This transcript is brought to you thanks to the hard work of Joell Abbott.

Welcome April to the Keto Woman podcast. How are you doing today?

I’m great, thank you. Very honored to be here.

Well, it’s lovely to see you. We have spoken before on Zoom so we have had face to face chat. We haven’t met in person yet, but I’m sure we will one day. 

I can’t wait 

So you know how this goes. You’ve transcribed a few podcasts and you’re a regular listener so I know you know how it goes.

Yes, I’m very aware.

Tell me a bit about you.

Well, I had a pretty normal life growing up and the oldest of three daughters. My dad worked for the County, my mom worked whatever job she was able to that allowed her to stay at home and raise the kids, but you know, still be the proud woman that she was. We worked together for dinner every night. Our meals were, my dad was what my mom called a meat and potatoes guy and so we would, you know, have meats and some vegetables, a little bit of starch. We never really had snack foods very often. Processed food just wasn’t really a thing in our house for a long time. My mom believed from whatever information source she had that you should have a starch at every meal. So we would have potatoes or she made the best spaghetti. I could eat her spaghetti forever, but that was pretty normal. 

I didn’t really have a real big weight issue when I was younger.   Started probably around junior high, so seventh or eighth grade. That was also around the time I started getting regular episodes of depression. In high school I played sports, but other than that I wasn’t really an active kid. I was a reader.

What is that sort of mid-teens? I never know exactly what age you’re talking about when you refer to the different grades in America.

7^th grade is about 12, 13 and that’s also around the time I got my first period. So a lot of hormonal things going on there. Probably played a part in several of the things that I was going through, like the depression and anxiety.   just kinda worrying a little too much about everything that was going on around me. I started having problems with my self esteem around that time too when I got to high school. So that’s ninth 10th grade, 15,16. 

I, like I said, I played sports, but there was almost always a period of time between when classes ended and practice began or waiting for the bus to take you to the next game you were going to play. And I started to fill my time visiting vending machines and I would fill my bag with snacks because I was bored and there was nothing else to do.

And then when you go for an away game and the bus is taking you wherever with your team, if it’s pretty far away, they’re going to stop somewhere and let you some dinner. And of course it was always fast food. There was a gas station across the street from the school and I took public transportation about 10 miles home. So I would sit at the bus stop and if it was taken long enough for the bus, I just pop into the gas station and grab more food, which is of course it’s always snack food. So not good stuff for you at all. 

And I would do that and I would eat it on the way home and then I’d go home and have dinner with the family. So it was just kind of this cycle of a progression of going from fairly healthy at home, cooking meals to just more and more processed food all the time. And it became my go-to, whatever my emotion was, whether it was boredom,   you know, I had a frustrating day at school or whatever the case may be. I just started turning to food after high school. 

I got my first job and well, my first real job and it was working the cash register at a fast food restaurant. I was in that job for close to 20 years. It was an absolutely horrible job. I did have other jobs at the time, but I always ended up going back to fast food because I was really good at it and it was comfortable for me, but it really was awful. I worked my way up from the front counter person taking orders all the way to the store manager. 

I was a troubleshooter for a period of time, which is a manager who goes from store to store, gets them in line so that they’re performing well again and then moves on to the next store, which is, it can be pretty stressful because you’re moving in over another manager and pointing out everything that they’re doing wrong. And so, you know, there’s some hostility there. 

You’re always kind of the enemy.

Exactly. That’s exactly it. 

And is that the sort of element that was when you talked about it being a horrible job. Is that part of it? 

Very stressful. It was a very stressful job. Customers are horrible. Anybody who works in public service is gonna tell you that even though the customer is supposedly always right, they’re pretty awful about it. I’ve had food thrown at me, I’ve been threatened because one of my employees forgot to not put pickles on somebody’s sandwich. It’s not a good environment. On top of that, how we were treated by the people that we worked for was not stellar by any means. We were scheduled for 60 hour shifts, but as the store manager, I was constantly on call. There were many, many times where I’d get a phone call on my day off somebody who didn’t show up for their shift, so I’d have to go in and work, you know, a double shift. There were a couple of times where I actually worked three shifts in a row. I never got chance to go home and sleep and you couldn’t get time off if you needed it. Everything was about..

It doesn’t sound like the time off that you were thinking that you had off, you know, your weekend as it were, that the time off that you’d expect every week. It doesn’t sound like you could ever rely on it. You couldn’t make plans for proper downtime.

Exactly. You couldn’t make any plans. Like I remember I had to almost bribe somebody to cover a shift for me so I could go to my grandmother’s 90th birthday party and my sister’s college graduation. You know, important things that other people in the world can go to. Right. But your fast food manager, you have to be here whenever we need you. And we don’t care what’s going on in your life. You shouldn’t have a life. You’re supposed to be here.   yeah, it was just, just super stressful. I had a few anxiety attacks because of that job. I ended up in the hospital twice, several years apart, but both times I thought I was having a heart attack. My anxiety was so bad. Managers got free food, so I had lots of access to things that were not good for me. I drank soda all the time and always the sugar sodas, right?

Like I used to joke that when I die, they’d find dr pepper in my veins. And I thought it was funny. Now I’m horrified that those were the, those were the thoughts that I was having. But,   you know, free French fries, burgers, milkshakes, everything.   I didn’t eat a lot, but I was eating it, you know, every single day because I couldn’t afford really to buy much in the way of groceries. And why would I? Because I was getting free food. I didn’t really know that that stuff was bad for me. It was what everyone ate.

And I bet you weren’t allowed the time. Even if you were having that food and you know the kind of choices you made within that environment because as we know there are, there are ways to eat healthily in most fast food joints, but I bet you wouldn’t have been allowed the time to actually sit down and take some time and have a proper meal.

That’s absolutely right.

I bet you were just grabbing mouthfuls here and there pretty well consistently, you know, all the way during the day.

Yes, there were many days I didn’t have any time to sit down and eat and so you’re right. I would just go grab something, pop it in my mouth and then run off to the next thing. Probably a lot of grazing, you know, none of the stuff obviously was the kind of food that I was used to. You know, my mom made home cooked meals every night, but nobody ever really said anything. People commented on my weight. 

Of course I had the standard 15 or 20 minute visit twice a year and the doctor would always tell me, eat less, move more, right, eat more salads and get more. And then that was the end until the next visit. Nobody ever really directed me on, these are the things that you’re doing that are probably not really good for you, so let’s do this instead. I never had any of that until I started getting more and more sick. 

I did go through some time where I was trying a lot of different diets. I did Nutrisystem, I did Slimfast. I never did Weight Watchers because I think I knew even back then that public shaming wasn’t going to be my thing. I had an aunt who was in weight Watchers and she told me, yeah, you go in and you get weighed in front of everybody and then everybody comments on how well or not well you’ve done. And that was not for me.

I was going to say. Yeah, that doesn’t sound like much fun, does it?

No, no.   I even did this weird crazy thing where you attach small metal balls or beads to your outer ear and it was supposed to help curb your appetite or something. It didn’t work.

It doesn’t sound like it would work. No.

Don’t even remember whatever. Supposedly science there was behind that. But you know, I mean I was, I was desperate, you know.

I do kind of remember, actually, I vaguely remember there was supposed to be some kind of pressure points around your ears somewhere. Maybe that’s what it was. Yeah. It must’ve been something to do with that. I do vaguely remember reading that. Yeah.

Yeah. I did Atkins.   I lost 80 pounds doing Atkins, but then I ate a noodle and gained it all back plus some right. At one point later in life, I was engaged to be married. I broke up with a guy about a month before the wedding because I found out that he’d been cheating on me the entire five years we’d been together. 

At that point, I fell into a very, very deep depression. I could hardly function. I was kind of on the outs with my family at the time, so I didn’t really have anyone to turn to you. I was fighting through all of that emotional pain alone. It was so hard. I remember one day I’m working the drive through and I was crying in between customers. I would take an order, start bawling again, take another order, keep crying. I mean it was just, it was so hard going through all of that, but that was the day that I decided, okay, enough is enough. No man is worth what I’m going through and I need to work on me. I need to start healing my heart. And   yeah, so it was tough. But obviously I got through it. 

My son was born in 2003 I was a single parent still working in this very high stress environment. I had headaches all the time. I used to keep up 500 count bottle of ibuprofen on my desk and I ate it like candy all day long. I was fortunate in the fact that I had my parents to turn back to when I would get those late night calls or you know, the weekend calls. My mom eventually became the family babysitter. When my sister started having kids, it was just a blessing. I don’t know what I would’ve done if I didn’t have them finally babysitting for middle of the night phone calls or this is the 12th day in a row you’ve needed me to babysit. You know, the, it’s just impossible and very expensive. It was real great when my mom did that. 

Then in 2009, I lost my job, which of course caused another very, very serious depression, I’m the  kind of person who’s kind of defined by my work and my work ethic. I’m probably more on the extreme side of the work ethic. I had never in my life lost a job. It was just devastating. It was unfathomable to me that I had lost that job. I didn’t really know who I was without work and I had no income.

Well, especially when you, when you put so much into it, despite seriously.

Yes, definitely. I mean, I gave that job my life for almost two decades. All the blood, sweat and tears, and in return I got booted. I mean, it turned out to be a blessing in disguise, right? I mean, I probably shouldn’t have stayed at a job that was giving me anxiety attacks and the stress and depression and all the, all those horrible things, but at the same time we have a comfort zone and even if it’s painful, sometimes we stay there because it’s comfortable and we know it. Right?

Change is scary, isn’t it?

It is absolutely scary, especially something you’ve been doing for so long and then all of a sudden you’re thrust into the unknown and you’re just like, Oh my gosh, what do I do? I don’t even know what to do anymore. I had managed to save a little bit of money so I was still able to pay the rent, but I ended up on unemployment of course. And I was also on WIC, which is government assistance for mothers and their children, and I had to do all that so that I could still pay my bills and keep food on the table. And to me it was very demeaning. The negative self talk I had was so real. I mean, at that point I very literally hated myself for the situation I had put myself into. It was really all I could do to get through the day. And I don’t know if I would honestly be here now if I didn’t have my son at the time. I couldn’t leave him, but I was in a real deep, dark place at that time. 

So I started working whatever jobs I could find. Eventually I ended up working at a convenience store, which is probably not the best place for somebody with a food addiction. So very easy access to more crappy food. I gained 90 pounds in less than a year after I lost my job. Near the end of 2010 I finally found full time work in the finance world. So I had begun a second entirely new career. I had that job for five years, but it was also very stressful and at the end, the work environment was very, very toxic. I was still gaining weight. My food choices were just ridiculous. I can think back now and wonder how it was that I hadn’t killed myself with food by that point. I remember the look on a friend’s face when they saw me dipping Fritos and beef jerky in ranch sauce. It was just incredible. 

My sleep was horrible. I was exhausted all the time. I remember feeling like I was dying when I would try to go to sleep. I actually got to the point where I would say a little prayer when I went to bed thanking the Lord for my kid and asking him to make sure that he’s taken care of if I don’t wake up tomorrow. It was, it was,  it was just awful. I had constant migraines almost every single day. One day I actually fell asleep at work. This was my new job. I was horrified. I went and got tested and I found out that I have severe sleep apnea. When I went to the clinics, CPAP class, the doctor and all his staff said thank God and told me they were glad I showed up because my apnea was so severe that I should have been dead.

Wow. Really?

Yeah, so it’s considered an apnea. If you stop breathing for 10 seconds.

Okay.

If you have five or more episodes an hour, you’ve got sleep apnea. Severe sleep apnea is defined as 30 apneas an hour. I had over 740 apnea was the night that I was tested, so I averaged about 105 apnea as an hour and each one lasted on average for 13 seconds. So I essentially was having to apnea as a minute, which is basically hold your breath for 13 seconds, take two big breaths and then hold your breath again for 13 seconds and just keep doing that over and over. And that’s what I was doing in my sleep because I was doing that. I was never getting into REM because my brain was waking me up to remind me to breathe. And that’s actually why I felt like I was dying. I kept waking up on the brink of falling asleep and thought that I was drifting away. And I had been doing that for at least four years. It was crazy. 

So after I was diagnosed with sleep apnea, I was also diagnosed with type two diabetes, which was devastating to me because my dad already had it. And both of my grandfathers who had both died from complications from the type two diabetes. I got really thirsty at work one day I just have this unquenchable thirst and I went across the street and bought a half gallon of orange juice and I drank the whole thing in one go. I just couldn’t get enough of it. And my friend said, I think you need to go and get checked out. That really sounds like diabetes. 

And so I did. I got tested and the nurse practitioner called me at nine o’clock at night and said, you have to come in tomorrow morning. We need to talk to you. It’s urgent. Of course, I got real worried and I went in and they told me that my blood sugar was somewhere around 450 my A1C was 14 so they put me on Metformin. 

Fortunately, I never went on insulin. I was able to control the diabetes pretty well with the Metformin despite eating the standard diet that they give to diabetics. Right. I actually gotten my A1C down to  8 one point in 2014 I went through a really traumatic experience with a narcissist and that brought back all the depression and the self loathing and my diet totally went out the window. I had some more medications added to the pile. I was already taking two different medications for anxiety. I was already on a Statin plus the Metformin, Glipizide, a couple others. I can’t remember.

What were you doing from a diet point of view before it went off the rails? You were just trying to white knuckle it through the hole, you know, trying to control it as it were with the typical eat less, move more and dropping the fat content and all that kind of stuff. I guess the typical advice.

Yes, that’s exactly what I was doing. I did the whole chicken, broccoli and rice, you know, lots of rice. Rice is good for you.

So pretty miserable. Before then, there was no real comfort you were getting from food?

No, I never felt good on any of the diets I had been on. I would see some successes as in I might lose a little bit of weight, but I never felt good. I was either always hungry or I’d get irritable, so maybe hangry. I didn’t even realize that I was inflamed until I found keto.

I think the only way you tend to feel good is from that virtuous aspect. The only thing that feels good about it when you’re white knuckling your way through a diet that you’re not enjoying, you feel hangry all the time. The only good thing about it, the only time and the reason that that gives you to have any kind of sort of high spirits is that your sticking to it and maybe things are going well because maybe you’re losing some weight or something. I think that’s, for me anyway, that’s the only sense of any kind of anything that approached being happy. I got out of it.

Agree 100% I was proud of myself for being able to do something so hard despite the fact that it didn’t make me feel any better or heal me even. It was more of an emotional effect than a nutritional effect.

So it’s not surprising. Then when something really hits you from an emotional point of view that there’s just no way that you’re going to be able to continue with something that is so awful to begin with.

Exactly. I remember my dad, of course, he was concerned about my weight. He offered me a brand new wardrobe. If I just lose a hundred pounds and I’d go to him and say, dad, I found this new diet. I’m trying this, I feel good and it’s working and I’m really sticking to it, but then I didn’t because it wasn’t working and I didn’t feel good. I got my first bout with a very serious infection called cellulitis a few years ago, 2015 I think, and that’s a bacterial infection in the deep, deep layers of the skin. It eats away at you from the inside. It can lead to sepsis and if it’s severe it is life threatening. It’s extremely painful. It feels like a million glass shards stuck inside under your skin. 

When I got to the hospital, my fever was 104, I had sepsis. I was there for a week. I was on constant antibiotics. They were giving me, gosh, two or three different kinds of antibiotics through an IV and I think they were giving me some oral antibiotics as well. They were just drowning me in antibiotics for this. It was so bad that I gained almost 50 pounds just in inflammation. Of course my weight was ridiculously high at that point, so when it was time for me to go home, they gave me what’s called a pick line, which is a tube that they insert inside your arm and it runs all the way up your arm and to your heart chamber so that you can inject antibiotics there directly so it gets pumped out right away and that was so that I could continue administering the IV antibiotics myself at home. I was on medical leave for weeks. 

When I finally was able to go back to work, I had to walk with a cane because I was limping so bad. The cellulitis was in one of my legs. I had to keep my leg really elevated, so it was very uncomfortable trying to work a desk job with my leg sticking out to the side. 

Actually I had cellulitis four different times. Once you get it, it’s much easier to keep getting it. Happily though the last one that I had was in 2016 which happens to coincide with when I found keto, so when I found keto, there’s kind of a story to that. 

Someone I knew at the time had told me about this totally crazy diet that he was doing that would supposedly cure all my problems. Right?   And this guy was, he was very fit and healthy, but I didn’t believe anything that he was telling me. Don’t eat carbs. Right? Your brain needs sugar. You know glucogoneo… what? That’s not even a thing!  You’re stupid! 

You know, I just thought I knew everything. Right? You ate an entire package of bacon for lunch and that’s all you’re eating today. Give me a break. My doctor’s already told me everything that I need to know. Right? 

So I was just totally self righteous on this path of he was wrong. And I was right. We had some pretty heated arguments about what was best for me. He pointed me to the keto subreddit. I didn’t use Reddit at the time. I have an aversion to toxic communities.   But I started reading some threads, if not just to have enough information to go back and research somewhere else and prove him wrong. That was really my motivation.   so I started reading some things and enough people were posting successes and defending them with sciencey words that my curiosity got triggered.

People talk about how anecdotal evidence is worthless. Yes, but when push comes to shove, those are the stories that grab your attention. Those are the stories that make you think, Whoa, hold on a minute. If they can do it, perhaps I can do it and perhaps I can get at least some of the results that they’re getting.

Exactly. I’m a very curious person by nature. My two favorite words are why and how I probably get a little annoying with them.

I bet you’re a questioner.

I absolutely am. A questioner. Yes, yes. I actually have a little bit of rebel in me and I can’t remember the other ones, but yeah, I kinda, I kind of go through cycles, so I’m real good at research. So I started paying a little more attention to the articles that people were linking, spent all day Googling, going down all these different rabbit holes, you know, having 30 different tabs open on my browser. I found Dr Berry’s video that’s you know, kind of famous now, which is the really sarcastic video about why you should not do keto and sarcasm is my native language. I loved that video. 

Then I started listening to the 2ketodudes podcast, which was my first ever podcast. I was drawn to it because of the science and like you said, testimonials are the things that get you thinking. Maybe I can do it, but I want it proof. I didn’t just want the testimonials because anybody can say, hey, this is working for me. Right? It’s the internet, everything’s true or not. Right. I wanted to know why it was working or where people lying because I’d been trying different diets. 

I was vegetarian for a while. I was on this quote unquote healthy diet that consisted of gallons of fruit and veggie juices. I was proud of myself for spending a couple hundred dollars on a juicer and a lot of money on fruits and vegetables just so I could make myself a little tiny glass of juice everyday.

Best of the whole virtuous thing again though, isn’t it? It feels so virtuous and pure and clean to be drinking basically a shit ton of sugar. Yes, exactly.

I’m not a cook because I spent so many years in that toxic environment cooking. I just, I don’t want to do it anymore, but I was so proud of myself that I was able to create veggie burgers with a ton of beans and all these other things. You know, I was doing the right thing finally.  I did the whole forks over knives thing. I watched all their videos and their quote unquote science and I totally fell for all of that. This was the only way for me to be healthy, right? Not right.   

I actually went through a period of being pretty angry when I was finding out all this information about keto and all of the things that it could fix in the human body. Because while I was doing this research and learning, that’s when my dad died and he died from liver failure, kidney failure and heart failure, all brought about by his diabetes that he had had for, gosh, I think it was two decades and it made me so mad that this information was out there and nobody was telling my dad. He was on dialysis, he had dialysis at home. There was surgery that he had to insert basically a pouch into his stomach so that he could pump all these chemicals into his system because the system wasn’t working on its own. It was just a horrid ordeal for my dad. His last few years were awful and it was awful to watch him go through that. 

And so I just got infuriated that all of this information was out there, but nobody shared it or at least nobody who could help my dad. And part of my motivation for going through all these other diets was to find something that I could maybe help my dad with. You know? I mean by the end, he couldn’t even eat. He was always a big burly guy. And when he died, he was 90 pounds. It was not,   it was just not a good way for him to go. So,   I really try not to think about that too much because I will still get angry about it.

Of course.

But I don’t think that’s a healthy place for me to be, but it’s part of why I share things in the group is to show other people that you don’t have to live like that. So I learned on the 2KetoDudes that Reddit had done me wrong. In Reddit I was told over and over and over again that if you’re already fat, your keto should be low carb and low fat. Don’t eat any fat because you already have enough. 

Carl and Richard of course said, no, no, no, you need the high fat to get your body primed and used to burning fat. Your body doesn’t know how to access it anymore. And I had been doing keto for almost a year by that time, of course, with no weight loss or any significant loss of inflammation, which were two of the biggest results that I was looking for. 

So I started over, I tracked and I made sure that my fat was higher than my protein. I stayed under 20 grams of carbs, but I was counting net carbs. I was eating mostly good food or what I thought was good food, like you know, chicken breasts, lots of vegetables like broccoli and cauliflower. I did still eat a lot of snacks. They were keto snacks, but I was eating all the time still and I would eat a lot of processed meats like beef jerky, sausages, things like that. I learned about fasting around that time and I tried it, but I wasn’t ever successful at it because I was too hungry all the time and I also had a serious mental block about it. I was literally panic at the thought of not eating. 

After doing that for several months and still not seeing the results that I was looking for. I got really, really discouraged and I let the holidays do their thing. I ate all the food, the bad food. I felt awful. I got sick and one day a coworker said to me, you know, it’s not worth it. That stuff makes you feel awful. It’s just not worth it. And it kinda clicked for me again. She’s right. Even though I’m not seeing all the results I want, I was feeling so much better on keto. I was not walking like a 90 year old woman anymore. I had plantar fasciitis that was gone. My depression was much less severe and it didn’t come around as often as it used to, which was a big deal because I’ve been depressed almost my whole life. And so those results were enough to get me back on track and ready to recommit again. 

I kept coming back to keto even though I wasn’t getting the results that I wanted because the science was there. All the different podcasts that I started listening to, all the research that I was doing following Annette Bosworth, Dr. Berry, of course, 2KetoDudes, Keto Woman podcast, everything included science and everybody pointed to where they got the science from, which is something that I had never seen on any other diet. Everybody just said, well, it works because it works, but it wasn’t working.

Yeah. Just, you know, stop asking. So many questions. Just trust in the process. Trust that it works. Nope.

Right. I want to know why. Right. Faith-based dieting did not work for me. I had no faith in it anymore, so I recommitted again. I was really, really focused on getting the food right. I had decided that, well, I just wasn’t following keto strictly enough, and that was the problem. I’m the problem. Right. My choices are the problem.

 It’s gotta be your fault. Right? 

Right. Exactly. Because that’s what we’re told. Right? If whatever you’re doing isn’t working, it’s your fault. You reminded me that it’s not just about the food and that I needed to look at all the other things. Sleep stress, eating window, you know, there’s a whole list of things that can affect your success. But I was hyper focused on the food and at that time my family situation was particularly stressful. Some toxic relationships there. Still dealing with the loss of my dad and the aftermath of things that happen with that.

Mom’s Alzheimer’s was much worse. She had finally been diagnosed and her decline was pretty rapid. So even though I had all those things going on, I never considered that that affected or would affect what’s going on in my body. I tried fasting again a couple of times, but I still really had a hard time with it. And this time, not only was it hard mentally, but also physically because I had to get sick when I started eating again. 

So I decided I would try carnivore. Still keto but stricter, right? Just kinda trying to dial down more into the why of why isn’t it working? I was bound and determined to figure out why keto wasn’t fixing me. So I went very, very strict. I was always under 20 grams of total carbs on keto. At this point. I thought again that I was getting my fat ratio appropriate, stopped snacking. They were rare. So though I started the carnivore with just meat, a little bit of cheese, some eggs, the eggs made me feel unwell, so I stopped eating them. I had things like pork chops, bacon, chicken breast. Again, because I love the white meat. I prefer it over the dark, steaks, ground beef. I drank beef broth instead of coffee because coffee made my stomach hurt. 

