be offered a strategy that potentially can really help you with that and that sense of empowerment and feeling that it’s your managing it rather than the other way around, I can see that being a huge relief.
Yeah. You’re in the driver’s seat. And I think the other thing too is a lot of health is an investigation. So a lot of people, I mean I work as a dietician in private practice as well, and a lot of people want a yes or no answer. So, for example, they come in, they want to lose weight and then they’ll say “Okay, with these strategies we’ve spoken about today, am I going to lose two kilos a week for the next 10 weeks?”, or whatever it is. And I just think “Well, we don’t even know if you’re going to lose one kilo. We have to just try this, give it our all, and if it doesn’t work, that’s okay because at least we’ve tried it and then we’ll try something else or we’ll tweak it”.
And we are constantly investigating, and we are constantly individualizing until we find something that does work, and I think that is lacking a little bit in the standard healthcare system. People always like a good one size fits all – if you want to lose weight, this is the diet use, if you’ve got Type 1 Diabetes, this is the diet you use, if you’ve got IBD (inflammatory bowel disease) this is the Diet you use.
I think we need to kind of step back a little bit and we need to break diets down into strategies. So, if we broke the low carb, high fat diet down into strategies, one of the strategies might just be to reduce your intake of processed foods. And that’s one strategy and we haven’t even spoken about carbohydrate. The person or the individual will go off and they’ll do that, maybe they’ll do that for a couple of months and maybe that’s all they do, maybe they will see some positive health improvements, maybe they won’t.
But then they’ve mastered that one strategy and it’s now become a habit, and we haven’t labeled it with anything, we haven’t called it Keto, we haven’t called it low carb, we haven’t called it Paleo, but we’ve made an improvement. And then the next one might be, okay, well let’s think about reducing your carbohydrate intake, let’s just cut it down by half, or let’s just get rid of the carbs at one meal of the day, or something like that. And maybe that’s what they then try on next, and they do that for a while.
I think that layering of strategies is going to be far more effective than just saying, okay, well here’s the Keto Diet, or here’s the Paleo Diet, or here’s the Vegan Diet. It’s a “Which one do you want to do?” kind of thing. I think we do need to get everyone involved really, particularly the person that’s actually going to go away and do the diet. They need to create their own diet using these different strategies that the health professional offers them, and we’re seeing a lot of that actually. What we’re seeing more of in the scientific literature is where studies will investigate more personalized approaches.
So, for example, I’m doing a systematic review at the moment, I’m looking at all low carbohydrate diet interventions for Type 2 Diabetes and that’s going to help me build a protocol for my Type 1 Diabetes research. But basically there are some studies out there that will just say, okay, well our dietary intervention is just 75 grams of carbohydrate per day for every single participant no matter what. Full Stop. And there’s no individualization, there’s no flexibility, there’s no changing of that carbohydrate description after a few weeks or anything like that. Whereas there’s other studies that will base the carbohydrate prescription on the individual’s progress.
So, for example, we can take the recent study by Steve Phinney and Sarah Halberg, the Virta Health study where they didn’t just say “Okay, well here’s a set carbohydrate prescription of 30 grams”. They actually sort of started between this range of 20 to 50 grams, but then individualized everybody’s carbohydrate prescription based on whether or not they could get those therapeutic levels of ketones, and then other studies have done the same thing based on glucose levels as opposed to ketones.
I really like that because I think that that says “Okay, well, yeah, we may have to go really low carb at the beginning to help you sort of get to where you need to be”. But based on your progress towards your goals, whether it’s glycemic control, whether it’s weight reduction, whether it’s high levels of Ketones, whatever, we can actually be flexible in how much carbs you have, how much fat you have, how much protein you have. And again, as we were saying before, it puts the individual back in the driver’s seat and, if they want to reach those goals, it’s their health and if they want to reach those goals, they have the power and capacity to do that.
Oh, I can’t agree with that enough. I know it’s one of the things I just bang on about all the time about making this work for you, not the other way around. It’s not you who’s got to find a way to fit with some prescriptive version of the Keto Diet that you’ve been told. You know exactly what your macros should be for the day, exactly what you should and exactly what you shouldn’t be eating. And there is a lot of virtue in taking some kind of plan just to get started because you know there’s so much information out there and it’s very difficult to know what’s going to suit you until you try something.
So, you’ve got to really take some kind of plan to get yourself going and get into the swing of it. But I really encourage people to find what works for them. I think it’s so important and that’s part of the whole empowering side of it is that there will be a version that is perfect for you. It might be super low carb, it might be that you’re on the higher and you found that works for you. Carb ups might work for you. Carb ups might be the worst possible thing you could do. More protein, less fat, more fat, less protein. There are so many variables that there is going to be a perfect set up just for you.
I agree with that too, and your own health goals are going to change throughout life as well and your metabolic health is going to change, which means your diet can change as well potentially. And I think of using myself as an example. When I first went from being overweight and having a problem with binge eating and the loss of control, then moving over to a low carbohydrate, high fat diet where I was able to eat a lot of fat and keep my glucose stable and not have any binges.
When I first moved over to that space, if I were to have something that was carbohydrate dense, that would just be very, very negative for me, that would cause me to get those feelings that I was going to binge, I’d get anxious, I wouldn’t feel good, and I’d potentially be at risk of losing control and all of that. And that was at the beginning of my journey with low carb, high fat eating. But now it’s been many years since then and I can have some more carbohydrate on occasion.
It’s Christmas time at the moment, and the other night we had a Christmas party and I had a dessert. It was actually a really beautiful mango Mousse, you know? No, it wasn’t Keto. It was made with sugar. It had a lot of mangoes in it, and it’s not something I eat every day. It was something that I was doing because it was Christmas and I made that conscious decision I was going to have some and I felt really, really good after. I didn’t get those feelings like I was going to lose control or I was getting anxious or anything like that. And that’s because now I’m at a different stage of my health journey where my whole metabolic system and my mental health is so different to what it was five years ago. So my diet can be different to reflect that as well. And I think that a lot of people would find that they also had their own similar experiences, but maybe with different examples.
Yes, exactly. And yes, it just depends, doesn’t it? I mean, I did, I did a similar thing on my birthday and I didn’t even eat the whole dessert. It was actually a bit too sweet, but, I had some of it, and I actually woke up feeling awful and it reminded me how eating that kind of food can make me feel. And I felt miserable that day, that depression, it’s sort of come in full force and I thought, oh, this is not nice feeling like this. So, I’ve made a real conscious decision. It’s going to be easier this year. I’m on my own at Christmas and really, I’ve just got too much to do to spend days feeling like that. So I’ve made a conscious decision not to have any of those foods.
And I went to a Christmas party. Oh. And I was very lucky, actually, the guy who’d done it, and he’d done all the cooking, and there were so many Keto things on that table of food. It was fantastic. Yes, there were crackers and carby type things, but there was a lovely plate of chopped vegetables that we could use for the dips and the things that the dips were – there was a lovely chicken pate, there were some fatty type dips- and it was actually perfectly easy to stay completely compliant. I had a nice time, had a couple of glasses of wine and didn’t feel awful the next day.
That’s wonderful. And that sounds like an amazing little Christmas space there. That’s a good point as well what you say because a lot of people will say “Can I go out and have Chinese or can I have rice?”. They’re always wanting to go and have something that they used to have and they used to enjoy. And sometimes the answer should just be, well, if you really want to do it, just think about what it’s going to mean for your metabolism and what it’s going to mean for the progress towards your goals. So, for example, if your goal is to lose weight and you want to go out and have some Chinese with fried chicken and fried rice or something like that, then maybe your progress towards losing weight is going to be slightly slower. But as long as you’re aware of that, that’s okay.
And so some people will then go “Oh yeah, well no, I don’t want to do that”. And when they relate it back to them and what they want, it’s not like I’m not sitting here going “Yes, you can. No, you can’t” for any benefit of my own, it’s all for the individual. And when they just reframe it like that and they say “Oh, it is actually my choice. The more I do things like that, like have something that’s carbohydrate dense or something that I know is going to spike my insulin levels, the slower it’s going to take me to lose weight and I don’t want that to happen”.
Alternatively, people might be okay with slow progress and they want to make things a bit more flexible. And a lot of people, just like what you say happened to you, will go and have something that they’ve cut out of their diet for a while and when they put it back in, they’re just like “Whoa, I don’t feel good eating that food because all of a sudden that metabolism has stopped because the insulin has spiked and the body has to rely on glucose until we can get back into that fat burning state and inflammation levels are higher and there’s a lot of other things going on”. But of course, you’re going to feel different.
Your whole body is using a different fuel source that it doesn’t like anymore. And so even that can actually be a positive thing for people because then they say “Well, I don’t want to do that again. You know, I tried the chocolate cake and I don’t want to go back”. So that’s a really important part in people’s journeys as well because then it comes again, back to what you said- I’m making the conscious decision this Christmas where it’s technically the hardest time of year for everybody to stay “healthy” and you’re doing it easy because you know that you don’t want to feel bad and you don’t want to feel sluggish and you want to feel good and you want to celebrate this season. And I think that’s what we should all be striving for.
Exactly. I think it can be a very useful learning experience. And I always say to people, if they’ve, slipped up and fallen face first into the chocolate cake spontaneously or people who are actually considering it for a particular event or something and asking advice what they should do. I know I say, “Really, please, whatever you do, don’t pile on the guilt and beat yourself up about it. Don’t go down that route because that is just going to waste your time. Just be mindful of it. Be mindful of the experience and approach it as something that you’re going to learn from. And be very mindful in the moment. I was mindful in the moment of eating that dessert and thinking, wow, this is actually really sweet.
So you were saying about something people often want to try again, something that they used to really enjoy, if they’re really mindful in the moment of having that thing again, 9 times out of 10 they’ll probably realize actually they don’t enjoy it as much now as they used to. They’ve had it up on the pedestal all this time for something they’ve been diligently avoiding. Now it’s in front of them and they’re eating it, it doesn’t taste as good as it used to, or perhaps it did and you enjoy and you see what happens as a result of that -you might find that you are metabolically much more flexible and you deal with it fine and you decide it’s something you’re going to do every now and then. Or you wake up like I did feeling awful and think “That’s a really good reminder of why I’ve been avoiding this kind of thing because I just, I just don’t want to feel bad. Thanks”. But either way, whichever way you look at it and whatever the outcome is, it’s really valuable to learn from it.
I love that. I think this is such an important conversation because it’s basically, 50% of my job as a private practice dietician is trying to help people understand this, that everything is a learning experience and as long as you are mindful about it and you take something away from it and learn from it, then it’s always going to be positive. It doesn’t matter what your decision is, it’s always going to be a positive one. And that’s why I think now, I would never be able to go back to the person that I was and make the food choices that I made when I was in the midst of my disordered eating because I’m too mindful now and I learn from every single experience that I have. And I’m still on my health journey.
There are times where potentially I’ve over eaten and my stomach is bloated and my pants don’t fit me or whatever it is. But I just go “You know what? I enjoyed that. I’m really full, maybe a bit too much, maybe next time I’ll think about not eating so much that my pants won’t fit, but it’s okay, it’s alright. The food’s going to digest, I’ll be fine.” You know, just whatever, I get over it. And before when I was in the midst of disordered eating, that sort of feeling where your belly is full and bloated is what gave me the worst panic attacks and the worst anxiety. And so now it’s just so different, and being mindful is one of the biggest things that has helped me overcome that I guess, in combination with better nutrition because there is a difference. And you may have had a similar experience, I don’t know, but there is a difference from how you feel when you’ve overeaten a ton of carbohydrate dense foods with how you feel when you’ve overeaten a ton of low carb, high fat.
Oh, for sure.
It’s very different. What, one of them is almost like you’re kind of high, when you’ve eaten a lot of carbohydrates, I guess you’ve got a lot of glucose in the system and you’ve got that feeling of being high, the high blood sugars and just unwell in the head and the body and feeling bloated and heavy and all of that. But then when you’ve eaten or you’ve overeaten too much high fat, lower carb foods, you do get that fullness. But that’s usually just it your mind is still the same and your mood doesn’t change necessarily.
That’s exactly it. You’ve literally just eaten too much and it’s like you were saying, you have to loosen the belt. Maybe undo your jeans. Yeah, but, but that’s it. You don’t have all the other things that go with it, like maybe feeling dizzy or sick or all the other things that, like you say, when you start messing around with, with your blood sugar that make you feel, yeah, really not good.
And it also usually means that in the four, five, six hours after you’re feeling that way you’re not going to eat anything. Whereas, I remember I used to have a binge on 5,000 or 10,000 calories worth of low fat, high carb foods and I’d feel horrendous. But then two hours later I’d be ready to do it all again because I’d be starving hungry. That’s another really important message as well. If you’re going to overeat, make it high fat, low carb.
It could be a helpful strategy for Christmas coming up because we know there’s always too much food and it’s okay to have days where you’ve eaten too many calories or something like that. It’s okay, we are going to have those days where it’s higher calorie because the appetite’s high or, or something’s going on and then we’re hopefully going to be balancing those out naturally with days where we’re busier and don’t have as much time to eat and we’re eating lower calories.
So, I don’t think we need to overcomplicate things, but really having that intuition to be able to say, I’m hungry, I’m going to eat now or I’m full, I’m not going to eat or I’m not hungry I’m not going to eat that, that’s really important as well. And that’s not something you can necessarily teach yourself either. I think that actually comes through getting your metabolism right, through good nutrition and healthy lifestyle principles as well.
Megan Ramos actually has it as a fantastic strategy for if you’re making that conscious decision, to have some of those high carbohydrate things – leave them to the end of the meal. And for me it is usually the dessert. It’s relatively easy here in France to make pretty good Keto decisions from the menu, and I can have something like, I had a set menu the other day and the first course was a goat’s cheese and ham tart with some pastry and it was very easy for me just to scrape off the ham and the cheese and eat that with the salad and just leave the pastry to one side. That was really easy to do.
It gets a bit more difficult when it gets to the other end and it’s the dessert. But what she says is you fill yourself up on the Keto foods so you don’t have much room left. And the example she uses, which has always been something I love too, with a roast dinner, is roasted potatoes, and she could just eat so many of those if she had them at the start of the meal. But by putting them at the end, she can literally only manage one or two. And so you still get to have it if you want to. You might decide by the time you get there you don’t, but you can still have it. But you really minimize the impact it has purely by not being able to eat much of it. I love that. I think that’s a really a really good tip to, to fill up on the lovely Keto foods first. And so literally not leave much room.
I love that tip as well because again, it’s putting the individual back in the driver’s seat and letting them make that conscious decision. Yeah. So that’s not a bad tip for the festive season coming up. And I think that is partly how I was able to overcome a lot of my binge eating because the urge to want to binge and overeat wasn’t something I could just switch off. It took a while for that to settle and for me to have control over that. But, um, the way that I really helped myself get out of that was just by over fatting. So, I want all the time. No, it is like, it is a really important part in some of our journeys. And it was for me, I had to just really go crazy with the butter, the cheese, the cream, which so many people online would be like, oh my God, too many calories, blah, blah blah.
But my initial priority at that time, or my first priority was to stop the binge eating. It wasn’t necessarily to lose weight at that point. Um, and so I remember I was really diving into the sort of like fat bomb type recipes, like the Keto ice cream. Um, and they, uh, what are some other things I was doing just like real cheesy sauces and butter sauce on every single thing I was having and just drowning my plate with coconut oil. Um, I remembered that when I was eating dinner. It would just, the whole table would just be covered in oil after because I just have to put on so much.
So, then I couldn’t possibly want to have, a binge on something after. And it really, really worked. I mean, yeah, I was overeating calories, but I was at least, I was doing it in a way that was able to keep my glucose and insulin stable, and then that allowed me to really just break free from the toxic dieting cycle. Um, and that over fatting term, I actually use it for people to help them to get into ketosis as well. If they’re trying to get into nutritional ketosis, even if they don’t have issues with binge eating, um, but they’re chronic calorie restrictors or people that have been avoiding fat for a long time. sometimes the body won’t get into that state of nutritional ketosis if it’s feeling stressed because you’re not giving it up enough calories from fat.
That’s a very common thing for people that are just pro dieters and they’re just like, Yep, got this. I can lower the carbs super easy. Yup, I’ll have fun. I’ll have protein, but just not have enough food or enough energy from fat. They just may never get into ketosis. And then they’re sitting in that sort of state where they’re not quite burning fat for fuel, but they’re not quite burning carbs or giving themselves, enough carbs and they just feel absolutely terrible.
So we go through our initial stage of over fatting, which a lot of people love and a lot of people are so afraid of as well. Um, but we go through that initial stage of over fatting and the goal isn’t in that time to lose a whole bunch of weight. Um, but the goal is to help the body burn fat for fuel and teach it to burn fat for fuel. And then once we’ve done that, we can go, all right, so now let’s tune into those hunger and satiety signals and pull back on the fat or the food if we need to.
It’s really difficult isn’t it? Because so many people approach it from a weight loss perspective and it’s really helpful to switch that perspective, especially initially to an improving your health perspective. Maybe there are no health issues at all and the only thing that you need to do is to lose a bit of weight. But it’s, it’s pretty rare. There are usually, there are other things that that come with it. And I loved what you were saying that your approach to start with was regaining control with the binge eating and nothing else mattered. Because once you could get a handle on that, then you could start getting everything else to fall into place. If you were overly panicked at that point that everything had gone completely wrong, if you gained a pound or two, there’s no way you would have stuck with it. So, I do think it’s really important to get your priorities straight.
Yeah. Prioritize your health goals and then prioritize your strategies as well. Especially with the new year approaching, people are wanting to just jump headfirst into these diets that they believe are the perfect diet for a perfect life and perfect health. Um, but it’s, it’s, you’re going to hit a position where you can’t execute that diet perfectly, whether it’s an event, um, or you go out for dinner or something happens at work and, and do you feel like you need to go get ice cream? Whatever it is, there is going to be something that comes along where you can’t execute that diet perfectly.
And if you have your priorities, where maybe your very top priority is to be gluten free, let’s say it should be gluten free because you have an issue with metabolizing gluten for example, then if nothing less, you achieve that number one goal. You stay gluten free. Even if you end up eating sugar or more carbohydrates or damaged fats or whatever it is, as long as you stay gluten free, then it’s like, okay, cool. I’m still progressing. I’m in the driver’s seat, I’m still in control in control. Oh, you might have a different goal that you’ve prioritized or whatever it may be. But I think that’s important as well, that keeps it unique, that keeps people on path. Because going on and off the “diet” is a part of the Diet.
It’s about the process isn’t it?
Yeah. There may be some things that are just complete non negotiables for you. Like in that example it was gluten that was a non negotiable and then there’s other things that are slightly flexible. But at the end of the day, that’s how we create the perfect diet by having those points of flexibility within the diet as well.
Exactly. I think we spoke about being mindful of what you’re eating, mindful of how you feel, all those kinds of things. I think it’s also really important to be mindful of your personality and what your like in your approach. I find Gretchen Rubin’s Four Tendencies fascinating. And knowing yourself is really helpful in knowing what kind of approach is going to work. Some people love rigid guidelines, they find it very easy to adhere to that, and they like accountability, and so following a really strict plan is going to work really well for them.
Someone like me who has a rebel tendency, strong overlap with questioning tendency, I just push against that the whole time, always pushing against it. So the kind of approach that I was talking about going into the meal and allowing yourself to have something if you want it, not putting down those rigid guidelines “you can’t do this” or “you can’t do that”. As soon as someone tells me what to do, and that includes me, my first instinctive reaction is, “hell no, I’m not going to do that, in fact, what I’m probably going to do is the complete opposite of what you just said”. That is my gut instinct reaction to anybody telling me, trying to impose what I should do. Whereas for somebody else, it’s going to work really well. So I think it’s really important to know yourself and how you react to change.
I love that you brought that up because it relates to my own practice, but also to the research as well in low carbohydrate diets. Just as you were saying, I love to find out when I first meet somebody in practice, are they a moderator or are they an abstainer, and actually get them to identify that for the different types foods that we’re talking about. So, alcohol is a big one where I like to say to people “Okay, are you a moderator or are you an abstainer?”. And some people will just know straight away “Oh, I’m an abstainer. It’s all or nothing. I’m either going to have a bottle of wine a night or I’m going to have nothing”.
And then they’ve just created their own strategy for them, when they are ready to look at alcohol as a strategy, then they can go “Okay, Yep, I know it’s just all or nothing for me and I’m just going to completely get rid of it”. Alternatively, they may be someone who’s just doing four glasses of wine a night and that’s something that they want to prioritize as on improving. And so they say “You know what, I’m a moderator. I can bring it down to two glasses of wine a night and I can have an alcohol free night on the weekend”. And for them that’s okay.
And by having that sort of approach, they’re more likely to go off and actually do that because if we didn’t find out if there are moderators are abstainers and we just said “Okay, now you’ve got to cut that wine back to, just having it three nights a week, two glasses of wine, whatever the guidelines are for alcohol intake. But if they’re an abstainer that makes no sense to them, they can’t, they’ll try and have one or two glasses and it will just lead to the whole bottle or more of the wine.
But if they actually were able to recognize that they were abstainer and actually just say “You know what, if I’m going to be improving my alcohol intake, I’ve just got to get rid of it and that’s what’s going to work for me”. It might be hard at the beginning, but really it’s going to be better for them in the long run, and it’s a decision that they’ve made. And the way this ties into the low carb literature is that we have this massive issue in nutrition science, and it’s not just on low carbohydrate diets, it’s an issue of compliance and noncompliance.
So, we could have this great big study and we have 150 people and we put them on a diet, let’s say it’s the Mediterranean Diet, and we might have 80% of those people that just don’t do what the prescribed diet was. So, it might be to eat x amount of fish per week, it might be to have 40% carbohydrate, it might be to have low fat, whatever. But if the Diet doesn’t work for that particular person or they don’t make sense of it or the way it’s delivered to them is wrong, then they may just not do it. They might not do what they were told, they may do a completely different diet or something. Then we are trying to make conclusions based on the prescription as opposed to “what did they actually end up eating?”. So a lot of nutrition research makes its conclusions based on the prescribed diet whereas some will factor in compliance and ask “Okay, well what did they actually eat?” and not go on to analyze the results according to what they actually ate.
Everything’s always about the prescribed diet. And I mean, I don’t know if there’s one way that’s better than the other, but I think what we should be doing is going “well how can we improve compliance?”. I think that is the thing we should be looking at in the nutrition research and little things like what we’re talking about today like individualizing it to the person, bringing in the behavioral strategies, having flexible prescriptions as opposed to a one size fits all. Those things could be the things that help us improve compliance.
And maybe this extends to other diets as well. So maybe it’s not just the low carb diet where we can improve compliance but others. So then it comes back to that question while if you want to do a different diet, if you want to do a vegetarian diet or a low fat diet or whatever, we can help you do it. So there are people out there that want to do those other forms of the diets and that’s okay. We’ve got to think of these strategies to actually help people stay compliant – finding out their personality type and finding out their social history. Can they cook? Who do they live with? What is their job like? Are they under pressure and under stress? Do they get sunlight? All of these things make a difference to people’s diets and which diet they should be recommended as well.
Exactly. It’s so variable and asking those questions of the participant, finding out why things didn’t work well for them can be so useful. I think this has been a fantastic conversation and I think very timely in the new year – like you mentioned before about people often set themselves up with all these goals that are quite often unachievable in the New Year. So, really getting to grips with understanding yourself and what might work for you might be the best goal you can have to start with. Maybe you could give us a top tip to kick off the New Year with.
I’m glad you asked that because I was just about to say my top tip before you asked and then I would’ve had to come up with another one! So my tip today is to really know your “Why” every time you make a decision. Let’s say for example, it’s the New Year and you want to do this low carbohydrate, high fat diet thing. Cool. No worries. Just know why you’re doing it.
Every strategy you implement, whether it be reducing processed foods, whether it be increasing your fish intake, whether it be choosing wild caught, whatever it is, always know your “Why”. Come back to that reason why you as the individual are making that choice. Because all too often I see people just looking up what they should be doing online, seeing what other people are doing and going “Oh, I have to do that. That person is doing a 24 hour fast, now I have to do it”, and that’s not the case.
Not everybody needs to fast, not everybody needs to do Keto, not everybody needs to do to all these things that we’re seeing online. So really saying, “Well, why am I doing those things?’, and if I have a valid reason as to why and I think that strategy is going to work for me, then I’ll do it and that’s fine. So that’s probably the most common word that comes out of my math in clinical practice is “Why”. Why do you want to do that? Because all the time people are printing things off the Internet and saying, “Well, my friend is doing this, should I be doing a five day fast?” and all of that. And everything’s got a potential benefit to it. And it’s that investigation, if you want to try something, okay, let’s try it, but we need to know why you’re trying it and not just because so and so online is doing it.
Perfect. Well thank you so much. It’s been wonderful catching up with you. I’ve really enjoyed it.
It’s been great. And we were having a few issues with this recording because the cicadas at my place were so loud, so I’m glad that they have been nice to us tonight and really shut up in Australia. There’s always these problems with the noisy wildlife, so we’ve been lucky tonight.
Well thank you and I, and I hope it’s a fantastic year, for you.
Daisy’s latest extraordinary woman, Jessica, returns to the podcast to chat with Daisy about her year on the low-carb conference circuit, her thriving nutrition practice and her PhD research. She sure has been busy!
Jessica is an Accredited Practising Dietitian and PhD Candidate based in Sydney, Australia. In early 2018, she published the first systematic review of all low-carbohydrate diets for Type 1 Diabetes management. To further contribute to this area of science, she plans to conduct a primary clinical trial as part of her PhD.
Jessica’s passion and drive for nutrition not only stems from her love of science, it has also been influenced by her own health journey. During her teenage years and adolescence, Jessica was completely sucked into the toxic dieting cycle and experienced many years of disordered eating. At University, she was lucky enough to learn about the fundamentals of human biochemistry, including the role of dietary carbohydrate in glycaemic control and fuel utilisation. She quickly put the pieces of the puzzle together and started implementing a low-carbohydrate, high-fat ketogenic diet in her own life. Within just months, Jessica rekindled her love for food, nutrition and health and broke free from the toxic dieting cycle for good.
Jessica has made a commitment to empower as many people as she can with the knowledge, skills and support to experience “Food Freedom” for life. Jessica is the Founder of Ellipse Health and enjoys working with clients all over Australia and internationally via phone and Skype.
This transcript is brought to you thanks to the hard work of Trish Roberts.
Welcome back Annette to the Keto Woman podcast and another episode of ask Dr Boz. We got another long list of questions here. See how many we can get through today. How are you doing today?
I am doing great. Thanks again for having me. Again, I just love your audience. They have been, some of the most engaged and ask amazing questions. So thanks for letting me participate and use this as a remarkable teaching opportunity.
Well we’re not going to take up time with catching up with me this time. We’re just going to dive straight into the listener questions. You’ll be pleased to hear at home listeners. Okay, so let’s start with Louise. Yes, my mate, Louise Reynolds who surprised me recently. Some of you who, in my Facebook group, who see me on social media, will know recently how she… She was very scheming and she said she was planning to come down and surprise me with a visit. And when I opened my front door, it ended up to be none other than Richard Morris. One of the 2 Keto Dudes. It blew me away. I opened the door, my outside light wasn’t working, so I’m peering out into the darkness, and this voice comes back, hello Daisy. That’s not Louise.
She really did do a good job because she was consistent throughout. She gave me all these updates about her journey, how she’d been held up here, and held up there, and how the flight was going. Incredible. She did a very good job. So maybe the top tip to take away from that is, don’t always trust Louise Reynolds.
Or trust her with a really good secret.
Exactly – no, a very good friend. And it’s very typical of her to spend a lot of time and a great deal of effort in doing something…planning something really nice for somebody else. That’s very typical of her. So it’s nice to start off with a question from her.
So Louise says, as an older woman, she says…she’s not so old…I’ve been working out lifting weights with the aim of further reducing body fat, trying to maintain 130 pound weight loss…we are actually weight loss twins, we both had weight loss surgery, we both had a very similar journey, we have lots in common…and she wants to improve muscle tone. While I’m lifting heavier weights, she uses the Stronglifts 5×5 app, so she’s been tracking it – which you’ll be pleased to hear – the scales now say I have gained 10 pounds since May, while my waist is still the same – my belt hasn’t changed. Is this weight gain muscle? This doesn’t make sense as I’m not looking Herculean and still have flabby jiggly bits. She doesn’t have so many flabby jiggly bits.
That’s beautiful because it is this process of when our bodies lose weight…I do a lot of education on igniting your autophagy and just that recycling of tissue, so 130 pound weight loss is amazing. Congratulations. That is a huge mark. I will tell you that in the course of internal medicine care for two decades, I can tell you there’re only a handful of people that I’ve ever helped lose that much weight. And prior to the keto journey over the last couple of years, it was incredibly intense exercise, and they mostly gained it all back. So I just want to say congratulations for losing it and really igniting your metabolism to be able to keep it off. So the question really centers around, doc what’s happening on the inside? So I’m just going to assume that these 130 pounds were off by May. So she was at that 130 mark, and really has been kind of plateaued, and looks like maybe even gained about 10 pounds since May.
Oh yes, she’s actually lost that weight and maintained it for, I don’t know exactly how many years, but at least several years before that.
If she was my patient, what I would first do is a little bit of studying. Because the weight gain on a ketogenic diet…people say I’m skinny, should I be on a ketogenic diet, I don’t want to lose weight. There’s an equation here that as much as we talk about calories aren’t the most important, they still do weigh in, especially once your body has stabilized. I don’t mean the amount of calories as much as I mean the timing of your calories. When you look at 130 pound weight loss, and then her body kind of just holds in this pattern, and really resets. You can make the argument that in many ways there’s a psychological component that says they got to this level, they kind of are able to say thanks…thankfulness, almost relaxed, like look at how much better my life is.
And now she’s been there for you say a better part of a year and is saying, I wonder if I can take it to a new level – a new level of health. And again, I commend her. When you’ve got that big of an accomplishment, and you just hold the zone of making sure all of your behavior changes are solid – that you do predictably get your good rest, and eat a ketogenic diet. Great. So now let’s bio hack where she is right now. The first thing I would do is actually I would tell her to go do a DEXA scan. Most insurances…she lives in the United States, right?
No, actually she’s Australian, but she’s in the United Kingdom working and living. Now I happen to know that she has had DEXA scans, and I’m not entirely sure what the results were with that, but I know she has had them. So if that tells her anything, she will know that already, so I’m assuming that’s not too much of a factor.
That’s perfect. Because again, what we’re looking for is, how do we take out the noise of weight and get to the…what is the body’s makeup of where the weight’s coming from? The first thing that I look at in older women that go to a ketogenic diet is, I’ve been impressed with how quickly their bone density increases. And that bone density is from these fat-based hormones that on a low fat diet, they really are difficult to push the hormones high enough to spark that bone growth. Again, they’re all based out of cholesterol and fat, and so on a low fat diet many times they are lower than they should be. They get onto a ketogenic diet. The weight loss happens. But what’s really happening that’s exciting for me to watch is the brain repair that’s happening, the coating of the neurons with a more dense fat around all their nerves. That’s a slow process. It does not happen overnight, but it is amazing how much better their system works electrically – meaning the brain, neuro conduction, and the nerves. And then finally to watch what happens with the bone density – that a ketogenic diet produces enough of the hormones, one of those being your growth hormone. And as you age that’s supposed to go down. But I will show you that the studies have seen that you can see a rise in that growth hormone if you ignite the process of a ketogenic diet.
What I mean by that is there are some rules. So Louise, I would want to know what time you wake up in the morning and then that wake up time will give me a pretty good guess that your circadian rhythm is hopefully matching the light hours. And I know I talked about this a lot in the last episode I did, but I just want to quickly remind you…if you wake up at six o’clock in the morning, and you put that cup of coffee in, And the coffee may be black, and I count that as fasting – I’m talking about me. But if you’re looking at the process of igniting a weight loss, or getting off of a plateau, or in Louise’s case, I would be wondering, have we been pushing her growth hormone, and spiking and valleying her growth hormone, to improve her bone density?
That weightlifting could be turning into some improved muscle mass – which you say, is that Herculean or not…but a DEXA scan would be able to tell us. So we want to say what time she get up in the morning, what time does a cup of coffee go in? And then how long does she eat for? Like, what is her time that she spends eating? And if she snacks all the way until bedtime, like oh I only ate twice today, but I had a handful of macadamia nuts at six o’clock, and then I had a little glass of kombucha at 8:30 last night…the calories that are going in are too spread out, and her history of being that overweight is going to lock down that reset. Like she’s going to stay stuck at this level until she’s resets her system.
Okay. I do have some answers for you because I happen to know Louise quite well. One thing I was going to ask you about though was the DEXA scan, because I have heard that that can be variable in how accurate it is, especially when it comes to differentiating between fat mass and muscle mass. Presumably it can be more accurate with bone density. And I think it’s interesting actually…I mean, people joke around, don’t they…saying, oh you know, I weigh x amount because I’m heavy boned. But it’s interesting that you could actually increase some of your weight with the bone density. That is one thing. And with the muscle mass as well. So I happen to know that she is not like me. She’s not really a snacker, and I think she quite often possibly just eats once a day.
She does tend to be very low-carb, verging on carnivore – she calls herself lazy carnivore. I know she sometimes does have a little bit of chocolate and some dairy, but very, very low-carb – often one meal a day. She’s not really a snacker. I do happen to know though that her sleep is bad because for a couple of different reasons – she is often having to be up late at night talking to a partner in Australia, and again early in the morning. She does some consults with students, quite often really early in the morning – it can be five, six o’clock in the morning. So I know that she very often doesn’t get enough sleep, so that potentially is a factor. But presumably all this weightlifting she’s been doing, that’s going to improve the bone density, and obviously the muscle mass as well.
Well, what I would contend is that she’s doing the right activity to increase her bone density and her muscle mass, as long as her hormones aren’t fighting her. That steadily elevated cortisol level, which is your stress hormone, it really resets during the sleep hours. So if her sleep is a little goofy, I would try to figure out a schedule that protects her sleep better. The other part that I would have her do would be…what is her morning fasting sugar and ketone levels when she first wakes up. What is that ratio? I would love to know what her insulin level is, but that’s going to be a blood test and a doctor’s visit, and then insulin’s goofy so you should do it a few times to know that you get it right because so many variables go into it. And it’s pretty darn expensive. The best next estimate of whether her insulin is low, would be to look at whether her blood sugar get into those 70s in the morning, maybe even 60s sometimes.
Yes, I think so. I think she does tend to be, yes, have nice low numbers actually with her blood sugar. And I think her ketones…I know she measures, so she could certainly give you those numbers.
And do you think are ketones are pretty good in the morning? Her blood ketones?
Yes, I have a feeling that she complains that they’re not as high as she maybe thinks they should be, or would like them to be, but I know her blood sugar’s always down. They’re certainly well into that range that is quoted as being the range they need to be in. But I think sometimes she wonders why they aren’t perhaps a little bit higher. But as we know, it’s not always a numbers game. You don’t have to hit certain numbers. Different people have different levels, don’t they? That’s ideal for them depending, to a certain extent, how much you’re using them.
Right. So if she’s got this weightlifting process that she’s doing, what I would have her do is, I’d want her to hit a ratio of 40 or less. So let’s say she’s testing her blood sugars and her blood sugars are, 60 or 75 and if her ketones are less than one, so 0.9 0.8; that’s going to put her ratio above a hundred, or in the high nineties to 100 depending on what her sugar is. So to say, well how can we increase that ketone? And this is where I would put, if in fact she’s got nice low blood sugars but her ketone numbers are lower, then I would push her to fast longer. Like give me once a week – and this is what I do – I start on Sunday so she can watch me on social media, and then I fast until I hit a ratio of 40. Now in patients who are really sick, if I’m really fighting an autoimmune process, I want them to hit a 40 every morning in that ratio of taking their blood glucose and dividing it by the ketones.
That’s what I’ve seen – we could see the improvement when they did that. If you have a situation like this where she’s doing pretty good activity and saying, I wonder why the weight’s going up, I would at least hit 40 two mornings a week. It might be that you say, I’m going to fast for 36 hours. Or maybe don’t put a timer on the fast, as much as you put the bio-markers where you said, okay, your body hit our goal. And what you’ll see is if she does this week after week after week, even just hitting it once, you’re going to see about the second month that she realizes what hours it takes for her system to empty, meaning the glucose to go down, and the ketones to rise. And of course that’s where the cognitive function is better. They feel better. I would push her to check that ratio in conjunction with what her story is.
The other number that I would check is, I would love to know what is her blood sugar / ketone ratio after she works out. So again, the demand for energy is higher when they work out. I work out in the morning and when I check my blood sugars before the workout and after the workout, my blood sugars go up and my ketones go down while I work out. And I think it’s been very teachable understanding of my own body to say, yes, I’ve taught my system that we use ketones to…I’m talking about myself in the plural…I use ketones to fuel my body during that workout and my body is adapted in a way that it can do that. And I think especially as long as she’s been keto that I bet she’s doing the same thing, which is a good sign.
But that confidence that what you’re doing inside the muscle – inside the body – your sugar will probably go up, your ketones go down. But check it. See what happens while you work out. And I just think those kind of bio-markers help understand why is the weight going up. If you want that weight to go down, if you’re really looking for the next level, at least get the numbers below 80. But if you’re looking for any type of like remodeling, like getting autophagy to not have the flabby skin and all this stuff that there is pretty good evidence about. We can’t send you to the lab to check your autophagy, but we can have you look at these ratios, and those are in your home. And I would push her to at least hit 40 twice a week. So fast long enough to get to 40 twice a week, and then the rest of the time try to stay under 80.
Oh, she’ll take that on board, I think. She has a very acute scientific mind and so she’ll see it as a project and we’ll collect the data. Yes, I think that will appeal to her a lot. I can see her doing that and I’ll get some feedback and find out what happens.
Okay. The next question is from Siobhan. You’ve mentioned, she says, concerns over low ferritin. It’s one of your favorite topics, isn’t it? How low is too low? Mine tends to run low, eg around 45 to 80 regardless of whether I’m eating chicken or pork or entirely red meat – several pounds of red meat a day. Could this be related to other problems I’m not aware of, like folate deficiency or is it not something you’d worry about with yourself if you are asymptomatic?
Well, so let’s go back to why ferritin is such an important marker for me. I talk about brain performance and have quite a lot of patients that have had depression, or just slower mental processing because of trauma. It can be emotional trauma or physical trauma. So repairing brains is a very big part of how well their whole life does. Ferritin is one of those markers that you can’t make some of the nerve, the brain hormones like the neurochemistry without iron being around. And ferritin is a little bus that runs around and delivers the iron. If ferritin is too low, the lowest I’ve seen is not measurable – like less than four. They were like zombies. Their brains were just turned off. Their speech was quiet. They couldn’t articulate. The ferritin and iron goes back into their system, and bam! At least the brain is awake.
When somebody comes in and their ferritin is below 30, I do a really strong education to say, the fastest way to get this iron above…the minimum that I like to see patients at is 50. Between 50 and 150 is a good level If it’s below 30, I’m really going to talk to them about liver – braunschweiger, liverwurst – whatever way they want to do it, and just how powerful that iron replacement is compared to elemental iron. Iron supplements are another great option. They just take a lot longer and you don’t absorb as much. When they get below 20, I actually push them to go get iron put in their vein because it’s going to take us so long to get from a low iron, that’s that low – like in the teens. First of all, their brain’s not going to focus long enough to keep doing what I tell them to do. They just can’t. And it is 2018. This has been around for a while. You can go in and get iron put into your vein, and what would take you six months of iron tablets to replace, I can do with a two to three minute infusion. That’s not overly expensive unless you go to and infusion center and then I’ve seen it cost like $2,000. If you just get it as an IV push in a clinic, it’s pretty cheap. However, too low is anything below 30, I’m chirping at them. When they get above 40, I start to say you could have a little more, but it’s not nearly as critical as when it’s below 30, and specifically below 20.
I do a little bit more education on ferritin. Ferritin is something called an acute phase reactant, which means when your body has a response, ferritin is a protein. And so if I slug you on the arm enough to give you a bruise, you can see ferritin rise. So when people come out of like a car accident and they wonder how much blood loss they’ve had, but they have like 15 new bruises and a broken rib and an arm in a cast and you say, gee their ferritin’s nice and high. You can’t trust that. You’ve got to wait until the inflammation goes back down to see what is their true ferritin level. Ferritin is just a marker of how much iron your body has. I wouldn’t worry about a range between 45 and 80 – that looks pretty healthy. But then could it be related to folate deficiency? Folate is another one of those….I’m a big fan of eating the sprouts of vegetables. First of all, it’s very low carb with a really high density of nourishment. If you have brussel sprouts or broccoli sprouts, they are just really high in those leafy greens, and it doesn’t take a lot to get you the nourishment that you need.
They’re those things that taste irony, aren’t they? I’ve always been a bit of an odd child in that I liked those irony things. Really dark greens and spinach. I still do. They’re the things I love, but they’re the things that are naturally rich in folate.
Absolutely. You can take a supplement. Folate’s easy to take and absorb really well in the multivitamins, unlike iron. Those are a few rules with iron. Like don’t take it on…acid needs to be there…lots of rules. But folate’s pretty easy to absorb. And if you do any kind of greens, it’s pretty easy to get that in. I would just tell her not to be fully deficient. Don’t do that because it is a big part of how your body functions as well.
Yes. Interesting. I seem to remember that my ferritin levels were quite low so I looked them up because I thought, Dr Boz is not going to be very happy with me, and so I looked them up and mine is actually 11, and the reference range they give here in France is 13 to 150. I’m sure you’ve got something to say about reference ranges and although the lower limit might say one thing, that’s not the what you would consider to be the optimal lower limit because that includes everyone, doesn’t it? Including the extremes – which you don’t want to be. Perhaps you could just have a bit of a mention about that before you tell me off about my ferritin level.
I think we have an answer for your sleep problems, actually. Looking at reference ranges, let’s take glucose. If you go back into the textbooks from the fifties and sixties, the normal glucose range was from 60 to 80. When I tell patients that their glucose of 101 is not normal or 98 is not normal, they instantly say I googled it and I’m in the range. Where do you think we get these ranges? It’s where we take a standard deviation – I think it’s 1.5 standard deviations – in our population to tell us what is the range. And sadly the world is very low on magnesium. That range is interesting. The world is very low on iron. And the world is very high on blood sugar. So these ranges have evolved with our population and don’t necessarily reflect what I would want for my patients, my children, my husband…for the people I care about to say, no, no. no, no, you don’t want to be anywhere near that.
When you look at a ferritin level of 11, and so on that can you see the word that says saturation on that panel?
Yes, I might have that actually.
So while you look that up, I’ll keep going. If you look at a ferritin of 11, what that’s saying is when we drew the blood, we only found 11 buses that were scooting around your system delivering iron. And again, ferritins are proteins. If you don’t have a lot of iron being delivered to the system, then there’s nothing for it to do. If you increase the iron delivery, then the ferritin will compensate. Now that bus is so full I can’t fit any more iron in it, so let’s make some more buses. And that’s this protein that is carrying around iron. And without any reference point for where you’ve been, just knowing that your buses are down to 11, you haven’t been low on iron for a week or two. How long ago was your gastric surgery?
For me it’s a constant problem. I come in low on iron, low on ferritin. It’s been a consistent problem for a long, long time. In fact, when I had the last surgery – I had plastic surgery, and the surgeon actually insisted that I have a transfusion while I was in the hospital. It was ideal obviously because I was there hooked up anyway, so they put some iron in. And yes, my levels temporarily went up really high. I have tried to be much more consistent about supplementing. But I do supplement, but I’ve just really, really struggled to get my levels up no matter what I do. No matter what I supplement. I’m just looking at my panel here, and I don’t know exactly if they translate…I’ve got transferrin. I’ve got two saturation numbers here. I’ve got saturation, iron in transferrin and it’s listed as CTST here. I don’t know if that translates directly…and that gives it in two different values. I’ve got one value of 4.12…and that’s I think micrograms per liter, I’m not sure. The other one is 73.75.
Is there a percentage after the 73?
No, but the other one I have, which does have a percentage is called coefficient saturation of iron. That’s 13.36.
So, that’s awful.
Essentially what that saturation is doing is saying, let me just peek on this bus and see how many seats are filled with iron. When the saturation is 80, then you’ve got 80% of the seats filled with iron. So those buses are busy doing their job.
Ah, okay. So even though you’ve got fewer buses, they’re full. It’s not as bad as if you’ve got fewer buses and there aren’t many people on them.
What it tells me is that when you have the low ferritin, but you have pretty high seats filled – so the saturation in there is filled – it says, she’s increased her iron recently and she’s trying to get ahead – it’s working. The buses are filled. Because once the buses get – I think 60% or 70% – then there’s more stimulation of making more of those proteins. But if your buses, only 13% of the seats are filled, there’s no reason for you to make any more ferritin. There’s just not enough iron for them to do anything. So the process, you’ve got to break the cycle. If you were coming in to me to get a kidney transplant, I would have to prove to the transplant team that you are ready to receive this kidney. And one of the factors for being healthy enough to receive a kidney is what is your ferritin?
We would break the cycle like that, with an IV infusion of iron. You can go back in the history books about IV iron and it used to be this awful thing…we put people in the ICU. It was really dangerous. But when I was in medical school, there was a pretty big breakthrough that they put sugar – and don’t freak out for a ketogenic diet – but they put sugar around the iron and the delivery of the iron was so safe that we can now do it in a clinic. Now healthcare in our world has changed, so many times they just don’t bother with it. Doctors kind of get nervous about the history lesson of iron being difficult, but truly the data…we give these IV infusions of iron to neonates, to babies that were born too early. It’s very safe and it stops the cycle.
Because even if you start eating iron perfectly right now you say, I’m going to eat only braunschweiger for the next month, your gut has to absorb it and you’ve had a rewire, a re-routing of your system, or a gastric bypass. So it’s not uncommon for stories like this to say, the reason she’s tired, the reason she’s still struggling with that resetting of her sleep cycle, is because her brain doesn’t have any ferritin. It doesn’t have any iron. That is a powerful change in how well they think, how well they concentrate. Not only do you add in that you’re a menstruating woman who’s had, you know, leaking out the other end too many years. When you’re this low on iron, you shouldn’t have a menstrual period when it’s that low. Those are valuable little red blood cells, don’t waste them.
And obviously I’m being a little funny there, but the point I’m making is that you’re at a higher risk to not get ahead when you’re in this stuck situation. And it’d be the kind of situation where I’d say, go into your doctor, say, I’ve done this so many times, can’t I have an IV infusion of the iron? And I don’t know how it works in your world, but in our world it has to be low enough, or a certain level enough, for them to pay for it through your insurance. But I think the criteria, if it’s anything like in America, with that low of an iron and consistently feeling that heaviness in the morning or that fatigue, I think you could be covered by some insurance companies. And if not, two infusions of this is worth like seven months of iron pills. So two infusions and you are leaps ahead for resetting this cycle, this problem.
Oh, it’s very tricky and it’s certainly something I will look into. But yes, the system is so completely different here. Sadly my GP is very aware that I have this problem, but like I say, it’s been years that I’ve been borderline anemic, really. Yes to the extent that I mentioned that there was actually doubt as to whether I’d be able to have one of my operations because it was so low. So it’s certainly not something that they’re going to voluntarily let me do. I think the only option will be is to find out if there’s anywhere privately that I can go and have it done. Yes, like I say, a completely different system. But I will certainly look into that because I know it’s an issue. There’s one question that I have that I’ve remembered that came up with this question on the thread, and it is something that’s relevant to me and to a lot of other people. I forget who said it, so, forgive me for forgetting that, but someone mentioned that if you’re hypothyroid – and I have the Hashimoto’s form – that a lot of the groups that advise around that are saying that actually having too high ferritin is a problem, and that having a lower end of the scale ferritin, is potentially a good thing if you’re hypothyroid. Do you know what they might be referring to?
Yeah. You’re saying hyper or hypo.
Hypo. Hypothyroid. Yes.
Okay. Hyperthyroid is an over-functioning of a thyroid, right? Over-functioning of the production of those hormones. And especially if you had Hashimoto’s, those proteins are coming out of your thyroid because antibodies have been attacking it. So it’s an autoimmune problem. Your body is attacking the thyroid when it wasn’t supposed to do that. But here you are. And in that setting, this excessive production of proteins can happen in many layers. When somebody has one autoimmune problem, like they have Hashimoto’s, it increases your risk of getting other autoimmune problems.