So as I was cutting things out, the things that remained, I was able to tell that they were part of the reason I wasn’t feeling well. I think that when you are not feeling well all the time, you get used to it and you don’t really know that, you’re sick, that you’re not feeling well. The things are making you ill because it’s just what you’re used to.

What did you do? Kind of acclimatise to it, don’t you? It’s only when you take it away for awhile and then you put that food back in and it hits you all in one go that you realize how bad it was. It’s just cause you’d had these doses every day, every day, every day. Your body just adapts to it, doesn’t it? And you, you have this, what is seems like a lower level, but chronically, you know, it’s all the time, but when your body actually gets a rest then you hit it feels like you’ve been hit with a truck.

Yes, exactly. I did things like put heavy whipping cream in my coffee,   which was for the fat content, but also for the sweet content. I was still having a difficult time with sweets, cravings. And I remember you and I had talked about that and you suggested, you know, we’ll try, try not to have anything sweet for a week and see if your cravings go away. So I did this,  carnivore for about three months and I still didn’t see any change in the weight or the inflammation. 

I was definitely feeling better physically. But the weight and the inflammation, those are the results I’m looking for. Not because I’m vain and want to lose weight. So I look better. It’s because I am heavy enough where not losing weight, it’s not an option. My doctor told me, I don’t know if you have enough time left to lose weight slowly, and she recommended me for bariatric surgery and I almost did it. It was not for me. I couldn’t justify to myself cutting out a piece of my body because I couldn’t get a handle on food. And so I said, nevermind, I don’t want to do this. And continued trying to figure out when and how keto would work for me…

This transcript is brought to you thanks to the hard work of Alison Gover.

Welcome Renee to the Keto Woman podcast. How are you doing today?

I’m doing well, thank you. Thank you for having me.

Oh, you’re very welcome. It’s nice to see you again. We saw each other at Ketofest.

Yes. Lovely to actually see you back and forth.

I know. It’s nice. It makes it extra special when you’ve met in person and when you see someone, well it’s like seeing them again almost. You have that memory of them being literally in front of you.

Indeed. Yeah. Terrific too get to hug people.

Yes. I’m a big hugger. Did you enjoy Ketofest?

Yes I did I mean it was obviously quite hard.

It was very hot.

We’re accustomed to that in Texas. It was a little unexpected there, but yeah, the festival was fantastic.

Yeah, it was good fun, wasn’t it? But like you say, hot.

Sunday was not quite so hot and that was great, but Saturday, yeah, I think I sweated out all my electrolytes.

That’s true. I ended up flipping burgers actually. Well flipping burger buns. I was walking around the plaza seeing how everyone was doing and Julie from Fox Hill Bagels was desperately trying to get all her buns flipped, and was stressing out because she needed help. So I put my apron on and helped her. But you could imagine in full sun in the heat that we had standing in front of the grill.

I was watching you guys, the sun was coming straight down on you. There wasn’t a cover and you were over that grill. And I thought good grief they’re all going to die!

It was incredible. And I wasn’t doing it for very long and I nearly melted. But the reason I brought that up actually was just to mention Chris Bair from Keto Chow. Luckily not far away, was the Keto Chow stand. And he came over with these beautifully cold bottles of water ready, filled with some electrolytes, which was an absolute mercy. Really, really helped. Because as you say, when you’re sweating and it’s hot like that, you’re just leaching out all your electrolytes and that just ends up making you feel worse, doesn’t it? So enough Keto Fest chatter, tell me a bit about you.

I started my first diet when I was 10 years old and my mother thought, well, if we get this sorted out now, then you’ll be good for the rest of your life. And unfortunately, she had been sort of dieting all of her life as well, and wasn’t very good at it either. So that started the diet yo-yo for us, for me, in particular, and we’d get close to our goal and then something would happen and we’d go off somewhere else. And it just was 40 years of the diet yo-yo for me. But in 2012 I was staring down my 50th birthday and I thought, okay, I’m about to turn 50 things change for women. And if I don’t lose it now, it’s never gonna happen. So I thought, right, we’ve got to get this sorted out now. And you know, I started New Year’s Day and I did pretty well for a couple of weeks and then fell off another couple of weeks and fell off. And by April I actually needed a bigger size. So I was going right the opposite direction.

Well that’s what happens, isn’t it? That’s the problem, it’s just one of the known things about, well, I suppose any kind of diet, actually you could include Keto in that, if you do any kind of diet where you lose weight and then you go back to your old habits, you not only regained the weight you’ve lost, but a little bit more as a nice little bonus.

So I decided to do some research and I recognized that my major issue was because I ate for emotional reasons, if I was stressed or upset, I would just go straight to the refrigerator. So I thought, okay, we have to sort this out. I’ve got to get a handle on that. So I did and I started losing weight and I actually reached my goal weight the week before my 50th birthday. And I’ve been there ever since. So it’s now coming up to seven years of staying right here where I am around somewhere between 115 and 119 pounds. So I’m only five foot three so there’s only so much this little body can carry.

And I know in the notes you sent me talking about it, that you actually, that first chunk of weight you lost when you first hit your goal weight, that was nothing to do with Keto, am I right?

No, it was, it was low fat, low calorie deprivation, starvation kind of diet.

Not much fun then.

It was awful. But I thought, okay, this is what I have to do to get there. This is what I have to do. And unfortunately when I was trying to maintain it, it was a real struggle because I’ve found that you lower your calories, I never went below 1200 but still, I just couldn’t seem to eat too much more and maintain my weight. So two years later I was sort of tired and hungry and really cranky all the time. And I thought, okay, there’s something wrong with this picture, I’ve got to do something different. So I got back on the Internet and was doing some more research and I found a metabolic test and when I got the results of it, it said, you need more fat in your diet. And I thought, fat, fat, we’re not supposed to have fat. So I went through that initial thing. But what I found interesting was that they gave me a diet, it was, it was low carb, it was pretty much Keto throughout the day. But in the evening you got some grain, but not a lot of it, just a small portion. And I was having butter and cheese sauce and thinking I’m going to gain weight, but I lost two pounds that week and I was already at my goal weight. 

So I thought this is not supposed to happen, this is weird, I was sort of skating around things and still having some sugar here and there and all of that. And in the New Year, I guess that was 2015 I started finding stuff on Keto and I thought, okay, this sounds weird, but all right. And I would play with it a bit, but I wasn’t willing to give up my sugar yet, so I wasn’t getting, the whole ketone thing. But I finally decided, okay, I made a rule for myself. I only have sugar on Sundays and after about 10 days, the first week was really hard, but after about 10 days I was like, oh, okay. I see how this feels. I really don’t like the effect of sugar on my tongue when I have it, it’s just this funny feeling. So okay, we’ll just give up sugar, go straight into Keto in April of 2015 and I have tried to find my balance. It took me a while to find what I really needed to do, but I love it. It’s fantastic. I don’t feel hungry all the time. I still have to sometimes think, okay, what are you hungry for? You’re not really hungry. What are you looking for? And sort through that emotional side. But it has worked very well for me.

And so presumably that’s just a much more comfortable way of maintaining that weight loss, a happier way.

It’s much happier way. So I get bacon and butter, what else do I want? If I really need a snack, I’ll go do some bacon and that makes me happy.

That’s a problem, isn’t it? If you’re having to eat in a way that, as you just said before, it was making you cranky and irritable and so it’s a bit of a white knuckle ride the whole time trying to maintain it. That’s a lot of energy. You’re losing doing that.

Yeah, but you’re right. I mean there are times when I get hungry on Keto, but it’s because either it’s been a long time since I ate last or I didn’t get enough fat in my meal at the last one and that I’m beginning to recognize, particularly if I’m like at a conference or something and they serve a meal, I have to make sure I get the fat or I’ll get hungry.

That’s interesting isn’t it? Finding out what for you are the things that really keeps you satisfied and I see a lot of people playing around, particularly with the protein to fat ratio. It seems for some people adding more protein is the trick and the fat makes no difference. You know, obviously I’m not talking about them eating low fat, but that doesn’t make the difference. Whereas other people, if they up the protein too much it actually makes them hungry and then it’s all about just figuring out what that perfect balance is for you.

It’s what works for your body, it’s really important.

And so you’d already approached this whole massive area that affects so many of us, of the emotional side of eating before you even started Keto, so you kind of had a handle on that, well, had more than a kind of a handle on it. You had a handle on it going into Keto, but a lot of people, and I’m one of them, it’s still something that I very much struggle with, going into Keto and they see so many people saying, “Oh, I’m not hungry anymore. I eat till I’m full and then I stop. I don’t have cravings, everything’s fine and rosy and dandy and I’m losing weight and everything’s golden” and it seems to work that way for some people it often seems to be men, and I’ll ask you about that if there is any kind of difference in experience between the genders, shall we say, but I think for a lot of us it’s this bit that’s missing in the picture, I think maybe this is a predominantly female thing as well. We think it’s something that we’re doing wrong that we’re failing because Keto isn’t working as well for us as it is for other people, so it must be something that we’ve done wrong and then we start beating ourselves up and obviously that’s going to just fuel back into the whole problem with emotional eating. Perhaps you could just give us some guidelines, I know this is what you do, so we’ll go into all of that. How did you start doing this? Is this something that you’ve always done? Is this something that you started doing via your own experience? I’ve thrown a lot of questions at you there, so you just start where you want to.

The counsellor and coach in me says, no, you’re not doing something wrong. Lose that thought because that’s not going to help you at all. The problem is that from birth, when a baby cries, Daisy, what do we do? We usually put something in their mouths, whether it’s the bottle or a breast or the pacifier to get them to stop crying we put something in their mouths and it works. So very much it is how we are trained, how we are wired. When we are upset, we put something in our mouths and the problem came when we changed out that dummy that pacifier for a donut. So it’s something that’s hard wired in us, this is how we work and just like, I don’t know how it was in school for you when you were first going to school, but we walked everywhere in a straight line, eyes forward, hands beside our side, whether we were going to the playground or to the cafeteria or to another classroom. But as we got older, we didn’t have to do that anymore. We learned other ways to get where we were going to go. So it was what we were taught as children and as adults we have to learn, okay, I’m upset. I want some soothing. How do I get that soothing in a way that is appropriate for me, for my situation, for my personality, for who I am. So that’s kind of the progression. 

And one of the things that I teach to my clients is it’s not hard to overcome emotional eating. We just have to get the hang of it. And I use hang as an acronym. So the H is am I hungry? And if you’re hungry you probably do need something to eat or you need it soon, right? So if you’re not hungry then go to the A, what is your attraction to food right now? What’s going on? Because there’s always something going on. If we’re crash landing in front of the refrigerator, it’s not just hunger. There’s something within us. So what is that driver and then the N, what do you need other than food? What would soothe you right now? What would help you? What would make you feel a little better? And then the G is go, go get that. Because that will soothe you more than any food ever could. And it’s a process. You’ve been doing it the other way for a long time, so give yourself some grace to work your way into it because once you get the hang of that, then it’s like, oh, okay, what do I need? Um, I need some time with my dog, or I need a hug or I need some help with this project, and then you can get that and it’s much more soothing. Does that make sense?

It absolutely does. I’m just trying to figure out, and presumably it’s a question to a certain extent of simply practice and some kind of discipline in kind of forcing yourself through those steps of exploration in the first place. Because it feels to me, and I know this battle’s gone on in my head, and it can be as you’re walking to the fridge or as you’re walking to whatever contains the item of food you’re going for. I’ve had that conversation in my head as I go there. You’re not hungry. I know I’m not hungry. I know I’m not going to it for that reason, but I guess the problem I have is that that argument is very limited. It’s just, you’re going there for the wrong reason, don’t do it. And the other side is, but I don’t care. I’m going anyway. And it’s this battle battle, battle, battle battle and the “I don’t care, I’m doing it anyway” pretty well always wins. But I’m guessing from what you’re saying that that’s a bit of a negative feedback loop in a way. What you need to do is harness that critical voice and turn it into a different practice.

Yes. Well, and if you can, you obviously recognize, “okay, I’m going to do it anyway”. And sometimes that is a choice. You get to make that choice. You’re an adult, you get to choose that and then you can deal with the consequences later. I often reckon it to paying taxes. We do that because the consequences are great if we don’t. So you have to make a choice there. What will be the consequences for me? Well I won’t get to my goal weight or I will gain, and you know what? That’s okay. If that’s where you are today, that’s where you are today. Tomorrow you may be in a different place and it is the perpetual making different choices that get you turned in the direction that you say you want to go. Well if you don’t want to go there, don’t go there. 

But don’t beat yourself up for it because that’s not what you actually want. And I think learning to choose what you actually want in any situation begins to lessen the hold that has on you. Because it is, it is such a mental process in the end and it’s healing some of those wounds that you may not even realize right now. And that’s, you know, that’s how people end up with me for long periods of time is cause we’re trying to figure out, okay, what exactly is going on and why are you bucking against that? There’s something deeper there because in the end it all comes down to what is the driver of this behavior. And once you figure that out, then you can change the driver. But it is a process and beating yourself up only sends you to needing more soothing, right? And then you get into that perpetual cycle of beat myself up, I need soothing so I eat and then I’d beat myself up for that. And it just keeps going.

And how’s the best way to try and start breaking out of that then?

It is a choice in the end, it is, okay, what do I actually want? And if it’s food, then the consequence is that you will probably gain some weight and that can be okay. But giving yourself the freedom, I know it sounds kind of silly, but somewhere within us likely there is a small child who was not given that freedom and we have to soothe her or him and get that taken care of. This became very clear to me right after my grandmother died because when my mother had passed away a few years earlier, I crawled into the refrigerator and I gained a lot of weight. And when my grandmother passed away, and we were tight, oh my Nan and I were really, really close and I thought, okay, I can do that again and gain more weight or I can start breaking some of the connections that I have with food and her and get better myself. So it very much comes down to a moment that affects you and how you choose to go on from there.

And I do think when you were talking about making that choice to sometimes to eat and there’s going to be that potential consequence of gaining weight or if it’s the wrong, in quotation marks, food it could make you feel ill I do think, well I found myself anyway that Keto gives me some kind of freedom in that that is much more limited.

Yes.

With high carb food, I literally go completely off the rails. You know, the train goes completely off the rails and it goes absolutely crazy. And I can gain weight like you wouldn’t believe in a really short period of time.

I would believe.

But at least with Keto, I’m not saying it’s solved the problem because it hasn’t, but it does limit it and that there’s still some overeating that goes on, but it doesn’t go completely off the rails.

Right, because carbohydrates always want more. You cannot satisfy yourself on all of those carbohydrates. You just can’t, they don’t fill that need in the same way. They’ll fill your stomach in the same way.

Yeah. So it’s that combination, isn’t it, of what you’re still lacking with this needing to fill this emotional need that’s going to exist. If that’s an issue that you have, whatever you’re eating.

Yes.

But if you can remove the physical side of it, it is going to help, isn’t it? It’s going to make it a bit easier to maybe start tackling the emotional side.

Yes. And it does help when you’re not hungry all the time. It is so much easier to overcome emotional eating when you’re not starving because you don’t have that panic of, your base self saying I’m starving, I need something. Well you’re not gonna be starving. If you’re eating Keto, you’re going to be a little more satisfied once you work out what works for your body. But you also, as you say, if you eat something off plan then it kind of makes it worse.

Yeah. And it can really start a binge type cycle. I mean I see so many people. It’s when you talk about the whole, I think this would be an interesting thing to talk about, the whole question about a cheat day or some kind of planned off plan eating and people as much as the plans they make, it’s just going to be for one meal or one day or one holiday. The risk is, and for some people it does work like that. You know, I’m just going to do this while I’m on holiday for example. And when I come back everything goes back to normal. And there is some kind of logic in that and I’ve, I’ve found for certain things that works for me, I actually do that with chips or French fries as Americans call them. I will not make them at home. I never make them at home. I don’t allow them through the door. But if I’m out somewhere, at a restaurant, I don’t go out that often so it’s not actually something that arises very often. If they look like they’re good, I won’t bother if they’re not good chips, then will have them and that for me works. But for other things, interestingly, the crisps or chips, this whole translation with food thing I find fascinating.

It’s amazing. Yes.

But those that doesn’t work. If I have those, even if it’s out of the home, that will lead to a cycle that ends up with me buying them and bringing them into my home and before I know it it’s every day. So it’s interesting, I think that some people can do that, putting it in a certain box and managing it that way. Some people can do it with certain foods, but a lot of times it ends up just starting this cycle that one day, one week’s holiday turns into, before you know it, weeks, months, years even.

I think if you think about that in terms of other places where you are disciplined, then it might give you the tools to apply that same discipline to this unless you choose not to. And that’s fair enough. I went to a wedding in April and there was literally nothing, nothing that did not have some kind of sugary coating to it. And I thought, okay, I can either be really rude to the hosts and not eat at all. Or I can say, all right, it’s one evening, it’ll be fine. So I went with that, so as not to be rude. I didn’t need a lot, but you know, I tried to enjoy every bite of it. And I think that’s one of the things that’s key. If you’re going to have something, try to enjoy it because you’re going to pay for it later. And two days later I snapped at my dear sweet husband and I said, oh gosh, this is the sugar talking, and he was like, okay. 

And I recognize that when I have the sugars or carbohydrates in excess, well, in sugar, anything is excess, right. It does affect me emotionally that blood sugar high and low makes me ratty. Hence the reason I try to stay away from it, but I try to enjoy every bite and I have to say it was all very good, so I enjoyed it and then had to deal with the consequences of my day of not feeling my best because I was just, oh, everything was irritating that day. It is just not worth it to me to do that in another setting, you know? Unless I’m being rude to somebody, then I was like, okay, I don’t want that awful feeling of being that ratty so I won’t do it.

I think a big part of it is being mindful and aware of what’s going on, isn’t it? I often say to people when they’re in that day afterwards and they’re feeling whatever they’re feeling, whether it’s emotionally bad, physically bad, both, I say to them, record this in some way. You know, make a video of yourself, write it down, whatever it is in the moment when you’re feeling it, make a note of it because we’re very good, aren’t we of forgetting.

Deleting those memories, yes. That particular day was very stark to me, so I thought, okay, now you’ve got your memory to hold onto. So do that.

And this work that you do with emotional eating, is this something that you’ve always done or is this something that developed because of your own experience to apply to the counselling work that you do?

Well, I was a counsellor obviously before that, but yes, the focus on emotional eating just came out of my own experience and recognizing that a lot of other people struggle with that as well. And I think sometimes when you’re in the desert and you find water, you want to share it with others because if I can help someone else overcome their emotional eating, that’s wonderful. Because it’s helping them heal their heart a little bit and there are so few opportunities to do that with people that I want to take everyone I get

Tell us a bit more about that. Tell us a bit more about your work and your business. I like reading your notes. I like the whole, the imagery you have with the packing your own bag, that progression.

I think our bags kind of get packed for us as we go through life. Then we’re dragging all this excess baggage with us for decades and sometimes you have to unpack, just like when you come home from a trip, you got to take all this stuff out of the bag and then you can pack what you want for the journey you want to be on rather than the one that you stumbled into. So if the overeating and the emotional eating doesn’t fit who you want to be doesn’t fit the journey you want to be on, then get rid of it and choose what works for you. I tend to work in three main areas for people. We start with your body because if you don’t work out what works for your body, then you’re going to struggle. So find the thing that works for you in Keto. Find your macros, find your comfortable spot. If tracking works for you, track. If it doesn’t work for you, please don’t do it. Right? 

So find what works for your body and then we deal with some of that baggage because that will affect you. And if we can unwind some of the experiences or the things you think about those experiences so that you can get free of them, you can heal your heart a bit, then you’re set and then your best self. So your body, your baggage, your best. Because if you begin to cultivate who you are at your best and live that way more often, then life gets easier. I was born red headed. I have a temper, I am stubborn and dealing with some of those things helps me have a happier, more peaceful life. And I really liked that and I don’t know about you, but when I am living in my best self, I make much better choices about everything. Including food.

Yes, that’s right. And what does your Keto look like?

Right now in August, I’ve been doing carnivore mostly so it’s sort of 90% meat and fat and animal products and I like seasoning. I like cocoa and I like tea. Those are my plants. So I’ve been pretty carnivore. I think we have vegetables on Sundays at the moment and I feel great, but I probably will go back to having at least a serving of vegetables a day because I just like them. I tend to do a fatty tea at breakfast with some Collagen in it and then I’ll have lunch. I’ve also this month been playing with a reduced eating window, so I’ll have my main meal because I wake up hungry. I think my time, my body clock gets stuck on Welsh time from the years that I spent there. So I prefer to have breakfast and lunch, maybe a late lunch and skip the evening meal. And that works for me because I make dinner for my husband and then I have that for lunch the next day. And it doesn’t bother me to not eat. I sit with him but I don’t have to eat at the same time.

It’s interesting how, just like you say, finding what works for you and also appreciating that that changes as well.

Yeah. At some point I will go back to having dinner, you know, at six o’clock with my husband. Just not right now.

Yeah. I’m really interested with how people do on carnivore because I was expecting to find that it suited me really well because I, like you, was finding that I was eating a lot of the time that way anyway. And so thought sort of taking it to the next level would be just like, you know, dialling it up and making it even better. But it went the other way for me. I didn’t do well at all, especially with my mood, but also obviously screwed around with my hormones cause I started getting hot flushes all the time and I just thought, oh well this, you know, it’s just time for that to start them. But when I stopped doing it they stopped as well.

Oh, you want to avoid that.

Yes, exactly. I do still get a few but just it was like all the time. I said, oh no, this is not fun.

We don’t want to do that. But I tell you, I made a, a bit of a shift earlier this year because I heard someone say that, I think it was Kim Howerton actually, she said we were trained by WeightWatchers that fruit and vegetables are free. So when we come to Keto we know that that fruit must be monitored, but we take all of those vegetables into Keto and wonder why we’re not getting the results that we want. And I thought, oh yes, because I was the queen of the eggs Florentine for breakfast, right, I’d have some vegetables with every meal and it made a difference when I cut those back because they’re carbohydrates too. They may be good carbs, but they’re still carbs and again, dialling in what works for your body.

Yeah, that’s right. I absolutely agree with that. But I found, I think it was Dr Nally who is talking about it on the Two Keto Dudes podcast with Carrie particularly talking about how she tried carnivore as well and didn’t do too well on it and does better with some vegetables. And, and he was saying yes that this, and having a small amount, he wasn’t talking about having massive platefuls of salad, but he was talking about, having some greens, even just a small salad every couple of days could make a big, big difference. But not, having masses. Like you say, having too many can be problematic for people too. So it’s always about finding that balance isn’t it?

Yes, for you. Because your chemistry is different to my chemistry and just because somebody else can can have all the Keto treats and the nut flours and all the rest of it. It’s not a contest of “she gets to have that and I don’t get to have that”. That’s just not the way we need to think about this because what you’re working on is what works best for you.

I think that’s partly what’s enjoyable about Keto and certainly what I see for so many people is that they find it really empowering because they start feeling like they’re getting some control back and starting to make better choices and seeing how their body reacts and finding that they are starting to get some control back over their health, that they felt that they might have lost or was forever gone and they’ve just accepted the fact that they’re on some kind of progressive disorder journey and there’s nothing they can do about it and all of a sudden they start to feel good.

Absolutely. Because I know it made such a huge difference for me because I was no longer hungry all the time. I wasn’t tired all the time and I certainly wasn’t cranky. So it made such a huge difference for me, I can’t imagine ever going back to eating the standard American diet. But what’s interesting to me is my grandmother back in the seventies I guess when we first started, said, Renee, all you have to do is cut your sugars and starches and you’ll be fine. So she knew, she couldn’t do it for herself, but she knew. It’s just been refreshing to come back to that and think, oh yeah, I remember when the low fat thing came out and I was thinking, that doesn’t look good, but we tried it, right. That’s what they told us to do.