Yes, I’ve heard that before. It tends to come in packs.
Right? So think of the excessive production of protein is another way – and I don’t mean the protein in your muscles, I mean these little proteins that travel around and send messages from one cell to the next. And that’s what’s happening in Hashimoto’s, is your body’s getting a message from a protein that you’re not supposed to make. Then you are an increased risk for having proteins that tell your joints to swell or to break down all your blood vessels and have lupus. So other autoimmune problems. But in general, the milieu of proteins is higher in people who have autoimmune disorders. So when they say, your ferritin might be high. Yeah, well, first of all, you don’t have to worry about that. You’re so darn low and your seats are empty on your bus, that we are so far from that problem, it’s like not worth mentioning.
But in the spirit of answering the question, if they have a ferritin of like 280 and you say, oh my goodness, are they iron overloaded? No, they’re autoimmune. Their body is attacking itself and is producing these extra proteins. One of them, it looks like it’s ferritin. And so the ferritin can be high as a product of this immune system that’s kind of gone awry. It’s stimulating itself to produce things. And when that happens, all kinds of things go wrong. Ferritins are not normal. When I said earlier, it’s an acute phase reactant, like you are producing a protein because you got all bruised up in a car accident, there are other things that are chronic inflammation that increase ferritin as well. So it is something that you have to look at all the numbers. Your history gives me the hint though, that you don’t absorb it right, and that’s from the surgery – of the weight loss reduction surgery – it’s really common. And so that’s why I would say skip trying to eat it. Put it in your vein. Your brain is depending on it.
Right? Yes. And that makes sense. I mean I didn’t have the bypass, but presumably it’s one of those things that I don’t absorb as much just because the stomach size shrunk down. And I know that different things are absorbed in different places, but it’s certainly been a problem for me for a long time. So yes, that’s something I’ve obviously got to look at. Because I have taken supplements and I still struggle to get those numbers up.
It’ll turn your stools dark and you’ll have very little absorption because of the chemistry of what supplements are. If it was me. If I was in your situation, no kidding, I would do a liver fast. Like you only eat braunschweiger for the better part of a month. And I know that sounds very restrictive, like is that possible? But liver’s high in vitamin C. Livers is a very fatty meat and if you had just bone broth and liver for a month, could you increase it on your own? The cells that are supposed to absorb it are clearly not working right. All meat has iron in it. Why isn’t your system absorbing it? Because it’s going to take you the better part of a month to navigate the system to find out could you even get IV iron, I’ll tell you I do it here in the States, but I’m one of the very few that does this. That’s a whole other story, but the point I’m making is in your case it’s going to take you a month to crack the code on how would you possibly get IV iron. If in that time you did an ultimate challenge of saying if the cells in your gut are still alive, and present, and in the right pathway that food passes by them, then I would be on a bone broth and braunschweiger fast for a month and just say that’s it. That’s all you’re going to eat for a month and watch what happens to your iron. Because that would tell both me and you whether you can absorb it. And once you get those cells out of hibernation and they’re back to actively working, then you can go back to do what I tell most patients, which is: if you’ve got that low of iron, I can give you an IV, but braunschweiger, a tablespoon three times a week. That’s powerful. That’s a lot of iron. And even if you don’t like the taste, eventually you’ll get past it.
Because that’s the other point. Like I said, I have had an infusion before. If you get your numbers up with that temporary fix, is it going to be the case that unless you make other changes, it’s just going to drop right back down again. You mentioned about this reset and restimulating, or is that just simply not going to work unless you do these other things as well?
Right. So somehow you’ve got to get iron sustainable in your system. You’re at the age where menopause is hitting your world, you’re not going to have menstruation as a loss anymore so it does get easier to get ahead. But I would contend that the fastest improvement for a lifetime, is see if you can wake up the cells that actually absorb iron. Sounds like they’re not absorbing much. The infusion you had, you had somebody else’s red blood cells put into your body and those are only going to last for about two weeks in your system before your body gets rid of them. Now you get the leftover iron that was in them. So that’s the good part. You got an infusion of iron by way of those red blood cells, but you don’t have to expose yourself to somebody else’s blood parts to get iron.
You can just get iron and that I think is safer and less risk. What it does is, all that iron…suddenly those little ferritin buses are going to have a hundred percent saturation. They’re going to be filled with iron, and that’s going to say, hey, we’re too full, we need to make more ferritin. And then you’ll have higher. So then you get a higher carrying capacity and that allows you to not be right on the edge here. You cut your finger and you’re going to have a lower… your red blood cells are already probably tiny little red blood cells instead of these big, plump, efficient, red blood cells that deliver oxygen. That’s probably, in part, why your fatigue is still lingering.
Right? Yes. Really interesting. So it is a case of doing the two things at once, stimulating your system interaction, but then doing the sustainability part to keep it going. Very interesting. Well we’ve started talking about me again, so let’s go back to somebody else.
Jojo has a question. She would like your thoughts on her recent overall cholesterol being so high at 357. What other tests should she get done? This is her first blood work since starting keto in July. She knows it’s common for this to happen, ie the cholesterol going up, but the more advice she can get, the better.
Right? So why has cholesterol become this marker of worry for the world? And it is because it was linked to heart disease, except they didn’t do such a great job when they first discovered this at linking the two in a correct manner. What I first and foremost remind patients is, cholesterol is the carrier. This is what carries fat from one section to the next. When I put you on a diet that’s 85% fat, guess what? The carrier is going to get higher. The cholesterol is going to get higher. It is not the predictor of heart attacks. You can better predict a heart attack with the size of your waistline. If you put weight on in your tummy, that’s a better predictor of a heart attack than your cholesterol was. So that’s easy. You can do that one at home. Your morning fasting blood sugars, those are a better marker of a heart attack than cholesterol.
Other tests from your doctor? I would encourage every single person who wants to know if they have a risk of a heart attack to look at a calcium score. This is a very high speed, MRI that takes pictures of the coronary arteries. If you have a zero on your calcium score, it is a protector for the next 15 years that you will not have a heart attack. Way better than I can do with that cholesterol, which is going to change depending on what your diet has been for the better part of the previous six weeks before I checked the blood. When I look at a calcium score and it’s zero, I can have a lot of confidence that the inflammation going on in their body is still very low and not depositing calcium into those coronary arteries.
Other markers that are somewhere in between are a Highly Sensitive C Reactive Protein. I say that very specifically a Highly Sensitive C Reactive Protein. This is a marker of inflammation that is designed to specifically predict what the inside skin layer of blood vessels is. In America there’s this cartoon that would happen after school called The Magic School Bus and this teacher would teach you about science and things with the magic school bus. Her magic school bus could get really tiny and she’d drive down the arteries of a human body and teach about anatomy. So if you were driving down the artery and you looked around the skin layer that lines the tunnel, the Highly Sensitive C Reactive Protein helps me know is that inflamed? And that is a predictor of a heart attack. You’re starting to put cholesterol deposits in that layer. Guess what? It’s very inflamed and it’s going to do that even before your blood sugar is high. Before you have a change in your Hemoglobin A1C, which is a predictor of diabetes.
If I needed to know if you are going to have a heart attack and I needed to be the most confident, if I got to grab which one I would look at first, it would be a calcium score in your coronary arteries and I’d vote for a zero. If I don’t get to do that. You don’t need a doctor’s prescription to do that. If you look at any – in America anyway – if you look at any place in America, you can just call up the cardiology team and I think it’s like $25. It’s really cheap. So it’s a quick MRI. It’s a screen for calcium. And if your score is zero, congratulations. If it’s like 250, we’re talking about some significant risks. I have a patient over the last six months who it was like 2,500. So you talk about the question we started this with where they have heart failure, and boy that calcium score is…that’s a delicate equation. We need them carefully monitored by a physician as they make some changes. But instead of focusing on the cholesterol, I would look at those markers instead.
I think another one that I’ve always thought as useful, and it’s funny that this question follows on from Siobhan’s question because she’s the lipid queen. She loves her lipid analysis. But I always think the triglycerides are a useful marker. People talk about the size of LDL particles, don’t they? But if you know your LDL, and you know your triglycerides…Triglycerides is literally a measure of how much fat is swimming around in the blood, isn’t it? And you want it low. That, to me, whenever somebody says, my cholesterol is high, the first thing I ask them, but what are your triglycerides doing?
That’s very true. I used to tease patients that if they wanted to outsmart their cholesterol screen for a life insurance – triglycerides were something the life insurance would look at more than the cholesterol, than the number, she was just reporting, and I said, if you want to outsmart them fast for three days before you go into that test. Triglycerides are really a reflection of what did your body intake recently, and is the storage tank full. Triglycerides are high when the liver is already jam packed full of stored carbs, that you’ve already got your fat cells and muscle cells overflowing with store carbs, and so the body’s turning them into fat lobules and trying to find a home for them. And those triglycerides, you’re right, it’s fat in the blood, but it has everything to do with the last few days.
So I tend to say, that’s another thing that I get to learn from if I see that on the panel. But if I get to pick I want to know in my dad like, are you going to die of a heart attack in the next year? If he hasn’t eaten for two days before he comes in for his triglyceride look, then I’m going to have a false sense of thinking he’s safe when he’s really not. But if I get a calcium score, it’s a marker of actual disease that’s happening now. It’s cheap, there’s no radiation. This is a magnetic MRI. It should be the gold standard. It is a better predictor of how well they’re moving in the right direction. And again, you do not need a doctor’s prescription to do it. It’s done in a cardiology office usually. Our hospitals do them for screening. It’s like a lead magnet or a funnel to get into the cardiologist. So be careful where you go but it is cheap. So I’d still push towards a calcium score over a triglyceride.
Yes, and it’s definitely something that Ivor Cummins has been talking about and campaigning for a long time, hasn’t he? He would like it to be a standard test that’s performed, and yes, I can see why.
I think we’ve got time for one more question, and this comes from Kate. If night sweats interrupt your sleep – and it sounds like for her this is happening about every two hours – is there anything that can be done? She meditates. She started taking plant-based estrogen cream, and she does all the typical food and bedtime habits. Is there anything she can do to improve that? Maybe you’ve got an idea why it’s happening and how she get around that. That sounds very uncomfortable to have to put up with that all night. We talk about how important sleep is, that’s going to interrupt to isn’t it?
Here are some assumptions I’m going to make about Kate. She’s got night sweats and it’s happening every couple of hours. She’s got an estrogen cream, so that makes me think she’s been to a doctor. The first thing whenever I hear about somebody who has night sweats, is that can be a danger sign. Unexplained night sweats are one of those medical mysteries that you should definitely…tuberculosis does this, a growing cancer does this. They are a warning signal that can be dangerous, so I’m going to assume because she’s got a prescription medication there on her list that she’s already been to a doctor and actually had her own medical advice on this. When I look at two hour cycle of night sweats, I get nervous about how long has she been practicing that? And I don’t mean it in an accusatory way, I just mean that brains get wired and they keep using the same wires.
If she’s in a transition in her health where she was on a low-fat diet and now is on a ketogenic diet, after they’ve gotten keto adapted….so let’s say they’re six weeks into a ketosis diet, we start to see that these hormones like growth hormone, and cortisol, and estrogen – fat-based – they all begin with a fat. And so those hormones start to rise. And so if you’ve had a low-fat diet and you’ve had the hormones that weren’t great. And you can tell by, is there a hair nice and thick? Are their fingernails nice and strong? Is their skin nice and resilient? Those things are just kind of by-products of a healthy fat supplied diet. Those hormones have to be stable. But if the hormones have not been supplied…I talk about the supply chain, but in a ketogenic diet, what’s really happening is the supply chain for testosterone, and estrogen, and cortisol, and growth hormone, those have been intermittent and they’re not predictable when you’re on a low-fat diet. But when you become ketogenic, you now have this constant steady supply of fat. The supply chain becomes predictable, but then it hits the body – especially for somebody who’s not used to what estrogen is supposed to be – and the production of estrogen. Estrogen and progesterone can cause night sweats. If she’s having ovaries that are sputtering, like they produce some estrogen and then they don’t – that’s because she’s going through menopause. Or maybe it’s the reverse – which I’ve seen happen – is they go on a ketogenic diet and the ovaries have kind of shutdown saying, we can’t produce any extra energy to the ovaries. We have all these other things that aren’t supplied. Ovaries are an extra, so they kind of go into early menopause. But then they get a ketogenic diet and bam, they start producing estrogen again.
And as those ovaries wake up, you’ll see about almost a two month pattern of sweats that happen that I wouldn’t be adding extra estrogen cream. I would say journey through this and just be checking your numbers in the morning that that glucose to ketone ratio that you’re really hitting a good supply every day. I’d want her numbers to be 80 – like glucose divided by ketones at least 80 every morning for two months. And that would give me the confidence that she’s supplying her hormones with a steady level, that whatever is blipping up and down to cause the night sweats, has stabilized. When women go through menopause, if they’re estrogen would just stay high, they wouldn’t have a night sweat. If it would stay low, they don’t have night sweat. It’s when it bumps up and down that it causes the body to just break out in a heat wave. If that’s what this cause of her night sweats are, I would study herself a little better. First thing in the morning, check those numbers, and if you’re hitting 80 every day and stay there for two months, and this will pass. Easy to say when I’m not the one staying up every two nights,so…
Yes, and it’s interesting and it shows again how important the context is. And like you say, it does sound because she started doing a particular kind of treatment that she has consulted with a doctor. It’s obviously important to reiterate what you said at the beginning that if you’re getting unexplained night sweats, that it could be indicative of a serious problem. So that’s definitely the first thing that you’ve got to do is go and see your doctor about that. But yes, certainly the first thing that came to my mind was menopause because it’s just supposed to be at a typical thing that’s associated with menopause, isn’t it? That you just get hot flushes and sweats because of that. But like you were saying, it’s not necessarily as simple and straightforward as that. It can be to do with a shift, a hormonal change for a number of different reasons, one that can just literally be starting to eat ketogenically.
The other key there is your first instinct was to think of menopause. My first instinct was to think of fever of unknown origin, which is this danger signal of somebody better be looking. And I think that’s why it’s important that…why don’t you see a lot of doctors out there saying generalized advice? And it’s for stories just like this saying, well I heard this doctor on the podcast say x, y, and z. And I just want to remind everybody, I love teaching about the ketogenic diet and answering questions, but I do not replace your doctor’s relationship. I’ve had a lot of folks reach out to me saying, how do I find a doctor like you in my area? And I would say take them my book. And I’ve had so many stories come back where they’ve said, I just wanted my doctor to open up their mind and see this. And I’ll be honest, I’ve been that doctor where people bring me a bunch of things to read and I do try to read them, but sometimes it’s like if I take a bath in activated charcoal, my fingernails grow better. And I’m like what? You know, some silly things that you’re just like, I don’t have the space for that. So when you first start saying to a doctor who’s a traditionalist saying, I’m going to eat a bunch of fat and get skinny….
So instead of doing that, just take them my book and say, read the first 10 pages. And what it does is it shows the sceptic of me saying; this can’t be real, could it? I would know this if this was real. And then I unpack where I found the first nuggets; where I had to stop my practice and look into this. And then as if a sign from God said, let me practice on the person I care about the most, which was my mother. And that’s what the story does is tells you her story while I teach about this ketogenic process. And boy, I’ve had some amazing messages back saying, that’s what I did. I took him the book, and by golly he’s doing ketosis himself. So I would encourage you go to Google type in Any Way You Can, and take the book to the doctor if you want that. But do not take medical advice from me over a podcast.
No, exactly. Nothing beats that relationship with your own GP. But potentially you can influence them to change their opinion. I’ve certainly worked with my GP over things. I haven’t managed to…there’s certain guidelines obviously that they all fall within. And obviously as you’ve heard, I bump up against those with having the low iron, but he was very receptive when I went in and spoke to him about retesting my thyroid and treating with T3 and not just T4. So it’s always worth having that discussion with them, isn’t it? Because they are there ultimately to help you get as well as you possibly can.
Yeah. And I contend that relationship is not replaceable. That it is an incredible privilege to sit in front of someone as they tell me about their healthcare, and that I get to be on this journey with them. And with that responsibility is a host of education and commitment to saying, okay, this is my job to help you, and that cannot be substituted through a podcast. So just don’t surrender that they’re going to know you better than me. And if they don’t quite think like you want them to, help them.
Exactly. The point we’re getting at through this discussion of different topics – and it’s something that I really love about what I see happening with women in particular who embrace keto – is that sense of empowerment, and the self-confidence to be able to help drive their own health treatment even if it means arguing a bit with their doctors. And putting across things that they’ve discovered because they get to know their body better with these little tricks that you shared with us, like about pressing your thumb down on your shin. But these seemingly silly little things, but all add together…getting your numbers, getting your blood glucose, your ketones, all the rest of it…really getting to know yourself well gives you that empowerment and that confidence to say, no, I know when I’m well, I know when I’m not well. Here’s an idea of what my treatment could look like. I think when they really – doctors I’m talking about when I’m saying they here – when they really see that you’re really invested in your own health, and you’re prepared to put the work in and really work with them, I think they’re more likely to help you rather than if you’re just coming in with a list of problems all the time without potentially seemingly to want to help solve them.
It’s very powerful. I like to write and I think the stories that you get privileged with as the patient…in my book you’ll hear how I heard about a ketogenic diet? A patient told me. I know medicine can have this kind of closed down mindset, that they’re in it for the drug companies, and they charge too much, and I’ll tell you the system is broken, but the people that I attended medical school, that I know are my colleagues, in their hearts, they didn’t do all that because they hate people. They want to help you. And if you can just kind of nurture that side of them, what you’ll find is very caring industry of people who’ve done a lot to help another essential stranger, so give him a chance.
Of course. Yes. I completely agree with that. Well, we have more questions, but we’re out of time. So we’re going to come back with another episode very soon. But in the meantime, if you do have comments you’d like to make, if you’ve got a question of your own for Dr Boz, let me know and maybe see it featured here in the next episode.
Absolutely. I will include in the show notes, the glucometer thing that I talked about, and I wrote out those ratios that I was talking about – where this is what I recommend, and you can find them on my website as well. But I just want to again say thank you. Your audience is amazing. And when the podcast was posted the first time, it was just such an overwhelming response of wanting to learn, and being hungry for information. So I just say, you guys are the best, thank you.
They are. I have to second that. They’re fantastic. We love you.
So I will be signing off and hopefully there’s a positive response, and we can do this again.
Absolutely. I’m sure there will be. Well, thank you once again. It’s been a pleasure talking to you again today.
This transcript is brought to you thanks to the hard work of Trish Roberts.
Welcome back to the Keto Woman podcast, Annette. How are you doing today?
I am doing great. Thanks for having me back, Daisy. This is a true privilege. I love your audience.
Well it’s really nice to see you again and yes, they love you too. And we had such great feedback that we thought we might do a…what’s going to turn out, I think, to be a regular episode where listeners can ask Dr Boz their questions, and we can go through them and have a bit of a chat about different things that come up.
I also got quite a bit of feedback when we were on and just had such positive response for explaining what we did with just listening to your story and your headaches, and how important sleep was in the equation of really repairing and resetting a metabolism. So I just want to say thank you for being willing to share your story and how many people it helped by just sharing where you’ve been, and being a little vulnerable to say life for you isn’t perfect, when it isn’t for anybody. But when you share it publicly, sometimes it can make people nervous and they shy away. But you were able to just talk through your history and what those headaches had done and how they had evolved, and where the sleep a story came from. And just a lot of great feedback saying I learned so much by listening to that.
It’s funny because I did mention in the intro, or the…it was probably the outro actually…I mentioned that I do have a tendency to stay online too late. One of the reasons is, because in the main I’m talking to people in America who are at least six hours behind me. So obviously that’s a problem. But I asked people to tell me off if they saw me up past midnight. And people have been very good at telling me off. Unfortunately, I don’t always listen, so I feel like we have a bit of a follow-up coming on, so I will have to own up to some of my sliding tendencies.
The beauty of 20 years of practicing is, when people talk about the changes that are made, boy, there’s so much that’s involved in a behavioral change. It is more than just a doctor saying, the science says, if you don’t want dementia, you should get eight hours of sleep and it should match the light versus dark hours. Okay. So there’s the science. Now add the humans. And man, we messed that up so many ways for so many good reasons. And I think if you’re looking for two mantras that I use and how do you change behavior? The two tested-over-time things I continue to tell myself or encourage a wife who’s trying to help a husband, or a son who’s trying to help a bro…someone who’s trying to help anyone…the two things that have stuck throughout time when you’re trying to change behavior is…focus on improving you. And stay connected to the person you’re trying to change. So that whole scolding, shaming, belittling people for not making the best choices, that doesn’t improve behavior over the long run. You’ll get a short term improvement, but nothing that is sustainable. Sustainable acts come from seeing a model behavior, like somebody who is trying to work on something themselves. And then if you want to change somebody and you never speak to them, you’re never in their life, it’s pretty hard. Stay connected, and keep working on you. So in that aspect, how have you been?
Well I have to say overall that I improved. It had got to a point where it was so bad as I think I said…talking about my sleep, this is…that I was often not starting to sleep until the sun was coming up. So, I’d really set myself up for the worst possible case scenario there. And so I did start pulling it back and I did get very good about getting to sleep. Or at least going to bed – because it can take me a while to get to sleep – but at least being in bed before midnight every day which is a massive improvement for me. And that has slipped, but it certainly hasn’t slipped back to where it was, but it’s still often…I’ll start thinking about it. I’ll look at the clock, and it’s 11 o’clock and I think, right, I really must start winding down now. I’m not going to start watching another television program or I’m not going to start doing something else. I’m going to start winding down whatever I’m doing with the intention of being in bed by, or before, midnight. And then before I know it, I’ve got involved on questions or comments in my Facebook group or something like that. And before I know it, I look again at the clock and it’s like half past one, two o’clock! And I’m like, oh no. And so then I shut down and I do, right, I’m going to bed now. On average I would say it is more like a half past one, two o’clock, which is a slip, but it’s not back as far as it was. I have been aware of that and I have been thinking, yes, I must get good again about bringing it forwards.
I tell you my biggest problem, and that is getting up in the morning. I can remember you saying when we spoke in the first place, I can’t do anything about telling your brain when to go to sleep, but I can tell it when to wake up. I tell you the problem. I will have great motivation and resolve when I’m going to sleep. I think, yep, tomorrow’s going to be the day that I start getting up on the dot of whatever it is, seven o’clock…it’s never going to be seven o’clock…eight o’clock in the morning; at least set myself a time that I might achieve. That’s it. Eight o’clock I’m going to be up. I’m going to be out of bed. But when that comes around and the alarm clock goes off, it’s like no, it’s just not happening and unless I’ve got somewhere I have to be for a certain time, my resolve and my motivation just completely goes out the window.
And then of course by getting up later…although I am better about pulling myself up and getting up before a certain time, so I don’t let it go as long as it used to…then I’ve slept too long, which of course then makes it more difficult to get to sleep at a decent time the next night when I should be asleep. So it just keeps having that knock-on effect because I am one of these people who ideally does like a nice solid eight hours sleep. And so just do the maths. It’s not difficult. If you haven’t got to sleep until two, three o’clock in the morning and you still want that eight hours, that’s why it’s so easy for it to keep getting later and later. I do know that that is probably the answer but I just have to make myself get up. I can be 100% resolved to do that, but when it comes around to it, it’s really, really hard.
Let me give you some encouragement. The human brain really only can perform its best for 16 hours. So as you look at what we’re trying to do is we know that that circadian rhythm, which is set by sunlight and as much as our electronics and our lights have messed with that, there still is signal in people who do the night shift, that they have a circadian rhythm that is still present in the morning. Now they end up with other rhythms that show up years later with a night-shift worker. But when you study their brain performance, when they took people who are sleep deprived. The study starts with medical students. So they want to get a good grade. They’re very motivated to follow the rules. They get put in a sleep lab if you would, and without any distractions over the next three or four nights, got a really nice, good reset of sleep, so their sleep debt was kind of caught up. And they wake them up and they do these tests of intelligence. Kind of like how do you solve a puzzle, and how quick can you put this pattern together? And so it’s kind of like an IQ test and it’s timed. And you know they’re smarty pants and so they did really well. And then they keep the students up for 24 hours and they did the test again. And then they kept them up another 24 hours and tested them at 48 hours. And then they let them get some sleep, and then they go back to their life, or not the life, but they go back to these places where we can monitor their sleep. Instead of giving them eight hours of sleep like they had before the tests, they deprive them of one hour. And they did that for a week.
At the end of the first week…now its seven hours instead of eight…I am a mom, I’m a doctor, I have a full life, and this is naughty that they did this and told us because it’s seven hours instead of eight. At the end of a week, they were functioning as if they’d been awake for 24 hours. If you extended that seven hours versus eight hours for two weeks, they were functioning as if they’d been awake for 48 hours. So the brain’s cognitive efficiency, its ability to perform has such a profound performance level of making good decisions, making reproducible, efficient, and calculated decisions based on rest. Based on eight hours of solid sleep…how are you doing? And if you’re waking up, there’re points against that. And if you’re not in bed for that long, you’re certainly not getting the right hours.
They then let the students sleep again, retested them at the eight hour level. They went back to their performance that they had before and then they let them sleep six hours instead of eight hours. And at the end of one week they tested as if they’d been awake for 48 hours – two days. So the people who say, I can live on six hours of sleep, we have really good evidence. It shows what you’re sacrificing is the mental acuity, very efficient performance that can only be found in the human brain associated with good rest. I get a lot of questions about why are my sugar’s high or Doc this keto diet isn’t working for me, and the first thing I’ll talk about is their sleep. If you want your weight loss to continue, if you want your body’s metabolism to go back to what it was designed to be – which, we aren’t designed to be obese – we are designed to be a body weight that’s pretty close to that BMI chart as much as that gets negative reviews from the masses. But that body weight, it matters and your body will gravitate back towards that if you give it the right tools and the right settings. And one of those settings is the reset that happens in your mind, in your brain, in those eight hours of sleep. So now that’s the science. Now how do we help a behavior change? So let me give you some good ideas. It’s not that you’re maliciously staying up. You’re staying up because it’s been a pattern. You set a pattern and there’s something comforting about listening to a story, whether that’s on television or podcasts or books or reading. So escaping your life into a story has been a tradition for thousands of years in our human race that we use stories to kind of cope with life or learn life.
And you’ve got one of those habits. That’s not a bad habit. That’s better than drinking. Better than using other forms of escape where the habits can really hurt people too. So we say, how can we transfer the comfort that you give yourself with those stories to something else? And I would encourage that to be a desensitization skill or reset. And what I mean by that is, if you say, okay Doc, I’m not going to watch a movie, but I’m going to play scrabble or I’m going to play online a bubble-popping game or something. Again, that’s an isolated activity with an electronic instead of a human relationship. Those lights are very stimulating to the pineal gland, which is what our circadian rhythm is set from. So if instead you said, okay midnight’s the goal, I would actually push you back to about 9:30 that you turn off electronics, and even if I know…
Yeah, I’m making a face!
So you find something comforting that you can do to help reset yourself. I’ll give you some suggestions. These are things I’ve had patients do over the last couple of months, maybe six months, that I’ve just really found helpful. I don’t know if you have them in in your country, but in America there’s been a kind of a swelling of something called a float. It’s a really dense, highly saturated water filled with Epsom salt, which is again, a magnesium base. It kind of mimics the dead sea salt that you can’t sink. So these little spas have essentially a pod. It’s like a bathtub that has filters that clean the water when somebody’s done, but the pods or the tank has such a high viscosity of like 1100 pounds of salt in the water.
So you can’t sink and you’re in this pod, and they turn off all the lights, and you have ear plugs in your ears, so there’s no sound; there’s no lights. And then there’s this infusion of magnesium. Magnesium is one of the things we know can be absorbed through the skin; especially when we’re trying to shut down our minds. If they’re low on magnesium, this really helps. Now if your magnesium’s normal, you’re going to pee it out. It’s not going to be any big deal. But one of the key signals that your brain will receive is a timeout. Jason Fung does a really good job of talking about removing a signal and that is the best way to reset it. Not decreasing it, but removing it. And same thing goes for the sounds and the lights.
You really feel like you’re floating in space because you can’t sink. Most people fall asleep by the time the hour is up because their brain just really finally shuts down. And I will contend that if you signed up for like three floats, by the third float…I’ve had such positive response from patients trying to reset their sleep habits saying, I’m trying to find something that can comfort you. Most of the spas here are open until 10 o’clock at night. So if you took the nine to 10 o’clock spa, on Monday, Thursday and Monday, over a course of 10 days, you would be amazed at how well you feel by just removing all sensation. Now you can do this in your own bathtub too. An Epsom salt bath in your own bathtub would be fine too.
What you want you might not do such a good job of – because you’re all by yourself – is you’ve got electronics in your house and you’ve got distractions, and you got on the telephone and you’re texting, and you’re listening to a book. So it’s not the sensory deprivation that happens when they do these little spas. Just try to remove all of that input. And boy, what a great antidote. Other things that I know are out of tradition, but are very helpful for the human brain to shut down when you’re reprogramming sleep, is to get a pencil and paper and just journal.
Some people don’t like the journal part of it and I do a workshop on brains of addiction and how do we break cycles? And one of the little activities I do is a three minute timeout. Nobody in the whole workshop – and I’ve had as many as 200 people in the room – nobody can make us sound. No burping, farting, laughing, nothing. Three minutes of complete silence. And then they take the utensil, should be a pencil in the wrong hand. So if you’re right handed, it goes in the left.
Ah, yes. You mentioned this before. Yes, doing the cursive L’s.
And that little rhythmic…just give yourself a three minute saying, I don’t want to do this. I want to keep doing my electronics at night or whatever keeps you awake. That habit is powerful. It sounds silly. Like what could this possibly do? But I do a lot of work in jails and of course they just sit in the dark and if they’re anxious, they have no tools to start.
And I can’t tell you the number of letters I’ve received over the years saying, you came to the jail, you might not remember me, I did your silly little loop thing. I still do it to this day because it calms my brain so quickly. And there is something about the cursive language, the cursive writing – even if it’s just an L loop, it doesn’t have to be words – that’s rhythmical and almost like hypnotic, a form of meditation for your brain. So I’m going to encourage you to detox starting around that 9;30/10 o’clock hour, giving two hours of anything to comfort you that doesn’t have to do with electronics.
Yes. That’s certainly going to be a tall order? I can certainly see the logic in what you’re saying and yeah, I’ve got a very logical brain, so that always appeals to me. But yes I live in the middle of nowhere in rural France, so going to one of these isolated…that’s not going to happen. But as you were talking about it and then you did say towards the end, it’s something that you can do at home. I do actually have a tub of Epsom salts, so that is something I can do. And yes, as soon as you mentioned journaling, it’s something that I encourage people to do, especially if they’re trying to find a problem. If they’re saying they’ve got a problem of some kind, whatever that is…their weight loss has slowed down or whatever it is, I always encourage people to journal. So it’s something that I should start doing myself again because I have seen the benefits of it. I think it is a good way of just downloading those worries and concerns that you’ve had during the day instead of…and I’m very much the kind of person…I call it brain whirring, and I go to bed and certainly if there are things I’m still worrying about, they just go around and around and around in my head, and I can’t get to sleep. I just lie there and I potentially lie there all night not being able to sleep. So yes, I can see the benefits of calming yourself down with the magnesium bath, downloading all those concerns onto a piece of paper and then going to bed. That sounds like a very good night-time routine.
Yeah. What you’re trying to do is bio hack it a little bit, which is keeping in mind the brain only performs for 16 hours a day. You are human. That’s the limit. After that, you’re really hurting yourself. So shut off. To shut off at 16 hours can be like trying to flip a switch when you’re a human. So adding magnesium definitely calms down the body. And one of the best, most relaxing ways to do that, I contend is still the skin. A nice warm bath – 40 minutes of pretty tepid water has got some good evidence behind the replacement of magnesium, and now you’re adding tricks to your shutdown process that help protect you. Like remember that 16 hours is all you get. After that, you’re going to have to undo this somewhere in the future. Maybe it’s not tomorrow, but somewhere you’re going to pay the price for the poor performance you’re doing because you’ve been up too long. And then the next step is find things that comfort you. Find things that just help offload that stress.
Yes, and getting a bit more strict about the mornings. I’m one of these people who is really just not a morning person and feel so groggy if I get up early. But you just have to get through that and establish these new habits. I can see myself and I remember you saying before that whatever you feel like, you’ve just got to stumble through that grogginess until it becomes a habit and your body is used to getting up at that time of day, and starts to get alert that bit faster.
You had the advantage last time that you’d just been on the other side of the pond and so the light was matching your schedule better and then you said, I couldn’t believe how much better. I felt. I’m like, yep, that’s how that works.
Exactly. So I know I can. Yes. That’s a very good point to remind me of that actually because yes, I’m sitting here saying that I get really groggy if I wake up early in the morning, yet when I was in America for just over a week, I was awake and alert at half past six in the morning, and I didn’t have what I tend to get here…if an alarm goes off, or even if I wake up early my tendency is to just feel groggy and go back to sleep. I didn’t feel like that at all there. I was quite happy to well, I’m awake, I’ll get up now. So, you’re right, it’s obviously possible for me to do it. Just need to establish a habit.
Right? So the good news is, is that you and many people trying to change behavior, the most powerful part is to not scold yourself. Just have forgiveness. This is a habit. This is how you change it. Set up some things that make it easier. Like don’t have a super dark room that allows you to sleep when the light is up. And I know that, we want darkness when you sleep, so don’t have the neighbors light shining in there.
Well actually, yes, that’s a precise advantage that I have, and I only have very light curtains actually if I draw them, but I never draw them. Yes, there’s no light coming in from anywhere unless it’s daylight. So yes, it’s perfect for me to just leave the blinds open. So yes, that morning light comes in, although obviously in the winter it comes in later, but still…
Yeah. Well you can have a couple more hours of sleep in the winter and still stay on your circadian rhythm. How have your migraines doing?
Yes. Good. I still get them, but not too often. And I think that they were tied quite a lot to hormones. I’m definitely in that peri menopausal period, and hadn’t had a period for ages – since May. I didn’t have one for about nine months and, no, I wasn’t pregnant. And then they came back just for a little while and then they went away again in May, and all of a sudden earlier this month, I got one again and I got more migraines associated with that. So I think there was a tie in. So I think that has kind of helped them diminish. But not bad. I would say on average I still get probably one a week. I’d like it to be one a month, but certainly better. Better than they were.
So that’s progress. We’ll keep going on the sleep and I would contend that when the sleep is stable, the migraines will be even less.
Yes. I can believe that. I completely can believe that. So enough about me.
I know you’re always a little hesitant to share, but I just think it’s such a great teaching opportunity. So thank you for sharing. The good news is, is you’re the leader of a tribe. So when you sent the casting call out to say, does anybody have questions? Wow. Look at all the questions you can get.
Yes, we got pages and pages. So I did mention in the post that, don’t worry, there’s going to be more than one episode. So yes, we’ve got lots. So let’s get stuck in, shall we? Okay. So the first question is from Terrilee: Heart failure patients like myself are informed to limit salt. How do I keto on low sodium?
That’s a great question. I’m going to use a couple of patient examples to do some teaching. So my dad is 75 and he has an injection fraction, which means the percentage of blood that’s pumped out of his heart every time it beats is under 50%, somewhere in the forties. And this is officially what they call heart failures. When you’re squeezing that blood out of the heart every time, if it’s more than 70%, 80% of the blood that goes out of the chamber every squeeze, that’s considered normal. As that muscle either gets too thick or becomes damaged because it got low on oxygen, that transition has a failing rate and it cannot squeeze as much. When somebody has heart failure that term is a representation that the blood going out of the heart, doesn’t have the power behind it that it used to.
So people say, well, do I have heart failure? And one of the best ways that I start to look at heart failure is to go to your shin bone – the part of the front of your leg that’s between your ankle and your knee. And I don’t want you to touch on the muscle. I want you to actually go to the shin bone. And this is a place where you don’t store fat. It should be bone. It should be skin. If you’re dissecting a human being, it should be skin and then bone. So I have the patient usually put their foot up on my knee and then I take my thumb and I push on their shin bone. Usually they say, ow! What I’m trying to do is push on the thumb enough to make the blood not come into my thumb.
And again, I’m pushing on their shin right against the bone. And I push there for 30 seconds. If you think you have heart failure, this is one of the places where I would have you do this. And I’ll tell you, even I’ve had times where this thumb print, after 30 seconds I lift the thumb up and I run my finger over the shin and I can feel the indentation. Fat does not leave an indent. Fat does not leave an indent. Fluid that’s in the wrong spots – called oedema, the fluid outside the blood vessels – you’ll leave an indent. And this is one of the markers – there’s several, but this is one of the physical exam markers that you can do at home that my patients, I ask them how deep is the thumb print today. And this helps them measure how they’re doing in their heart failure.
I can always do the fancy tests like the echocardiogram where we can measure your heart, but when there’s an indent in your shin, it’s one signal for me to say that your heart and your kidneys aren’t getting that fluid out. So if you want to make the fluid worse, add a bunch of salt, which is where Terry Lee’s question comes from. If you’re on a keto diet, we talk about that fluid, that volume of fluid inside the blood vessels, it drops so quickly and your kidneys flush out the sodium and potassium and magnesium, to kind of keep up with the fluid coming through the kidneys, that you can get dehydrated. And so we say add salt, add water. Okay, now you have heart failure. So in the setting of heart failure, I tell my heart failure patients to look at their indentation on the shin of their leg.
And even if you don’t have heart failure, I do this sometimes too to see how much fluid am I retaining. And when I’m feeling kind of punk, if I have swelling in my legs, it’s another signal that things aren’t working as efficiently as they should. Your lymph system, your blood pressure, your kidneys are all part of how that fluid stays out of that space. And when it sneaks into it, it says you might be falling behind. So when I have a patient who’s on a ketogenic diet and they’ve had a history of heart failure…say my dad, he checks his weight every morning so he can tell you what his weight level is. The first few days that you do this, it’s kind of noisy. But if you get about 15 data points of weight, you’re going to see what’s your typical weight. But the other thing I like them to add is how much fluid is in that space, in that shin bone.
And so if they have a big dent, a medium dent or a little dent – that tells me is it okay for them to add more salt? So if their weights are doing okay and they have a pretty strong thumb dent in there, I’m going to tell him not to add any salt until that that fluid is out of the shin bone. Because it says the body’s got all this extra fluid. The other part that I have been very encouraged by with people with heart failure is that, sodium is one of the many electrolytes that hold on to the fluid inside your blood vessels. And you’ll know when you’re low on sodium because you get intensely thirsty. So listening to that signal is way more important than my blood tests, than my thumb pressure.
When people are intensely thirsty, it’s a sign of dehydration and sodium being low. And I don’t just mean I feel like I need a drink of water. When you look at heart failure patients that are constantly thirsty, their sodium is often low. But my heart failure patients have to follow up with me pretty closely on this ketogenic diet, and once they get the rules of where their body’s at, once they get through the transition, then I use these things like, we look at blood pressure because blood pressure also tells you what’s the volume of fluid and how well is your heart pumping through those hoses. And then we look at that little indent on their shin as a way to say, how are you doing? And if there’s a big indent on their shin, I tell them to lay low on the salt, please don’t add salt right now. Your body needs to get rid of that fluid and the salt is messing up the equation. So it’s a long answer and it’s complicated. So if patients have heart failure, the degree is also very important. That’s one doctors should be walking with you on. And I do encourage patients to know about their own, like check your shin, see how much fluid you’re storing.
Yes, that’s absolutely fascinating. And I’m totally biting at the bit to do it myself now but I’m going to have to wait until afterwards. But yes, it is a standard thing isn’t it? I hear it all the time. And I say it to people all the time when their saying…especially when they’re starting keto and going through that carb withdrawal stage, if the having headaches…it’s one of the things that I do if I’ve got a headache, is to take some more salt. It gets thrown about a lot, take more salt. Are you getting enough salt? And recently I’ve been regularly measuring out a teaspoon and a half of salt every day and making sure I take it through the day to see if it has a beneficial effect because I hear it so much and I say it myself so much. It’s just interesting that it’s just another one of those things that is potentially a general rule, but you have to be self-aware of what’s going on in your own body.
And I like these simple tests you can do on yourself that just increase that self-awareness of your own health. So when you hear one of these people throwing out this generalization, eat more salt. Well, yes, okay. That’s okay if you say it, but it’s not necessarily going to be right for me.
Right? The other part is that if you have healthy kidneys and a healthy heart, salt is easy to get rid of. Your kidneys are really efficient at wasting it into your urine. So healthy people, if they have too much salt, their body gets rid of it. They don’t say, oh, salt makes you swell. Well not if you’ve got good kidneys and you’re hydrated. I can have a bunch of extra salt and it doesn’t do that if you’re healthy. I would contend that most people starting on a ketogenic diet, or coming from a place that their health hasn’t been great, which might be what attracted them to this. If you’re a seasoned keto producer the salt has a lot more forgiveness. On that first journey when the water’s coming out and the shin thumb print is heavy, you might need a little help guessing what’s the right replacement? And the scale gives you a pretty big hint too.
Hmm..interesting…very, very interesting. Yes, I will definitely hold off on throwing out that general advice. Just take more salt because it’s not necessarily going to be appropriate. It’s more a question of maybe more salt. Perfect. Okay.
Question from Sandy. She has a question about avoiding healing diverticulitis. Since a recent visit to hospital, she was just discharged a few hours ago when she wrote this question. Does a keto diet encourage…or I guess what she means by that is to potentially bring on an attack…because it’s diverticular disease. I know it a little bit about this because my stepfather was diagnosed with it. Diverticular disease, when it has a flare up is diverticulitis, isn’t it? And so obviously that’s what she wants to avoid. Does she need more fiber to avoid recurrences? You get the point, what can she do? She wants to avoid this happening because it’s obviously very painful. And I know there are all sorts of things that are said about what you need to avoid eating to avoid an attack. Like people talk about avoiding seeds or things that can get caught in those diverticular…because they’re little pockets, aren’t they? So perhaps you could just explain…better than I have…exactly what the problem is. And I know it’s something that’s very common as well, because I looked up the statistics and apparently it’s something that’s very typically you have, once you get to a certain age, but perhaps just explain a bit more about what it is and f keto can help. What maybe you need to avoid to having an onset of this problem?
I love this question. It is near and dear to my heart. The book that I wrote, which is about my mom at 71 who had had cancer for over 10 years; and her cancer was in the white blood cells. The way we first found out that she had cancer was she was put into the hospital for a diverticulitis attack. And 10 years go by with chemo, and not chemo, and life, but all along this diverticular disease continued. And when the book starts she had had a few flares of a diverticular problem, and that’s when I started the ketogenic diet. At 71, knowing she has hundreds of pockets of these diverticular outpouchings in her lower colon. So let’s just describe what diverticulosis is. As you look at the stools passing through the large colon, when it gets to the last section – I would say like two feet before the rectum, two feet before you go to the bathroom – there is an increasing water removal from the stool. So the stools become more bulky. During that phase the pressure inside the colon over years of life can be so much that it causes a weakening in part of the last section of that colon. And there is an outpouching.
So everybody’s heard the word colonoscopy. If you’re doing a colonoscopy and you feel that lower colon full of air, you can see that you’re taking these little outpouchings and you’re blowing up a balloon, essentially. So the inside of the lumen, the central part of the colon, is filled with air and it puffs out these little diverticula. But they’re not reinforced with a nice muscle layer. They’re very thin casings around this balloon. If you have one or two of them, no problem, but if you have hundreds – you don’t usually end up in the hospital without quite a few of them – what happens is that as the stool traverses from that last two feet, if you get some stool stuck in these pockets, it doesn’t have a muscle to squeeze it back out of there. You just have to hope for the movement of the stool, and the kind of forward motion to empty them out. And if the stool gets stuck in there, it’s an abscess and that’s going to require surgery. We try to reverse it with fasting, and with nothing by mouth, and some antibiotics in the veins. We do all kinds of things to reverse when you get close to the danger point. But if indeed you do get an abscess in that part of the colon because of diverticula, it’s a surgical emergency. You are going to need a surgeon.
She’s right to have a fear that the surgeon seems to think that she’s going to have her colon cut out. And I just want you to see with my own mother at 71 in the last section of her colon with hundreds…I mean you can probably say thousands…she had so many diverticula, it was too many to count. I put her on a ketogenic diet. So that gives you the answer to say, is it safe? But in that same aspect, there were several things that were helpful for her to process and live life without upsetting her diverticular disease. They talk about not having seeds and not having popcorn, isn’t it? But that turns out not to be that significant of a finding. What we think is a better progression of helping this disease state settle down…because having a little pockets isn’t going to hurt you at all. You won’t even know they’re there…it’s when they become inflamed, which is when we take the word diverticulosis, and we turn it into diverticulitis. That’s what will end you up in the hospital.
Those hurt, they have lower pain, sometimes their bowels stop moving, and that really does require a surgical emergency. My patients who have diverticular disease and have been flipping in and out of diverticulitis, I will really be strict about the times that they eat. Bowels rest when you’re not eating. So if you read the book, what happens with my mom is she does really well on the ketogenic diet, and then she gets a dose of IV sugar. She gets an IV in her arm and sugar goes into her veins, and everything swells up including those thousands of diverticula.
So again, it comes back to this how we talk about inflammation, and how keto reduces inflammation. And I was just thinking earlier, when you were saying that about it getting infected, but inflammation is presumably what starts causing all the pain that you get.
Yes, that’s exactly where I was headed with that. She had such an infusion of sugar and then it inflamed anything that was delicate. And in her body, that section of her bowel was delicate. And it swelled up so much, it swelled the colon shut.
Yeah. At which point we did the most powerful thing to help her diverticula, and she fasted for over a month. And if you read the book, you’ll see what happened during that month and how many things changed. But thank goodness she’d been on a ketogenic diet before that, so her body and her mitochondria were totally ready to use ketones as a fuel. And she lasted over a month before she actually did end up with surgery, but she should’ve died. She should’ve died. She should’ve died. Because no, there was no stool coming out her bum – it was all blocked.
And that was…you’re supposed to die, so… The point I’m making is that when I look at what things do I encourage my patients to do when they have diverticulosis who’ve had flares, is time restricted eating becomes really powerful. What time restricted eating means is you start the clock with your circadian rhythm in the morning. So the sun comes up and your clock starts. Now I want you to limit that you only get the next 12 hours to eat. Now I have people play games and say, but I want to eat at night. And I’m saying, nope, you don’t get to move your circadian rhythm, especially in the world of improving your immune system and that inflammatory response. So keeping the time restricted eating from…my mom has her first cup of coffee in the morning around 5:30 or 6:00, so I tell her she can’t put food in after five 5:15 because I wanted it out of the stomach by the time those 12 hours are done.
That doesn’t mean that you’re gobbling it down right at the top of that 12th hour. That doesn’t work. I need you to be finishing the eating at the 11th hour so it’s out of your stomach by the 12th hour, giving you 12 hours of time restriction where your bowel gets to reset and rest. And if you want to look at the best protection against a diverticular disease, it is time restricted eating. The colon gets to rest when you stop eating. And so if they snack all day long, and what many people don’t realize is that your metabolism begins the first drink you have in the morning, especially if there’s anything in it. If it’s water, you can make the argument that you’re continuing a fast, especially if the volume of water is, I don’t want, people tend to have low volumes of water, but if you’re looking at a trial, how does the GI start its secretions, and the liver start its metabolism? Circadian rhythm matters, the sunlight matters. And then that first gulp of a significant amount of liquid will start your metabolism going. My mom drinks coffee. That coffee is her first thing in the morning, and from 12 hours after that I want her not eating anymore. And that’s what I do with my diverticular patients. That’s difficult to do. We talked about changing habits with your sleep patterns, but it is just as difficult when I ask a patient to say, I want nothing in your mouth after, essentially 5:30.
Yeah, that’s another thing I’m a shocker for. So that time restricted window, but also you did mention there, so there’s this benefit as well in not eating too often, even within that window.