Well, and it wasn’t overwhelming. That’s what they told us to do. Backed up with the government health guidelines pretty well around the world. Not absolutely everywhere. But you know, certainly in the States, certainly in Britain and the EU, it’s just this, fat is bad. You need to reduce your fat right down, especially saturated fat because that’s the worst thing of all. You’ve got to eat your five a day, you’ve got to stay away from too much red meat is bad you. But these things have been drilled into us for so long. I think a lot of us, even though we know that fat is fine, even though we know it feels good, we still sometimes feel guilty when we’re eating it. There’s just that automatic response because it’s been drummed in for so long.

There is that, “gee, I hope this doesn’t come back to bite me in about 10 years”, but at the same time I feel so good and the lack of hunger is just wonderful because I was hungry all the time. It worked, I lost weight, but I was not happy on that. And I think food is too big a part of our lives for us not to be happy with what we’re eating.

Yes, and who wants to live in a constant world of deprivation?

Well, one of the things I tell clients when they are like, “okay, I’ve got to have this, this has to be a part of my life”. I say okay, that’s fine, work around it and if you’re going to have something like if you’re going to have your crisps, here’s what you do. You set it aside until you’ve got time and then you put it on a plate and you use the appropriate utensils. You sit down, you lay a place mat, lay your table, make it pretty. Sit down and enjoy every bite of whatever it is you’re eating and if you can do that, have it without any guilt whatsoever. Just enjoy that food. Squeeze every bit of flavour out of every bite because then it will be much more satisfying to you and you don’t have that wraparound guilt thing going on because you’re an adult. You’re allowing yourself to have this particular thing on this particular day. 

The problem is we tend to either eat at the sink or pull up a chair to the refrigerator or watch in front of the television. I had this one client, a fella who had ice cream every night and I said, that’s fine. Just work it into your plan and sit at the table. Well, he said not at all, I want to eat it in front of the TV. I said, are you bored? Are you focusing on the food? Because if you are, if you want this food so badly, then actually enjoy it, focus on it, get all of the sensory experience out of that. If you’re watching TV, you’re not enjoying the food. So just make your choice. What do you want? The TV or the food and if you’re bored watching TV, why are you watching TV?

Yes, I must admit that is my tendency because I live on my own. I tend to, and maybe it’s, you know, it’s a multitasking thing in a way as well, but I don’t really see the point of sitting at the table and just eating because it’s just me, you know? So I’m not talking to anybody or anything. I’m just that, I don’t know, it just doesn’t feel right. So I am always doing something else. Usually watching the TV when I eat, but you’re right, and interestingly enough, when I am eating with somebody else, I’ll eat less, way less. I think that’s partly to do with the speed I eat because I’m talking and eating. So it takes longer to eat what I’m eating, but I would say almost without exception, I eat less when I’m sat down at a table eating with somebody else.

Well, and some of that is just attention. I remember years ago, Oprah had gone to France and she bought two croissants. She said, I knew I would swallow the first one whole and I got the second one so I could enjoy it and I thought, okay, yes, we do that. We get through something and then it’s almost like we haven’t had it because we ate it so fast or because we weren’t paying attention to it. Therefore we need more of it because we want to enjoy it. Well if you just enjoy it the first time, if you allow yourself to have that time when you’re eating, as focusing on the food, you know your eyes on the food that you’re eating. Gratitude for whatever was sacrificed for you. Get the sense of it, the smells of it, listen to your knife and fork cutting. Just get all of that sensory experience. It doesn’t have to take long, but when you’re eating, eat, enjoy the food, and it’s likely that you won’t eat as much because you’re getting all of the sensory experience in that one occasion.

It made me chuckle to myself then, well not chuckle, shiver probably more appropriate word, when you are talking about what Oprah said, because that’s exactly how I feel when I’m eating kinds of foods. It’s actually a sense of panic if there isn’t much of it. If it’s a very small amount, just taking the first, well, just actually the thought of eating it, if there isn’t a large enough stock of what it is, I’m panicked about that because I know that I’m going to run out. And just as you were talking, it made me think, absolutely, you’re throwing away a certain amount of that just sort of trying to fill that need before you even really start tasting it. So you’re having to plan for so much more than you actually need because it’s not actually the need in quotation marks that you’re trying to satisfy, not actually that food that you’re putting in your mouth.

So the question is what is that need?

Yes.

And that’ll be different for everyone. What is it that that says to you?

And I’ve seen the futility of that. I’ve told this story before, Haagen Dazs ice cream was always the thing that I used to really love, I remember it was in the summer. Supermarkets aren’t usually open here on a Sunday, but in the summer they tend to be because the tourists are here. And I raced to the supermarket to get there before it closed at midday, just about got there in time and got a load of Haagen Dazs and I came back and was sitting eating this and I didn’t really want it I knew I didn’t want it. It was at a time I think where I was on, I think probably the low carb part of my journey. It was certainly way before Keto, and it might’ve even been actually way before when I was just in the normal yoyo dieting of things and on an off period, but just eating this working my way through these tubs, and it was multiple tubs of Haagen Dazs ice cream and certainly wasn’t enjoying it. I had tears streaming down my face, I was desperately miserable. I was shoveling this stuff into my mouth, trying this futile attempt, I guess, of trying to soothe whatever the problem was.

Yeah, and if you can find what you were trying to soothe and unwind that, then it’s much more likely that the food will lose its importance to you.

This transcript is brought to you thanks to the hard work of Debbie Mitchum.

Welcome Elena to the Keto woman podcast. How are you doing today?

Hello Daisy. Thanks for having me. I’m actually very excited to finally talk to somebody about migraines. Who knows what migraines are herself, which is really cool. 

Oh yes, absolutely. 

There’s nothing better than introspective when you talk about a disease. You actually know what it is like, right.

For sure. We’ve been trying to record this for ages, funnily enough we were laughing about this before. We’ve both had to cancel due to migraines at some point, which is kind of funny. But we’re, we’re finally here and it’s fantastic to be speaking to you. 

Yeah, it’s certainly also been my fault for having to finish the PhD thesis and lots of things going on. So, my thesis in two weeks, I’m still a little bit stressed, but fairly migraine free, so it’s all good. And I’ve been looking forward to this since you asked me like months ago. Yes. 

Yes. It was quite a long time ago when we started talking about it. But the timing worked out quite well in a way because yes, like you say, it’s good to finish your thesis first.

Yeah. And you even skim read it. I’m well proud of you and honored. 250 pages. Well done.

Well I was, I was very interested in, there were, there were all sorts of things in there that we’ve chatted about a little bit before we start, so we’ll have to remember to bring up all the points in our actual recording.

Okay, great. I guess you have a list. Otherwise I’ll pull out the thesis again and we can go through it.

So, let’s start by hearing about you and how you got into keto, how you got into your migraine research.

Yeah. So, as you can imagine, and as I already mentioned, I’m a migraine patient myself. It’s, I think it started about when I was about 14 maybe half a year after I started the contraceptive pill, which is very interesting because having talked to a lot of patients within the course of my study now there seems to be a connection to starting the contraceptive pill and migraine onset or migraine worsening. But I just went to several doctors, nobody knew what was going on, psychologists and whatever brain scans. And finally, I diagnosed myself using the internet actually with migraine and from them then on is basically continuously gotten worse. So despite trying everything, and you know when you’re 16 you’re trying to go out with your friends or have a drink here and there and the least you want is really have a stable lifestyle of going to bed at the same time and not eating all these triggering foods. And, but I really tried and despite all efforts, alternative and medicine or pharmacological therapies, it just got worse. So after I think it was June, my bachelor’s degree, I was always interested in the brain, but I started reading psychology and my bachelor’s degree and my migraines actually became chronic and that’s something where you have more than 15 days per month of migraines or at least eight of those have to be migraines. The rest can be headache and just really crippling. Your migraines are starting to control life. You cannot go anywhere with that pain. I mean you know that when you have a bad migraine you can’t really control or ignore pain in the brain. Really. It’s a, it was quite tough, and you never knew whether you could take exams or whether you would have a migraine that day and plus social life. It was really bad. People don’t understand and so well by the end of the degree I realized that I couldn’t be doing a normal job with these migraines anyway. So, I decided I’m going to change my career path and not become a psychotherapist but go and read neuroscience instead and maybe within my lifespan, figure out more about what is a migraine and what can we do to actually treat it. So more looking into what might be the root causes, where is it coming from and why? Because I went to so many specialists and nobody actually answered that question, what is a migraine, why are we getting it? And of course, you can’t treat it.

Yeah. Cause if you want to really properly treat something, you’ve got to find that root cause.

Exactly. And not just treat the symptoms, not just treat the pain. And as we discussed earlier before this recording,  with triptans, those acute migraine medication or even with analgesics, you cannot take them more than like 10 to maximum 15 but that’s already pushing it days per months without getting medication overuse headache or this risking to get one of those. Because your brain basically adapts and then it adapts to having these chemicals around. And if you don’t have them around, then you get something like a rebound headache. So, your body is anticipating what these triptans do to your serotonin receptors because their serotonin agonists and if you don’t have those around, there’s not enough serotonin anymore to basically endogenously activate those receptors. So, then you get a migraine when you don’t take those drugs, which is even worse. Right? So, it’s like a vicious circle. So, I was stuck in that situation where half the time I could not take anything against the pain and that basically means you’re out for days in your dark room and you can’t do anything. So very unsatisfying. And  this is why I then went into neuroscience and I was lucky enough to have an open neurologist in Oxford who took me on and I did two of my masters, both master’s projects or thesis in migraine research with chronic migraine patients was one in neuro imaging. 

And the other one was STEM cell IPS, CS induced pluripotent STEM cell research with migraine neurons basically, which was also interesting. But for me it was most fascinating to be close to the patients in that neuro imaging. And there was this one incident and I still remember very clearly where the scanner broke down for one patient and she had to come back and she comes back into the lab the second time and I almost didn’t recognize her. She was walking up straight, she was smiling, she’s lost weight, she was like a completely different person. Back then I already started forming my theory that migraines are at least in part an energy deficit syndrome of the brain. She comes back and I asked her, what did you do? And she told me she’d been fasting for two weeks and that completely shocked me. He says, oh my God, she’s not eating for two weeks. And we know that not eating is one of the most potent migraine triggers. Right.

Typical triggers.

Exactly. And she was having a glass of red wine every night and it was fine. She had not a sandwich and I was like, wow, I couldn’t believe it because this is Oxford medical school or psychology medical school both together and the neuro-science in Oxford. We did not learn that the brain can metabolize anything else than glucose. Right. So, I didn’t even come across ketone bodies during the whole year of my studies there. And I was shocked, and I didn’t understand it. And I went about, and I chose the end of the degree. I was procrastinating in the library again as usual and was flicking through a nature magazine and it had an epilepsy special in there. And one of the articles was actually on the oldest treatment for epilepsy, the ketogenic diet. 

And I read upon the mechanisms and this was like the, I think this was the best aha moment I’ve ever had in my life. I was like, okay, this explains his incident with a patient, and this could also be the solution because reading upon the mechanisms, they were all migraine relevant. And few people know that actually migraines and epilepsy are genetically related. So, some kids would grow out of epilepsy and into migraines. It’s almost very similar pathophysiological mechanisms. The two, so some kind of parts of epilepsy are kind of like more severe versions of a migraine attack in a way you could end a lot of epilepsy patients even have migraine.

That’s interesting. How does that work? Why is the link though?

They see epilepsy as a migraine. It’s a hyper-excitable brain. It’s problems with your ion channels in the brain that make your brain super hyperexcitable and this can be exacerbated by energy deficits and when neurons fire in synchrony and they all fire at the same time, you basically get an epileptic seizure. That’s your seizure, uncontrollable firing, right, and a migraine CSD or Chronicle critical spreading depression, which is the correlate of the aura phase in migraine, which is this phase of visual. It could be visual but could be any other sensory deficiency that precedes the headache for about an hour and can be anything between five minutes and 60 minutes long. Basically patients go black on one side of the visual fields or you some go paralyzed. Some could also be like a aura of the body. Or you lose speech or something like this. But that’s also basically in the back of your head. This is basically a cortical spreading depression means that neurons fire in synchrony go over the cortex in a wave and that’s followed by no activity. And that’s basically when you then lose sight or lose control partly of body or loose speech, wherever that wave is traveling to basically. 

So synchronized uncontrolled firing is basically the underlying physiological correlate of an epileptic attack.  Migraines have that component to at least to some degree also antiepileptic drugs or the preventative drugs that are probably the most effective or among the most effective in migraine. So, if you reduce your excitability in the brain, you can help a migraine attack. And there’s also the link between hyperexcitability and energy metabolism because basically what makes a neuron fire the firing of a neuron is called an action potential. And there’s something called a resting membrane potential between a neuron and the outside of the neuron, which basically determines how likely the cell is to fire. Simply put, it’s almost like a wall between say the ocean and the land, the wave are the action potentials. If you have a high wall, the wave is unlikely to go over the wall onto the land, so you’re unlikely to get an action potential, which means your brain is calm. The lower the wall and the wall would be this resting membrane potential. The lower the wall, the more likely the waves are coming out to come over the wall. And whenever the waves come over the wall, the neuron will fire. Keeping this wall high or keeping the membrane potential high, which in the neuron is done by basically carrying out ions against a concentration gradient to basically keep this potential is an electric difference between inside and outside. In order to do that, you need to spend a lot of energy. So, 50% of the brain’s energy demand actually goes into caring ions across their potential difference in the brain, 50% it’s massive. So, if you have reduced energy in the brain, of course this wall is going to come down. When the wall comes down, your neurons are more likely to fire. What does that do? Well, first of all, you might get a migraine attack. But also, most migraine patients have some kind of sensory sensitivities. 

So hypersensitive to light, to noise, to smells.  Why? Because it needs much less of a trigger for the neurons to fire. If the wall comes down, they fight easily. So, life becomes much brighter and noise becomes much louder.  So, I think that’s how you can explain those other issues that come with a migraine attack before and during an attack as well could also be explained by this energy deficiency and by these neurons that are firing more likely. And the genetic predisposition here is a shared one between epilepsy and migraine would be, and there’s so many different ion channels in the brain that basically carry ions across membranes. That’s a function. Right. And if you have some that are predisposing you for a lower wall already or an increased tendency to fire and you put yourself in an energy deficient environment by only eating carbs. Right. Or you have mitochondria damage, then basically those two come together and you get a migraine or, you get more migraines. And I didn’t want to distract from the personal story, but maybe we could come back to this later. I believe that migraines, one says that chronic pain has lost as one in function. That’s what’d you say? Acute pain. Everybody knows it’s very important for evolution and once it becomes chronic, people say it’s lost the wanting function. We just need to treat the pain. But I doubt that. I think that pain always has a warning function. A migraine is a very potent warning of our brain that it’s in an energy deficit, that it’s, the oxidative stress is too high. It’s a very, very powerful means for the body to force us to stop what we’re doing to rest, to go in a dark room, we’re nauseated. We don’t want to move. That’s one of the most migrant symptoms. Movement makes it worse. Light makes it worse so you basically you shut up all sensory input, you conserve the energy you have until the homeostasis in the brain is restored and then a migraine stops and very interestingly during the migraine attack, early studies about 50 years ago and they’ve completely been forgotten about, showed that during a migraine attack, irrespective of what people are eating, ketone bodies are calling up and like policies is going up so it’s like a counter reactive response of the brain saying Oh we have an energy deficit now we need to ramp up some kind of energy that we can actually use. I now know that my migraines are trying to protect me from something and knowing that also helps you to kind of accept what you have. In a way I guess it’s not your body forcing this migraine onto wanting something bad is actually trying to protect you from something that is super harmful. It might increase your risk for Alzheimer’s in the long run or for some kind of brain damage in the long run because there is migraine stroke in patients that have migraines with aura. Typically for a very long time. I’ve been working in neuro imaging as I mentioned before, for some time you find this micro lesion in the brain. People usually say a migraine doesn’t leave a mark, but it actually does, so the more you get them, you actually do get to see it in the brain. Even with like a very course neuro image of like one square millimeter, which a on a on a much finer level, you’d probably see other things as well. Ions accumulate in the brain and all sorts of things.

Yes, I have read that actually and it makes complete sense.  If something is happening that your body is warning you against, it’s likely to leave a mark of some kind. 

Yes, and it hasn’t lost its warning function. It’s just that our environment has become so maladaptive to our migraine warning genes that say that people have it chronically, and of course it’s debilitating, but that also means that they probably have some kind of oxidative stress level in the brain or constant energy deficit. And that’s something you can also measure in migraine with neuro imaging these days, they have about a 20% on average ATP lack in the brain compared to controls, even between attacks. 20% less energy that’s not benign, and that’s episodic patients. That’s not even chronic patients. So, I don’t want to know how much lack of energy in the brain a chronic patient would have, and all the body can do. It cannot talk to you. It can send you pain signals, It turns these ancient mechanisms on, it turns the pain cause Kate on to force you to, to stop whatever you’re doing, to change something and tell you, hey, we’re not doing okay. There’s something wrong here. Right? That’s what pain tells you. And then in chronic patients it’s just that their genetic load is so high, and their mitochondrial functioning might be this bad. And there is other environmental situation with regards to food and energy might be this bad that they are constantly reaching the migraine threshold, the warning migraine threshold basically that the brain is always in such a state that it thinks it needs to warn them. Back to the personal story, just to finish that off, basically I stumbled across ketosis. I was like, this is it. I started self-experimentation. It went very wrong at the beginning because I had no idea what I’m doing and what a cute Jenny died is triggered like the worst migraine ever. I think it was fasting and I wasn’t in ketosis for like 10 days, which is crazy. My body completely had forgotten about how to make ketones or how to get them anywhere. But when I finally got it right, it was pretty amazing. Lots of self-experimentation followed. And then I knew that I wanted to do this in my PhD and nothing else. That turned out to be fairly tricky because everybody was like, Oh, you can come here but you do what we want you to do. I mean, as a pre PhD student, nobody believes you and it was fairly risky project, but then in Basel, and this is why I turned on Oxford in the end, is in Basel they said, if you come here, you can do it as a side project, and then before even starting my supervisor, he has said he has to leave to Germany. He’s, he’s leaving, he’s gone. So, my funding went, but that was basically the possibility then to say, okay, I’m going to make this my major project. I’m going to leave neuro imaging. 

It’s interesting, but it’s too far away from the solution. I want to do this Keto and migraine full time. And in order to get a grant that funds a full phase two clinical trial, which is fairly extensive, we decided to go the exogenous ketone round route, which is basically changing one variable only adding ketone bodies and find out what does the presence of ketone bodies change in a migraine patient with regards to potential mechanisms. And is this enough to show a significant clinical effect in those patients in terms of migraine day reduction and other outcome measures. And that’s been going on for like four years now. I think with the planning and everything and we’re in the last half a year. Last patient cohort is currently, in the study and then hopefully by next year we’ll have the results of that. But that’s basically the journey I’ve been. Now I’m towards the end of my degree and I was able to deep dive into ketone migraine, which is amazing if you can make your disease your passion, it’s kind of cool.

Exactly. So, you not only diagnosed yourself, but you’re going on to find the best treatment for yourself and for others at the same time. Yes, exactly. And we’ll talk a little bit about what your Keto looks like later because I know having had a conversation with you before we started recording, it’s going to play into something to do with what we’re going to talk about. So, I think it’d be better put that in a little bit later, right? Yeah, sure. You have spoken about already a little bit about what migraines are, but perhaps you could just talk a little bit more about that and also the connection you found with all the different triggers associated with migraines.

Yeah. So, migraines typically aren’t. That’s kind of, I maybe one more funny anecdote with regards to what a migraine actually is. Because when I was five or six years, I had a favorite movie called poom tin and Anton, it’s a German movie. And uh, I used to watch it on rainy Sundays with my friends. And in there the protagonist’s mother has migraines and her friend asked the dead, what are migraines? And he says migraines are headaches that don’t exist as in like she’s making this up. So, for the next 10 years following, I actually believe that migraines are a term for a headache that doesn’t exist for a made of headache. And then I had to, once I got there myself, I found out that they’re very real. So, migraines are not headaches that don’t exist. They’re actually even more than a bad headache. Typically, they’re from the headache, from moderate to severe quality pulsating.  They’re typically unilateral meaning they only appear on one side of the head. Typically, it could be some people have it strictly only on the right always and for some people it swaps. But typically, you have a preferred side where it happens, at least at the beginning. Eye pain is very frequent. Then you have kind of a premonitory phase, which precedes the headache attack up to one day or even more. And there you typically have associated symptoms, neurological symptoms like nausea, light sensitivity, noise sensitivity, smell sensitivity. Sometimes moving makes it worse and you have this like feeling of doom. Some people get really agitated. Other people get super tired and super fatigued and those symptoms can last throughout the headache phase. And then they will also typically last for the prodrome phase, which is basically the postdrome phase. Sorry, the phase that follows the headache. There could also be days even while you’re typically very fatigued and sometimes you have gastrointestinal symptoms. Most people have a lot of yawning. Maybe they pee more or increased appetite. It’s like your brain sensing there’s something wrong and now you need to eat as much as possible before the attack comes. A lot of people throw up. It’s much worse than a headache because you can’t ignore it. With a headache it’s like a pressure type of a pain and it’s your whole head typically and moving makes it better in migraine moving any kind of movement makes it worse.   pool sating sometimes stabbing quality is also fairly common. Does that summarize, I mean you could even, you could tell us, would you mind going, it feels like it’s fairly, it’s a fairly individual. This would be like more typical summary. 

 Duration wise, the diagnostic criteria says between 4 hours and 72 hours. So, between 4 hours and 3 days, which is quite correct. Typically, if I have a migraine that’s longer than three days, it swaps sides. So, I know, okay, next attack is starting. It’s not the same. 

You’ve got another one. 

Exactly. So, if that’s how you can tell and some people have an aura phase, you already touched upon this, about a third of migraineurs will have the phase of a visual or whatever, a sensory, defect. It will change. So, it’s only there for about an hour and then it will proceed, it could be a paralysis, it could be typically as visual, so visual disturbances, zag lines, blackout, whatever, these kinds of things. But it could be any sensory quality, losing speech as well. 

That’s fascinating to me because I used to have these incidents when I was younger, and they’ve always been a mystery always. And I may be had about half a dozen in total, but it was my late teens, early twenties. I thought it might be something to do with some type of epilepsy, you know, one of the really sort of low-grade forms of it. I just wasn’t sure. And the reason I didn’t investigate it was because I basically, I didn’t want to have my driving license taken away,  which someone told me if they start investigating thinking you might have epilepsy  that’s going to happen, but it never happened in any way like that. And I always had some kind of warning it was coming, but what happened was that I would kind of black out but stay conscious. Yeah. So, my vision would go completely. That’s a typical aura. My hearing would become muffled and the best thing I could do was just to sort of curl up in a fetal position. Terrifying. It happened once after a very stressful event where it was when I was at university in Liverpool and it happened just, actually on the phone to my mother and I think I terrified her because I said, I’ve got to go, I think I’m going to pass out. And I managed to get myself in the lift. I was on the 11th floor and then it happened. I couldn’t see, I could hear a little bit and luckily my, my roommate was either in the lift or was that, I think I managed to hit the right floor or was there when I got there and I said, you’re going to have to guide me to my room because I can’t see.

Yeah, it’s so scary. It’s so scary.

And it was very, very strange. It was, and I had no idea what that was, and I’ve never associated it with migraines at all.