Right. The first place I limit is to get them to only eat during the 12 hours. The second thing is I want you eating your food in a bolus. And what that means is eat, feel full and then stop. And that kind of bolusing of food, meaning not trickle it in over time, it gives the bowel times to rest, which is really important with the diverticular process. So when it comes to fiber and other things, a ketogenic diet does not tend to be high in fiber. I’ve told patients forever how important their fiber intake is. As I’ve transitioned into a ketogenic way of living and really looked at some of the evidence that says, if you time restrict, if you eating with a bolus, that gut lining is actually pretty healthy.
It’s not a mandatory. There are lots of times where our bodies went without significant amounts of fiber. Fiber has been the mantra in the medical literature though, saying, keep the bolus really full of fiber in those last two feet of colon if they have diverticula. And again, the science behind that is to say, don’t let the stools slip into those diverticular pockets. And the way you can kind of hold the osmotic pressure is to keep the fiber in the stool. And that’s one option. But I would contend you got to eat a lot to do that, and on a ketogenic diet it’s going to be really difficult to reach the threshold of how much fiber is necessary. I would push you to time restricted eating, and eating a real meal when you eat.
And it feels logically to me that if you can improve how everything’s behaving in the first place – so your colon and those diverticular are less sensitive, less inflamed in the first place – exactly what you’re eating becomes less important anyway.
Yes, I’ve seen the process of inflammation reverse at such a profound level on the ketogenic diet, better than anything I’ve done in 20 years as far as prednisones, or really strong chemotherapy drugs to kind of shut off arthritis, and shut off Crohn’s disease. You have these powerful drugs that will shut things down, and they are amazing. I’m thankful to live in this generation of healthcare. But when you added a ketogenic diet – which kind of got to the root of where this inflammation was coming from – not only did those medications work better, but some of them got off of all that. And that’s been another place where you look at what’s going wrong with the diverticula? You look at all the people who have diverticular outpoachings, and it’s a big percentage of all of us.
Inflaming those is an immune system that’s kind of teetering on the edge of not protecting our bodies as well. And I contend that the longer you are on a high fat diet, the better you supply the body with the nourishment to have a stronger immune system, to have those lower inflammatory responses, or at least not overproduce the inflammation when you have your inflammation response.
So if you have this vulnerability, if you like, if you have diverticular disease, you’re on keto, great, because it’s going to put you in the best possible position for these episodes not to happen. But I have read in my Facebook group, people who’ve had the odd attack. So the chances are that the reason that’s happened is that maybe they’ve gone a bit high carb for some reason? But presumably, other things can impact that inflammation. So maybe, again coming back to lack of sleep, or maybe they get stressed. All those things I guess, can potentially inflame things and make them really hyper vulnerable to an attack.
The other part about what you just said is that there’s this guessing, like oh, I’ve got diverticular disease…I don’t want to have diverticulitis…how can I protect myself? And I give this generalized answer, like this is what I do generally, but I don’t skip the part where I tell this patient, you should help me. Help me see what’s going on inside your body. And that really comes with checking these biomarkers that you can do at your home. That is your blood sugars and your blood ketones. It is one of the things I do on Instagram. I start a fast every Sunday and I fast until I hit a biomarker. I call it a ratio of 40. This is again trying to hit that autophagy; how to keep my body’s inflammation low; how to keep my body burning on a ketogenic journey.
Not because I have some super goal for myself… I’d like to lose a little more weight, but I like the way my brain functions. It’s almost a way to keep you accountable. I have patients who are looking for examples like, nobody fasts. Okay, I’ll fast and I’ll post my numbers on Instagram. This is possible. Then I have other patients that do it and they kind of send me the numbers and stuff. The point I’m making is that if this gal really wants to know what’s wrong – am I at risk for having a flare? Check your numbers. In my mom’s case, I would have her check her blood sugar first thing in the morning. For the ladies, put it next to the toilet. I don’t want you going letting the dog out, going and making them a cup of coffee, I want you checking it right when you empty your bladder in the morning. Put it in that place where you go to the bathroom and check your blood sugar, and then check your blood ketones. I can tell you that not only does that help me when the patient tells me, but it’s such powerful feedback for the patient to say you’re waking up in the morning and I know you think you’re on a ketogenic diet, but your ketones are less than 0.3 and your blood sugar is still 95 in the morning. And I think that helps them see why I want you to time-restrict that eating is because you didn’t empty your liver last night, you still have leftover carbs that your body is still producing and fueling off of, and now you don’t get to push your circadian rhythm back.
Your body already started when you woke up this morning and the light hits your eyeballs, and the first cup of coffee hits your stomach. Those break the fast in the sense of this medically-restricted diet. You can talk about fasting in another realm, but if you’re looking for how can I help this diverticulitis not to happen, I want the blood glucose divided by the blood ketones – I want that ratio to be less than 40. The more days she can hit that, the better I know she’s going to be protected from a flare. If she really wants to stay away from the surgeon, that ratio is what I would encourage her to reach for. With my mom, who had this problem and then she had cancer, we wanted her ratio to be less than 20. And I know that when you’re using the metrics for the European glucose versus the American glucose, you guys use a GKI, Glucose Keto Index, because you’ve got to divide your glucose by 18.
It’s a one-to-one ratio in your market. But in America you’d have to divide the glucose by 18, and then you have to compare it to your ketones. And then you want a one-to-one ratio. And I’ll tell you that was too much math for my mom. She’s a smart woman, but she was sick and I needed something simpler. So I took the glucose divided by the ketones, and if we could get the number under 20, we hit our goal. And we were super strict. When you read that book and see what we did during the time where her diverticula had blown up to the point where she couldn’t have a bowel movement, we only reached the ratio of 20 a couple of times.
But she fasted and you can read what that’s like in the book. She did that for all 34 days or something like that. In my case, I tell patients if you want weight loss, if you’re trying to get off a plateau – and I know several of the other questions were about what happens with a plateau – I tell them, look at your glucose first thing in the morning, divide it by your ketones, and if your ratio is 80 or less, you’ve got a pretty good chance you’re going to be in a weight loss zone. You don’t hit that once a week. You need to be hitting that every day if you want to lose weight. If you want to take it to the next level, which I encourage my patients to do…is a form of autophagy. And I talk a lot about how you recycle that body.
This woman has diverticular, which means things have gone wrong. That’s not normal. As much as it’s a population in 2018 – where most of us have this, if you go back and look at mummies, they didn’t have this problem. They had a different lifestyle, a different diet, a different body mass. Their insulin levels were nowhere near as high as ours have been as a population. So just because it’s common, it doesn’t mean it’s normal. So here she is, later in her years trying to say, uh-oh, this has happened. Can I undo this? And I don’t make any claims about undoing diverticulus, but I know that autophagy helps to recycle those broken cells; those broken parts of inside the cell; the debris that’s in your brain; for dementia; for cancer prevention; is linked to how well you hit autophagy at a regular routine basis. So these fasts that I start on Sundays and I post my numbers for, once I hit 40, I then go back to eating a ketogenic diet.
If I was being perfect…if I had Crohn’s disease, or I had ulcerative colitis, or I had psoriasis where I was really trying to get my immune system to reset, I would set a goal of hitting that 40 every day for at least 90 days and maybe a lifetime, because it would reverse and repair and we could have a pretty strong level of confidence that your system really does have some undo buttons in it…and that’s in this autophagy state. We can’t send you to the lab and say, are you in autophagy? But we can have you looking at some of the biomarkers at your own disposal. I’ve tested a whole bunch of glucose monitors to say which ones work the best. I can send you a link to the one that I’ve found. My patients have said this for years, but now I really have pricked my finger enough times to say, all right, at least when I use this test strip, it’s giving me the right numbers.
Don’t be duped by saying we have the cheapest strips. Sometimes those are taking four or five tests from my patients to get a number. The other side of that coin is you can test, you don’t need my prescription to do this. You can be at your house in your world, in your life, and you don’t need a doctor’s visit to do this. Just order the test strips and test yourself a few times saying, well, why am I stuck? Is this possible? How hard would it be from my body to reach that? And that’s the empowerment that I think 2018 medicine really has is that as long as you have somebody gifting you the knowledge, you can really bio hack your system into a lot better health.
That’s right. There are a couple of things I wanted to say there. I love it when I’m listening to something you’re saying and it’s ticking over in my brain. Hmm, I need to change a little bit what I do. When you said about how it’s really important to make it the first thing you do, and not the thing you do after you’ve pottered around, and you’ve let the dogs out, and you’ve made yourself a cup of tea, and then you’ve…you can guess this is what I quite often end up doing. So that’s something that’s going to change tomorrow and be stricter about making it the first thing I do. But yes. So what I tend to do, I have a little diary and I put my numbers in every day.
I tend to weigh myself every day. It’s just something I do. I don’t freak out when the numbers go up and down. In fact, I find it interesting with the fact that I can see that they do go up and down for no reason at all, actually reassures me not to take it too seriously, but I write that down, and then I write down my glucose and my ketones. So yes, it’s an interesting point that it’s important when you do it. But the other thing I was going to say…you talk about the test strips and how you can do it at home, but they do add up. They can be costly. But it’s the kind of thing I think that if you can do it rigidly for a while, and then you get a good sense of how you feel at different levels…for me, I can tell if my ketones have dipped because my mood goes down and I get more headaches.
If you test for a while and you’ve invested a bit of money in doing that, as long as you carry on doing what you were doing in that period of time when you’ve been testing and you know regularly that you’ve hit that less than 40 or whatever marker; as long as you keep reproducing that, you don’t actually need to be testing anymore. It’s only really getting yourself into the routine, isn’t it? Once you’re in that routine, you know what you’re doing, you know what works, you don’t have to keep testing ad infinitum. It might be useful to come in and retest every now and then, but you don’t have to be doing it for the next 10 years.
I think of it as the cost of discovery. That you’re going to pay $200 to come see the doctor – your insurance is going to cover a bunch of that. But if you spent that $200 on just you learning about you…I mean I think the kit that I…I’ll send you a link on the one that has both ketones and glucose in the same monitor. And again, the reason I’ve kind of gravitated towards this monitor is because I have spent six strips to get a ketone level on some of these other monitors. And nothing makes me more angry than having to poke my finger again. And just that cost. So, those strips are really reliable but then more importantly, the knowledge of what’s going on in you.
This person sends in a question and I instantly have a profile in my mind from the thousands of patients I’ve seen over 20 years, but it’s a guess of what she’s like, and what the problems are, and where she’s been, and where she’s going. She could best understand herself if she did one week, just every day, get up in the morning first thing glucose and ketone numbers. And if you’re using the American numbers, you take that and divide it. And what you’re looking for is a ratio of 40 or less. And if you don’t hit that, I’m telling you, you need to restrict the time that you’re not eating, and you cannot move the morning number. You have to move the evening number. I tend to start patients at 10 hours. At the 10 hour mark, you should have no food. That gives you 14 hours of eating and then I remind them that when the 10th hour gets there, you’re not eating. You ate probably half an hour to an hour ago, because it should be out of your stomach. So I really want you truly done with food at the 10th hour so that you get the 10 hours break. And if you’re waking up every morning with 10 hours of fasting and your ratio isn’t below 40 – and that’s your profile with the diverticular story – I would contend you’re in trouble. You’re going to end up with a flare.
If you’re saying, doc, I’ll do anything; I want to do anything to not end up in surgery. Like, okay, here’s the rules: first thing in the morning, test yourself for a week. Get that ratio below 40. And if it means that your body is so insulin resistant, and you’ve been overweight for so long that you had to fast for 12 hours every day, or you had to time restrict for 14 hours every day, I’m telling you, it gets better, okay. This is a skill that you learn to say no in the evening to food. Salt and water is the only thing you get after that time. And I can’t tell you the number of patients that have walked away from some serious medical interventions because they got the numbers, they checked them. Now they usually come to my keto group because you kind of need a little support…it’s a lonesome journey if you’re doing this all by yourself. There’s plenty of ways of support: from listening to podcasts, to checking out YouTube videos to having a support group of your own. But those all have been the links to say how do you change the trajectory that your health is going…measure yourself!
Yes. It’s very true. I meant to say earlier, when I write those numbers down and I can guarantee that if I’ve had a snack late at night and because I always write it underneath, if the blood sugars up a bit higher than it should be – than it normally is – maybe the ketones are down, maybe not. It kind of depends, but the blood sugar is the definite marker. If it’s higher than it normally is, and I put underneath with big exclamation marks, that’ll be the late night snack.
It’s real. You are human. There is something powerful about changing behavior with that instant feedback for how you see yourself.
Yes, it’s very good to have it there in black and white, isn’t it? Because it’s something you can’t argue away. Well as usual Annette, you’ve gone into such amazing depth and given us so much information and knowledge to take away. We’re up to our time on this episode, so we’re going to round it out now. I knew when I put up this topic in the group that I was going to get lots of questions, and that we were going to have to go onto multiple episodes, so that’s what we’re going to do. Thank you very much for making a start on this big long list and we’ll be back soon with some more questions and answers.
This transcript is brought to you thanks to the hard work of Michelle Richter.
Welcome Carrie Brown, to a special pre- Christmas holidays podcast on Keto woman podcast. How are you doing today?
Hello Daisy. I’m doing great, I always have a great day when I talk to you.
Oh, that’s nice. Me Too.
It’s like talking to an old mate
Exactly, exactly. It’s, it’s very comforting isn’t it?
Well I suppose for both of us, ’cause you are in France surrounded by French people speaking French and I’m surrounded by Americans, which I love, but still they’re Americans and so it’s like, yeah, it’s kind of a bit like coming home talking to you even though we’re like across the other side of the pond from each other.
I know and I saw you post in your kitchen group the other day that, that you’d been talking to a friend in the UK for a while. So, you were talking particularly British after that. It does affect your accent doesn’t it, depending who you’ve been talking to.
Yes. Yes. I was, I was talking to England, and I can’t remember who I was talking to now, which is really weird because it doesn’t happen very often. But anyway, yeah, I talked to England for a really long time and it was awesome. I’m pretty sure that I sounded a lot more British at the end of it than I did when we started.
Yes, it does work like that. I tend to be a little bit of a chameleon with that and pick up bits and pieces depending, depending on the people you’re talking to at the time.
After a couple of days I was calling the trash bin rubbish and you know, things like that.
Put it in the bin!
Yes. I, I notice a lot of your, a lot, a lot of your Americanisms now there are a lot of things in your general speak that are much more American than, than British. But that’s, that’s what happens I guess when it’s, when you’re living there and those are the words around you all the time, you just naturally start picking them up.
Well, I, I just think it’s, it’s how you get on because it’s… so British people, we all grew up watching American TV, but Americans don’t grow up watching British TV. So British people are much better at knowing how to do American than Americans are at knowing how to do British. And so, I, I found when I moved here, so if I want it to be understood and didn’t have to explain myself every five minutes, I just used their phrases, their expressions, their words with my British accent, but with all of the American phrases and words, and that’s kinda how it goes. So now I just use, yeah, I just use just so that I don’t have to explain myself all the time. I got out and have to explain a hundred times over what rubbish is or what a bin is, or I know a lot of Americans know some of the core things, like they know that a hood is a bonnet and a trunk is the boot, but there’s a lot, lot, lot more different words that the British use that they don’t know. And I just found it easier to use their words and phrases and call it good.
It’s very funny I say that. So that’s one of those that little light bulb moments that I hadn’t thought about what the reason was for why as Brits, we seem much better at those translations and of course that’s what it is. Of course, it’s TV as you’re, as you’re growing up, it’s obvious. I’d never thought of it before, but that’s why it is completely dependent on the television you watch. You know, I mean I can remember, yeah, growing up and watching obviously the American films and programs, but also picking up all the Australian lingo as well because of watching things like neighbours, you know, and that that is absolutely isn’t it? How you, how you pick up those things and learn the translations and if you’re not watching them, you don’t know.
And there’s a lot less. In Australia there’s a lot more Australians who grow up on British TV, but not, not so much in America. So that’s why we are better at being American than the Americans are at being British.
Absolutely. Now, yes. Now it all makes a lot more sense to me. Anyway. We are talking about the holidays.
Yay Holidays or whatever it is. We’re supposed to call them now.
Exactly. It gets, I mean, you know, it’s always going to be Christmas for me. Even though I’m, you know, I’m not religious and don’t actually believe in the whole Christ behind Christmas thing personally, but it’s just for me it’s just a name for that time of year in the UK. I know particularly in America, it’s a different holiday season. It really seems to start at Thanksgiving and, and sort of carry on from there. But there are, I mean there are so many different festivals that come into play this, time of year aren’t there, and I think that’s why just calling it holidays is probably a good way just to encompass everyone and everything
Yes, I think you’re right that in America there’s so many more different cultures here than in England, but also there’s thanksgiving and that’s the big holiday here, whereas in England everything revolves around Christmas, like we really only have one big I mean we have Easter but even that isn’t anything like the scale that we do Christmas.
Christmas is the biggie isn’t it, yeah.
And that’s when we get, you know, everyone takes like 10 days off and you know the public holidays everywhere. And so, for me, like you, everything was about Christmas. Even though I didn’t grow up in a religious family either, you know I grew up in a household where we went to church for weddings and funerals, for me it was all about Christmas because that’s the big holiday. So, for me, I’ve just, you know, I spent my entire childhood saying Merry Christmas and now it’s like, well now people, some people choose to be offended about that. And I’m like, it doesn’t actually, it’s just a nice greeting like really just like it’s just a pleasantry, like I, you don’t have to get bent out of shape about the fact that I said Merry Christmas and not happy holidays. However, having moved here I can see how it’s more because there are so many more holidays here and you don’t know what the person you’re talking to celebrates or doesn’t or whatever, that it is just easier to.. it feels more inclusive to say happy holidays rather than Merry Christmas but I do still trip up.
Like I had a blood draw yesterday and as I left I said to the lovely Gal who took my blood as I walked out the door, I said I mean this the nicest way possible but I hope I don’t see you again, because you know, who wants to go for a blood draw, so I said in the nicest way possible I hope I don’t have to see you again, but merry Christmas and I was just like Oh, I was supposed to say Happy holidays, oh whatever. The other thing is that in America the Americans get incredibly excited about every holiday. Like they decorate for every holiday Halloween’s a huge thing. They redecorate the houses for every holiday. I mean everything and it’s very, I have found it very, very difficult not to get sucked into that and I don’t mean that in any bad way at all. In fact, I’ve started to actually look forward to the change, the, you know, every holiday they decorate their houses and they wear green on St Patrick’s day and I’ve actually come to appreciate that and enjoy that. It’s not really something I participate in, I don’t wear green on St Patrick’s day, but I love the enthusiasm and the excitement with which Americans embrace every holiday they possibly can. So happy holidays does seem more appropriate here.
And it’s nice to spread it, have some different festivities around the year as well rather than having it all at one time of year. But I think, I think it’s just when you grow up with something and it’s a habit, it’s so enshrined in like you say it, the words tumble out of your mouth without really thinking about them and I think, you know, a lot of things have changed in the last couple of yearswhere we’reactually having to address some of those things and some of those phrases and words that tumble out of our mouths automatically and we’re having to start to think about how other people might react to those, and I don’t think that’s necessarily a bad thing but I also don’t think it’s a problem that it just takes us a while to have a transition from one to the other and have to keep reminding ourselves, like you were saying, Oh I meant to say happy holidays but merry Christmas tumbled out. I don’t think that’s a bad thing. I think it’s nice to be aware that we’re trying to change it to make sure that it’s more inclusive and that we’re not maybe offending someone by, by saying the wrong thing. I think that’s a good thing to be aware of that I think probably people are forgiving of us if it takes a little while to get used to it.
Yeah and I think there’s a lot of people, there’s this furore.. furorey… I don’t know if it’s reached France yet but there’s some people who have gotten their panties in a wad about the song Baby It’s cold outside, which was written in like whatever, 1940 something and like there’s a bunch of people that are just getting really upset saying we shouldn’t listen to it and he’s talking about date rape and blah blah blah, blah., and the rest of America is going wait what? Like, have you heard the music that’s being written today, and you’re okay with that, but you’re not okay with this.. like what? But I think, and sometimes I’m like we got on with, like this stuff was never a problem, why is it a problem now. I think one of the things is that the world has got so much smaller because we do travel. It’s like we’re not like just in our little culture bubbles any more. We do have to start embracing other cultures and being more inclusive because we travel and the Internet has made the world so much smaller in that we can touch all these things now, whereas before we couldn’t you know, we were in England and what was good for England was, was good. And we didn’t think about the rest of the world because the rest of the world didn’t touch us and we didn’t touch them but then with the Internet and then travel, now all of a sudden it’s like, well actually we can’t be insular. We can’t just sit here and think, well, you know, it’s all about us. It’s right and proper in my opinion, that we should start embracing the other people and the other cultures that we touch now by virtue of the Internet and travel. So, but I think that’s why for you know, 60 years things like baby, it’s cold outside weren’t a problem. But now, you know, maybe we do have to look at things in different ways. Of course, no I don’t think we should stop listening to it, but.
Well my perspective is on it. And there was, there was a post in my group about that and they were listing all the other things that should be banned because of that. And, and, and my first reaction was, was to laugh it off. And that post actually got flagged by somebody and I had a discussion with them about it and it opened my eyes as to how, okay, we’re not, we’re not necessarily saying this song has to be banned, but we’re just having aconversation about actually this song that has been part of our culture. Think about the culture it was written in the people maybe who wrote it. And some of the words and some of the phrases that are in it are actually potentially triggering people and hurting people. And we are in a different environment now. And I, but I think it’s just, it’s not necessarily about saying what songs we should listen to, shouldn’t listen to what should be banned, what shouldn’t be banned. It’s having those conversations, it’s like having the ‘me too’ conversations. It’s like having the, the, the different gender, uh, conversations, the race conversations, all those things. It’s about having the conversations. And actually for me, that what I always benefit from is just opening my eyes to different points of view and actually having those little light bulb moments. Gosh, yes. I’d not thought about that. My first instinct was to laugh, but here I am hearing from somebody who has actually felt really unpleasant when they read that post and it actually impacted them in a really negative way. So immediately that’s going to, that’s just going to alter my perception. I don’t, you know, I think that’s a good thing. It’s just about learning and appreciating other people, isn’t it?
Yes, I just think that’s hard.
Yes, it is hard, very uncomfortable.
Some people would rather just carry on laughing and ridiculing because if they don’t, they have to stop and think about, wait.. maybe that is impactful, and that takes work and we’re humans and for the most part we don’t like work so it’s easier to you know, keep on keeping on with what you’ve done for your whole life or what you grew up with. But I do think and I think maybe because this is the fourth country I’ve lived in, I think I’ve had an advantage in I’ve been forced, right? I say that in air quotes because I chose to move those full time. So, but when I say, you know, having made the decision to move, then if you want to get on well and be successful, you have to integrate into the society you’re in. And so, I’ve been exposed to a lot of different cultures and a lot of different views and now I can see why we should try not to be lazy and we should try to see it from the other person’s point of view and maybe make a new decision, maybe not.. maybe stick with where we were, but at least be open to learning why different cultures do things a different way or how people that have had horrible experiences might come across some things. So, but you know, as humans we are lazy and it’s easier not to do that because it’s work I have just been exposed to having to do the work because if I wanted to survive in wherever I happened to be living, then that’s what I had to do, so I’m kind of grateful for that. I’ve been forced into not being lazy, dammit.
Yes, exactly. And I think you’re absolutely right and that was in a way that was, that was my first reaction when I had to start thinking about that post and what went with it. It was, you know, I don’t have time for this or I don’t want to go down into this quagmire.
Just get over it, why are you making a drama?
Yes, but the rest of me, the biggest part of me was, well, no, this is important and yeah, suck it up. You’re going to have to feel uncomfortable for a while. But ultimately what comes out of it is that it’s interesting learning about other people and, and how they feel and the benefit you get from going through that brief period of feeling uncomfortable, I think has so much value. And people who refuse to do that in my opinion are missing out,
I’m endlessly fascinated with why people do what they do. Why people think it doesn’t mean that all necessary change my mind, but I love to see how someone sees something in a completely different way to me. I’m just endlessly fascinated with psychology and why people do and say what they do
For sure, and I love to have things that I think, or I thought that I believed quite strongly and challenged because sometimes it does get changed. That’s how I started low carb and Keto actually from somebody challenging me and saying that I was talking a load of rubbish about carbs, which, which I was and it was somebody really challenging me but doing it in the kind of way that pulled me in and said, you know, go and look at the science and this is interesting and because I had respect for her as well. It was just really a fascinating journey finding out about what she was saying and probably trying to prove her wrong and prove myself right. Not being able to do so in the process and look what a different path, you know, that sent me off on, so I think sometimes people can radically change what you think.