So, the interesting bit is that all phases of the migraine attack can happen on their own. So, you can have an aura without the headache following. You can have the headache without the aura. You can have premonitory phases without the headache as well. So, people can have isolated auras, which is basically almost like a small epileptic attack. And depending on where this wave is traveling to. So, you have to imagine, right? We said that keeping your resting state with membrane potential upright takes 50% of the brain’s energy. Imagine there’s now a wave of electricity traveling over your cortex at the same time and you then have to rebalance all the minerals in your brain. That takes a lot of energy. I think it increases energy demand by like 200% or whatever and oxygen demand and everything. So it takes some time to basically get those neurons back into a state where they can fire again. If your neuron can’t fire, you can’t see, feel or hear anything. So basically, what probably has happened is that this wave was traveling across your visual cortex in the back because all your vision is basically centered in the back of the head. So that means if something troubles over there and basically enables all these neurons to do anything, that means it’s all vision is gone. That’s very interesting. The studies on the, I think, Second World War, First World War,  British soldier had these very weird helmets that would basically stop at the back of their head. So, you’d have a lot of, or quite a few soldiers coming back that has a wound or a shot into the back of their head and they would lose selective parts of vision depending on where the bullet has hit. So, if something would have hit all of your visual cortex in the back, then you just can’t see because the neurons, they are not working anymore. So, brain function, at least in some regards is localized in the brain.

Oh, how interesting. 

Would you probably have it as an is an aura, a prolonged or maybe even so then you can see it for patients, typically when they have it the first time it’s, it’s terrifying. They think they have a stroke. But the good thing is about an aura phase and that’s, where people shouldn’t be too terrified or worrying too much. That typically function comes back within the hour. So, it is more energy demanding. It does create more oxidative stress, which is probably why often aura phase of migraine headache starts because of all the oxidative stress, all the metabolic strain it puts in your head. Right. I mean, it now has to rebalance all these things after this electrical wave of activity. And that takes a lot of energy. It takes a lot of electrolytes. It takes a lot of oxygen and it takes a lot of things to get back on track, but it usually does. So your vision will come back and you’re feeling in your arm. Will come back and all these things, but it’s a fairly terrifying event. And that will be a prime example for an aura. Quite a bad one.

Yes. How interesting. And it’s, and it’s what I realized that it would pass fairly quickly. It was anything from, you know, 10, 20 minutes. I just knew that, yeah, if I just lay down, I mean, it’s the safest thing to do, isn’t it? Sit down, lie down somewhere.

It’s the best for you brain as well. You rest, you’re not spending energy on walking, for example. That would again, expand energy that your brain would need to restore itself. So, it’s kind of intuitively you do the right thing. How interesting. You’ve solved a mystery. Yeah, yeah. I mean there’s other things I’ve been wondering about and it’s like little puzzles that you can solve along the way. It’s kind of nice if you can explain your symptoms looking back. Because you always end up going to a medical doctor typically doesn’t help because I don’t have explanations as to why things happen. They only have a symptom treatment response. Typically for an aura, there’s some drugs you can take, but it reduces the aura frequency by like 20% or whatever. It’s really not worth it, but it’s good to know that when it happens rest, lie down, don’t do anything. Maybe have some magnesium’s and minerals, maybe if you can get something down.

It kind of makes sense that it happened at that period in my life. Maybe where, you know, a lot of things are changing with your body because it doesn’t seem to have carried on. That was something that happened within a period of a few years.

Yeah. So, your threshold would have been much lower because if you’re stressed, and that’s something that was very interesting to me because there’s psychological stress and there’s physical stress and we always think that these are different things. But actually, they’re fairly similar in terms that all of these stressors or stresses, irrespective whether it’s physical or mental, is basically causing oxidative stress. And oxidative stress is the common denominator of all migraine triggers, irrespective of how unrelated they seem to feel. So, fasting, skipping a meal of course causes hypoglycemia, stressful, oxidative stress, increases stress, mental, physical, aerobic exercise, any kind of exercise. And that’s why migraines typically have an intolerance to exercise, causes a lot of oxidative stress. And if oxidative stress exceeds your antioxidant capacity, so your body’s ability to buffer this oxidative stress, then it will do a lot of harm. So, if your exercise is triggering a migraine, it’s actually doing harm and you shouldn’t be exercising, or you shouldn’t be exercising at this intensity. 

Because what oxidative stress also does is it’s damaging your DNA, it’s damaging your protein, it sets you up for all sorts of potential chronic diseases long term. So, you really don’t want that. Then sleep changes, oxidative stress. Again, you can see that in nurses, in people that change their circadian rhythm, those come with more migraines and metabolic diseases or varying hormone changes. Female hormone changes during this cycle will increase oxidative stress also, and that’s where the pill comes in. I said that was a correlation between pill and a contraceptive pill, which is basically given out like candy to any teenager. I found publications that show that pill onset increases oxidative stress even in athletes by 50% but 50% more oxidative stress. So now if you have a migraine genetics in your underlying system, then taking the pill might be enough to set you off with migraines for life basically.

And talk a little bit about what you were saying about triggers being like a bucket because it really explains, doesn’t it, how some people get them a lot and some people get them rarely.

Yeah, so there’s a few more alcohol, sensory triggers. People have weather changes as a trigger even that makes sense. Because of atmospheric pressure. It decreases or increases the oxygen as in the air and you have alcohol and sensory triggers will also increase oxidative stress, especially blue light for example, is increasing oxidative stress not only in the eyes but also through the skin. So, we can see that all of these migraine triggers that we know are basically working on a similar pathway. Now if something targets a similar pathway, that basically means that you are adding up the stressors and you can think of a migraine threshold maybe as a bucket full of water. Some of us will have the bucket half full already when they’re born because they have migraine prone genetics. Then you’re getting the pill for example, right? So, your migraine bucket is becoming increasingly fuller. 

And then on this bucket you’re now adding, as a female adding this as a cycle in hormones. For example, estrogen is very antioxidant. So, one during the time of your period when it’s high, you’re less likely to have this water bucket overflowing because it’s kind of buffering. It’s a bit like the estrogen is letting out a little bit of the water and increasing your migraine threshold. So, this explains why some triggers like a glass of wine might be fine during some parts of the months. Whereas if you have other stresses at the same time so you haven’t slept well, all of these things you haven’t eaten, you’ve done exercise, you’ve had some alcohol depending on your genetics and your environment and how full your bucket already is. These individual triggers might then set off a migraine, have the bucket overflowing or not. Basically, a full bucket means migraine attack and all these trigger factors together will maybe cause a migraine attack at some point and not at the other point. 

But if you’re born with a bucket that is already full, you’ll have a migraine all the time. Or if you’re born with a, with a bucket that is half full, but then you’re on this worst diet or you have mitochondria dysfunction because of toxins or other things and that sets off that your bucket is full, then you also have a migraine all the time. So, it’s always an interplay between the genetic water load and your environmental water load, and when those two are added together, and environmental could be several different triggers, so many different things coming together. But if both of those come together and make the bucket full, then you have a migraine attack. From evolutionary perspective, it makes sense that some of us have these hyper excitable migraine genes because typically you’re already during attacks. You don’t have this habituation phenomenon, which basically means habituation is a way for the brain to conserve energy, which means that typically one of the rules is that your brain only encodes for change. 

So that means we’re not like a computer, we’re not firing all the time. Basically, a brain is only set up to fire when things change. So, if a normal healthy person looks at a checkerboard, let’s say, or a wide wall and it’s not changing, the brain will just stop firing. But in migraine brain will keep firing. It doesn’t have habituate, so it’s spending more energy, but it’s also basically alerted all the time. And you’ll see that in migraine patient typically is this perfectionist person and always kind of a little bit more sensitive to light noise and on all those things, even between attacks slightly. But if you think about a tribe of people, every seventh person has migraines in the world. There’s like a billion of us. If you think about a tribe being made of, Oh I don’t know, 20 people, you would have three migraine genetic people in there. 

And they would be the first ones to hear when a lion is coming at night because they have light sleep, they pick up very small sensory cues. So those would be the ones that might be saving the tribe from lion because wake up first. There must have been some kind of evolutionary advantage to having these migraine genetics around because if a population is affected, 15% of the population are affected by a certain genetic combination and genotype. There’s no way that didn’t have an evolutionary advantage at some point in time. So that just means that all the environment has changed so much that we’re now at a disadvantage with those genes. But otherwise it would not have stuck around that 15% of the population have this. So migraine really must have had some evolutionary advantage and that was probably maybe on the one hand, and that’s very speculative, but saving the tribe from things that require somebody to be alert all the time, even during sleep, more or less like being hyper-responsive. 

And on the other hand, it’s a preserve mechanism that shows you something’s wrong in your brain where an energy deficit, oxidative stress is too high. We now need to rest. And it’s very interesting how you can, and this is described in this nature and neurology paper that I sent you that was in my thesis. Basically, we cannot even mechanistically explain how we get from attack triggering to the resolution of the attack once. Why adaptive behavioral changes. We are forced to rest and do everything. So that homeostasis is basically conserved. And that is done by via molecule, one of them and neuropeptide that is causing pain called CGRP. And CGRP is basically what now Novartis and Eli Lilly and other pharma companies are blocking with their CGRP monoclonal antibodies, which is these injection-based treatments that have just come out recently. And they call it the migraine with [inaudible]. 

I think it’s an injection you get once per month. This is basically blocking the action of this molecule, but this molecule also seems to be part of mitigating the attack because it’s very antioxidant. Yeah. It’s basically the body sending out a pain signal and the solution in the same time. It’s stopping you from doing things, but at the same time it is kind of treating the initial problem. And another thing that is going on, like the third pillar of the whole migraine attack thing is the metabolic changes that happened during the attack. One of the things that can fairly reliably or was shown like 50 years ago, again to fairly reliably trigger a migraine attack in about 50% of cases is a giving a glucose tolerance test. You get 50 to a hundred grams of pure glucose to migraine patient and 50% of them will develop an attack in the coming hours, like 8 hours. 

It’s always delayed for the eight hours. And if you look at those that develop an attack and those that don’t and their metabolic responses, fatty acids, lipolysis and ketone bodies only go up in the ones that get a migraine attack and they’re eating normally they’re eating the same as the control group basically. If you want to trigger a migraine you give them sugar and then you see that there is a metabolic response. Basically, our body is trying to help us to save us there really because a, it’s changing your metabolism. It’s providing the brain with an alternative energy source because it is increasing glycolysis, increasing ketogenesis. It is sending out this molecule that is antioxidative and other molecules to seizure a piece, just one of them. But at the same time, this molecule also hurts because that’s the only way we would be stopped from running around and doing more damage for the brain. Expanding more energy.

Let it work. Yeah. 

That’s a long explanation. Sorry, I think I’m rambling on too long. 

No, no, it’s fascinating. And I remember what you cited in the migraines used to be referred to as hypoglycemic headaches. So that makes perfect sense. It’s that crash afterwards. 

Yes. About a hundred years ago. And then, you know, modern studies came along, pharma came along and then this was completely forgotten about for 50 years, almost a decade. And people have thought migraines might be a vascular problem and then it was neurogenetic and now it’s hyper excitable. And yeah, those things do play into the picture. But a hundred years ago this neurologist was treating his patients already with a low carb diet very successfully.

And it makes perfect sense then. And that’s the way I’ve always felt with this stacking system. With the bucket being full of the different triggers that by changing your diet you empty a load of water out of that bucket straight away. Yeah, exactly. Lower your threshold right down because there were all sorts of things that used to be reliable triggers for me for migraines. You know, things to do with the weather, surf, it was really hot or if a storm was coming, smell was one of the biggest things for me. If I walked past someone who was wearing some perfume or cigarette smoke. I could guarantee that I was going to get a migraine straight away. They do still happen, but nowhere near as often and so it makes total sense that by changing that big thing, changing my diet has dropped that threshold down.  It makes sense. What you were saying earlier about the problem when you’re  having the migraine is that lowering in ATP function and elsewhere, you talk about with ketone bodies that they’re capable of increasing relatively speaking to glucose that they can, you can produce more ATP. So, it makes sense. Yes. That by treating, if you like migraines with ketones, you’re getting that energy balanced back in place.

Yeah. You have a more effective energy source there. That’s true per oxygen molecule consumed. Basically, you also circumnavigate any problems or a lot of the problems with glucose metabolism and transport. So dude, one transport is might be deficient, which is the officially the transport system that gets glucose into the brain and, and insulin, insulin is also needed for, for glucose metabolism and ketone bodies are completely independent of these two issues. And then there’s more that comes with this dietary change, right? You also have less hypoglycemia. You have a more constant supply because you can use your fat stores now, which you were not able to use before. You might have more micronutrients in your diet as well. When you clean it up, you have less processed foods, less processed foods mean less oxidative stress again. So just getting ketones high is not the answer. 

We saw this very recently with a study on one of the first ones on cancer, brain cancer and ketone bodies. They were put on this very nasty Nestlé shake product, which is like the worst ingredients that you could ever give to anybody like rap seed oil and processed oils in there. But participants were in very high ketosis, like five millimoles and they would still die as quickly as a control group. There was no change at all from being in ketosis, which is why I stress so much. The quality of your ketogenic diet is key. It’s not just about having ketone bodies presence. You also need the antioxidants, the minerals, the vitamins. You need to make sure that you don’t add trans fats or any crappy fats, which would make matters maybe even worse. A high quality, real food ketogenic diets adapted to your micronutrient needs and to your antioxidant need. 

I think that’s the key. Also checking whether dairy is a problem for a lot of migraineurs. Dairy can be problematic, especially casein. Playing around with a non-dairy, more like paleo ketogenic diet can help.  But there’s a lot of things that this diet can set right. One of them is a mitochondrial functioning. Ketone bodies are antioxidative on their own, so the antioxidants and when you burn them you produce less oxidative stress, which again puts less metabolic strain on already damaged mitochondria. And you have the transport issue, you increase mitochondria biogenesis, so you have more powerhouses in the cell. Ketone bodies are able to reduce brain hyperexcitability via very many different, I think at least four mechanisms are now known. So that’s also another issue that is key for epilepsy and migraine is that you reduce or increase the inhibitory transmitters in the bright and reduces hyperexcitability, which again will empty your buckets of water is one of the ways. 

And, and its anti-inflammatory inflammation plays a role in almost any chronic disease. So again, that’s water out of the buckets. And the nice thing about this ketogenic diet approach or ketosis in general, maybe even in part exogenous ketones, we will have to find out. But is that it targets so many migraines rather than mechanisms, even the gut microbiome. There are about eight migraine mechanisms that we know are targeted or potentially targeted by ketosis. And migraine is a very multigenic disease as any chronic disease. So that means that many different pathways and things are probably involved in an individual migraine patient’s migraine, you cannot treat a chronic disease with a one target drug approach because there’s not one target in a chronic disease. And the beauty about ketosis and ketone bodies is that it targets all of these different mechanisms individually or together and migraine that might be completely different in one person to the migraine mechanisms in another person. 

Both of them might profit because some of their migraine causing mechanisms are effected by ketone buddies and the other person’s as well because they just have such a big variety of metabolic and signaling action signaling being like they change your gene expression or they change hyperexcitability so they’re the signaling and metabolite at the same time alternative energy substrate, but also changing all these other pathways in a favorable fashion. And I think this is why there could be such a potent migraine and even as a neurological disease strategy because they target so many of the known chronic disease or neurological disease pathways that are involved all with one molecule basically. It’s quite fascinating. 

Yes. I was going to ask you about inflammation because I’ve read the migraine is potentially an inflammatory disorder, but it would make sense if you’re causing this damage. 

But that’s again too simple, right? 

Yeah, exactly.

People say it’s a hyper-excitability problem. The, I would say it’s primarily inflammatory. The other people say, Oh, it’s vascular. The other people say, Oh, but it’s purely energetics. It’s too simple. And also, there’s probably migraine subtypes that we just can’t distinguish because the phenotype, so what we see is fairly similar, but this maybe there’s a thousand different migraines. Right. 

And are these also maybe secondary issues? Like what you were saying when we were talking about the triptans, and you just touched on it there, the migraines were thought of as a vascular disorder. Yeah. But your argument is that that’s just a secondary thing that happens because of it. 

See is, you know when you ask a migraine patient, they have this pulsating pain, right? So pulsating pain basically means that some kind of vascular receptors must be involved. Right. So, so when I had migraines 10 years ago, they told me, well, it’s basically that your arteries in your brain are dilating, they’re pressing against the skull and it hurts. 

But that’s the symptom rather than the cause. Yeah. In the dilation. Now they know that the dilation, it doesn’t correlate at all 

the dilation of the arteries and the pain onset is not, the timing doesn’t fit at all. There’s definitely not a vascular disease, definitely not. But the dilation could be the brain trying to get in more blood, more blood meaning more nutrients and more oxygen. Right. So, you have a delayed dilation in the brain. I could just be a secondary effect. As you say, it’s probably not causative, but also the triptans are targeting receptors on arteries. But also, that is a just one thing that we know they do, and they probably do other things as well. They could also inhibit a neuropeptide that is involved in pain for example, or work via completely misunderstood mechanism. We don’t fully understand why triptans are working at all. Really. 

So similarly, to what you were saying earlier, actually part of this pain response that you’re getting but packaged up with that is a potential treatment. So, it symptoms of the cause, but actually what’s happening in your body is helping treat that original cause, treating that migraine and actually by treating those symptoms, potentially you’re dampening the treatment that’s just happening naturally in your body. 

Not with a migraine and not with the triptans necessarily or the analgesic. I would definitely say don’t necessarily suffer through an attack and be like never going to take triptans or ibuprofen or aspirin., I don’t do that because it’s just unnecessary pain and suffering. So I still take those because I know that those don’t target the CGRP, but I think I would personally not do this injection based treatment of CGRP, monoclonal antibodies because I know CGRP, this neuropeptide is also expressed very highly in the gut and it’s not a selective treatment so you basically just block the action of one peptide in the body, which I think is kind of crazy. There’s not a lot of side effects yet, but if you do that for a long time, I’m really not sure what it does because we’re also inhibiting other bodily functions and we don’t really know so I’m going to wait and see, but I know that for some people it really is a life changer in the sense that their pain is gone. 

For others it doesn’t work at all. I think it really depends on what kind of neuropeptide cocktail is responsible for your personal migraine pain, but you need to remember you are blocking the pain and the same goes for triptans. You can see it as a center in the brain and the brainstem that basically lights up. When you get a migraine, you can see that that is still ongoing while you’re taking the triptans, which means the migraine is still there. Triptans do not abort the migraine. It’s just not true. The same as analgesics and this rebound, migraine is not a rebound migraine. When the triptans wear off, the attack is just there and it’s going to be there for that much longer. If you take the triptans and then you go to work and you do your whole stressful day and maybe even do exercise and you’re not resting at all, I will not do that either. You need to be aware that the pain might be gone, but the migraine is still there, so you need to take care of yourself during this attack. If you don’t want it to come back, he would still rest and do things a bit more slowly, in my opinion. So that would be my advice. 

Yes, that’s a good point. So, you’re taking something to get rid of the pain, but you should remember what you would have done where you not to take it, which is exactly that lie down in a dark room. Exactly. 

Don’t endure the pain if you don’t necessarily have to and you can tolerate those drugs quite well.  At least are under 10 days a month I would say. You really shouldn’t be taking them more often day wise let’s say. But yeah, don’t forget that you have the migraine in the first place. That’s a very good tip. Remember what it would be like or what you would be doing if you were still have this attack and it probably wouldn’t be running. You’re going to work, doing the laundry at the same time, picking up the kids and cooking and shopping and everything and like these hours of migraine, probably not. 

Yes. It’s actually still do what you would have done and talking about different ways that you can help. Maybe you could talk about some ofthe preventative treatments you’ve listed in your thesis. There weresome different vitamin supplements, all sorts of different things, including the ketogenic diet. 

Yeah. It’s quite interesting. There are some studies that show that antioxidants basically can help migraines, quite a lot as good as drugs actually. And it’s those could be CoQ10 300 milligrams, that could be riboflavin.  Riboflavin is vitamin B2 400 milligrams, so high dose, but also just a good complex, B vitamin and magnesium can help. Also, it’s responsible for 300 enzyme function and we tend to be too low. So, a good mineral supplement can help and there’s also alpha lipoic acid that has been shown to be my one protective, which is a strong antioxidant. There’s other antioxidants astaxanthin. There has not been a study, but it goes into the similar lines. So that’s something one could think about as well. If one wants to figure out the migraine. A best thing would be actually, I mean these things are just done an edit to the patients. 

I mean CoQ10 you could always do, but there might be other minerals or essential vitamins that are lacking. So I would always try and advise too, if you have the funds, do a blood test, minerals must be checked in full blood and vitamins, you can also check and see whether you might be lacking some of the things or even more. And then you can add a broad spend, high quality multivitamin or selectively take the things that you’re lacking could be zinc as well and that will improve your mitochondrial functioning and mitochondrial functioning is at the key for migraines. And you can add a ketogenic diet if your mitochondria are not working because you are lacking some vitamins or you’re completely toxic, for example. You can add ketones almost as much as you want. It won’t help much because also ketones need to have mitochondria that are producing your ATP. 

It’s like, okay, so in a car, right. It’s a bit like if you are calm and tolerant, if your glucose metabolism isn’t well, it’s like a Petro car and you’re feeding a diesel all the time, it won’t run well. Right. But if you are now giving diesel to a diesel car but the diesel car doesn’t have an engine, it’s still not going to run. So the engine is your mitochondria, you can swap the fuel, but if you don’t have an engine in your car, you can swap the fuel as much as you want. The right fuel won’t do anything. You need an engine that can make energy that can power your car. Right? So, the first step is to get your engine right and then you can change the fuel. So that’s what I was also referring to in this paper that you were talking about is get your mitochondria as best as you can. Antioxidants, whole food diets and supplement either if you have the funds selectively, if you don’t have the funds with a good broad spec multivitamin in a way that has everything that we need. 

And something like magnesium is, is a kind of thing that you can take without doing harm. It’s very obvious when you’ve taken too much, isn’t it? 

Exactly. And CoQ10 is the same. Ubiquinol is the preferred version. There are two versions of CoQ10 which might be worth mentioning. Ubiquinol is the reduced one. You’d ideally want that without maybe a hundred milligrams is enough. If you have Ubiquinol then you probably need to take 400 milligrams because it still has to be converted with the minerals and the or the vitamins more. Always try and take the active version and for example, there’s four different versions of B12 and cyanocobalamin is even toxic. So please also don’t go to the supermarket and take the cheapest multivitamin you find, it’s probably going to do much more harm than it does good because if you have non-active vitamins you liver  needs to detox them again, your liver is already busy with all other toxins and oxidative stress. So yeah, don’t save on that. It’s probably better to take nothing then take a bad supplement. And then there’s other things that you can do. So we talked about vitamins and minerals, we talked about getting antioxidants in your diet, which is basically colorful vegetables if you can. And it could also be in supplement form. 

This brings us quite neatly to a conversation we were having before where I touched upon earlier asking you what your keto diet looks like. We were talking about a few things clicked in in my mind again about what happened when I did my carnivore challenge and one of the things that increased a lot were migraines. I had other issues too with hot flushes and acid reflux and my mood was bad as well. But when I mentioned that to you earlier, your eyes lit up and you said yes it was something that was very common and the people doing a ketogenic diet if they suffer from migraines, need to be aware of and that’s where the importance of these micronutrients might come in. Perhaps you could talk a little bit about that cause you just touched on it there with the fruits and vegetables of different colors. 

Yeah, so basically, I figured out for myself that a very restrictive ketogenic diet that only basically has green and white vegetables wasn’t really cutting it and I mean carnivore would just be unthinkable. I think I did it for a week, it was horrible. There’s something called an ORAC index and that basically measures the antioxidant content in foods, the foods and even coffee has antioxidants. The darker or the more colorful a food is basically the more antioxidants it has. Like blueberries is super high, chocolate, coffee and then other colorful fruits and vegetables and basically if you think about, a migraine patient typically on a regular basis exceeding their antioxidant capacity. So oxidative stress is a good thing in moderation, but whenever oxidative stress exceeds your body’s capacity to fight it, it’s bad. And if you take out all the foods and fats and proteins, they don’t have a lot of antioxidants. 

This ORAC index is very, very low. So basically, that means that likely, even though they have some ketone bodies present and there is somewhat antioxidative, they will still be lacking potentially, or they will still do better with increasing antioxidant via their diet to help the mitochondria fight oxidative stress. I figured I’m doing much better having more food and vegetable colorful because I wasn’t even eating carrots or tomatoes or peppers that really can help getting more of those in it. For me it did. And for some patients also, so then you can either add exogenous ketones or MCT oils or, maybe it’s even enough to just be in ketosis some of the times. Some intermittent fasting might help. A lot of patients also struggled with the fasting because there’s something called glycogen resistance that has been found in migraine. It’s basically the opposite of insulin resistance. 

Glycogen resistance means that you will not turn on ketogenesis and gluconeogenesis as much because you’re resistant to glycogen, which is basically the hormone that tells your body when you’re fasting to produce more energy. And if you’re resistant to that, you get more resistant by fasting. You basically need to do the opposite than an insulin resistant person. You need to eat more to get this fixed. So that’s another interesting aspect in a migraine that is different to other metabolic diseases basically. But yes, so increasing antioxidants can be done with supplements, but also you can use the power foods that come with micronutrients that come with all these polyphenols and flower needs and these things that can be beneficial for migraines. Actually. And for mitochondrial functioning. 

So, you’ve worked your way to, you were saying before we started recording that your ketone levels are lower, but you feel a lot better. You’ve gone through a sort of stricter keto diet to now including, 

and I can still be in ketosis that said though it needed about, and that’s something we find in epilepsy too. It needs about two to five years in an epilepsy kid on a strict ketogenic diet. And then whatever gene expression changes and therapeutic effects they had during the ketogenetic diet is outlasting the duration of ketosis. So basically, if a kid has 80% reduction of seizures, that will be a point in time where they can stop a ketogenic diet completely. And these kids sadly go back to Western diets and it will still have 80% reduction and that might be something that’s happened to me as well. I was in higher ketosis for two and a half years and then was this point where I could go away and still have this reduction in migraine from like I had 20 days on average and I’m now down to maybe three a month. 

I’m not sure if that was the major driver, but even during this stricter ketosis, I would feel better generally. I also like energy-wise in to body ache and like, you know, burning muscles. The more carbs from, not from the grains, I’m not doing any of this or even legumes. I can only beans again and stuff, but I wouldn’t recommend that. But just from more colorful vegetables and having some fruits really helped me. And the only explanation for me is it’s not the carbs, but it’s the things that come with the carbs of fruit and vegetables that you cannot get with the meat. 

Very interesting. And what do you feel about treating when you do have a migraine treating it with exogenous ketones and that, just is a question actually about the trials that you’re doing, are they taking exogenous ketones sort of on a daily preventative basis or are they taking them as a treatment for a migraine? 

It’s prevention. You need to think about, you need to basically on a chronic basis, empty the bucket with the ketone bodies. It’s like it’s my migraine is a cascade of events, right? It could be and I don’t have much evidence and for me it’s hard. It’s work sometimes and sometimes not. If you catch a migraine super, super early and the pain cascade hasn’t started, maybe you can abort it with exogenous ketones. But really what you need to do is increase the threshold or lower the water in the bucket on a regular basis. So, we’re using them as a preventative, increasing the threshold, reducing the frequency. 

Your mimicking what other people are doing with a diet. 

Exactly. If you think about a migraine as a process, like a stone sitting on top of a mountain rolling from a mountain, once the stone gets rolling and it becomes full speed, it’s almost impossible to stop that stone. And it’s a bit like that in a migraine. Once the pain cascade has started, once these newer peptides that caused the pain in your brain have been released, you can take all the exogenous ketones you want. More energy is not going to stop the peptides from being around. Right. It might make the attack less long, less prolonged. It might make it less strong, but it’s probably not going to, it’s not a painkiller. It’s not going to stop the pain because pain basically is these peptides being around and the receptors being activated. So it will be very interesting to see and I would really love to do that trial with patients that are very experienced and can have this like feeling of when the migraine is coming, if they take enough ketones early enough in the whole process, whether it could abort an attack even. 

But we don’t have that data. I only have patients coming to me saying that it’s worked for them and that’s really interesting. Also like on this a ketogenic diet from the conference from Dominic D’Agostino. I had several patients that have seen a video before or read my poster and they’ve done that, and they say it works. But I don’t know if this is a regular occurring thing. I cannot reliably make it work. Sometimes it would, sometimes it wouldn’t, but I’m also now I’m doing so many things. I’m also on the road and I don’t have them with me all the time, so I think I’m taking it too late when it doesn’t work, when the pain is there already, it’s too late. It won’t do anything, 

But it’s kind of something that’s maybe worth a try. It’s just something that I’ve mentioned in my Facebook group. Yeah, and some people have tried and really found it helps. So for me anything like that. Are they taking the racemic or the D, do you know?  Just a racemic type one that you can buy on Amazon, that kind of type exogenous ketones. 

Yeah. Interesting. Interesting. Because the lower blood glucose, the racemic so it’s interesting. 

So yeah. Great. Yes, I mean it seems to me that if you can help with something like that as supplement rather than taking any kind of pain meds, it’s worth a try. Oh, certainly. That’s something that I want to try myself. 

Because yeah, all these pain medications, again, it puts quite a strain on your liver and your liver is already super busy in a migraine patient typically. Any medication has to be detoxed and we typically underestimate how quickly you can kill yourself with ibuprofen because it leads to liver failure. It’s like I don’t know what, you take six of them or eight of them at one go and you can kill yourself. It’s like, it won’t kill you if you take two, obviously, but that doesn’t mean that taking two on a regular basis is not going to somehow negatively impact your liver with time. Right. So if you can find a natural approach to that by all means and a ketones, if even if it’s, if it’s a D BHB, even better because as the endogenous version, the human identical one because then you only have things around that are human identical. So that won’t have any side effects because it’s something that is around anyway. They’re harder to get hold of. Right, they’re harder to get hold of still we’re working on it. I’m working on it because I wanted it for myself. So maybe one day hopefully. But yes, until then, I mean racemic if you don’t take it for like 10 years, there’s also safety data for the racemic is not going to kill you. Certainly not. All right. It’s if it helps by all means.

Perhaps you could round up with what you call the four-step approach to improving mitochondrial functioning and energy metabolism in migraines towards the end of your thesis. I read that the recommendations that you have for everybody who suffers from migraines. 

Oh yeah, certainly. We’ve kind of touched upon the first two, right? The first one we talked about is a individualized supplementation of the micronutrients. And this could also be hormones, so not only vitamins and minerals, but also some people have menstrual migraines which get really bad two days before their period, which is basically the time where your estrogen plummets and you don’t have this oxidative stress protection, your insulin sensitivity changes during that time. So sometimes people with menopause get really bad migraines and maybe they would profit from some human identical. Again, that’s the key. Don’t take synthetic hormones. They’re not the same ones that your body makes. It needs to be bioidentical; hormones can help. So basically, getting the base right, getting your engine working, getting your engines in the body, working, getting the base, giving the body everything, it needs, all the ingredients for good function first. And the second step will then be increasing antioxidant capacity. So that could be with food, with supplements and also would using oxidative stress and that could be toxins. Smoking, too much alcohol. Actually, it’s really interesting if you tolerate alcohol well, it’s basically the best test to see whether your liver is doing fine. If you have alcohol intolerance, that basically means your liver is struggling. It’s kind of nice to check in with yourself sometimes. Can you tolerate alcohol? If yes, your liver is probably doing okay. If not, you might have to increase your antioxidants. The third pillar is stabilizing blood glucose, and this is essential for migraine patients that often get a migraine in the middle of the night because blood sugar plummets. If you have easy carbs like in a glucose tolerance test, typically what comes after is a delayed insulin response that is exaggerated, which then needs to reactive hypoglycemia, which you want to avoid, so basically low GI diet would be essential, so get rid of any. 

Of course, that’s where that one of the biggest triggers is skipping a meal. Exactly. You can just see how eating ketogenically is really going to help so much with that pillar. 

That point doesn’t even have to be ketogenic, that could be low carb. Low carb can stabilize your blood glucose very well. 

Anything you can do just to stabilize it. Stopping several highs and lows. 

The fourth pillar, the final pillar is that if that doesn’t help, then providing your brain with an alternative energy substrate might be key and that’s the ketogenic diet. Potentially if you struggle and your liver isn’t making enough ketones, or you have to put more vegetables into feel better. This is why exogenous ketones could come into the picture and MCT oil if you tolerate it, but if that has not helped yet, then you really need this alternative energy. Then you run better on ketones than you do on carbs due to transport issues or whatever it might be. So that’s when you really should go strictly on a ketogenic diet or get other sources of ketones in if you can. So that would be the four-step approach that I summed up my thesis with. 

Something that just dawned on me  just going back to the beginning when you started talking about those different steps, if somebody has a regular, like with time of the month when they always get migraines, they can reliably know that they’re going to get migraines. Like you were saying that the couple of days before their period say, and that happens every month despite all the other things that they’ve done. Would that be a good example of when you were talking about taking exogenous ketones more as a preventative way or right at the top of that pain cascade getting in there before the pain starts, would it may be good for somebody like that to say take exogenous ketones for those few days when they get migraines every month certainly as a preventative measure.

 For example, before your period, for some people,  period is stressful, estrogen plummets if you have menstrual migraine, it might well be worth experimenting, adding exogenous ketones in two days before the period starts because they know they will get a migraine and seeing if that helps things. That’s exactly what you can do for like a targeted approach where you know, or when you’re extremely stressed, and you know you didn’t sleep well, and you know you’re bound to get a migraine. Maybe not wait for the first symptoms. Just take high dose exogenous ketones and see how you’re doing. 

 Because if you’re saying that for it to be effective, you need to get in there before the pain starts. Exactly. That just suddenly dawned on me. That might be a good way to do it. I would definitely recommend that. It’s been wonderful talking to you, and I could go on all day. Likewise, but I know you have to go. Perhaps you could round us up with a top tip. 

If there’s a numberone tip that I would recommend, and that’s something that I had to learn quite painfully because I was one of those perfectionist migraineurs who’s always listened to everybody else and I took all these, general advice on board, like, sport is good for everyone. Do sports, don’t do that. Don’t do that. Whatever the number one thing you can do and really learn is listen to your body. Your body will tell you what it means. Once you get rid of your addictions or whatever, the best thing you can do is listen to your body. Does this feel good? Does exercise feel good? Does it trigger a migraine? Does cheese feel good to me? Does whatever? Does a very strict ketogenic diet few good or does something else feel good to me? Don’t think because it works for somebody else it’s going to work for you. 

It was so individual, nothing even the color red is going to look different to every one of us. There’s nothing that is basically assured to be the same with you then to somebody else. So, the only person who knows you have to become your own doctor. You have to take care of yourself and your health yourself and listen to your body. It’s going to send the right cues if you listen to it. And the migraine is one of those cues. So, the migraine is telling you something and you need to change things in your environment until you figure out what is good for you. And this could even be getting rid of toxic relationships that chronically stress you and put water in your bucket. So, you really have to sort out through not only your diet, but also your supplements, your relationships, all of these things that stress you and that you might have not been aware of. All these things will make your bucket full in order to get water out of the migraine bucket. If there’s one advice is listen to your body while doing it.

 Perfect. 

Thank you so much. Yeah. 

 It’s been a great pleasure. 

Thank you, Daisy. Have a good day. 

And you 

Bye.

This transcript is brought to you thanks to the hard work of Liz Myers.

Welcome Maggie, to the Keto Woman podcast. How are you doing today?

Fine, thank you.

Now, we’ve known each other for a long time, and I have to say that when I started this podcast, I had you in mind to interview — because I think people will find your story and what you do really interesting. So, going away a little bit from the kind of people I usually interview in that you’re not keto, but you’re certainly extraordinary. It’s nice to be here, and be here with you, actually face to face in my living room, today, here in sunny France. So perhaps you could just tell the listeners a bit about you?

Oh, where to begin really? The job I’ve had for the last 18, 19 years was a total change of direction for me, because before that I’d been a teacher in a secondary modern school in North Yorkshire for 20 some years I suppose. Something like that. And I decided, although I loved the job – and I really did love the job teaching, it was great, lots of challenges – but I decided it was time to go. One year I was cycling through Europe on a summer holiday, and I just decided I wasn’t going to go back to teaching that September, and I’d already got my notice written out and I submitted it from Slovenia – actually Ljubljana – that was taken in by the office staff and I never went back, which was probably not such a nice way to leave. But that was just the way it was.  So I decided that’s what I’d do.
For a couple of years I was doing some supply teaching, and I was doing a few other bits and pieces, traveling, doing a lot of cycling, a lot of traveling across Europe, and had been to South America before that. 

And the Kosovo war happened, 1999 roughly. It broke out, I think it was 1999, and out of the blue I got a phone call from an organization based in Canterbury to ask — I don’t know how they got my name. I have no idea, I never ever found out.  But they asked me if I’d be prepared to drive a convoy vehicle to Kosovo with aid, because the war was, as everybody knows, it was a long time ago — It was very vicious in Kosovo. The Serbs and the Albanian Muslims were being attacked. The Serbs were actually doing a lot of the attacking, both sides were entrenched in warfare, and the people were suffering very badly.

Villages were being burned, and some terrible things as happened also in the Bosnian war before that, although I wasn’t involved with aid work in that particular confrontation. So I decided, okay, I would, I didn’t know quite what to expect. I didn’t know whether it would be or not dangerous. I just thought, why not? And I drove a vehicle out with a convoy to Kosovo. It was a very difficult time. The war was still just going on, although they were desperately trying to get some peace agreements going. Then of course the UK government decided to bomb Belgrade, which more or less ended the war. But where I was positioned up in the north in Mitrovica, there was still a lot of shelling going on. It was an interesting time, not having been in an area where they were shelling ever before, and rifles firing at night over the river into our areas.

We delivered the convoy, we delivered the stuff to the people who needed it, and people who lost everything, and then drove back to the UK. But I met somebody there who said, “Look, can you come back out? Because we have an organization working here in Mitrovica, which desperately needs volunteer help”. That was in the November of ’99, and in the January/ February of 2000, I went out again with a van that somebody had lent me, full of stuff, and drove up north to Mitrovica by myself, which was a bit tricky. I stayed in Mitrovica, and I met this organization up there who were reconstructing Albanian villages from the shelling and the burning, and was trying to give people back some shelter. Big job, very big job funded by the EU, and I joined them and then I was there for three months, and that was the start of my aid working life really — as a volunteer.  I’ve always been a volunteer.

Was it interesting? I can’t — knowing you, I can see why somebody would contact you in the first place, but how fascinating that — wow. I wonder where your name came from.

I don’t know where it came from. I think I’d been writing some…I can’t remember what it was. Definitely through some contact I had that I’d met doing something in that two-year period. Somebody had contacted this organization in Canterbury because they were involved with it and said, look, I bet I know somebody who will come out and you know, your shorter drives – I bet I know somebody will do it called Maggie. And I guess that’s how it happened. But that’s all I can imagine happened. So that was it – three months in the north of Kosovo as the war sort of died down and reconstructing and trying to help people and build houses and deliver shelter in the high mountain villages. So, that was the start of it. 

I carried on working there over the next couple of years. And then in 2003 the organization called Edinburgh Direct Aid, which is the one I now work for, they asked me whether I’d be prepared to front a project working in the West Bank. The situation in the West Bank was getting ever more difficult. The occupation by Israel — villages were being cut off from other villages. They started to build the new Israeli wall, and we were taking medical supplies to clinics that couldn’t access the main towns. So, I went out to liaise with the Israeli army, which was another very challenging job and prepare for that. And then the rest of the team came out. Again, another very challenging, very sad, very distressing, very anger inducing job. Because I went out thinking, well the Israelis, you know, they suffered a lot of suicide bombs.

This is during the period when the Palestinians and Hamas and everybody was, you know, there were suicide bombers going, quite frequently bombs going off in buses in Israel. And of course, that was appalling. But on the other hand, the West Bank Palestinians were being denied access to Jerusalem, to Bethlehem, to lots of places. And so I felt sorry for both sides – but for my first 24 hours in the West Bank trying to get in into the West Bank through the main checkpoint at Ramallah, and I saw how people were treated and I’m afraid, I realized where my loyalties began to lie from there because what I saw go on was very distressing for people.

It’s very difficult isn’t it? Because it’s the everyday normal people who are affected by it.

Yes, exactly.

Not the same people or people who are in power controlling it. Different groups of people isn’t it? That’s where it gets very difficult I think, working out sort of where your sympathies lie because it’s very emotive, isn’t it when you are dealing with ordinary people?

So, I mean you have ordinary Israelis being killed, of course, on buses. And I mean at that time, if we were driving, if I was driving in Jerusalem, I was always told to not drive behind a bus because the risk was very high at that time. Sometimes you couldn’t avoid it, but…

And how terrifying for people to live that that?

Yeah, absolutely. Very terrifying. But then you began to see what was going on, and why the Palestinians were reacting like that – it was out of just desperation. Then I got involved in… well, I pretended to be a journalist, but I was attending a lot of the peaceful rallies to try and stop the olive groves being destroyed for the wall. To stop the wall, preventing access to the farmer’s fields. You know, farmers, Palestinian farmers who’d been working their fields and their olive groves for hundreds and hundreds of years, and old farmers who would sit — I saw them sit down in the field and cry as bulldozers moved in.

Just sliced through them.

Army bulldozers just moving in and it’s very difficult to stay impartial when you see the suffering of people. I didn’t see any bus bombing, so I didn’t see the aftermath of a bus bombing, which of course would be horrendous.

And of course, that’s not the impact of the ordinary people in Palestine, is it?

No, it’s not.

And that’s not the farmer sitting down in his olive field doing that?

No, because if they been able to access their land as they’d always been able to and carry on with their – not to have these new settlements, which of course were settling into the West Bank, which was meant to be the land for the Palestinians. It’s a very complicated situation. But settlements were growing up everywhere. Israeli settlements, they were a group of very right-wing Israelis that would go up to some hill top on the West Bank and they’d start to build simple wooden shelters and they say “This is Israeli land now”. And the army would protect it. So, then they’d have a big fence around it and a big wall and that would cut off another road.

The Palestinians couldn’t drive on road certain roads to get to places. Gradually you saw all their freedom being eroded. Not only that, the checkpoints, the checkpoints became something like out of, oh I don’t know, out of the Second World War – big wire fences, loads of barbed wire – big watch towers and turnstile gates that you had to queue for hours to get through. I mean, I’ve seen elderly people faint at those checkpoints because they just were having to wait so long to just to get home, having been to try and visit somebody in hospital and so – so many freedoms going. So that was the project we were doing, and we were trying to provide medical stuff to these small outlying clinics that were cut off from even towns like Ramallah and Bethlehem and Jerusalem. So that was quite an interesting time but, upsetting. Very upsetting, I found that.

Yeah, it must take its toll on you personally.

Yes, it does. I mean the women were incredible. The women would go peacefully to the army lines, because the army would have their Land Rovers lined up ready to move in with the bulldozers behind them. And the women would go… because the trouble with the men going, you’ve got these young men who pick up and throw stones, and you can understand why they want to throw stones at the army Land Rover. A, it was pointless, and B of course, the army would just fire rubber bullets and lots of tear gas. I mean the number of times I got caught up in tear gas was, oh…and once you’ve had a bad tear gas attack, you never ever forget it. Horrible.

But the women would go, and the army were much more restrained. The women would go, and they would talk to the men, talk to the army. There were some members of the Israeli army who were very reasonable, they looked a bit sad that they were having to do what they were doing. They were following orders, and the women, sometimes women would turn them back. They were more successful in turning the bulldozers back. And I would join those protests with the women. But of course, as a Westerner, I still had to pretend I was a journalist. Otherwise, I would have been not allowed back into Israel. You can’t just, you know – that’s what’s happened to so many western protesters out there. They’ve not been allowed back in, and then you can’t do anything.

So, there was that. Yes, that long distressing period of work there and then lots, and lots, and lots of work over the next 10 years. Pakistan earthquake, tsunami in Sri Lanka.

You go wherever you are needed?

Yeah. Where we are asked to go. I mean we’re only so small, so we get very little funding so we can’t do a great deal except that when there’s a major disaster. The Pakistan earthquake in 2005 was the case in point. There is a huge Pakistan community in Edinburgh and in Glasgow where we are based, and when that earthquake struck – I mean killing 75,000 at a stroke, really more or less – our office was inundated with requests from wealthy Pakistani families saying, “Please can you go? We don’t know what’s happened to the family here. We don’t know what’s happening here. Please can you go, here’s money. We can put in as much money as you need.” And we got thousands and thousands of pounds in. So, I was sent out to see where the greatest need was and what we could best do with this money. I worked there from 2005 and of course it was terrible, the earthquake. I remember going into a mountain town called Balakot, and the stench of dead bodies – I’d never smelled anything like that. And the destruction, it would look like a nuclear bomb hit the place. And there were many towns like that. Living conditions were terrible. I was in a tent most of the time, and we were working up in the mountain villages where whole schools and whole villages had been wiped out. They had no shelter, they were sleeping out under winter, Pakistan winter.

It was very urgent. I went out and was transported from village to village by UN helicopter. I was dropped in with my tent and my gear and maybe another colleague and we would stay there for maybe a month working, and then the UN would supply us with what was needed, like stoves, winter stoves or whatever, and that went on. The projects developed. We put clinics in, we put so many things into the villages that had lost everything. They’d lost all their medical clinics.

That’s why I like having heard your stories over the years, you get called into that emergency relief situation.

It is emergency relief. Yeah.

But then you also work on some projects that are going to have a more long term, sustainable impact.

Yeah. What we never do at Edinburgh Direct Aid, we never just go in, try to deal with an emergency when we can’t deal with it – when we’re not big enough to deal with an emergency.

But we do emergency aid in the places where big agencies don’t get to. And they don’t get often to the sort of, the really little difficult places high up or wherever and that’s where we go. But then we tend to stay there and we tend to develop projects from that, like “Where most needs a medical clinic?” Because all the villages need…they’re very highly populated and they all need medical care. We would start thinking what we used to do though, one of the best things we did, we’d send in a big container of aid, a 40 foot, 10 ton, 12 ton container. We’d empty it, distribute the stuff, and then most people just send the containers back to the pool. But I suggested that maybe we could buy the container and we could convert it into a clinic because it’s a big space inside a container.

But the problem was getting that as a converted clinic, we could convert it – which we did, I did it with a fireman, a local fireman who came from Edinburgh and the two of us were out there two months converting this container – then we had to get it flown in to a mountain village at 10,000 feet. I went to the UN said, “Look, do you fancy this challenge? Because we’ve got it here and we can put it somewhere lower, but I know that this particular village, Koncan really needs it. I’ve been up there for several months in the tent and it’s desperate”. So they talked about it. The pilots of the helicopters, great big helicopters they were using, they said, ”Okay, yeah, we’ll do it” – the UN said we’ll do it, why not? 

We converted it on the field up in the northern part of Pakistan, unbeknownst to us, only about 300 meters from where Osama bin Laden was living and was later killed by the Americans.  But we didn’t know he was there, he was in a house next to the airfield. We converted it and then the day came when the UN were going to airlift it. It was a fine day, I was up in the mountains ready to receive it. Somebody else was down and waiting for the helicopter to attach the strops and carry it up over the mountains. Well, it’s a story in itself really. I don’t know whether you want me to tell you very briefly the story? They got it on the strops. They flew it on a pretty windy day up into the mountain at 10,000 feet. All the villagers were waiting to see it, about a thousand villagers, which we’d kept back up the hill. I was down with a special handpicked team of local villagers. We’d prepared the base, in came the helicopter. This thing was swaying and spinning in the air and the helicopter you could see was struggling bit to control anything.

And we were waiting for it and our job was to grab the strops as they came down to try and stabilize it. So we did, we ran onto this narrow terrace and grabbed the strops, brought it down – but the helicopter was spinning and you couldn’t control it. We had to drop it, and we had to release the strops to release the helicopter before it crashed, climbing up onto the top of the thing and crawling on our stomachs to release those strops off the top of the roof of the container. Unfortunately it dropped it with the door jammed against the side of the mountain. After the two months of converting it, we couldn’t even get in it and it was absolutely – well, I was at my lowest ebb at that point and sat down and had my head in my hands.