This is not at all what we were supposed to be talking about.
No we’ve gone off on a bit of a ramble.
That’s a brilliant segway into one part of what we’re going to talk about I’m going to talk about which was understanding and embracing the fact that not everybody, feels merry and bright at Christmas or during the holidays, whatever we’re going to land on calling it.
Yes because there is that expectation isn’t there?
There absolutely is.
You know, happy holidays, bonnes fetes is here. Everyone’s supposed to be happy and having fun and, and feeling festive and it’s all, yeah, I hate it. Hate is a strong word. That’s not true, but I don’t enjoy the festive season that much, I find it very difficult
And there is a lot there’s a lot of people who do not feel merry and bright and actually there’s a lot more people who do not feel merry and bright around the holidays. Rates of suicide are up at the holidays, rates of reported depression or clinical depression are up during the holidays. So actually, there are less people being merry and bright than more and our little discussion that we hadn’t planned on perfectly points out that it will be really useful. I mean, I hesitate to say that we have to, I do think we have to, we all have to make the choice to do it, but I think it will be incredibly helpful to mankind if people who do not suffer from depression or suicidal thoughts, it will be incredibly helpful if those folks could at least try and understand or, or embrace the fact that there’s a lot of people that do struggle and how they can help it to not be such a difficult time for so many people. So, having the conversation about mental health at the holidays I think is incredibly important. Although anyone that knows me knows that mental health is my thing I think it’s incredibly important and I think it’s particularly important around this time of year.
So, I suppose, I think a good way maybe to approach this would be both sides would be how best to get through it as the person who’s in the position of not feeling great at whatever level that is. And from the other side with friends and family and people who know that person or suspect that someone they know a loved one feels that way. How best to help them through that time. Like I say, I find it difficult and my way of dealing with that is generally just to sort of hide away and make particularly the day, Christmas Day, but the time around it just as sort of cosy and as nice as I can and, you know, cuddle my dogs and my cats and just try and do things that will make me feel relatively nice. I don’t know. I don’t really have a perfect strategy of getting through it. I’m not sure that there is one um, but you know a lot more about this and maybe thought more about it, I don’t know what are your feelings from both those angles about how best to get through this in one piece
So, as a sufferer or an ex sufferer, Christmas, as we said at the beginning, Christmas has always been a huge thing for me and when I was a kid growing up, it was the best time of the year. I mean, it really was those two weeks over Christmas and New Year.
The excitement, right?
Oh, the excitement was incredible. It was the only time of year that my brother and I had chocolate biscuits, cookies. It was the only time of the year we had candy, sweets, chocolates, crisps you know, all of that like soda, like fizzy drinks. We never had that stuff during the year, we only ever had it . So, so, and not that food is everything but it was that two weeks was so different that it was this hugely exciting thing. And you know, in England, the build up to Christmas is huge and it’s like, you know, we actually decorate our houses and you know, do fun different things.
Oh, exactly. And it starts, yeah, it starts at the beginning of December and my, my birthday’s in the first week of December, so that’s when the weekend there’s my birthday, we’d get the tree and that would be decorated. And that for me that was, yeah, that’s, that’s the beginning of Christmas. That’s when it all starts kicking off what it did and the excitement. Yeah.
So, it’s a huge, huge thing and it’s terribly exciting. And so that’s what I grew up with. So historically Christmas was always good for me and then, you know, I got older and recreated that for myself, but then ( I lose track) 12/13 years ago I don’t talk about this a lot, but I was married and I became unmarried 12 or 13 years ago and it wasn’t so much, the loss of, cos’ I’m an introvert, so being alone is not an issue for me. So, it wasn’t loss of that, I think it was the loss of having someone to focus on or buying gifts for or I don’t know what it was but when, and I have no family either, so I’m kind of in this bubble of just me. And so, 12 years ago what I decided that I was going to do was I decided that I sat down and thought about, you know, what are the things that I really, really love to do and my, favourite things are driving. I know I should have been a truck driver, I missed my calling.
Yes I know your epic road trips
So driving, going to see new places, exploring new places and landscape photography, and so I decided that every year I was going to like open up the map and put a pin in it and say, I’ve never been there, you know like I’ve never been to Yellowstone or I’ve never been to Yosemite or as I used to call it, I don’t know, I’ve never been to death valley or I’ve never been wherever, I’ve never been to Taos, New Mexico and I would leave around the 18th or 19th. I’d pack up my forerunner and I would just go on this epic road trip. And um, and so I would literally leave before Christmas kind of started and, and I’d get back typically New Year’s Eve because like want to be home so that I was with my kitties for the fireworks ‘cause they were always terrified, so I always used to try and get home on New Year’s Eve so I was there for that. So that’s kind of 10 to 12/14 days.
I would be out like discovering new places, driving, shooting new landscapes, you know, I’d eat, what I wanted when I wanted, there was just like, and I would find the, I wouldn’t even realize which day was Christmas Day. I, you know, I would, I kind of literally just miss it and, and for me that works really, really well. So, and there’s no, it also takes away, ’cause I don’t know about you, but for me, and I think for a lot of people, single people or people who have families but they’re not really very connected with their families or their families are toxic and they don’t really like to hang out with them, which is perfectly fine by the way. Um, I think it can be that being invited to someone else’s holiday celebration or someone else’s Christmas particularly is awesome. It’s wonderful that people, you know, open their arms and their houses to have you come and join them for what a lot of people is a very special time of year, but for me, I often feel worse when I’m in a group of people than when I’m actually on my own, I actually feel lonelier kind of being a gooseberry. And I don’t know if Americans know that term or not, but, but I feel whilst being a gooseberry on the kind of fringes of someone else’s Christmas Day or Thanksgiving than I do if I was on my own. So, while I always get a load of invitations, I would, I’d like, you know, I’m road tripping. I’m going, you know, so what are you doing at Christmas? I’m not, I’m going to be in Taos New Mexico. And so it actually made it okay to turn down all these lovely invitations, which came from the best intentions and the best hearts of, you know, people that I love, but spending Christmas with another family I find harder than being on my own, so road tripping was my, was the way that I handled it, and so that meant that the holiday period between Christmas and New Year, once again became my favourite time of year because I was focused on going off and doing the things I love.
The other thing that I’ve done in the past is over Thanksgiving when I was working in corporate America, there was that 10 days over that Thanksgiving week, where Microsoft who would kind of shut down, no one was there. So, it was like, well I might as well just have 10 days because nobody is going to be there anyway and but what I used to do was that was my, that was a cookbook writing 10 days. I wouldn’t write the whole book obviously, but that was when I would like do, I’d be creating recipes like crazy. Like I do five to seven recipes every day. So, I was, I had this massive project for that period of time and everything will be focused on that project. And so again, it took away the, you know the invites from people that you don’t want to turn down because you love them and you don’t want to make them feel bad. But I’m like you know, wow, I’m going to be, I’m working on a cookbook and I’m scheduled that day and thank you very much and I’m afraid I won’t be able to, so it took that away. But it also kept the focus on something creative, which is I’ve always found incredibly good for stopping the emotional roller coaster. It keeps you focused on something, it keeps you busy. It’s just there’s so much good things. So those are two strategies that I have used over and over and over again that’ve been really successful either having a really big creative project over, for me it was Thanksgiving and it was writing cookbooks and um, over the, the Christmas slash New Year’s time, it would be road tripping, opening up the map, I’ve never been there, I’m going to drive there and I’m going to shoot it with a camera and, and discover new places. And so those are two things I’ve done to completely eradicate the, the word terror came to mind, but I’m not sure that’s the right word, but for people who struggle with depression or people that are alone, either because they are single and have no family or because the family, you know that situation is not good. That’s the way I’ve dealt with those two ideas for how I dealt with the times very successfully and I kind of breeze through them without even realizing like, oh, oh, it’s those, y’all supposed to eat Turkey today, you know, or whatever.
Oh, that’s, that’s fascinating. And it’s brought a few things into place in my mind when we, we went from that earlier on, both sharing that and remembering that immense excitement that we used to feel as children at Christmas, and you know, I can remember knowing that I wasn’t allowed to go into open stockings until whatever time my mother had set because it’s seven o’clock in the morning or something, you know? And, and those were the days where there was, there was nothing you could do. Um, I think I had a tiny little radio that I turned on that I think the BBC might’ve come on at five o’clock in the morning, but before that there was nothing. So, it was, you know, maybe a book or something, but that, oh, having to wait because you were so excited and you wanted that day to start. And that overwhelming feeling of excitement and joy and anticipation and I think part of the problem, it’s just sort of come home to me really, and it’s obvious really is that we’re trying to recreate that. That’s our standard, that’s our benchmark for what we think Christmas should be. And of course, attaining that level is nigh on impossible and I think to a certain extent it does get recreated by people who go on to be parents and have those young children themselves and then enjoy Christmas or that period of the year, the celebrations in that time. They enjoy it vicariously through those children and get that level of excitement again and experience it in a slightly different way and I’ve seen that participating last year I was, I was back in the United Kingdom with we thought and it, and it did turn out to be my stepfather’s last Christmas, so it was, it was really important to be there, but I got to see the excitement of those young children and get some of that excitement of the day again and I, and I think, but I think the trouble is if, if you don’t have that and like you were saying, it’s very difficult. Some people can involve themselves in other people’s Christmas and get enjoyment for that, but I feel the same as you do. I felt a bit like a gooseberry it and it just makes me think of what I don’t have rather than I have in that moment, which is, which is not really helpful for anybody, but I tend to sit at home focusing on what I don’t have and you know, waiting for that phone call to hear from my niece and nephews or those kinds of things. And so, it, but that’s what it just dawned on me with you were saying about focus, it’s changing your focus to something else and having that project or something else to do. Yes, putting something in place, this is what I’m going to do.
It’s also planning and I think planning one, you can build the excitement if you know this thing is going to happen, but also it means that you don’t inadvertently wake up and you’re sitting there waiting for your niece and nephew to call or whatever your scenario is. If you have a plan when Christmas morning rolls around, you just, you’ve already got a plan. You’ve pre- decided what you’re going to do. It could be as simple as you’re going to get up and take yourself off to the wildly expensive buffet at the fancy pants hotel or the, you know, wherever it is, which is something you might never do, but you have a plan that you’re going to go do that. So, you get up and get excited and you get dressed and you put your mascara on or whatever and you go and have the fancy pants, keto of course, breakfast buffet for $45 or whatever it is. So, I think planning is super, super important for folks who are either in a situation where they’re alone at the holidays for whatever reason or people that struggle with being sad or depressed or even suicidal at the holidays. I think planning is really, really, really key. And as I say for me, having these big plans, having some creative projects to work on, having a schedule, it may sound dull, but trust me when I tell you that it’s always worked out to be the absolute opposite of that because I’ve, you know, my Thanksgiving’s up, got to the end of the week and I’ve produced this amazing thing or you know, I’ve got something to show for it. And, and I’d been so busy that I haven’t really had time to think about what I don’t have. And, and I’ve also been able to gracefully decline any invitations because I already had a commitment. The commitment was to myself, was, was still a commitment, you know a commitment to ourselves is as important as a commitment to someone else, um, so or going away and so those for me have been hugely successful. And I think planning is, is important. So, you know, start thinking now about what you’re going to do.
And the other thing I’d really like to have people think about is don’t be afraid to start your own traditions or develop your own family culture for how you deal with holidays. Because it might be that a lot of people in the family are secretly thinking the same thing because tradition and culture, and a family cultures can be so strong like nobody wants to do it, but everybody keeps doing it because they’ve always done it. And everybody’s afraid to say, why do we not do this this year? Or why don’t we do something else? Or you know, one part of an extended family is, is too nervous to say, you know what, we’re not coming this year. And so, I would just encourage you all to think about or if you’re in a family to sit with your family and go, you know, does this tradition actually work for us? Are we doing this because it’s the best thing for us and are we doing this because we enjoy it, are we doing this because it’s a positive thing. Or are we doing it purely out of traditional habit or culture? And don’t be afraid to, to start a new culture or new tradition for your family, even if that’s a family of one. You know, my tradition now, my culture is that over Christmas I road trip. And so actually last year I didn’t road trip, but that was the first time I hadn’t road tripped, Um, but that was because I randomly decided to move from Seattle to Connecticut, so I was busy getting the house ready for selling, the house ready to sell and packing and purging, and so I had this massive project all over Christmas, I don’t even remember which day Christmas was, but I had this massive project. It wasn’t road tripping for the first time, but I still had this massive project and that just kept me occupied and busy. And of course, I was excited about the move and I always find purging incredibly beneficial. I feel like my brain clears out when I clear out my environment.
Oh, and the weight lifted. Yeah. When I deal with, I’m dreadful for writing things on scraps of paper and I and I just collect them and then it just becomes this over flowing mass and it just stresses me out looking at it and when I do deal with it, it’s like a weight lifted. And I love what you were saying about having a project and what you were saying two-fold in my mind it came in thinking about when you were saying is that you get that real sense of achievement and fulfillment for having completed that project that you set yourself. But also, I can see it being a great reminder because when we, when we start doing these new things and trying to form these new habits, it doesn’t always work perfectly the first time. And it’s something that takes a bit of practice, but I can really see how that’s going to help for the following year, seeing those, so with you, the lovely landscape pictures from your road trip or all the new recipes that you created, that’s going to be a really good motivation for helping you plan the following year, so I think that’s, that’s a, that’s a great idea and I’m going to try that.
One of the reasons that I suggested you might want to look at whatever habits or traditions or cultures you and your family have because I remember when I was still in Corporate America and way back, way back when, before keto and low carb and all of that, on Thanksgiving what I used to do was I would go to rent box and get six movies, and I’d roast a Turkey on the Wednesday night, Thursday morning I’d make an enormous pile of Turkey and cranberry sauce sandwiches, which is like my favourite food ever, and I’d make this enormous pile of sandwiches and I’d get my six movies and I’d get my six cats and we would literally spend all day on Thanksgiving, on the couch, eating Turkey sandwiches and watching movies, which for anyone who knows me knows that like I barely even know where my television is. Like I’m just not a TV watcher or a movie watcher. So, this was like an extraordinary day for me. But it was something that was really, that I did really look forward to and it wasn’t traditional at all. It was Turkey sandwiches and movies. But for me that was really different. And to spend an entire day relaxing, just hanging out or watching movies on the couch was like such a delicious thing because I never, never did it. And so, and this was years back, before I started road trips and keto an all of that. But that was like that became my thanksgiving tradition was that was how I did Thanksgiving.
And the following week when we’d all go back to work and we’d all share, you know, hey, how was Thanksgiving and I would tell people what I did. Almost everybody as long as we were just one on one in my office or whatever, every single person would say, wow, that sounds great, I wish I’d done that and I’m like so what did you do? And they’d say, well you know we and I have this stream of people who would like secretly wishing that they had just hung out, you know, with their pets or their spouse and kids and a pile of sandwiches and a bunch of movies and just chill there all day. And so that’s when I started thinking. So why don’t you like, why like be brave be if it’s not working for you. Hey, if you just doing it to keep other people happy or you’re just doing it because it’s tradition or like sit down with your family or with yourself and go, does this actually work for me because if it doesn’t then I’m going to create something that does. So that’s why I, I just would like to encourage you all to examine like why you do what you do and if it’s actually working for you. And if it’s not, don’t be afraid of, like just making your own tradition up and as something that serves every member of your family. Like maybe you have some introverts and some extroverts and some, maybe you can, if you’re in a family unit, maybe you can split yourselves in half and dad and you know, x number of kids like to go hiking. Just don’t be afraid to figure out what works for you now and do that. And I think, I think you’ll find that a lot more people will struggle a lot less if they do that.
Yes, it’s a, it’s a good point. And I can see even maybe taking turns, you know, if you have a family unit where you all want something completely different is maybe doing, doing it differently each year that and you might actually, well you will learn something about each other and might find, you know that you end up forging a tradition that the ends up, does end up suiting everyone. It’s a fascinating idea to just potentially shake it up. Not if you don’t, you know perhaps you, you absolutely all love the way it is and you love the traditional day and that’s, and that’s great but I think it’s, yes, I think it’s a really interesting idea just to, just to have that conversation because like you say, everyone might just be thinking we’d like to do something different. What about, I think we’ve kind of probably covered it really by just showing how people might be feeling this time of year, but is there anything, any tips you would give to people who do really enjoy this time of year are either come across someone they feel isn’t and they might want to help them out or they have a friend or a relative that they know doesn’t enjoy this time of year? What, what strategies would you offer them with how to help their loved one get through it?
So, I think people that don’t struggle with depression or suicidal thoughts, I think that a lot of them find it really difficult because they don’t know what to do with this, and I think part of that is that they’re scared of doing the wrong thing or saying the wrong thing or being in over their heads and it’s all so difficult in that if you don’t understand the difference between a clinical depression and situational depression or someone that’s just sad, then it can be very frustrating to have this miserable person kind of hanging around. So, I think the first thing I would like to encourage people that don’t suffer is to just try and get an understanding that a clinical depression or suicidal thoughts. It’s like having a broken leg. It’s not something that we can, we can’t just go, oh, I’m going to toss my, crutches away and walk because you know, I’m just going to get over my broken leg. You can’t think this way out of a clinical depression any more that you can think yourself out of a broken leg. So, you know, or if you’re diabetic, oh, I’m just not going to have, I’m just not going to have that diabetic coma. I’m just not going to do it or I’m just going to wake up, just wake up out of that coma. You know what I mean? It’s just a lot of people ask us to do the impossible by snapping out of it or it’s not something that we have control over, so I think it’s super important if people would try and understand what it’s like for people that struggle with clinical depression or suicidal thoughts, if they could just understand that it’s not something that we have control over and then give us space.
And so, for me, when I wasn’t you, I think everybody knows that my, my bipolar has now, I haven’t had any symptoms of bipolar for over three years. So this is kind of in the past for me, but when I was there, it was, the thing that helped me most I think was having two or three close people who understood and who realized that when I was having a difficult time, I didn’t actually necessarily need anything just to go and hang at their house, just like don’t sit in the corner of their house, just to not be alone was incredibly helpful. But I think the mistake that a lot of people who don’t suffer make is that they think they have to entertain you or, or try and cheer you up or try and do something and we actually don’t need you to do anything. We just need someone to be there and not judge us. That’s so, there were times where I would call my girlfriend or I would text her and I’d say I’m having a really difficult day. And obviously there were times she weren’t able, but when she was able she would just like, okay, I’ll be over. And she would show up like with, with Thai, coconut soup from the take out and a redbox movie in her pyjamas with a quilt and she’d just show up and we wouldn’t talk about it. She was just there and we would just eat soup and then we’d go hang out on the couch and watch a movie. There was no, it was just her being there that was important. It wasn’t that she had to, we didn’t have to talk about it. She didn’t have to try and get me and bring me out myself. She didn’t have try and cheer me up, there was no pressure on her. She just had to be there and know that I was having a hard time and not put any pressure on me to change do anything, be anything, you know what I mean? She was just there. So, I think being there is just possibly the most useful, powerful thing that you could do for someone who’s struggling and take off of yourself any need to try and fix us.
Yes, don’t take responsibility for anything.
Don’t take responsibility. And so, there were other times where I would like, I would text her and say, uh, can I just come and be at your house? And she’d go of course. And I’d show up and we wouldn’t necessarily talk to each other. I would just clamber on the couch. Her kids would be watching whatever. I would just clamber on the couch in the corner and quietly and just be there. And that most of the time was all I needed. So, I think, you know, our friends and family can, because they love us and because they’re trying to help, because they want to help us, but they, they think that they have to do these big enormous things to try and do that. And you really, in my experience don’t, just being there for someone or just the other thing that I thought of the other day you was, I don’t think, and this may sound a bit woo woo, it doesn’t matter what you call it, whether you call it the universe or God or whatever you call that higher power. In my experience, if I get a thought about something, anything, if a person pops in my head, I don’t think that’s ever random. So, if I suddenly start thinking about someone I have trained myself, though I will, I might text to a heart emoticon or I might say, hey, I was just thinking about you or I might call them, or I might, but I’ve learned not to ignore random prompts about things. And I think that can be really, really helpful for people who are suicidal or depressed. But just knowing that someone is there, it doesn’t have to be a big thing just, and I think so often we, we have these thoughts about people and we go, oh, she’s busy, I won’t call her now. And then we forget. Or oh, Um, I you know, we just brush it off. But I think that those prompts from wherever you think they come from, it doesn’t really matter. I think they’re really important, so I’d like to encourage people, everybody actually is if you get a thought like that about someone, just act on it and it doesn’t have to be huge or big or take a lot of time. It takes literally three seconds to text an emoticon or to say, hey, I was just thinking about you, hope you’re okay, love you Bye. That can be literally life changing, literally life changing.
I really, yes, I really agree with that. I’ve had such a big smile on my face when people have done that to me and yeah. Hey, I was just thinking about you or yeah something. Just to know that people do think about you sometimes and people care and, and just like you say just that, just that one Emoji or that one sentence or those few words it does, it really does make a big, big difference.
For someone who is swimming in a sea of depression or despair that they have no control over. So let me be clear about, I’m not talking about as terrible as is my puppy died or, or you know, whatever situational depression where there’s a reason for being sad, I’m talking about clinical depression where there’s actually, it makes no sense that you’re depressed, you just are and as I say it’s like having diabetes or a broken leg, there’s nothing you can do about it. It can literally be that little insertion of someone in your life like a phone call or a text or just a thing saying hey, I was just thinking about you, can almost like pop us back to reality even if it’s for a moment that might be all it takes to get us back from the ledge. And, and so I’d really like to encourage everyone to, if you, if you have a thought about someone, act on it. And the other thing, and I know there’s memes all over the Internet about this and there’s that old adage that, you know, be kind because you don’t know what someone else is going through it really ,really ,really is true. There have been, I mean I, when I was before I figured out my bipolar and keto and all of that, I would show up at work and I would be suicidal but it’s kind of, you can’t let people at work know that because one, it’s not fair and two that will, that’s not a career enhancing move, and, and so, you know, nobody would know. And the emotional pressure of having to hide that all the time is absolutely staggering. I mean, the effort involved in having to put on a game face is absolutely huge. And so, I just, nobody knew, nobody at work had any idea how I was struggling inside. And so, it really is, I mean, I think particularly during the holidays when we’re supposed to be merry and bright and, and so we do because we don’t want to let side down and we don’t want to be the Grinch and we don’t want to be all that and so the pressure on us to be merry and bright is even greater, than normal. And at the same time there’s a lot more people that are suffering silently. So that adage right now is that, you know, be kind because you don’t know what someone’s going through. It really, really, really is important. We are surrounded by people who are battling and I mean really battling for their lives and we have no idea, so be kind, always, always be kind because you really, really don’t know what might be going on for that person. And, and just a little bit of kindness can make the hugest difference. It doesn’t have to be this big magnanimous thing, it can be just a small little gesture can make the hugest difference to someone who’s struggling with mental health issues.
It really, it really can. And we, we haven’t spoken much about it well at all about it and we are coming to the end of the show now. But I do think it’s important just to touch on how important if you possibly can and it, and I know it’s can be difficult to stay on track, but staying keto really does help keep you afloat during times that there’s a lot of pressure coming in and, and it, that in itself I certainly find can be what makes the difference. And I, I went out for dinner on my birthday and it was predominantly keto, but not completely. And the next night I also had some chocolates and because it wasn’t that much, I didn’t go completely out of Ketosis, but I dropped down the levels that out of the levels where I do best at and I woke up feeling awful. I woke up feeling like somebody had died and, and you know, there was no reason for it. But that just shows how quickly that change in the way I ate, affected my mood. And of course I just went back to eating the way I should and actually within a day so that that picked back up, but it just goes to show that if you throw that massive spanner in the works and you go off plan and you’re already feeling a bit vulnerable at that time of year, that can be something that is going to plummet you right, right down and I know it isn’t always possible and I’m not, I don’t want people to get too stressed about it and I certainly don’t want people to punish themselves if they do go off plan, but just to be careful because it’s just that extra thing isn’t it? That’s really going to impact your mood.