I just thought all that work, all that money – not that it costs so much. Suddenly I looked up the hillside and a thousand villagers were rushing down the hillside, like Zulu, and said, “Don’t worry Maggie, you relax, you stay there, we’ll move it”. And of course, over the next five hours they got levers, they got planks of wood and millimeter by millimeter they moved it back onto its base until we could open all the doors and everything was absolutely fine. That was a tremendous memory I have of just how badly the villagers wanted their clinic, and how much they were prepared to do and how hard they were prepared to work. And when I was at the point of giving up, really.

I think it’s also a good illustration of the relationships you develop, because as you mentioned before, you go into these places.

Yeah.

But then you stay a while and you develop these relationships and it has become, you know, a challenge that you want to achieve because you’ve made these relationships.

Exactly. You, it goes beyond that. You invest in the village, and you invest in the people, and they get to know you and you know them. You know what they need and what they want and yeah, like absolutely, you’re right. You build up a very close relationship with people – there are people I’m still in contact with in that village, because the clinic is functioning. It’s a vaccination center now, delivering babies. Later that year I delivered a baby myself up there when I was up there very late at night, I was needed – the midwife couldn’t cope on her own. She needed somebody there to help. There was no light. The light had failed – times like that you realize just how important that clinic was and still is. Yeah, it was good. And we did other things, water systems, new pipe systems for the villages.

And the conditions you’re often living in when you’re there, you’ve told stories of bedbugs and fleas.

The fleas. The fleas… one of my real worst things, I did everything to avoid the fleas, but it was impossible. They just were everywhere. And you know, you’d go into some of the houses to have some of their milky tea on a cold winter’s day and you’d sit on the – they were in their blankets. I mean, they’re immune to them. But of course, they loved me and I, every now and again I’d have to go down to Islamabad to deflea and wash my clothes, and try and get some ointment for the bites. Oh, terrible, terrible time.

It’s the kind of thing that could tip you over the edge, isn’t it?

Oh, easily.

Dealing with those levels of stress. It’s just the kind of thing that…

No, scratching yourself to death up there in a tent at night…oh, horrible. And you know, there was nothing to be done. I had flea powder everywhere, which is pretty toxic, actually. Stuff that you shouldn’t really have, but I didn’t care at the time. I’d have basked in it, I’d have swallowed it, I’d have done anything to get rid of them.
There were many, many interesting years in Pakistan, and other projects. And then flooding – we had flooding emergencies and I was up, I was back out for the flooding, and then I was back out to put another clinic in. One we built this time ourselves.

And landslides, caught in landslides, so many landslides and some very dotty times. Really, when I look back on it, it makes my spine shiver now. When I think what I got away with, really. I think I was very lucky. I mean, I have absolutely no religious, not a religious cell in my body. I think I was extremely lucky to get away with what I got away with. And other people didn’t, some of our villagers lost their lives going over the track, you know, up to the village where the clinic was. Their vehicle got swept over by landslides. But I was never in a vehicle that happened to. We always managed to just stop suddenly before the landslide hit and reverse…. things like that.

Well, I know you’ve been in places where you’ve been ducking down low to avoid the crossfire.

Yeah, well that happened in Kosovo, one time we had to dive in between a load of big lorries because they were shooting across and trying to sniper the at the soldiers.

Where was the place you ended up, I remember you telling me this story where you were ill on the plane, and you ended up on this great long trek sort of semi-conscious.

I was hijacked by some Kosovo Albanians who were smuggling – I think smuggling arms into Kosovo. I think they were part of the Kosovo Liberation Army. I was on the plane, and we’d landed. I’m very, very sick. If the plane is turbulent coming down and I was so ill, I couldn’t, I was virtually unconscious, and I got to the queue. They carried me. These four men carried me to the queue for the passports. Took my passport out my bag and I was carrying a lot of money – stuffed down my bra, stuffed down my knickers, everywhere I was carrying money. They took the passport, and they got me through immigration, and somebody was supposed to be meeting me outside, but I didn’t know who it was. Somebody from the organization, but these four chaps just threw me in a car. Well, they didn’t throw me in a car, they put me in a car. I was so ill…I was so ill, had all my bags and my money and everything and they took me through the UN border and because I am a westerner, I think I was probably very useful to them, because they kept saying this woman’s ill, we’ve got to get her.

I was vaguely aware of that, and in the middle of the night we drove through the night. I don’t know where we were going, and I ended up in some remote farmhouse somewhere in the middle of Kosovo. I don’t know where it was, and I was so ill, I didn’t care. I was put into bed with three children who were all asleep by this time. I don’t know what time of the morning it was, and I went to sleep. I just slept. And then I woke up in the morning and I, well, I woke up some time in that day and I felt a lot better. I thought, oh my God, where am I? Where’s all the money? Where’s my passport? Where’s my bag? Where is my luggage? Where’s everything? It must’ve gone. I sat up and I got out the bed, and at the bottom of the bed was every single possession I came in with.

They put there, all the money, my passport, everything. And then within the hour, they’d given me some breakfast and taken me up to Mitrovica where I was working. So, there you go. You see, it could’ve been so much worse. How did I know? And I didn’t care. I really didn’t care. I just wanted to die. So – one has to have faith in mankind, I guess.

Maybe that helped in a way, that you were so out of it.

Maybe. Well yes, otherwise I’d have wondered what the hell was going on, I think. I’d have thought, well, you know, they would have taken money. Because I do remember vaguely that night they were unloading stuff from the boot and we were stopped at an army checkpoint, and they were looking in with a torch. The army, this is UN troops peacekeeping. I know these chaps were taken out and were frisked and I don’t know how they got away with it. I wasn’t really conscious enough to know. Yes, that was another interesting experience — I’d forgotten about that.

You were in Greece for a time weren’t you? With the…

When the Syrian refugees were coming across in the rafts in there, hundreds a day, well, thousands in a day. Yes. I spent two weeks there. That was very distressing too.

I bet.

Very distressing. The height of the Syrian war, little kids, little babies. The rafts would break, the engine would break down, and you’d have to run into the waters. They were coming in and they couldn’t get in and you had to pull them in, and then you had to get them from some remote beach to some help center. And I hadn’t gone out to do that particular job. I’d gone out with some money to offer it to a Greek organization that we were working with. But I ended up, I had this little tiny hire car and I was driving this little hire car over beaches, and tracks, and mountain roads, stuffed full of wet, drowning, Syrian refugees. And I don’t know how many I managed to cram in my car each time. They were wet, they needed help. I was passing babies in through the window. Then I had about three in the front with me, this tiny car and I would drive them to a shelter and then I just go straight back down again for the next rafts coming in. Yeah, that was very distressing, actually.

So often we’re so disconnected from the reality, the real human reality of what’s going on. And it’s just the immigrants – this group of immigrants, refugees. And they just become…

This amorphous group with long clothes, half drowned.

Exactly. And this is something we don’t know and are labelled by certain journalists as cockroaches.

Yes, that’s right. “Why are they coming here?”

But for you, you must, and anyone who watches the news can’t fail to be hit emotionally by those pictures of little children. Eh. You know? But for you, it must have been so overwhelming to be there, in the thick of it.

Yes. I mean, the thing about that job, and I suppose the thing about my job is that you are so busy and you’re so focused, and you have to think of the next thing you’re going to do, that you don’t allow yourself time to think, “God, this is terrible. I can’t do this, this, oh, I have to get away from here. I can’t bear to see another half drowned baby coming ashore crying for its mother”. And there’s no mother because the mother’s in some other boat or we don’t know what’s happened to the mother. You can’t stop to think, you just have to act all the time. And I suppose that’s what I’ve always done, and I certainly did in that situation. And you’re right about the refugees because so many people who don’t experience them close at hand fleeing from some terrible – the shelling in Syria was, was just ongoing all the time.

And they are teachers, they’re doctors, they’re nurses, they’re it IT consultants, they’re engineers. The ones I was bringing ashore, they were skilled people. They were, not all of course, not all highly skilled people, but so many were skilled people. Of course what gave it also a bad reputation was there’s also a lot of Africans coming in from Afghanistan, Africans, Afro from Afghanistan actually I met, but they were Africans too. So they were mixed in with the Syrians. They know this became a bit of a problem because people were saying, well – when the Afghanistan – why are they coming in? They were fleeing the terrible, terrible war going on still in Afghanistan. I mean the Taliban were blowing people up, attacking everybody and you know, they were caught in the middle of it and they have no hope.

These people, these young people, Europe was their big dream. Well, I mean I don’t think it turned out to be so good for so many of them, but…

They’re often this tiny minority. I mean maybe there are few people who are doing it for some kind of choice or economical reasons, but I can’t think how…

Economic migrants, yeah. I mean there were a lot of those, but most of them were fleeing conflict.

Yeah. But you know, the tiny minority in it, but they were all made to be, this is the majority. They’re just coming. It’s their choice or you know, they’re terrorists or whatever.

Yeah, absolutely.

Actually the majority are just very normal people, desperate.

Desperate to try and get some sort of better life for their families. You know, it was, they’re the children that were the driving force for these parents and, and they, they couldn’t foresee any future for them and they could only foresee death or hopelessness.

Yeah. Cause you’re not going to put your kids through that.

You’re not going to take on that journey and pay all that money. The ones that really need — the smugglers were obviously scurrilous. I saw them when I was in Turkey, and they would do anything to get money out of the refugees. The Syrians, they had quite a lot of money. In Syria, the life had been quite good, at a certain level, and they had money and they were bringing their money, and of course nearly all of that went to these smuggling groups, as it still does. We see it now happening from Libya of course. But that was another very — I keep using the word distressing. There isn’t really another word to use because when you see people in those situations, whether they’re Palestinians in the West Bank having their olive groves torn down, or they’re Syrian refugees trying to get into Europe through the Greek route to Lesbos, or Pakistani people in Kashmir after the earthquake, sleeping out under the open with aftershocks all the time and screaming.

It’s all distressing, of course. Always distressing.

They’re just people.

They’re just people, absolutely. They’re just people like everybody else here.

And how do you acclimatize going from that, to coming back home?

Well, that’s always difficult. The coming home is always difficult. Very difficult, I find. I get used to it after a while, but I don’t find the first couple of weeks very easy. I always find I don’t relate to people, because people will come up and say – friends who come up and say, “Oh, you had a difficult time there. What was it like?” They are happy to talk for 15 minutes maybe and then say, “Well, he hasn’t got a job yet, this son of mine.” Or he hasn’t got this or I don’t know what to do about this – and you think…

Everything must pale in significance.

But it’s a bit unfair on everybody because what’s going on in their lives – it’s very important. So you have to try and understand that. I do try hard, sometimes it’s a bit difficult. I suppose I’ve got used to it now. 

Lebanon has been particularly difficult. The Lebanon-Syrian border where I’d been working since 2014 – that’s been our main focus. That’s difficult because it’s been very dangerous through 2015-16. Again, I think I was very lucky to get away with that. I was tagged a few times by the militants because I was a prime target for kidnapping. But never, gung-ho. People say, “Oh, it’s a bit gung-ho to be there when all the other organizations had dropped out of the border towns”. Because of the risk of the Islamic state were there and Al-Nuzra, they’d taken over the town. We did stay in and work, but I could only stay there for maximum, a week. I stayed 12 days once, and I think I was probably very lucky to get away with that. Several times I had to come out after two days. I was so protected by the Syrian team around me, they kept me safe. Without them, I don’t know what would’ve happened – but we got a lot of work done. Was it worth the risk? Well, yeah, I would say worth the risk – but other people would say, “You’re stupid. That would’ve been stupid if they got hold of you as a bargaining chip, that would have been bad”. And it would, of course.

We balanced the risk very carefully beforehand – very carefully. And so, it wasn’t gung-ho. It was a very considered managed risk. That risk is now more or less gone, it’s much safer there now, but now we have other pressures. This year has been with climate… well, who knows if it’s climate change, but the weather this winter has been horrendous. The worst ever weather they’ve had, so I’ve been out there three times for emergency weather related work, and then I’ve just come back from political pressure on the Syrians to be to be sent back to Syria, which would be a disaster for them. They’ve been destroying the shelters, the army have moved into destroy their homes – their shelter homes – and so we’ve had to try and help with that work.

I saw a post recently that you put up on Facebook, something about they had to reduce the height to be allowed.

That’s right, for new rules. Crazy. Crazy.

Is that basically just an excuse to get rid of them?

Yes, it is, It’s pressure on them to go. It’s only in our town they’ve done that, where at the moment there’s about 60,000 refugees. Over the last three years, the refugees have tried to weatherproof their shelters. So they built cheap cement walls around, or put cheap cement roof on because they’ve needed to. That doesn’t mean they want to stay in Lebanon – the last thing they want to do is stay in Lebanon – but the government decided that anything with cement was a permanent structure, and they do not want them there as a permanent presence. So, they made a stupid rule how everything had to come down to one meter in height. The army said “If you don’t do it, then we’re going to move in with bulldozers and you’ll lose everything”. How could the disabled, which there are many, how could the elderly start to demolish their cement homes?

You need lump hammers and you need pneumatic drills and, they have reinforced with steel rods. We got a team of Syrians together that we had trained already in construction. We do a lot of training in construction, ready for their return, and they’ve got all the skills. We put a team of 15 together with our manager, Nabeel, and they went to the worst camps. The UN asked us to go to the camps for the disabled and the children’s camps and the widow’s camps and do managed demolition – which is knocking it down without destroying their water systems and their sewage and their possessions. So that’s what we were doing, then rebuilding with cheap, nasty UN supplied plastic sheeting and wood. So, come this next winter when the snow comes heavy, those shelters will collapse.

That would be very frustrating.

Very frustrating, yeah. We knew we were building shelters that would not withstand the next winter, or the next storm, really. The weather is changing there, the climate is changing. So, they won’t be very warm, whereas the cement shelters were much warmer. So we don’t know what will happen there, but at least we, you know, and that was fair. That was so distressing – elderly people would come to me and say, “We’d rather die. We’d rather die than have this happen to us, have our home destroyed. We might as well die. We can’t go back to Syria, they don’t want us here.” And it’s true – what do they do? And the disabled who didn’t understand, a lot of the mentally disabled, did not understand what was happening, they suddenly saw their home had gone. That’s still ongoing, the team is still working on that, still reconstructing. So yes, it’s, it’s been a very busy year this year.

Tell us a little bit and just briefly, about how Edinburgh Direct Aid works. I know you’ve explained to me before, it’s a very different structure from a lot of the bigger charities.

It’s entirely voluntary. We have a warehouse team in Edinburgh that works very hard filling the 40 foot containers, we send out two or three containers a year with clothing, with sewing machines, with looms, with material, with wool, with many things for women’s workshops and for clothing, for the children’s sports, clothing, toys, many things, basic medical supplies, although we’re not allowed to take in much medical. They’re all volunteers – the whole team is volunteers. We have a Treasurer, and we have two Fundraisers, and we have the Chairman who is 91 years old and still running 10 kilometers to raise funding for us – and it’s just run as a big family. I’m their main field person that goes out. Sometimes other people do go out, but I’m obviously the chief sort of Field Officer. So that’s how it’s run – just purely on a volunteer basis.

But what that means on a practical level, is that people who donate – all that money gets used. 

It does, yeah.

Rather than with one of the bigger charities…

Yeah, that’s right.

…where a big chunk of that presumably…

Yeah

I’ve no idea what kind of percentage, goes on wages and all sorts of things.

No, there’s a few stories about that, but I won’t go into that. I don’t know what our percentage that goes straight to the beneficiaries is. It’s very high, because also we try – I can’t always fund my own expenses for travel because I’m out there so often, I can’t. But I do when I can, because I don’t have much of an income really. Others that go out, – we have a retired doctor, and Dennis himself, who’s a retired mathematician, and some others who do occasionally go out, everything is funded by them. Nothing comes out of the funding – it’s all personal expenses that they pay themselves. That is very different to how most organizations would work. And of course, there’s no salaries or anything. We don’t get paid anything, it costs me some money during the year to go out, but I do get some of that back because I can’t simply afford to keep doing it. Some four, five times I’ve been out this year. So you’ve got flights to Beruit, and yeah, that’s how it works.

So it’s a small charity, but actively speaking has a big impact.

Big punch – I’d say we have a fairly big punch for such a small charity, and somehow the money just keeps coming in. It’s endless fundraising events that are very hard work. I don’t do the fundraising – I do talks, but I’m not big on the fundraising side, and I think that’s just as hard a job as what I have to do when I go out to the Syrian border. Fundraising is a nightmare, and we just rely on regular donors – some businesses, sometimes the Scottish government gives us some money. We have a very good reputation, I think that’s how we keep the money coming in. So – long may that continue!

Well, thank you for sharing some of your stories. Like I say, I’ve wanted to share them for a long time. When I heard you were here, I grabbed the opportunity.

It’s always a good opportunity for having my little relaxing holiday here now. Yeah, absolutely. It’s nice to tell the story of what we do.

And so what might be a top tip that you could share with our listeners? It can be anything you like.

Well, I suppose in the end, it would be what I’ve always said – even when I wasn’t aid working, when I was on my year long trip around South America and getting into all sorts of scrapes and difficulties, and Tiananmen Square and the massacre and I got caught in so many things…. It would be that no matter how bad things are, somebody somewhere will come along and help you out. Always, somebody will be there to help you out. You’ve just got to have faith that that will happen. Just when you think there is nothing that’s gonna get any better, and you don’t know what to do, and you’re really stuck, somebody comes along. There’s always a solution from another person or people. I would say that that’s probably my top tip – always think something will come along. And it does.

And you did mention earlier that you have this underlying faith in humanity that probably, may be what helps you get through some of those sticky situations.

Yeah, I think so. Absolutely. Even talking to a member of the Islamic state once by chance, I didn’t know he was – he was a very fluent English speaker, protecting his family, was going back to Syria to die. We had a really interesting, nice conversation. Not that I’m supporting in any way the Islamic state did, because they are really terrible. Maybe he was just a slightly different version of that, you see? So yeah, faith in humanity always – I think we have to have that. Definitely.

Well, thank you very much Maggie, it’s been a great pleasure.

Thank you.

This transcript is brought to you thanks to the hard work of Christine Specht.

Welcome to the Keto Woman podcast live from KetoFest! 

[Cheers and applause]

You can hear that in the background, the lovely audience who have made the trek up the hill in this incredible heat and humidity. So, thank you so much for making the effort, and welcome Karen Ogilvie to the Keto Woman podcast. I have been trying to get you on the podcast for ages.

Yes. Delighted to be here.

So, thank you, thank you for joining me here today. 

Thank you for having me. Yes, it’s been a long time coming. I think we’ve been trying to do this for two years now. 

Absolutely. So, tell us a bit about you. 

I’m a mum and a registered holistic nutritionist, working out of Ottawa, Canada. I’ve been working as, specifically, a low, very low carb registered holistic nutritionist for a year. Before that, I was working as a volunteer coaching people online, on how to reverse their diabetes and claim better health through a low carb lifestyle. At home, I have one little son, he’s 11 years old. And through him, I became interested in nutrition and that’s what brought me to keto. When he was three years old, he was diagnosed with autism and I was keen on helping him reduce some of his symptoms by following the recommended diet, which was gluten and casein free. Through that, I became more interested in exactly how nutrition affects our mental health and our general wellbeing. That’s what eventually brought me to keto, after my own diabetes and a-fib diagnosis. 

So how’s it been working for him? What kind of changes have you seen and over what kind of time period?

With him, I didn’t find too much of a difference following specifically the diet that was recommended by his doctor, the gluten and casein free. What I did find was that when I eliminated sugar and grains, he had good results, and when I increased his fats, specifically his fats through animal fats such as high DHA omega three fatty acids, he had more impulse control and he had better focus.

Tell us a bit about how that works. I know it can really, with autism you need to try and keep things as stable and in routine as much as possible, is that right? I can imagine that swing in blood sugars being the exact opposite of what you need. 

Everyone that has these ADHD behaviors will find a benefit from stabilizing their blood glucose, so that they don’t have the rise and the crash. With Freddie, I wasn’t specifically trying to help him with autism. He is proudly autistic, but some of his issues were stemming from the ADHD symptoms that he would have, so lack of focus and impulsivity. So by keeping his blood sugar stable, by removing refined sugar, and then helping him foster a better mood and better concentration by incorporating fish, fish oil, he found great improvement for those particular symptoms. 

What kind of issues do you find that he faces, you face, as a family? I’ve seen some of your posts online and you just have to deal with different stereotypes and all sorts of things flying around about autism. Tell us a little bit more about that cause it sounds like it can be difficult sometimes. I see you getting heated. 

It can be difficult sometimes. As I said, he’s proudly autistic and I catch him online sometimes. People don’t know that he’s 11 years old. I catch him trolling anti-vaccine people on YouTube. 

He likes to educate them, doesn’t he? 

He likes to educate them. He takes great offense to the idea that he somehow is disabled or injured because he’s proudly unique. He’s keen on that. He’s also very proud of his interests. He’s a math savant; he’s very interested in science. As I went back to school to learn about nutrition, he became very interested in learning, particularly about sugar. He’s a big fan of Gary Taubes. He likes to talk to people about the sugar in kids’ foods, fruit juices and fruit snacks and that sort of thing. He did a little demonstration for the kids at his school where he had all the different drinks that they would have in their lunch, like Gatorade or fruit juices, and then he would have the bags of the equivalent amount of teaspoons of sugar next to it.

That’s a good visual, isn’t it? You can see straight away just how much sugar you’re piling into your system. 

Exactly. From something that would seem as innocuous as a fruit juice. 

It’s supposed to be healthy. 

Is it supposed to be healthy? 

So, you got into keto as a byproduct of doing it for him. Just supporting him as a family, presumably. 

Yes, doing it for him, I became interested in nutrition. So when I was called into my doctor’s office and was told that I was this far off of the full blown diabetes diagnosis, I had an A1C of 6.2 and a heart condition called atrial fibrillation. I wanted an alternative to what she was suggesting, which was just restrict calories and get a gastric bypass. So I wanted to explore doing a restricted carbohydrate diet. I had done that in the past, and I had good success but kind of strayed, because I’d be told that’s not healthy longterm, it’s not sustainable. So, I decided to give it one last effort before agreeing to having a very invasive surgical procedure. I’m still down 80 pounds and the doctor is very happy with the results, particularly for my A1C. Now I’m nowhere near being diabetic with an A1C of 5.0.

Good for you. Along the way, you discovered passion for this. You want to help other people, made it formal. Tell us a bit more about that.

When I decided that I wanted to try being low carb again, when I was considering surgery, between the time when I had done Atkins in the 90s and now, all these Facebook groups popped up. So, I decided I was going to find Atkins groups. But, I was surprised when I went searching on Facebook, that there were very few Atkins groups, but I kept on seeing all these groups that were called keto or ketogenic. Doing Atkins in the 90s, I knew what ketosis was, so I’m like Oh, I’ll just join one of these. So, I joined a small group of people that seemed to be really keen on learning the science behind the nutrition of low carb. Before I knew it, I had agreed to help run the group. It grew; I think there was 3000 when I took it over and now there is over 110,000 in the one group and I think about 115,000 in the other.

Just a few, then. 

So just a few. 

What are they called?

We have two main groups, one is Keto Science Alliance, that we have general discussion and nutritional science. Then, we have another one that’s specific for food and recipe discussion, that we call Nondenominational Keto, so all forms of very low carb are welcome there. We have people that eat very clean, more of a paleo style, very low carb. And then we have the people that are “if it fits in your macros” and carnivores, and vegetarians, even have a couple of vegans but they’re all pursuing better health through a ketogenic diet. 

Keeping that focus in mind, not getting too judgmental about exactly how people do it, as long as they’re achieving the results they’re looking for.

That’s right. I know I have my own particular way of being keto. I prefer the paleo style where I restrict dairy and stick to whole foods, meat and vegetables mainly. 

So tell us a bit about your keto. What does your everyday keto look like?

My everyday keto, I have sort of the Monday to Friday keto. I believe in the 80/20. So 80% of keto for me is lots of olive oil and avocado oil, healthy fats and saturated fats from meat and leafy green vegetables. On the weekends, I put on my mom hat and do baking for my son to have his crackers and cookies and muffins and that sort of thing. So we’ll have little keto-fied treats. That’s been a lot of fun learning how to do some baking, with all these new products that weren’t around when I was doing Atkins. 

You aren’t a natural born baker, are you?

Not really, no. I’m just a cook at home or for my, for my son. But, the Keto baking’s been… 

Does he enjoy it? Does he help you out? 

He’s my food critic; he’s not really my assistant chef. So he’ll be brutally honest if a recipe is good or not good. He’s very particular because he’s sensitive. He’s very particular to certain sweeteners. So, he’ll tell me what he thinks. 

And you are now a qualified nutritionist, is that your label? What’s your preferred label? I know there are different labels that go around. 

I’m called a registered holistic nutritionist. So after running these Facebook groups for a couple of years, I decided that this is what I would like to do professionally. I went back to school, just as a general nutritionist course. I had the choice, I looked into going into university to becoming a dietician, but the problem with that is that I would become part of the college of dietitians in Ontario. They are still very much beholden to the food guide, which is very similar to the US food pyramid, healthy plates that you have in other countries. I couldn’t in good conscience do that because my preferred clientele would be somebody that is trying to control their diabetes through diet.

If you go down that route, you’re stuck, aren’t you? You have to recommend their guidelines. 

You’re very stuck. You’re generally working in a hospital or under a doctor. I did have some dieticians in the course with me; they expressed a great deal of frustration that all they were doing with their degree was handing out Xerox copies of the same old diet of heart healthy grains and fruits and that wasn’t ideal for most of their patients. So, I decided to take the hippy-dippy course that’s a registered holistic nutritionist. We deal with nutrition mainly, but mind, body and spirit as well. So there’s lifestyle coaching with that. 

You can color outside the lines. It doesn’t surprise me that you took that route; much more fitting for your character, I think. 

Yeah, I think so. I think so. Yeah, and I did enjoy it. It was really interesting taking this course because it was general nutrition and being a holistic nutritionist, they believe very strongly in biochemical individuality so that what works for me isn’t necessarily going to work for you and you address your client as a whole person. I’m not addressing just a symptom like you would in a hospital setting as a dietitian. 

I love that approach, and presumably you’re looking at everything else that might be affecting whatever issue it is they have, sleep, stress.

Oh, everything. Their relationships, their sleep, their career. Yeah. All those things to try to help them live their best life and have their best health. 

People tend to underestimate that. They often just, especially I guess if they’re looking at weight issues, always this blinkered vision really with just thinking about food. It’s got to be the food that’s the issue, without necessarily thinking so much about all the other things that have such impact.

It’s true! We hear it all the time. You know when you go to the doctors that if anyone who has a weight issue, they talk about it’s gluttony and sloth, right? Clearly you’re eating too much and moving too little, and I’ve found working with thousands of people over the last few years that it rarely has anything to do with either of those things. 

They’re far from that. Yeah. We just get a bit sick of being told the way out.

Sometimes, yeah. 

I would love to open this up to you lot out there. Maybe you’ve got some questions for Karen. Come up to the mic and ask away, please.

They’re shy, it’s early. 

Don’t make us put on our pretend voices. We did have this as a plan; it was an option. We figured first one of the day, searing heat, there might not be anybody there at all and we might have to put on pretend voices. Here we go. So, just tell us who you are and fire away. 

I’m Jackie and I would like to know how you handle plateaus in weight loss, for a woman.

Well, it depends on how long the plateau is. In our group, we think plateaus are normal and healthy. People reach a certain level of homeostasis, and that is something that they can either choose to break through and if they choose that, they’re no longer happy at that particular weight. Then we start looking at things like their food journals, particularly with meal timing. I find that a lot of people that are having a plateau, it’s not so much what they’re eating, it’s how they’re eating and when they’re eating. So we try to switch up fasting schedules. For me, I find with women in particular, especially mothers, sleep is usually what’s missing. So what’s happening is that they are very fatigued and they’re trying to get their me time after the kids go to bed and they should be going to bed too. So, this is when night eating is happening. So I find that if we can get good sleep hygiene with these women that a lot of the issues that are coming with night eating, snacking, eating out of the window and also hormonal balance resolves itself.

Right

Yeah. 

Thank you. Here comes my favorite.

Hi, I’m Becky.

You’re Becky! 

This was a perfect question; I had similar question with stalls. I’ve lost quite a bit of weight and certainly have a way to go, but there’s times that I’m pretty happy just having really good bloodwork, but you hear people talking about when we get this obese that our fat cells are dysfunctional or unhealthy. Is that unhealthy for us to continue to carry that weight or is there any research behind that?

There is research coming out of a lot of Nordic countries right now that actually as you age, maintaining the slightly overweight BMI and slightly overweight body fat percentage is actually healthier for longevity, that it is protective against disease. My only concern, if somebody is going to be maintaining a great deal of weight as we age is injury. It’s not a matter of that those health cells being damaging, they’re not disease causing, but it is good to maintain balance and flexibility. So ,with somebody like that, I would definitely be looking into, I’m finding some sort of physical activity to keep that person moving, to keep the joints healthy. But no, I really don’t see somebody maintaining a certain amount of body fat and as he gets older that being a bad thing.

Thanks Becky.

Hi, I’m Marie. I have a question about hormonal changes. So as we, we age and we go through the menopause, is there things that we can be incorporating into our diet that can help us without artificial supplementation, if you will?

For just some people that they have black Cohosh, they’ll take certain herbal supplements. I don’t really specialize in, in the herbals thats an extra area of nutrition that I haven’t really gotten into yet. But, there are some nutritionists who, who do that, that specialize in natural alternatives to maintain hormonal balance. I also work with a nurse practitioner, and she specializes in bioidentical hormonal replacement therapy. And I know, Jennifer Kleiman, who is my podcast partner, has worked with her and has had fantastic results supplementing for her hormonal health.

Thanks. Are there any just general foods that are preferred for it?

General foods? Well, I’m usually, I’ll try to get them to limit the, the phytoestrogen, things like flax and soy if you’re going through that particular change because some people find those aggravating when they’re, when they’re going through these hormonal fluctuations. Honestly, just having a very low carb diet and staying away from foods that can have soy and soybean oil added really does help keep energy levels stable and make those changes seem more bearable. 

Thank you

Hi, my name is Madge. As people see your success in what you’re eating, they always want to know what you’re eating and I try to tell them, well, this is what I eat.

But, it might not be the best for you. So I wondered, as a holistic nutritionist, how do you decide how to start them off? Do you just go with the basic, keep it low carb or do you listen to them and say, well, maybe you want to try this or…?

If they’re just learning, then one thing that I really like is Dr. Westman’s “Page Four”. It’s very simple. I don’t know if you’ve ever seen that, but you can, you can download it online. Dr. Eric Westman’s page four. So it keeps it very simple. It’s just meat, fat, vegetables. As a holistic nutritionist, because I’m treating the person as an individual, I go through a whole interview process where I, first of all, I had to figure out what they don’t like, you know, and a menu is not going to be very useful to something if I’ve got it full of tomatoes or something and they can’t eat it. And so, you know, we go through this whole interview process. I figure out what their primary health concerns are, their likes, their dislikes, their habits and we work from there and I give them a sample menu of, of things that I think that they would enjoy. After a couple of weeks, they’ll come back to me and we’ll discuss. It’s an ongoing conversation, discuss with them, what they did, like what they would like to try and how it was making them feel. 

That’s great because so, so many of them are like, well, can I have that and I can’t have that. And I was like, no, I can’t have that.

Yes. Yeah. Well, every, everyone’s different. I mean, my husband is very much, just a low carb if it fits in your macros person. But if I eat some of his grain based, low carb wraps, I feel terrible. 

Right.

So there’s no point in eating something that you don’t love, that you don’t enjoy, because the ketogenic diet is delicious. And there’s no point in eating something that’s going to make you feel sick. So, yeah. 

Great. Thanks.

Anyone else? Come on. 

Hello, I’m Lynne. Are there any patients that come your way that they have an like, alternate medical condition that you’re like, alright, I can’t touch you. Right. Or like if they have like severe heart history or whatever that might be, what are some key things that you go, okay, you need to really go to a higher level.

If I have somebody that’s coming to me with, with a health concern and sometimes they don’t even know that they have a particular problem, but that is part of my job is to get them the proper referral to somebody who specializes in their particular health concern. So, oftentimes I’ll refer them to a doctor or a nurse practitioner or a counselor. Oftentimes, they’re coming to me and they, it becomes apparent that they may have some kind of disordered eating, or some kind of serious psychological issue like depression, or suicidal thoughts. So then it’s my responsibility to get them to the proper services that are out of my scope. So, I do prefer to work with somebody who has a doctor that’s willing to explore in my area of expertise, which is the low carb diets, and I work within the parameters that that doctor or nurse has set up. 

Thank you.

Thanks Lynn. 

Has that ever caused issues? Have you locked heads, as it were, with a client who’s come to you and they’re like, oh, I talked to my doctor and they said I couldn’t do what you’d been recommending. Have you had struggles like that? 

Yeah, I mean, there are, there are some doctors that are still very much locked in. You know, the, the diet that we’ve been following since the 70s, 80s and 90s. Or, doctors that want their patients to go low-fat vegan. And I simply tell the person, well, you can get a second opinion from a different medical professional. I’ll never say that a doctor is wrong. Or, if somebody is very keen on following nutritional advice that is completely out of my area of expertise, like if they wanted to become a vegan, I would refer them out to a different nutritionist. It’s not my area of interest and it wouldn’t be worth their time or mine because this is the area that I’ve done all my research in.

That’s the kind of thing you need a specialist for, don’t you, because you really have to work hard to get everything you need. It’s possible, but it’s a challenge. 

Yeah, it’s true that some people that I’ve worked with that you have to tailor their, their diet because they have serious health concerns. Like, they’ve had gastric bypass and what I would do for somebody that wanted to control their diabetes through diet would be to have them fast and then feast. But, I can’t do that with somebody that has a stomach the size of a hard boiled egg. So, I adjust things and work with the medical professional that they’ve been seeing, if possible. 

Hi, I am Jeff Halverson, I’m with the Greater Boston Keto. So I guess my question, is how you decided where you wanted to get your credentials because I’m thinking of doing something similar, thanks.

With the school that I picked, I had choices, as I said. I looked into the university program to get a degree as a dietician, and it just, it wouldn’t have worked for what I wanted to do. I already been volunteering for a couple of years, coaching people in a very low carb diet. I had some options; it’s important to do your research. There are a lot of online courses right now that I see people getting credentials for, they call them credentials. There was one that I saw that a friend, a friend took and Amy paid good money into this, but the certification, when I looked into it myself, was pretty much meaningless. So, you really want to look into your state, your province, what sort of credentials you would need to have an alumni association, that’s important, and to be insured. So, there were a couple of schools in my city, in Ottawa, and I wanted to actually be physically in a classroom, that was important for the way that I learn. And I picked one because, actually the lady that owned that particular branch of the school, I had gone to high school with, so I did. I had the choice of one or two, and I went with the one that I knew and that had been established. So, I picked the Canadian School of Natural Nutrition. They’ve been well established. They have a really good alumni association. So, why that’s important is that if I have a client who has a complaint about me, she could go to my alumni association. There’s a reporting body; we’re self-regulated in Ontario. So it’s important to have that reporting body for your client’s safety. And, it’s also important to have insurance. If you’re not part of one of these alumni associations, it’s very hard to protect yourself, with liability insurance. 

Hi, I’m Scott, thank you so much. With these Facebook groups of over a hundred thousand members, first of all, that’s incredible. Congratulations. One thing I observe, is they exist for all different types of diets: the snake diet, high carb diet, the baby food diet, whatever, you name it. There’s always hundreds or a few thousand of members who are posting a lot, posting before and afters, clearly having success. Then there’s probably a ton of lurkers, you know, 60,000 people call it, who are just observing and learning. And then there’s the invisible graveyard of people who are not successful, who maybe have tried it and failed and stay in the group. So I’m curious how you kind of think about adherence, managing adherence with such a large group of people, making it easier to adhere. Or, if you just think about that as kind of not your responsibility, more sharing information and helping people who want to adhere.

We talk a lot in our admin group about protecting the novice experience. Once again, we keep it nondenominational keto; nobody is wrong, we’ll explain why, perhaps, something wouldn’t be a good idea for them. I’ve discussed it with my team quite a bit that when somebody starts a new diet, particularly when that’s as much of a drastic change from going from the SAD, Standard American Diet, to keto, you’ve got them for about three months on average, that that is the statistic. People will try a new diet, and within 12 weeks, they are gone. So, our idea is to protect that novice experience, that they have very positive results and also we make it so that they realize that this is an easier way to eat and that it is a healthful way to eat. So, when they do quit within 12 weeks, they will come back. So we do have a lot, I do see in our particular Facebook groups, a lot of people that they fall off the wagon for whatever reason, but because they had such a positive experience as a novice, they return. We do have very good participation rate in our group; in comparison to other ones, it’s about 70%. We’re very happy with that. That is one thing that I think we’ve done well. 

Great. Well I believe we have a bit of a funny. A KetoFest funny story to share. I think it stems back from last year…

Yeah. Last year, last year. Yeah, I was telling Daisy, when we were talking in the kitchen that I was hoping this year would be less traumatic at Keto Fest. What happened last year, Daisy was, there was a prank that was played on me and I think it was meant for Daisy. 

Yeah, I missed out, I didn’t, I didn’t know about this. It was all to do with the, the beach admin house. Yeah. The admin house was supposed to be a beach house.

Last year. 

So we get there and I’m thinking as we’re driving there, this doesn’t look like it’s close to the beach, but you know, maybe it’s somehow at the end of the garden or something? Didn’t look right. Get there. Cause I’m excited. You know, I love the beach and, all right, where’s the beach? Where’s the beach? That was the first thing as soon as I got there, it wasn’t there. So they, they changed the house, but my plan had been for all the admins to go for a midnight swim. I love that. I love, it’s a bit weird. I have a lake nearby, and I’ve been for midnights swims before and it’s great fun. I love it. So I had this plan that we were going to go for this midnight swim, but of course it all fell away because we weren’t by the beach. But unbeknownst to me…

No, see I was, I was not in the admin house. I was at the Holiday Inn and so was Richard Morris, and he had known about this admin house, there was supposed to be a beach and they were going for this midnight swim that didn’t happen. So we’d been working all day in RD86 in the kitchen and it was hot and we were tired. I got back to my hotel room and I had a shower and all of a sudden my phone goes, ding. And I look, and it’s Richard Morris, and I says, Hey, do you fancy a swim or you don’t want to come down to the pool with me? I’m like, Oh, yeah, sure, give me, give me a few minutes, I’ll meet you down there. He goes, no, no, no, no, I’m going to meet you in your room, which should have been, a tip for me. I’m thinking, he’s nice, he’s going to escort me down to the lobby. No. I’m like, well, give me, give me a few minutes. I’ll get into my suit. I get the knock on the door and I open it up and he’s standing there and he’s got his hands behind his back looking all proud, chest puffed out. And the first thing I think is, dear God, this man has walked down the hallway in wearing nothing but a black tee shirt. 

[muffled giggles and “oh wow”]

And then I suddenly realized that no, he’s not naked from the waist down. Instead, he’s wearing the world’s smallest black Speedo with his black tee shirt. 

[laughter]

And he goes, okay, well, let’s, let’s go downstairs. I said, you can’t walk down through the lobby towards the pool in that. He’s like, why not? This is my suit. And just then he laughs and he’s got his hands on his back and he pulls out and he’s got decent swim trunks.

[laughter]

And, he says, no, I brought this for the beach swim that didn’t happen. And he turns around on his heels to go into my bathroom to get changed. And just then I see it as he’s walking away, on the back of his tiny Speedo, Australia written right across his bum. But I’m pretty sure that was meant for you on the beach. 

I missed out. And of course, and of course in Australia, those are known as budgie smugglers, right? 

I didn’t get a very close look. I went hysterically blind for a brief moment. 

What I want to know is, is where they are this year? I mean, I’m staying in the Holiday Inn, perhaps we can do a replay. So as is customary, can we round up, please Karen, with a top tip. 

Sleep. I think I touched on this earlier before. Sleep is so important for your hormonal balance. And I find that a lot of people that are struggling with night eating, myself included, I have a busy life. I’m a mother, a volunteer. I work, I’m on the Facebook groups all the time. And, a lot of times we try to claim some of that time for ourselves after, our children go to bed, and it’s quiet, but often when you think you’re hungry, you’re actually tired. So, try to get that, that eight hours every night. I’m better at preaching than practicing myself as we all are. Especially when it comes to sleep.

It does make a difference, doesn’t it? I seem to fall into my natural sleep pattern when I come to the States. I’m absolutely dreadful about staying up too late, and end up still online probably because yes, I was nodding over there. Probably one of the people who say Daisy, are you still doing online? Go to bed because it’s four o’clock in the morning or something my time. But of course when I shift back in time here, I’m waking up at six o’clock in the morning all bright and sparkly and getting to sleep at a good time at night and getting a good chunk of sleep. So, I do well when I’m here. 

Well maybe I need to come to France to get better sleep.

Maybe we can do a swap. 

Yeah, there we go. 

Rangan Chatterjee talks as a podcast that I really enjoy listening to and he talks about the pillars of health and he maintains that sleep is the pillar that actually supports everything else. 

It’s true. 

And if you can get that solid foundation, the others will all stand up better. 

It’s definitely, it’s easier to exercise if you’ve had a good night’s sleep, it’s easier to keep your, your blood sugar stable. I know, if any of you test your, your blood glucose in the morning, if you haven’t had a good night’s sleep, a fitful sleep, not enough sleep, you’ll find that your, your fasting blood glucose is much higher. 

I’ve ordered, getting in on all these people with their self experimenting, I’ve ordered a CGM, so I’m going to see just how much my 4:00 AM late nights impacts my blood sugar and maybe that will be what I need along with people like Sandy telling me off to go to bed, might be what I need to, to get some sleep. 

And even with somebody who’s had a nightmare, you can see it in the CGM. It’s really interesting. 

Really interesting. Well thank you so much for sharing this Keto Fest live experience with me. 

Thanks for having me on. No, I’ve been waiting to do this for a long time. I’m glad we could do it. 

Nice. It’s so nice to spend time with you again, in general. Enjoy Keto Fest and thank you, my wonderful Keto Fest Lovelies out there for, for coming up here in this heat and sharing it with us. Thank you so much.

This transcript is brought to you thanks to the hard work of Jeanne Wagner.

Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? It’s that dreaded word, isn’t it? Calories.

Calories. You know what? The answer is, maybe, maybe they do. There’s a whole long list of things that we can consider when somebody is experiencing a weight plateau and yeah, calories is one of them. So for example, if you are just taking in too much energy from fat or from protein or even from carbohydrate or alcohol, if you’re just taking in too much energy and pushing through those hunger and satiety signals, because you’re eating for all the raisins or whatever it may be, then definitely reducing calories and trying to tune back into those hunger and satiety signals might be a strategy. So that’s often why people will use something like intermittent fasting. You know, they’ll spend that period, whether it be three months or six months or whatever it is, or shorter to get themselves fat adapted. And then they start to notice that the appetite goes down, and so they’re like, okay, well now I’m ready to do something else. 

And maybe the weight has plateaued. So then something like intermittent fasting where calories are being either spontaneously or purposely reduced by reducing meal frequency or reducing the eating window, can certainly be effective. But I guess as well, there’s so many other things to consider. It’s very easy just to default to the whole calories in, calories out thing. But you know, a lot of people, again, they try the calories in, calories out thing and it doesn’t work. So if it’s not working, well what else can we consider? And there’s a few little things that I look at in particular when it comes to weight loss resistance or weight plateaus. And one of them is iron levels. So if somebody is low in iron and it’s usually iron stores. So on the blood test, it’s called Ferritin, that’s your iron stores.

So if we’re low in iron, well that means we’re basically low in energy. So we need iron to transport oxygen around our body. And that’s how we produce energy. So if you’re trying to lose weight, you’re basically trying to get your body to expend energy to burn its stored energy. So it’s like a double whammy trying to get rid of energy from the body, but you don’t have enough iron to carry oxygen around the blood sufficiently. So the body is going to be like, well, hang on a second. We’re not getting rid of this precious energy that we have and we’re not gonna waste any energy burning fat because we don’t have enough iron. And it’s not like the body is consciously making that decision. It just can’t do it. And there’s the other theory as well where if the body is low in something like iron or one of those essential vitamins or minerals, it releases a bit of a low level stress response, which increases insulin resistance, which helps the body hold onto stored fat because any type of stress, it’s kind of like the body thinks it’s in a famine or in some sort of danger mode. So it’s not going to comfortably release any stored energy. 

So iron is a big one, massive one. And that’s something I think people should check specially, women of childbearing age or people with gut problems. So if you’ve got any sort of gut issues like inflammatory bowel disease or IBS or something where your ability to absorb nutrients is hindered iron is usually one of those things that’s not absorbed very well in those sorts of people. And then other things too, so it could be magnesium, a inadequate intake of magnesium is very strongly linked to insulin resistance. So you could have the perfect diet in terms of your carbohydrate macros, carbohydrate, fat, protein macros, sorry. And you may even be eating low calorie or you may even be in a calorie deficit and you’re still not losing weight. And so magnesium is a huge one because if you’re deficient in magnesium, essentially what that means is that the insulin signaling becomes less efficient.

So you become insulin resistant and then being insulin resistant actually makes you more deficient in magnesium because you use up more magnesium to make more insulin that you need. And so it’s actually like a vicious cycle, whereas your body is making you more and more deficient in magnesium when you’ve really need magnesium to get out of there and maybe restart weight loss or something like that. And magnesium deficiency is common. I know, I mean, when I was going through my dietetics practice, I remember learning about magnesium and they just said to us, Oh, you don’t have to worry about this one because no one’s deficient in magnesium. And I was like…

I thought it was more a case of everyone pretty much.

I was like, whoa, whoa, whoa. So we just don’t worry about it? Like no one’s deficient? Have you surveyed me? You don’t know what I ate. You don’t know if I’m deficient. Like how do you know? And I was just like, that’s not right. And so I actually delved into it a bit deeper and what they were trying to say, in their defense, was that so many foods contain magnesium. It’s abundant in our food supply that it’s not likely someone’s going to under eat it. So like, you know, it’s not like as obvious. Whereas if you stop eating meat, you’re probably going to be deficient. And I, and there’s, you know, cause a lot of food groups have it. But I thought that was, you know, that’s still not enough to then be like, okay, well everybody’s going to be safe from a deficiency because what we know about magnesium is that we all have a different magnesium bucket that we’ve got to fill up. 

And if you’re under a lot of stress, for example, which most of us are in this modern world, or you’re going through a very stressful period of work, or you’re doing a lot of fasting, which is a stress or whatever it may be, your magnesium bucket actually gets bigger. So now you’ve got to fill up a larger magnesium bucket so that you don’t have a deficiency. So trying to fill up a huge magnesium bucket -let’s say you’re really stressed at work, you’re also doing this fasting thing. Or maybe you’re doing a low calorie diet, they’re all stresses on the body and maybe you’re not sleeping well. Maybe you’re taking lots of medications- you’ve got this massive magnesium bucket and you just can’t, you can’t fill it. You can’t fill it up. So you become deficient. And that’s maybe where supplementation could be useful.

Because isn’t part of the argument, you mentioned that their argument was, that it’s really easy to get magnesium from foods. But I thought that that was one of the arguments actually that foods have less than less magnesium in them, so it is more difficult actually to get enough magnesium from the foods. Even if you’re eating a diet that is allegedly rich in magnesium.