It really can. Sugar and things that turn into sugar after you’ve eaten them can absolutely play havoc with your brain and if you’re one of those people that struggle more at this time of the year really, I would encourage you to do the very best you can to limit your sugars and things that turn into sugar once you’ve eaten them to zero. You, I think it’s a very, very slippery slope and I think it’s a lot more difficult for, for people with mental health issues to get back on track once we’ve gone off and, in my experience, it will make you feel worse and you’re already at risk, you’re already suffering. It will again, in my experience, because I know everyone is different, but in my experience, you will feel better if you stay away from the carbs, but I, but it’s probably when you’re feeling down is probably when you get the cravings more.
Exactly. That’s, that’s the problem, isn’t it? That’s one of the reasons actually why I’m glad I’m not in that, in that environment. So that you were saying earlier about feeling a little bit of an outsider in somebody else’s event or just not necessarily wanting to go to those sorts of days, for whatever reason. But one of the benefits of that is that you’re not putting all that temptation in front of you because I know absolutely. So, if I’m feeling at a little bit of a low ebb, I go to an event like that and all that food’s out in front of me, it’s going to take some Herculean effort for me not to have some of that. Even though I know how I’m going to feel the next day, it’s going to be really difficult. So, the easiest way to deal with that is not to, not to put the temptation in front of me in the first place. I know that’s not always possible, but ah it’s tricky
But again, the key to success here is planning. Plan. Either plan not to go to things like that because you’re busy doing your creative project or you’ve left, you’ve gone off and you’ve gone somewhere else. But if you are at home, plan. Make sure you have no carbage in the house. Make sure that you have all your favourite keto things in the house, you know if you have to splurge, and spend a bit of extra money to get the things that really, really float your tastebuds from a Keto perspective, do that because you’re worth it. You know you’re worth the money to get you through, you know, whatever it takes to get you through, do that, you know. And if you do need to, you know, I mean for me, I’m probably going to be home this year, which is going to be weird, but there it is. I may well go and get myself some foie gras because I love it. It’s my favourite thing to eat on earth. I would never normally spend that kind of money, but It will, one it’s liver, it’s incredibly nutrient dense. But it will, it will make it, it will stop me feeling like there is nothing or you know, do you know what I mean? And that can be my little celebration and I can get myself super excited about ooh today’s the day I get to cook the foie gras or whatever it is. Don’t be afraid to get all your favourite Keto things in. Don’t be afraid to splurge a little bit extra maybe on something you wouldn’t do normally or go out for a meal that someone else is cooking, keto obviously you know, whatever it takes to get you through, do that because you’re worth it and you’re important and you have value in this world and we don’t want to lose that value. So, I can’t stress highly enough how important it is to avoid all the carbs. If you are struggling with mental health issues, it will make a huge difference. But I also know how hard that is. So as Daisy said earlier, if you, if you do slip, don’t beat yourself up about it. Just get back to keto and keep on going.
Absolutely. And you know, we talk about staying at home and doing things special for yourself at home. But of course, you can take those goodies and treats with you if you are going to event or a family gathering or whatever it is and you don’t want to make a fuss, ask people to cook special things for you. You just slot into their take, take those treats with you and, and, and enjoy those. And when you’ve got something lovely in front of you, you’re going to be less tempted by those other things that are around. And that, that is certainly, I would have thought, at least likely to help.
Indeed, planning. Planning is key.
Planning is key And I think, well we’ve, we’ve had lots of, we’ve had lots of tips. I don’t know if you’ve got any particular one special tip to, to round off today?
Be kind and plan
Be kind and plan, yeah be kind and plan and know that you have value, even when you think you don’t. You do, don’t lose sight of that.
yes. Yes I agree.
And if you do lose sight of it ask somebody to remind you.
Yes, because there are there and that ‘cause there are people who care. There are people who care in real life that you can reach out and touch. But there are people online as well and there are groups and there are all sorts of things. So there really are places where you can get that love and support when you’re feeling like there isn’t enough.
Well I hope, I hope that’s helped. I hope it’s helped people who don’t suffer to be able to be better equipped to help those of us who do, and I hope the people who do suffer, feel like maybe they have permission to do something different. Do what helps them rather than them always having to think about putting on a game face and doing whatever to make sure everyone else is happy. Because yes, making other people happy is a good thing, but not at the expense of your health and all your life.
And, and you know, if it comes down to keeping yourself alive, I don’t give a frig what, if anyone thinks I’m being selfish when I’m busy trying to keep myself alive, I couldn’t care less and the same for anyone else that is in a clinical, depression or suicidal, it’s all about them and it should be because you know, we need to keep them alive. So yeah. If you’re in crisis, be selfish. you have our permission.
For sure. I hope it’s had some uplifting moments and given people some optimism for having happy holidays. It’s, you know, don’t feel the pressure to feel like you have to, but hopefully we’ve offered a bit of advice for how you can make the most of it and still have a good time.
Oh, and I just think you just pinpointed something right there was like just the act of feeling like you have to, can make it harder to just let it naturally happen. So hopefully if we relieve the pressure of having to be merry and bright will actually help you to be more merry and bright, because the pressure of having to perform has now gone. I hope that even that is helpful you know, it’s okay if you’re not merry and bright. And it’s ok to find a way to make yourself happier and brighter in whatever way works for you. And I hope that just, you know, giving you permission to do those things is helpful in you being able to enjoy this time of year more.
Yes, and as a little aside to that. I’d love to hear about it. So, if anyone does come up with some new and exciting projects, show us the results with, we’d love to see your equivalent to road trips or new cook books? It’s a, I think it’d be very interesting to see what people come up with
I would love to see people’s merry and bright holiday projects that have actually nothing to do with the traditional way you spend the holiday. I would love to see what you all come up with for, or I would love to hear about the result of your family council, where you sit down and go, hey, you know, this is going to be our tradition or you know, we’re going to change the culture of holidays in our house and this is what we’re going to do. And you know, I would love to hear about the new traditions that you and your families create for the holidays. I would love that.
Yeah, me too. Well, we’ll look forward to that. Thank you. Thank you very much for chatting to me again. It’s been, it’s been a pleasure as always, and I’m sure I’ll be, I’ll be speaking to you, uh, over the Christmas holidays, probably on Christmas Day itself. I imagine.
And maybe even tomorrow.
Yes, most likely. Well thank you very much Carrie.
This transcript is brought to you thanks to the hard work of Michelle Richter.
Welcome Rosie to the keto woman podcast. How are you doing today?
Thanks daisy. Very excited to be here. So glad for the opportunity.
Well, it’s wonderful to be talking to you and you are almost in the same time zone as me. You’re in Edinburgh, aren’t you?
Yeah, I’m in Edinburgh. So, I’m an hour ahead of you or yeah, ahead of you.
Hour behind. I’m ahead of you.
Behind Oh yeah.
Lovely city by all accounts. I haven’t been, but it’s somewhere on my list that I’d really like to go to Edinburgh.
It’s beautiful. As you can hear from my accent, I’m not originally from Edinburgh I’m from the north of England, but yeah, Edinburgh’s a fantastic city, really easy to get around, so yeah, I definitely recommend it for a trip.
How long have you lived there?
This time around about 10 years. I came up here to university, first of all.
Ah, that happens a lot, doesn’t it?
Over 30 years ago. Well I left again, I left for quite a long while and then we came back about 10 years ago and, we’re settled here again now.
Lovely. And what with all the awful things that are going on in Britain really, with Brexit and all the rest of it, things in a lot of ways seem to be much better north of the border from what I can make out. You have a lot of better policies when it comes to education and all sorts.
Yeah, I was going to be very careful and avoid things like politics, but yes, absolutely. Yeah. I increasingly, I’m very happy to be in Scotland and kind of, it wasn’t a choice to come to Scotland. It wasn’t that kind of choice. I came because of work, but now that I’m here, I’m really proud of it as a, as a small nation doing a lot of really good things.
Yes I think that’s very typical actually of, you know, people in Scotland to be very proud of where they live, which, which I think is nice. A very dear friend of mine, Kirsten is actually the woman responsible for getting me into Keto. She lives very near Edinburgh.
Definitely a place I want to visit.
Yeah, well I would definitely recommend it, you know, maybe before you haven’t got access without a visa, you know.
It seems incredible, doesn’t it?
But you haven’t got much time for that. So.
Exactly. Anyway, enough, talk about the hideousness of Brexit. Tell me about you.
So I, I’m 55. In fact I turned 55, two days ago, so only just 55.
Oh, Happy Birthday!
Thank you. And as I say I live in Edinburgh, I live here with my husband. I work as a management trainer and personal development coach. So, I spend my time running training courses and workshops and working one to one with people, helping them perform better at work or frankly, from my perspective, I just want people to be happier.
So that’s what I do for a living. And other than that, the sort of thing that’s been dominating for the last few years have been these health problems that I’ve had and my discovery that I could use a low carb diet or Keto diet to really make radical positive changes to my health and wellbeing. So that’s my current obsession really. I think
That’s a good obsession to have, isn’t it?
I don’t know whether my friends think that. They’re probably sick to death of hearing me rant on about it. But yeah, that’s been, it has been the story of certainly the last five years in my life has been dealing with that.
So tell me a bit about, you know, what led you to go looking for this magical solution? It sounds like it’s going to turn out to be, but you know, what led you to find something in the first place?
Well, I actually, I knew like what I called the Atkins Diet from, from 18 years ago. I’ve been, I’ve been really quite seriously overweight for 20 years, I would say. Certainly 18 years. And I can’t even remember how I found it in the sort of pre-social media days, but I did discover Atkins, got Atkins book, read Gary Taubes, read Protein Power and was successful in the short term on a couple of occasions in using Atkins style eating to lose weight. But then the dreaded sugar had its claws in me and it was always a problem to keep off it. But it was kind of my go to diet of choice if I ever did it. But increasingly as I got older I, you know, I’d be the sort of person that would decide on Sunday night that tomorrow I was going to go low carb again and possibly like by Monday night I was already eating toast or chocolate or what have you.
But what happened really to change things was I developed these health problems, which probably were going on for about eight, maybe eight to 10 years. I developed a lot of joint pain. I was also very fatigued, but I think I was just thought I was getting old and was, you know, had things I was unhappy about. But looking back, there was a lot of fatigue and so I even ended up going to a uh, being referred to a surgeon for knee problems and he diagnosed osteoarthritis. I ended up with very bad hips and things and it just got worse and worse until about five years ago. I ended up going to see a rheumatologist who at that point diagnosed fibromyalgia, which is this chronic pain condition that, you know, basically there’s no real treatment for, and this, I must be honest with, despite the fact that I was what you call Serum positive. So, my mother had rheumatoid arthritis and my blood tests suggested that I was at least vulnerable to it. But at the time of the diagnosis I wasn’t showing any really clear symptoms of rheumatoid arthritis.
And then for two years after that I basically got worse and worse and worse. And looking back, I had like untreated rheumatoid arthritis for two years anyway. Asked for a re-referral, got a diagnosis of rheumatoid arthritis. I think I was the only person in theworld who at that point was glad to have a diagnosis of rheumatoid arthritis because I knew from a couple of friends actually that have the disease that these days there is treatment for it. That wasn’t the case for my mother but now there is treatment.
It’s strange isn’t it? Often that, you say it can be a relief just to get a diagnosis just so that you’ve then got something that you can tackle. I was wondering if you could just sketch out the difference, cause you mentioned that you were diagnosed, first of all with Osteo arthritis. Another diagnosis is, rheumatoid arthritis. Perhaps you could just sketch out, you know, what the difference is because you know, arthritis is a massive umbrella that different things fall under, but there are there different characteristics aren’t there for the different types and different causes.
Yes, sure. That’s, thanks for that question. It’s good idea to do that. So osteoarthritis gets talked about as a wear and tear disease. So osteoarthritis happens in certain joints and, and these are very common fingers are very common. And what it is, is the cartilage between the joints erodes and it can be a really painful disease. It’s not just wear and tear in the sense that if you, if you run a lot or a jump a lot that you get it. There’s obviously some people are more susceptible to it, but that is dealt with usually by some steroid injections, maybe to ease the inflammation that happens thanks to the pain and the rubbing of sometimes bone on bone, and eventually surgery. But it’s treated as a kind of localised problem or joint problem.
Rheumatoid arthritis is an auto immune disease. So, in rheumatoid arthritis, your body attacks your own joints and attacks the cartilage and it’s identified through pain obviously, and also swelling often. And often people get red somewhat swollen joints, which I didn’t get these red joints that people often get. Also inflammatory markers. So, there’s something that you can get rheumatoid antibodies tested and if you’ve got that, they don’t know, you’ve definitely got it, but it’s a clue that you might have it, but you basically have your inflammatory markers checked, so CRP in the UK and also ESR, and then they just kind of, oh, they get, you get an ultrasound as well. But the point about rheumatoid arthritis is autoimmune in nature and it is treated through immune suppressant drugs. And it’s a disease that attacks the whole system so you don’t just have it in one joint and it’s subject to flares and all of this kind of thing. So that’s rheumatoid arthritis.
Yes. It’s interesting, isn’t it? Whenever you have any kind of autoimmune disorder, two things to say about it really is that the end result is very similar, you know, similar with my experience with underactive thyroid, the end result is similar, but the causes your body thinking there’s a problem and ending up creating that problem by, you know, by attacking. But the other thing is, and I remember Donna Lordy telling me this, that auto immune disorders tend to come in packs. So if, and I guess that’s again because it is kind of your body generally attacking itself, if you have one, it’s quite likely that you’re going to have or develop others to go with it.
That’s the thing that I’ve kind of really only made sense of now looking back because looking back a long time, I think I was suffering from autoimmune problems. So about nearly 20 years ago, so this was a period when we’ve made a big, a big move in our lives again to live in the country, which was all a disaster. But that’s a whole other story but anyway, it was a big change and I was diagnosed with hypothyroidism, but at that point nobody talked about it as Hashimoto’s. Nobody said it was autoimmune and it was only later.
Which is the most common form isn’t it.
Exactly. It was only much, much later when I was trying to investigate what I thought was fibromyalgia and I ended up at an endocrinologist in a sort of desperate attempt to try and find a way to solve this problem I had, and he said at that point, basically all hypothyroidism is auto immune, but nobody had talked about it in those terms. The other thing was that I had a premature menopause at around that time as well. Now again, when you look at things, nobody really knows what causes that, but there are definitely some theories that it is an autoimmune disorder and presumably in some way your body attacks your ovaries or something. Then I had this, the fibromyalgia, which isn’t supposed to be auto immune, I think it was rheumatoid arthritis at that point. And then during that fibromyalgia period, I also developed a short term, very acute auto immune disease called ITP, which is idiopathic. I can’t remember what it’s called, but basically your body attacks your platelet levels. So you basically don’t clot.
So this happened as well, and at the time I was given, they give you mega doses of steroids and it was really weird because I was really, really ill and in lots and lots of pain from this fibromyalgia, and I went on these steroids and all my symptoms disappeared. And I kept saying to the doctors, if fibromyalgia is an autoimmune, maybe steroids shouldn’t help it, steroids aren’t supposed to help fibromyalgia so maybe it’s something else. And it, I mean looking back, I don’t quite know why I got fobbed off, but I did. So it was then, as I say, I asked for a referral to a rheumatologist again because I was getting so much worse. And then very quickly they diagnosed rheumatoid arthritis. I think because my symptoms had got so bad that there was clear synovitis so that the fluid around the joints was clearly inflamed. So it was, it was kind of, you know, it was a no brainer at that point.
So at that point I got put on the standard treatment for rheumatoid arthritis in the UK anyway, which is again, loads of steroids, which was fantastic. Yeah, I put on weight but my God, I had energy. I was running around and it was wonderful, no pain, energy, and then they also put you on a variety of what they call it, dmards drugs, which is disease modifying antirheumatic drugs. And you come off the steroids, you taper down off the steroids as these other drugs, you know the other drugs take effect, which is quite slow. And it was very definite that my symptoms improved a lot. I mean, I was desperate before I was diagnosed, you know, I couldn’t get off, I couldn’t get off the loo, you know, it was, it was like my knees was so sore I couldn’t walk anywhere. It was just awful and my wrists were sore, it was terrible. I would get, you know, I had to book an assistance. I travel quite a lot for work, so I would have to book assistance at airports and be trundled around in a wheelchair. It was, you know, it was really bad.
So obviously immediately I felt much, much better. So that was great. But I didn’t ever feel THAT much better. So I ended up being, I would say like 60% better. And towards the end of that first year on the, on the treatment, I had a, had my consultant’s appointment and I was kind of challenging him saying, you know, is this the best I can expect? Because in the UK, the first line of treatment is these dmards, but there are actually new wonder drugs called biologics, which can treat rheumatoid arthritis. And they are apparently absolutely amazing. But on the NHS, you don’t get them in the first instance because they’re very expensive.
How do they work?
I don’t know. I don’t know. I mean, in all honesty, sorry. Not only do I not know. When I asked the nurse, they said they didn’t know.
They didn’t know either?
I just knew they were called biologics. I don’t know.
Yeah, but they weren’t available to you anyway.
They’re not available in the first instance.
So they would only go onto those if these other, these other treatments weren’t working.
Yeah. So a lot of people have very bad side effects from the, It’s a drug called methotrexate that you get put on in the first instance. And a lot of people can’t tolerate them. I could, although in the sense that I didn’t get sick or anything like that, but my white blood cells kept crashing, which is a symptom and I would have to come off them and then go back on them. And you’re getting tested, getting blood tests every week or every fortnight, the whole time because they’re monitoring your liver and kidney function and your blood, white blood cell levels.
So anyway, but I was on them for whatever, you know, for better or worse, but as I say, a friend of mine who lives in Switzerland has these biologics and she says, they’re like, well wonder drugs. So I was basically arguing for that and saying, I think I need to be on these drugs. And one of the reasons why I felt I should be on them, apart from how I felt was that my inflammatory markers were still slightly elevated and at this point the consultant said, well the reason your inflammatory levels are probably still elevated is because of your weight. And this was the first time anybody had mentioned my weight; my weight was high. I mean I was, at that point, after the steroids I was like a good 30 kilograms overweight. So I came out of that consultant’s appointment, which was October, 2016 I think determined to lose weight only so I could show the consultant six months for my next appointment, six months later, that it wasn’t my weight and I needed the good drugs.
Right? I mean I can to certain extent, I can see the logic. If you’re carrying too much weight then you’re putting more pressure on the joints. So I can see the logic from that point of view. But it does just seem to me that there are these umbrellas that get put over you and it can be too much weight, but the other things that, that doctors tend to talk about are that you have a progressive disease and they just start talking about pain management rather than try, you know, and 60% improvement is quite a good thing. And, and they just seem to quite often just get you used to accepting something that is way below you know, what, what is quite possibly achievable.
I think I, I don’t want to rant but I might do,
No, go ahead and rant.
I think one of the things that really challenged me you know, hands on heart I think, you know, losing weight would have been healthier in any respect so that’s fair enough. It wasn’t so much the pressure on the joints, although that might have been a factor, it was the fact that this, apparently there is a genuine association between excess weight and higher inflammatory markers. So, he was saying the inflammatory markers are down to your weight and not the disease. But one of the things I did discover during this last five years is that as a middle-aged woman, it’s very easy for people to not see beyond the fact that you’re overweight, middle aged woman who’s probably a bit depressed because she’s going through the menopause or something, even though I wasn’t, you know, all of these kinds of things.
But the thing for the consultant was that, you know, I think their hands are tied to some extent and they’re not meant to throw these biologics around left, right and centre because of the cost, and you know, I kind of get that, I see that. But I wasn’t happy enough. So I was determined to lose weight so I could demand these biologics. Plus, I was having problem tolerating the other medication so, I was on and off them on and off them all the time. So I did nothing for three months, really except eat lots of chocolate, you know, as per normal and panic. And then in January, after a fairly abysmal, yeah, as I say, chocolate fuelled Christmas, I thought, oh my God, I need to do something. And I couldn’t face doing low carb or keto, I just didn’t have the where with the sort of giving this comfort up just was too much.
But I ended up for some reason coming across Jason Fung’s book The Obesity Code and read it and he didn’t tell me anything I didn’t know in terms of insulin and the impact of insulin on weight, fat storage and the like. But there’s just something about it. I mean, he’s such a brilliant writer. He’s so no nonsense. He makes everything so clear. And he also talks about fasting, which I had never ever done. So it just, I just Kinda thought, I’ve no choice, I’ve got about 12 weeks to dump some weight. So I started with a little bit of intermittent fasting. I would do maybe one or two days a week, 23 hours. I didn’t go a whole day without eating. And I started back on low carb as I knew how to do it. And of course I started dropping weight, you know, of course I did because it works, doesn’t it?
But then what became really extraordinary was the impact of my rheumatoid arthritis symptoms. So, one of the things I’d been suffering from was a really, really bad back, which may or may not have been to do with the arthritis, but I had a terrible back, I’d even been sent to, in the previous year to get an x-ray and there was nothing in the x Ray. But so I couldn’t sit for more than about 20 minutes without having stabbing back pains. And I would have to go and lie down for a couple of hours. And I was swallowing Ibuprofen, like sweets and all of that and about, I don’t know, maybe two weeks after starting this, I was sitting at my desk working and I suddenly saw, I’ve been sat at my desk for two hours and it was one of those moments. So I kind of got up and walked around and I thought, I have no back pain. And let me tell you how remarkable this was because the first day I did a fast, which is what the first, when I got the book, I remember that I was going out for dinner in the evening to a works dinner, so I didn’t eat all day, which is great. I was very pleased. But I was actually wearing like one of these corset things that hold your back in place. So my back was that bad that I was wearing a kind of magical corset to cope with sitting at dinner for an evening, and two weeks later, I had no back pain.
And then it just began to be clear that what the sort of residual rheumatoid arthritis symptoms were improving. So there’s another moment, a couple of weeks, again, maybe three weeks, and I was walking the dog just round near the roads and I was walking along the street and I suddenly had this really weird desire to run. And I did. I just thought it was like my body was going, oh, we’ve got energy. Oh, we’re not in pain. And I actually, I didn’t run very far because I’m not a runner, but I kind of trotted along the streets for 20 yards because I had suddenly got this energy and this, this momentum and it was extraordinary. So, what became really clear was that this was having a, what felt like a miraculous effect or my residual rheumatoid arthritis symptoms.
And there was losing weight, which made me feel very happy and I would still slightly worry it was some kind of massive placebo effect. You know, I was just, I was happy I was losing weight. Um, but the fact is these symptom changes happened before I’d really lost much weight. So I maybe lost half a stone and I, and bearing in mind they had like probably four stone to lose, to come back to what would be regarded as a healthy weight. And that alone meant that I knew it wasn’t just weight loss. Nowadays, if I eat carbs again, so if I overdo refined carbs, my symptoms come back even without, even if I haven’t put on any weight, you know?
Yes. So that completely nixes the sort of the, you know, the stereotypical image that came into my mind about excess weight, you know, impacting your joints. So I mean, I’m sure there probably is at some point a certain amount of excess weight that does that, but it sounds like, you know, like you say that was minimal in the cause and effect scenario.
And also, although my knees were bad and my back had been bad and my feet were bad, my wrist was very bad, my elbows were very bad. I never walked on my hands. I never did any handstands you know, so my excess weight was never going to be a problem with that. So yeah. So I mean to cut a longer story short, what I ended up doing was coming off most of my medication. So partly because I was on and off because of the, the problem with the white blood cells and I was feeling so good and I was so full of hope that there’s a point where I had to come off and my GP was away and I just thought, I’m not going to go back home. I’m just going to wait and see what happens, and nothing happened, I didn’t feel any worse.
So, by the time I ended up in June actually start having it. It was a second consultant’s appointment then and we just discussed it and he said, well, your inflammatory markers are normal, you’re not in any pain, we’ll just take it from there. And that’s the situation now. So I still, I think it’s important for me to be honest, I’m still on this one, what I call the little drug, something called hydroxy chloroquine, which you get put on with the other drugs. So I was on two additional dmards on top of that. And this hydroxy chloroquine is prescribed because apparently the combined action means that the bigger drugs work better when you’re on hydroxy chloroquine but it’s never prescribed on its own. On its own it’s not meant to control rheumatoid arthritis symptoms. And I would like to come off that and I probably need to just get my act together to taper that down because why be on anything if I can get away with it.
Yes. have you tried at all, has there been any time where you’ve forgotten to take it or something and seeing if it does have an impact?
I’ve definitely forgotten to take it. Um, and I actually forgot to take it for quite a few days at a time sometimes because I do kind of forget to take things and yeah, it’s been okay. I think I need a clear run at it because what I want to do, and we can talk about cheating later on the diet, but what I want to do is have a really clear run when I’m absolutely clear that the only variable is going to be that I come off the drug. What I don’t want to do is, you know, come off it and then also have a maybe a bad weekend where I’m away or you know, all of these kinds of things. So I kind of need to gird my, as I say, gear up to doing that. But I intend to do that because why, not?
Yes, exactly. I mean, you know, all drugs have some kind of a side effect. You know, some obviously less than others and the benefits can outweigh those side effects. But, uh, like you were saying before that, the other ones you want, I mean, when they’re really affecting your platelets, that’s certainly not something you want. So presumably, yes the more you can come off, the better.
Yeah. I mean the, methotrexate and the other one that I was on Zorthocelescene, you have to be tested, certainly at the beginning every two weeks to check your kidney function and your liver function. Hydroxy chloroquine, you don’t have to be tested. They just assume you’ve got, you know, there’s not going to be any kind of immediately toxic effect. But obviously over time anything is going to be toxic to some degree.
Yes, exactly. but it’s not quite so worrying as the other so, I can see like you say, while you’re hesitant to just drop it and you need to properly plan for that. But yes. It sounds like that’s, something that’s foreseeable. But you mentioned, you know, we had a chat before we started recording you mentioned you know, some of the other benefits that you noticed from eating this way.
Where do I start? This is a problem and it does make evangelists of us because of it.
I know. We do have to, okay you do have to sort of reign yourself in sometimes don’t you? Because you make it sound too good and people start not believing you.
Yeah, I know. I know I have, yeah, my friends have been very tolerant. So obviously when you speak about controlling rheumatoid arthritis symptoms with minimal drug intervention, I mean that’s extraordinary but sometimes I forget that because my new normal is not to feel like I have that disease and I only had rheumatoid arthritis, well at worst I had it for about eight years, you know, even though I wasn’t diagnosed then. The thing that feels almost even more transformative for me is because it’s the effect on my eating habits. And by that, I mean my addictive eating habits. So I’ve lost weight. At the moment I’ve lost about 25 kilos. I’ll be honest with you, I talk in kilos cause I don’t like to think how heavy I was. I don’t really know what kilos, what kilograms are. So I can 24 kilos.
Really I’ve, I’ve got used to it actually I made that change when I came to France and I do actually after a while you can start thinking rather than having to translate it can’t you but yes, you’re right.
You do. The maths.
Sounds a lot lower yeah.
So yeah, I’ve lost all that weight and that was weight I’ve been carrying for 20 years and I’ve, I have lost bits of that weight in the past and never kept it off for. So like 22 months, I’m, you know, I’m still, I’m still edging down, edging down as well. And the biggest other thing has been the way it’s, it’s enabled me to manage a really strong addictive eating tendency. And that has been in my life 40 years. I remember, you know, I say sugar is my drug of choice. And basically, I remember I started abusing it probably from my early teens. I would eat, you know, total sugar addict and those of us that are similar, know what we mean by this, the sort of raging desire, emotional desire for this.
So my whole life, you know, my whole adult life, I’ve struggled to resist eating, but particularly sugar. And I would include refined carbohydrates with that because if you can’t have chocolate toast will do. It’s not that low carb has, it’s not solved it completely, but what it has removed is the kind of biochemical need and certainly the biochemical excuse for it. Like, oh, I’m feeling a bit tired I better have a bit of chocolate to perk myself up. It’s allowed me a kind of degree of biochemical stability I would say and satiety as well. Hunger management, that has given me a foundation to really address this because what you find when you take out the, all of the excuses of hunger or low energy or anything like this, you’re left with the naked psychological elements of what I think is an addiction. So you kind of have to, you, you just have to say, yeah, fair cop. This is an addiction and it means that you’re kind of clearer around doing it. So the intermittent fasting, I don’t do a lot of intermittent fasting, but what it did was allow me to believe that I could do without food for more than about three hours, you know, the fact that I could go for 8 hours, 10 hours, 23 hours without eating was, was definitely broke, It broke me away from a certain dependency on food.
Yes, it’s very good at reminding yourself what real proper stomach growling hunger is as well rather than that niggling head hunger. Oh, I fancy something to eat when you know you can’t possibly be hungry because you only ate two hours ago when you’ve actually, you know, not eaten all day or not eaten since the day before. And you get, you know that real, real hunger, it reminds you the difference in the signals
I think as well. Yeah, I think that’s absolutely right. And I think as well is it not just makes you realize what real hunger is, but it actually makes you realize that you don’t even have to answer to real hunger.
So any sense of hunger, It was like, Oh, if I don’t eat immediately I’m going to drop dead. When actually you can feel hungry and go, oh, I notice I’m hungry. I will really enjoy my dinner in three hour’s time or what have you. So, so it was that ability to tolerate hunger, I think as well. That was, was really extraordinary in terms of developing a different relationship with food. And then, so even though I was doing a lot of, you know, I was doing low carb, I mean the reason I don’t call it keto is not because I don’t think I’m ketogenic, it’s because I don’t track and I don’t measure ketones. So I’m quite sure in terms of the way I eat that, that it, you know, it is a ketogenic diet that it’s a very low carbohydrate diet, but I would still give in to the psychological pull of sugar and I would still not some sort of crazy, crazy binge, but I would go out, you know, secretly and buy myself, sugar and eat it, chocolate. And so it was that point when I just had to say enough is enough.
And it funny, it was a 2 Keto Dudes podcast. I was away, I work away and I was sitting in my hotel room having gone and bought, you know, German chocolate and eating it. And I was listening to, 2 Keto Dude’s podcast and there was a woman on it, not like an expert, just an ordinary woman, and she said she had to treat sugar like an addictive substance. And it was that moment I… Total abstinence. And it was that moment where you go, Yup, I can’t pretend otherwise I have to treat this like an alcoholic treats alcohol, you know? And for me, I’d, although the blood glucose impact of things like refined carbs are the same as sugar for me, the psychological or the emotional pull is sugar. So I could, I could have a piece of bread and I could probably get away with it and it doesn’t send me on a sugar binge, but if I have anything, which is clearly sugar, I’m on the slippery slope immediately. So, I have found this brilliant tip, actually this is a tip because I used to try and keep track of my sugar intake and I would put alittle tick on my calendar, I have a wall calendar. I would put a tick on every day that I didn’t eat it.
And of course, there were very few alarmingly, there were far fewer days than you would like, and then it was in earlier on this year I did this thing where I counted the days basically, I counted up. So every day that I didn’t take sugar I counted up. So I went from one and then second day two, three, four. And the longer I left it, the more I thought, I don’t want to drop back down. I don’t want to drop back down. Which was fantastic. And, and my husband reminded me that this is what alcoholics do. People that are in recovery can tell you how many days, and I think they can say how many minutes and all that kind of thing, but I can just do the days. And that was amazing in terms of me sticking to the, to the resistance of that.
Yes. Interesting. And so, you find it is certain substances that trigger you or, and or do you find it’s a certain level? Because I find both. I mean I would, I would say that I’m probably, yes, definitely a sugar addict but also refined carb addict as well. I mean I can’t just eat a bit of bread. I will, you know, that will be enough to, you know, pull me back in as well. It’s not something I can moderate, but I find two things. I find there are specific substances that will trigger cravings if I go near them actually, even if I just start thinking about them sometimes, but also, and I don’t tend to track that much cause like I can’t be bothered really. I’m a bit lazy when it comes to things like that, and also I just can’t, yeah, I just find it messes with my head too much.
But what I know is that I can feel if I’ve been eating too many carbs, if, so, if I was counting, if that count would have gone up past a certain point that I do start noticing that general carb cravings start coming back in. So for me, it’s two things. It’s the, it is the level of carbs I’m eating regardless of what they are. So I can be eating completely ketogenic, all ketogenic foods. But if I’ve just been having a few too many of the things that take the carb count up high, those cravings will come back as well as if I had the more obvious specific foods. So, does that affect you in the same way or do you find not so much, it really has to be specific foods that send you over the edge.
That’s really interesting. And I’m, I’m thinking about it, so no, I don’t think. I think my eating style is such that it’s is very low carb these days. So I suppose I’m eating a few veg, you know, like Broccoli or cauliflower or what have you. Add meat or fish and, yeah. So I don’t feel because I don’t track and I can’t be bothered with counting and all of that. And also, I kind of think that if this has to be a lifestyle, I’m never going to live my life like, you know, like I can’t do this sort of counting everything as I go along because then you’re not living then, you’re merely dieting. But no for me it’s the substances. So I could have like lots of lots of broccoli or you know, I wouldn’t find that I then it accumulated and sent me over the edge. It’s definitely the substance. I can get away depending on the circumstances.
So, if I was to cheat, and I don’t really like the word cheat, I can’t think of another word. So, it tends to happen for me If I’m out and I’m at a restaurant, like I was out for my birthday on Tuesday, it was a beautiful steak restaurant, fantastic, and they brought complimentary bread. So not only is it bread, but also, you’re not allowed to waste things, you know.. I mean that’s nonsense, so I had complimentary bread. I didn’t want to be ungrateful that they brought this beautiful bread. And then when I have my steak, so there was like a planned thing. I’m going to have some chips. If fact, I didn’t really have many, they were, I just had like a couple, the next day I walked, that doesn’t send me over the edge. But they also brought complimentary petit four with my coffee and I knew that if I’d had one of those, that would have been it. So no, for me it’s definitely the substance.
Right. Yes. That’s interesting. And, and as you started on that, perhaps you could share, I like to ask, guest’s what a typical day of Keto or low carb looks like for you?
Well, it’s, it’s actually changed quite a lot over the last 22 months and you know, so I’ve noticed like three different phases I would say. My eating has got more and more simple. I mean, that’s the extraordinary thing, which I think is also a good sign because it shows a level of, to say indifference it would be wrong because I still love eating and I love my food, but I’m not as involved, you know, I’m not as quite as obsessed and involved, it’s not like my identity isn’t built around, what am I going to eat today in quite the same way. So when I first started I was definitely low carb. I mean, I don’t know if I was keto, I wasn’t tracking, but I was very much like along the Atkins style. So I would be eating, you know, bacon and eggs for breakfast I have a big salad maybe for lunch or some kind of stir fry with some meat, and then and plenty of fats, plenty of vegetables, you know, lots of mayonnaise, all of this kind of thing.
And then I would cook in the, you know, for dinner I’d be cooking things like proper dishes, which had like starch substitutes in. So I would have the cauliflower rice, the, zucchini noodles, all that kind of thing. And I would even, and I would have things like, you know, I might make fat bombs or this kind of thing, although I am a bit lazy about things like that. I enjoy cooking when I’m in the mood, but otherwise I can’t be bothered. And then what actually also changed then, there’s so much, there’s so much information out there these days on social media and on websites around all the kind of general health benefits around keto and low carb, which I find very fascinating, very motivating. And I think I got more interested in what I would call food quality. So what then started to happen that I was still doing a very similar diet, but I was much more aware of things like seed oils and vegetable oils. So I wouldn’twant to eat those.
So I became more involved in the kind of environmental argument around food. So I was thinking about seasonal veg and food miles and all that kind of thing. So what happened was that my eating probably became more simple, still a more whole food just inadvertently really. And then for about the last three or four months, I have become, it’s like I’ve crossed the line and have become almost carnivorous. I think I’ve been reading a lot about the impact of like zero carbs, they call it or carnivory on autoimmune conditions. So, I don’t know if your listeners will be aware of the work that’s being done by a group called PaleoMedicina in Hungary, which is, they call it Paleo ketogenetic diet. So that’s been interesting. I have I been able to gird my loins, you know, to do it. I don’t know. No, I haven’t and I don’t know if I want to do it, but I’ve ended up with things being really, really simple.
So, I have eggs for breakfast or brunch cause I usually do two meals a day. yeah eggs for brunch or even that might be lunch, eggs with maybe some bacon or occasionally when I’m being extravagant I might even have steak. Um, and then in the evening it’s been pan fried fish or meat and maybe a few veg, but maybe not. And I’ve cut down a lot on the complexity of my food. And what I’m aware is that even if I haven’t gone the whole hog and gone, ha, pun intended and gone carnivorous, I definitely that the lower carb I go, the less I’m bothered by food cravings and the better I feel.
Yes. I think I would agree with that. And yes, the more I drilled down and the stricter I am, my cravings definitely diminish for the sweet things, the more of the things and I don’t know how much of a sweet tooth, well, I know how, do know how much of a sweet tooth you have, but I don’t know how much you satisfy that with making some of the Keto treats and things. I find, you know, and I do like those things and I do make them, again, I’m similar to you. I think we all go through these different phases of the different things we make and I used to make a lot and I make them far less frequently now. I tend to make them you know, when someone comes around for dinner or something and they’re, you know, they’re expecting a pudding, so I will make something, whatever, you know, a keto cheesecake or something, but those are definitely the things, even though they’re, you know, they’re perfectly keto, they’re compliant foods, they trigger those old, addictive tendencies. And I find it, well basically impossible to moderate them. So I tend to just make the smallest possible portion. Really, that’s enough for me and my guests, there might be some leftovers, but even so, even when I carry on eating those, there’s this, there’s only so much I can eat. I don’t make a great big one because I know I would just be back into it, back into it until it had all gone.
Yeah, I made some a while ago. It’s actually, my husband doesn’t follow it, but there was a period where he was, he, he said he would do it for two weeks before we went on holiday one year. And so I tried to make, to look after him and because he has, he does like his carbs. I tried to make some things likeGranola, so grain free Granola, it’s sugar free obviously. And I also made some waffles and they were, they were lovely. They were, they had, I didn’t even put any sweetener in them that’s remembering, but they were made from coconut flour and egg, you know, and they were lovely and I ate them compulsively. Yeah, they were absolutely perfectly keto, and there was something around the, I think there’s a tactile element actually. It’s like, you know, the pure, the texture and the mouth feel, if you like, of eating something that was a waffle triggered that desire in me.
And it’s, I’m always wary of saying, talking about this business because it sounds like in order to do low carb or keto successfully, you’ve got to give up all of these things. And for some people it’s fine and some people love all the cooking and you know, it’s like, oh great, do it, do it, do your cheesecakes and everything. But for me it’s been, it’s evolved. It’s not a force. I don’t go, oh, I must now stop eating these Keto treats. I’m not as interested. And the, the biggest thing for me has been this freedom. Freedom from my own food desire, shall we say now, you know, don’t get me wrong. I love it. I said, can you saying I love my food, I love it. I enjoy what I eat, but I’m not as caught up in it in the same way.
It’s like, it’s like all the unnecessary extraneous issues around food fall away. And it is this sense of freedom that is really remarkable. And I could never have imagined that I would be like this. And sometimes I’m a bit sad, you know, it’s like, ah, that was a big part of my life, you know, but would I give it up? No, I mean it’s the difference is great. I feel, I feel pure. I don’t know. I don’t mean in a moral sense. It’s like I’ve sloughed off all of this stuff that wasn’t helping me, this baggage around food and substituted it with obsession around Keto. But yeah, it’s weird. So the kind of reducing things has been more that I don’t want to do this stuff anymore rather than I feel I oughtn’t to.
Which is great, I mean, you know, if you’re not trying to force yourself into it, it’s just something that’s going to come naturally, isn’t it? Like you said, it’s just been a natural progression.
Yeah, it is, It’s evolved. And I forget that, and sometimes when people talk to me, cause I have a Facebook page and sometimes people ask me questions and I have to be really careful because if I told them what I eat/ate, they would be to be honest, I think people might be horrified. It’s like, oh no, have I got to eat like that and I go and like, no, no, eat like that if you want to eat like it, but if you don’t eat, you know, just do it your way, which is one of my mantras. But yeah, it’s very liberating. There’s no doubt about it.
Yes, I think that’s interesting too, to actually tell a bit of the history. Like you say, it can sometimes seem quite stark telling people, you know what you’ve eaten. I did an interview. There was some students asked for some people to do interviews on the forum the other day, for a course they’re doing, and I think their project was around low carb, and I said, I tell you what, I’m going to, I’m going to give you more of an average day because you know, yesterday for dinner all I had, you know, I cooked up some chicken thighs and I planned to have some vegetables and all the rest of it with it, and after I’d cook the chicken I thought, you what, I can’t be bothered.
I’m just going to eat two chicken thighs with some mayonnaise and it just sort of, I mean, you know, to you, that sounds fine and to me that sounds fine and two most of the listeners, that doesn’t sound abnormal at all. But I could kind of see the look of horror on her face because it does seem a bit stark. So I think that’s very interesting when you just mentioned that progression and just to explain to people, well actually this is where I started and these are some of the phases I went through and I did use to cook, all the things, and I had that phase where I ketofied things and coked the sort of carb equivalents, and now this is how I eat and perhaps, you know, when you ask me next year, it’ll be something different. The whole point is that it evolves and everybody’s different and you know, you don’t have to do what I’m doing.
Yeah, and I think the trouble with evolution is that you forget what it was like at the beginning or the dangers and when you talk to people. Um, but one of the things is that this way of eating has allowed me to trust my own appetites. And that is also one of these phenomenal things. And I know particularly for women, I mean it may well be for men as well but, for women, that is a completely alien concept and I am so aware that often like women I talked to, they asked me for rules, who were interested in my day, what should I eat, what can I eat, what can’t I eat and they want rules. And I keep saying, you need to do it your way.
So the only thing is you cut carbs low enough. And for me also that means reduce, I mean the sugar thing is a separate issue for me and that’s an addiction issue and that also affects how I do things. But all you need to do is cut carbs low enough and your natural human mechanisms of appetite and satiety will reassert themselves. And no, of course you don’t know that until you try it. And instead it’s how many carbs, how many this? Can I eat this? Can I eat that? Do I have to eat eggs? Do I have to eat meat? And I get really, I’m kind of sad about it actually, I think it was since, when did it get so difficult for us to feed ourselves?
Yes. It doesn’t have to be difficult.
But until you’ve experienced this is it’s, and I had a really interesting experiment. I called it an experiment, like mega cheat. I went away on holiday in September and we were traveling around Europe on the train. And I just thought, I’m just gonna eat whatever the hell I want. So I thought rather than having that mental battle, you know, will, I won’t, I just sort of say in advance, eat what I want. And you know, Eastern Europe cake, you know, I wasn’t going to not eat cake and in eastern Europe and it was like a really interesting, so I didn’t eat sweets. I thought I’m not going to, I know what that does to me, so I’m not going to eat chocolate and like bars of chocolate or anything, but I would have a cake with chocolate if I wanted. So various things were very interesting. Number one, how easily carbs got their claws back into me.
So I did three weeks on holiday and it took me another four weeks to get off back off it. So I did nearly, you know, best part of two months. I got back to certain extent, but sugar was, it was very difficult. So that was one thing. The other thing was how unsatisfying it was, the food. And when you talk about satiety, people go, oh yeah, yeah, yeah, being full, it’s not being full. There’s such a difference between feeling full in your stomach because of the bulk that you’ve got in your stomach and feeling sated and that I knew that low carb food did that for me, but it wasn’t until I went back to eating what was typical for me, typical way of eating before I carb fuelled, it wasn’t, I didn’t binge, it wasn’t like off the scales crazy. But I had, I ended up having carbs for breakfast, carbs for lunch and carbs for evening meal and I was hungry the whole damn time as in unsatisfied. And then I was actually craving a nice, you know, some pure meat by the end of it. Like, just give me some nice fatty meats, and maybe some eggs.
Yes you talked about that purity thing and it is that you eat because I’m somebody that yeah, things go wrong from time to time and you do get to a point and I mean, I do go completely out of control in a way that’s, it’s not good, but it gets me to a point where, yeah, I just feel like I absolutely feel the need and desire to get back to keto because it just, everything about it just I’m craving that I need to feel good, and you know, that sort of purity that you mentioned before because it just, like you say, it sloughs away all that horribleness.
Yeah. But the danger is when we talk about it to people, obviously your listeners, most of it, I suppose most of them, they’re already committed to this way of eating, it sounds difficult and holier than thou and strict. Yep.
You have to be really careful what words you use don’t you.
And the purity is, I suppose. No, I tell you what it is, I’ll tell you the right word. It’s clean.
But even that, even that the connotations, yes, yes. It’s very tricky.
Speaking as an addict, I feel clean when I eat these foods, I feel clean, but yeah, none of this is kind of, Oh, you ought to do this, be a good person, all of that kind of thing. It’s just becomes easier and easier. But as I say, I cheat. I, you know when I say I cheat, I fall off the wagon. So I’m very bad in restaurants because, well, I don’t like making a fuss, I don’t want to be a fussy eater. So when in restaurants, I’ll often have the burger and I’ll say I don’t want the bun. So I keep the bread off the plate. But then if I said though, I don’t want the bun and I don’t want the chips and I don’t want the, I just feel like one of these like dreadful fussy eaters, so I say to myself, and I still do this all the time, I won’t have the bone and then I won’t have any of the chips because I always eat the chips so I should just know myself, you know. And then I don’t like waste, like I said to you, well if they put them on the plate, I’ve going to have to eat them, but generally at home if I keep off sugar so that is like as in proper sugar. I can control things reasonably well. So it tends to be more in social occasions or occasions when I’m out of the house so I can be strict. Must admit I had half an apple last night, which is obviously very bad, but I had it with cheese and my husband got the other half. But I don’t think, I think having half an apple isn’t going to, you know, I cannot be the sort of person that having half an apple means I’m a bad person.
No, exactly and I think that’s where it’s important is to come, you know, keep moral judgment completely out of it. And it’s also, it’s the whole, you know, know thyself and the different things that are problematic and not problematic for you. You know, if you can have half an apple on a piece of cheese because it’s something that you really fancy from time to time and it’s not going to negatively impact you, then that’s not a problem, is it? And it also highlights the fact that, you know, just how adaptable all this is and how many faces Keto has and you know, they’re all perfectly acceptable, and yes, it’s fascinating. And that’s the biggest take away from me about this podcast is, is talking to, you know, different people each week and seeing just how so many different ways of doing it all work. They all work perfectly well, and it’s, it’s all about, you know, isn’t it, just finding the one that’s right for you.
Yeah, the one that’s sustainable for you over the long term.
Yes. Well, it’s been fascinating talking to you and I think we have a lot of things in common, especially when it comes to food addiction. You’ve dropped a few tips as we’ve gone along, but, what is your top tip to wrap up with?
Well, I have dropped my tips in, cause my, so my big tip was the do it your way, but I’ve said that. So make it, make it work for you, make it your lifestyle. The other tip, which I see, I struck me this morning when I hopped on the scales and its focus on process, not results. Now obviously the results are important, but I came up with this a long while ago through other dieting history. But what I realized was that if I went very much by the scales, if I got on the scales, having cheated, and I got away with it, it reinforced the cheating behaviour.
Mm. Good point.
So don’t get me wrong, I get on the scales. I still have, you know, I would love to lose another half stone or so to be at my proper target, but I keep an eye on my weight. But what I focus on and what I would recommend people try to focus on is following your eating, and if I say plan, I mean I don’t want to get into all of that controlling thing, but you know your eating style. So, compliance or adherence is really the only measure of success. So if I have followed my eating style, I’ve not fallen off the wagon with carbs, even if I haven’t lost weight that day I have succeeded because it’s only over time cause it’s a massive behaviour change. So what you need to do for success is enforce that behaviour change, so it becomes second nature, the new normal. You don’t even have to think about it.
Yes. That’s good. I like that. And it sounds like, it certainly sounds like it’s something you live by and, and have done very well with.
Well most of the time
Well that’s always the caveat, isn’t it? Most of the time.
Yeah, I do really, really, and that’s the thing I said about cheating, I do not want to set myself up as somebody who’s doing this perfectly at all, and I still manage it.
I don’t think there are many people who are really, you know, and I think, it’s interesting hearing about those imperfections and how we deal with them, how we resolve them, how we learn from them and move forward. That’s really educating and helpful to other people. So yeah, there’s good in the flaws.
Well, thank you very much. It’s been a great pleasure talking to you today, Rosie.
Well, thank you so much for the opportunity. You’re doing great work.