Agreed. So the soils are becoming more and more deplete in magnesium. So we don’t even really know how much magnesium is in the food were eating, you know, from the vegetables and the seeds and all of that. You know, if a food is fortified with magnesium, which a lot of those packaged bread and cereal products are fortified with magnesium, well that’s kind of a supplement really. If it’s being fortified, it’s not in the food naturally. If you’re doing that, then yeah, you might be able to argue that you’re getting in enough magnesium. 

But, you know, a lot of people particularly in this space aren’t eating those fortified breads and cereals and that’s when I think short term periods of supplementation can be warranted. So for this particular person who is trying to figure out why they are in this weight plateau, you’d go through those different types of things as well. So a lot of it is micro nutrient based, trying to figure out if somebody’s got a deficiency in one of these major micronutrients and if they do well, can we use short term supplementation, to help boost up the levels. And then once they are able to get things going again and we’ve seen adequacy in those micronutrients, then we can try and keep that there with food. So yeah, there’s, Oh my God, there’s so many others. Like I’m just thinking of more that I come into my head a well.

It can be difficult to test magnesium can’t it though. I seem to remember reading that the blood test to see if your levels of magnesium isn’t particularly accurate. Is it sometimes a case of sort of guessing what the problem might be in? I mean something like taking magnesium supplements is unlikely to do you any harm, is it? You just end up, you can tell if you’ve had too much because things tend to move through your system a little bit too quickly to put it a bit lightly.

Yeah, no, you’re right. So, a lot of the blood tests for vitamins and minerals are just completely inaccurate. Sodium magnesium is one of them. The blood tests for serum B12 is highly inaccurate and the reason the blood tests and the magnesium is inaccurate is because magnesium is stored in our bones. So it’s not really frolicking around our blood stream anyway. So it’s more used in the acute care setting where they’re trying to work out, um, people’s electrolyte balance and whether or not they need to give them supplementation to keep them alive and things like that. So that’s why the magnesium always appears on your blood test, but it’s actually not useful in determining whether or not you’ve got a deficiency. 

The way I do it is by one trying to predict how large someone’s magnesium bucket is. So do they have higher requirements and if they have insulin resistance, if they’re taking multiple medications, if they’re under a lot of stress, if they’ve got anxiety, things like that, then I just make the assumption that they’ve got higher requirements for magnesium and then you can supplement based on that assumption alone and then just sort of track symptoms and see if things improve. But also the other thing is as well is that you can calculate people’s magnesium so you can sit down and you can go, well, what are they eating? How much of my magnesium are they eating and match it with your prediction for increased requirements. 

But then the other factor that comes in, which is how this conversation all started, is that people are usually trying to lose weight as well. So if you’re trying to lose weight on top of an increased requirements for vitamins and minerals, sometimes you actually can’t eat enough food. Even if you’re eating all these magnesium rich foods, you can never get to that point where you’re going to meet your requirements because you’re also trying to lose weight and you’re trying to keep your food intake low. You don’t want to overeat. So that’s the other thing. 

You know, sometimes when you sit down and you put together, well this is what you’d have to eat in the day to meet your magnesium requirements. Someone’s magnesium requirements are really high. They’re just like, I can’t eat all that. Like if I eat all they have, I’m gonna gain weight and they might be right. So that’s another thing that needs to be factored in. But there are some blood tests which are good. So you know, vitamin D is usually a pretty good correlator of your vitamin D levels and your vitamin D status, and also some other good ones. Iron is good.

The iron tests are reliable aren’t they?

Yeah. But like for the minerals, they’re all pretty basic. They’re not really going to tell you much about your actual diet. Another good one that I’ll share is that I think a really good blood test to request from your doctor is something called homocysteine. Have you heard of it?

I have. I couldn’t talk about it. I’ve definitely heard of it. So I’m fascinated. I know the word.

Yeah. Well, I mean, I didn’t learn about this at uni or anything either, and I don’t think a lot of people know about it, what it is or what it does, but I learned about it through my own sort of health journey as well, and then I dived into the research. So basically it’s a protein and it will build up in your blood if you have a deficiency in either folate, which is vitamin B nine or vitamin B12. So if you just got a blood test for vitamin B9 and they looked at serum B9, a lot of the times your blood has a lot of this serum B9 floating around a lot of B12 floating around and your doctor goes, oh, that’s good, you’ve got no deficiency. But those two vitamins need to be activated to actually be used by yourself. 

So they can be floating around the blood and high amounts. But the question of whether or not your body is actually using those B vitamins can be answered by testing homocysteine. So if you test your homocysteine and your levels are elevated, you can assume that you’ve got a deficiency in either vitamin B9 or vitamin B12 or both. And you just sort of play around with that until you get the homocysteine levels down. So I think that’s a really good one because that definitely happened to me. 

I you know, when I went through my kind of stage where I was doing a lot of restrictive eating, I ended up with nerve damage in my hands and my feet and they, all, the doctors tested me for vitamin B 12 because vitamin B 12 is linked with peripheral neuropathy, which is nerve damage in the hand of feet. And My B12, my serum B12 always came back high, you know, it was, it was always, Yup, you’re fine. It’s got to be something else. They called it idiopathic peripheral neuropathy. And you know, seven years passed before I finally found out that the B12 blood tests really just does not correlate to your B12 stores. And my body had a problem in activating B12. So even though it was in the blood, my body couldn’t get it into the cell. 

And so I had to supplement with an activated form of B12 to help my body get that sort of B12 into the cell. And boy, I wish I knew about that seven years ago because maybe the nerve damage is permanent, and maybe that’s something I’m going to have to live with. And if I can prevent other people from having any permanent damage from a B12 deficiency or a folate deficiency, I’m going to spread that message. So homocysteine, get it tested.

That sounds like it’s potentially wrapped up with the problems that some people have with the MTHFR gene. Yeah, it sounds like it could be linked.

There’s a lot of different genes which are gonna affect your ability to activate B vitamins and other vitamins and minerals and so on. But yeah, so essentially when I say activation, that actually means methylation and the MTHFR gene mutation that you’re talking about, there’s a few different types, but one of the more well researched ones means that if you’ve got the mutation, then you have a reduced ability to methylate things in the body. So turning things on or turning things off like for example, being able to activate a B vitamin to get it into the cell, your body can’t do that very well. And you know there’s a lot of people walking around with these genetic mutations who have absolutely no problems.

And just because you have a genetic mutation doesn’t necessarily mean that you’re going to develop these medical problems from it. Everybody’s different. It’s kind of how it gets expressed in your body. I know with that particular mutation, a lot of people end up with miscarriages and problems with fertility because we know that folate, vitamin B9 is essential to grow in your human and to be fertile. And so if you’re not activating vitamin B9 and you’re not able to actually get that into your cells and tissues, then yeah, there could be problems with fertility and there could be problems with having a healthy baby, which is awful to think about and awful to think that there’s a lot of people that may have this mutation and may have those issues but don’t know it and don’t know how to actually test whether or not they are deficient in B12. I mean B9 or B12. So you can get tested for the mutation pretty easily and you just ask your doctor to throw on a test for MTHFR and they can just do it with your regular blood test and if you want to know about it, you can know about it.

I mean really the way you sort of manage that mutation is, is by checking on homocysteine anyway. So you know, it’s more linked to those deficiencies in B12 and B9 so if you’re looking at your homocysteine and keeping that am in a good range, then it doesn’t really matter whether you have the mutation or not kind of thing, but a lot of people like to delve into their health more. I would put a, a big beware sticker on that though because it is a little bit scary if you type in or if you Google the MTHFR genetic mutation… I don’t know, have you googled it?

Yeah, a whole slew.

Oh yeah. It’s like all the worst things, you know, just pop up like cancer, depression, stroke, miscarriage, nerve damage, Alzheimer’s. It’s like everything that you want to not get in life is what you’re now learning you’re at greater risk of. And so, you know, it was really scary finding out that I had that and I’m a health professional who’s able to look through the literature and kind of just cycle through it and figure out what I need to do. But there’s a lot of people that that would just completely overwhelm them and be far too much and maybe they don’t even need to worry about it. That’s the thing. It’s going to be a different outcome for different people depending on your lifestyle, you may have absolutely no problem whatsoever with the mutation or it could be something that’s crucial in your health journey to find out about.

Yeah, that’s the thing. I think it can totally be overwhelming, but it can also be that missing link for something like for example, when I interviewed Carrie Brown and when she discovered that there was this problem, it was suddenly, you know, light bulbs going on everywhere and gave her a way to treat and reverse, you know, her bipolar disorder along with eating Keto. It just, it suddenly, it’s a relief to somebody like that because they find out one of these root causes and the problems and it gives them a path for treatment. But yes, I can totally see the other way. If you’re not looking for something, if you’re not looking to try and fix a problem and you suddenly find out that potentially you’re vulnerable to a whole myriad of things, that could be very scary. So I suppose it depends what angle you’re coming at.

Yeah, that’s a good way of looking at it. And I’ll just quickly finish up by saying what you just said there about knowing she had the mutation and that knowledge and that management strategy in combination with the ketogenic diet is important actually because she may, let’s say as an example, never knew she had the mutation but when and changed her diet and she could still ended up improving her health with the same outcomes. It’s obviously going to depend, this is completely, I actually didn’t listen to the interview I don’t know her, but you don’t have to know you’ve got it. You can still just make the best decisions for your health and keep going on how you usually, you know, doing your, health goals and then working towards them, fixing your diet, whatever it is and you can still be fine. You don’t always have to know you have it. And so the ketogenic diet, the way it can help with the MTHFR mutation is by reducing or eliminating your intake of folic acid. Did she discuss this?

Not so much. It was more, she, well she found a big improvement just with the Ketogenic Diet and that really helped with her bipolar. But then it didn’t take her quite far enough. And by discovering that she had this gene mutation, that’s when she started supplementing with methylated B vitamins and noticed a huge improvement after doing it.

Yeah, that’s awesome. And so where that first benefit could have come in, obviously there’s all those mechanisms with the ketones that would be good for brain signaling and all of that. But as well if you go on a Ketogenic Diet you’re essentially getting rid of a lot of products containing wheat, and wheat is fortified, at least in Australia. Most countries is fortified with folic acid, which is the synthetic form of folate, which is actually really not good for somebody with an MTHFR mutation because you can’t process it. So you can’t activate that folic acid and turn it into the folate you actually need. It’s a synthetic form, which they say is very bioavailable. They say all folic acid, you can absorb it really well all as well, but you can ‘t actually then go and activate that if you’ve got this genetic mutation.

So having folic acid or a lot of folic acid can sometimes make your symptoms worse. So step one could be getting rid of the excess folic acid and then as Carrie has shared step two might then have to be going supplementing with those vitamins that you’ve been missing out on. And certainly that was the same with me. So I cut out my folic acid and had some benefit, not very noticeable with my nerve health. And then learning about this mutation and what it does with the activation of the vitamins just opened this whole new door for me cause I was at the point of my investigation of my nerve damage where I was kind of ready to give up. I was saying this is the last person I’m going to see about this and then I’m just never going to talk about it again. I’m just going to deal with the pain. But now it’s like I’ve got this, this hope again. So it is, yeah, it’s, it’s cool. But it is overwhelming.

Yeah.

So people out there, you know, if you’re going to test for genetics, take your genetic tests to somebody who knows how to deal with it and talk to you about it in a way that is applicable to you.

Yes. Real and practical solutions rather than being overwhelming. I think it’s fascinating how we start. I always wince when someone talks about calorie counting and and should I lower my calories? I get this reflex and I think straight away to start with, you started talking about energy intake and I think I prefer to to think of calories as energy intake. And yes, it might be necessary to literally reduce how much you’re eating, but I think it just goes to show and you’ve highlighted with potentially things that you need to supplement. I mean, and there are a whole load of other things that you could be looking at like stress and sleep and all kinds of things. But I think what’s so interesting is that we tend to jump straight to that conclusion because it’s been rammed into our brains that you’ve got to keep your calories down if you want to lose weight, but actually there’s a whole load of other things that you should be looking at first, and they all revolve around improving your health and well-being and actually it could be those that you need to look at probably are those that you need to look at rather than jumping straight on with cutting calories.

Exactly right. You said it. It was a really great question because it’s funny how we started with calories and then ended up with genetics. Sorry, just goes to show you know, there’s so many different things and I think it’s not a pretty answer when you can’t give a yes or no answer to that, you know, it’s not pretty, but it’s the truth.

Yeah. Just like you were saying in the interview, people generally, we all like a yes or no answer, but it’s just more complicated than that, isn’t it? That sort of, you know, it depends. Well maybe, but the other thing is what’s a plateau? You can get people saying they’re on a plateau they haven’t lost weight and you find out it’s just been a week. Well that’s certainly not what I think of as plateau. I mean I would go for months at a time without losing weight. Again, it’s just a natural part of the process, isn’t it? Just leveling out every now and then?

Yes. Super good point. I think that was my top tip on your last podcast. On our first interview. It was my top tip. I remember saying, you know, weight plateaus are a good thing or can be a good thing because yeah, we don’t just lose a kilo a week until we reach our goal. That’s not how our body works. We’re not machines. So having that period where you’ve lost some weight and then stabilizing so your whole energy homeostasis can reset and actually, you know, get that new set point and not work against you the whole time. Then can allow you to safely lose some more weight or more effectively lose weight, and keep it off.

Yeah, exactly, yeah.

Yeah. Instead of your body always wanting to revert back to the start weight, it will revert back to where it’s last got that homeostasis. If you do ever sort of revert, that’s because people are so afraid of putting all the weight back on and well, yeah, maybe if you lose it all at once by drastic measures, maybe you will put it back on. But if you do it slowly and gradually with those, you know, stepwise reductions and stabilizations in between, then you’re probably not going to put it back on.

Yes. I always think of it as your body just taking a bit of a breather. This whole losing weight business, it’s, you know, it takes quite a lot of work. It takes quite a lot out of the body. I just want to rest and sit where I am for the time being, but I love what you were saying about it’s a good way of just slowly bringing your set point down over time rather than your body wanting to go back up. But we do panic. I think if we’re someone who’s been overweight for a long period of time and we’re used to either gaining or losing weight, that’s what it’s always been. It’s been the cycle of one or the other and we lump maintaining a loss in with gaining because it’s not a loss. We shouldn’t, it’s a perfect place to be in just holding your weight.

MMM. You could argue the same for like HBA1C for example. If your HBA1C is 6.4 and then you get it tested, three years later and it’s still 6.4 I would be patting you on the back saying great, you’re doing something right. You know, cause it’s not progressively going up. Okay. But if we want to get it down, what can we do? And yeah, people are too quick to just find the negative in things and we need to look at outcomes not as like just good or bad. You know? We need to think of them more of sort of just like a continuum, like a scale.

Absolutely.

So, oh my gosh, we’ve almost recorded another podcast here.

Yeah I know! I was just going to say thank you so much. This is all first bonus content package and what a bonus content it is. Thank you so much Jessica, for taking that extra time.

That’s all right. I think I was about to say something else and then I was like, you know what? I think my brains fried now. It’s my bed time, so…

I’ve been draining, I’ve been sucking the life out of your brain, and this is you. You recorded another podcast earlier as well, so you must be completely frazzled.

No, it’s fine. I loved it and I think this is fantastic to everyone who’s a patron of a Keto Woman. I think that’s great. So I, I’m happy to give this long interview at 11:30 at night.

Oh my goodness. Well, thank you so much. We’re going to switch off now and I’m going to let you get some sleep.

All right. Good night. Thank you so much for having me.

This transcript is brought to you thanks to the hard work of Joell Abbott.

One question, three answers. 

Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? 

First up is my friend Richard Morris. 

We’ve actually touched on it in the recording today. 

Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? 

So reducing your calories will guarantee to reduce your what? It doesn’t all come off body fat. If you eating fewer calories than you need to be satiated, then by definition you don’t have enough energy from body fat. And so you need to find energy from other sources. And there are two easy places that your body can get energy from and it gets some approximately linearly, you will be using lean tissue. So you’ll be throwing the furniture on the bonfire to keep yourself warm. So burning lean tissue in your body and you will be also reducing your metabolic rate because you know, the other easy way to find calories is to make them a cost savings. So you furlough a few processes like growing hair, growing fingernails,  lots of things that are, you know, these are necessary. But you know, if you didn’t do them for one day, your body could probably justify doing that. And so what happens when you eat fewer calories than you need for satiation is that your metabolic rate slows and it becomes harder to calorie restrict. And that’s why people go off. So yeah, definitely having less calories will definitely reduce your weight. It’s probably not the best way to do it. Yeah. 

It is actually, and for women, something that often gets turned off is menstruation.

 Of course fertility. Yeah.

I remember somebody talking a while ago, they say your body’s very clever and it doesn’t think this is a healthy environment in which you should get pregnant, so it’s going to turn off menstruation so that you can’t get pregnant.

 It turns off fertility in men and women. It’ll turn off your sex drive as well. That’s a big old warning sign.  It will lower your testosterone if you’re a man and it’ll turn off your sex drive. 

 We don’t want you to reproduce. Thanks. You’re not healthy. 

Yeah, exactly. There’s definitely  lots of cost savings that can be made. I mean people can lose 400 to 800 calories a day in metabolic rate drop just by putting pressure on the caloric intake and it, the body fat, can only release energy at a certain rate. It’s roughly 31 and a half calories per pound of body fat per day. When you have a caloric restriction that is so great that it puts pressure on that, and you can no longer be getting the energy from body fat for one reason or another, then you know you’re going to get it from these other places. 

I’ve heard you talking about this before about how the fat person can’t, just literally can’t, access that fat cause you hear people saying, “ No, don’t eat high fat and you should be eating less fat if you’re trying to lose weight or you should be eating the fat on your body instead.” But there’s only a certain point that that’s gonna work too, isn’t it? It’s not just this absolute sliding scale where you can minimize the fat. You eat right down to a really, really low percentage and automatically dial that percentage up to be taking it off your body instead doesn’t work like that. 

No,  thin people can’t fast. You’ll find that a lot of people who are quote unquote healthy and shirtless on Facebook are not able to fast for more than a day. And the reason why is because once they’ve gone through all of the energy in the lipoprotein, they have no energy coming in because theyhave no ability to supplement their daily energy intakes from body fat. So yeah, that’s the case. But there are other reasons why you won’t be able to use fat. SI have 20 kilos of body fat, so roughly 44 pounds,  I can produce about 1,275 calories per day. So that’s not too bad. I mean, 1200 calorie day, that’s not too bad. So I can fast for as long as I want. But somebody who has, let’s say, 10 pounds of body fat on their body, they can only produce 300 or 315  per day. That’s not enough energy to be able to run your day. So that person is now going to be reducing their metabolic rate as much as they can. So they’ll go from a metabolic rate of 3000 down to a metabolic rate of maybe 1200 and then how do they make the extra savings, they start burning lean tissue. So that’s a really bad situation to be in. The other reason that you might not be able to use body fat is if insulin is high. There are people who even though they’ve lost a lot,  80 to 70 pounds of body fat, they still have high levels of fasting insulin. Insulin has two effects when it comes to getting energy from storage into use. The first is that insulin will basically tell your fat cells, we are going to concentrate on glucose now. 

So I want you to Hoover up all of the lipids, all of the energy in circulation, or I want you to get all of the, the fats out of circulation and store them. And I want you to pull as much glucose as you can. Alsouot of storage because we’re focusing on glucose. So that’s like  the signal that insulin gives the fat cell. So you know if your insulin is high, even when you eat nothing. If your fasting insulin is high, if it’s about 14, your fat cells are just sucking up all of that energy that they can, irrespective of how much energy you have available to you. And this explains the paradox of why the fat man is hungry all the time and has no energy to do anything that’s at the source. And then the other part is at the sink for energy insulin will prevent you from being able to get fatty acids into your mitochondria, which be used for energy. 

And there’s a bunch of ways that that happens. But in a type two diabetic, in somebody who’s hyperinsulinemic, they could have a 50 fold inhibition over normal person in terms of getting fat from circulation into their mitochondria to be burned. This is part of the reason why people who are hyperinsulinemic have really high triglycerides because they can’t use fat for energy. It just pulls in their circulation. They can no longer store itin their body fat because their body fat is full to capacity, but they’re not burning it. As soon as you drop insulin enough that they can burn their body fat or burn the energy, the fatty acids that are pulling in their circulation, all of a sudden their triglycerides drop. So if your insulin is high, that may be impacting how fast or the rate that you can burn fatty acids. And so these are all factors that, people think, oh, you know, if I’ve got 10 pounds of body fat on me, that’s roughly, three and a half thousand calories per pound of body fat. So I’ve got 30,000 calories, I need to go do 30,000 calories of exercise and then [I’ll have zero pounds of body fat on me. It doesn’t work that way. It’s a very complicated picture. 

So does how insulin sensitive or resistant you are, is that going to impact then how much you can pull from your body fat? So for someone like me who had, so basically I was twice my weight so I had 140 odd pounds of excess body weight. I wasn’t insulin resistant. I’ve always stayed quite insulin sensitive. My blood markers were always quite good. Does that mean that, and maybe that was why something like a very highly restrictive procedure like the gastric sleeve would work well, would I be the kind of person who could pull more from my body fat 

So hyperinsulinemia goes hand in hand with insulin resistance? Hyperinsulinemia just means you have high insulin and you have high insulin. There’s an argument over whether high insulin causes insulin resistance or insulin resistance causes high insulin. My attitude is that it doesn’t really matter. They both affect each other and they both contribute to each other and once you get started on this, it’s a sort of a Jacob’s ladder. It just never stops. If you’re not insulin resistant, then you’re able to lower insulin based on the signals of what you eat and so you would be able to, you probably with a caloric restriction, you are probably able to get to a lower body weight than somebody who was insulin resistant went through the same process. 

Right. But I would be able to pull more from my body fat. When you talk about the ability of only being able to pull so much, if you’re much more insulin sensitive, you can pull more so you can actually be someone who potentially could benefit when you’re wanting to lose weight from reducing calories a bit. 

Yes, definitely. If you, if you’re insulin sensitive, then you have access to more fat, more fat as fuel to turn into energy and if your insulin sensitive and your insulin is low, you’re in a wonderful state. You know? If you’re insulin sensitive and you go on a ketogenic diet, what happens generally is that you lose a lot of weight, then you get down to normal body weight very quickly. If you’re insulin resistant and you have high, high underlying fasted insulin levels, then you will alight at a higher body weight, you will plateau at a higher body weight. And then it’s just a matter of working out what tissue is causing the insulin to be high. Certainly, once you’ve lost 30, 40 pounds of body fat, it’s no longer a physical capacity limit on your body fat that’s caught. It’s not insulin resistance and your body fat that’s causing your insulin to be high. 

It’s another issue that’s doing the damage. It could be your hypothalamus, it could be your pancreas, could be your liver, could be muscles, it could be your immune system is also able to modulate insulin secretion. So yeah, all of these things. So as that point, this is why my advice is keep calm and keto on, get to your plateau and then keep calm keto on, and you know, at enough time at that weight  you’ll find what issue was doing the damage. And you know, it could be sleep, it could be, there’s a bunch of things that you can do. Yeah. Relaxation. They’re all part of keeping calm and ketoing on. But you know, I suggest not to calorie restrict, but if you’re naturally insulin sensitive, if you’ve done a fasted test and you can get down to four or lower, go for it. Calorie restrict. Yeah, give it a go. 

I think there are so many other things to consider before you do that. So yes, if you know in your heart of hearts that you’re eating too much, and I don’t like to really pinpoint it as calories, but you’re just taking in too much energy. If you know you’re have a tendency to over do with certain kinds of foods, you eat too much of them. I know I do. So if you know that you’re taking it, you can calorie restrict in the sense that you can reduce your intake a bit. May be by limiting the things that you know you have a tendency to overeat. But going past that, no, there’s more likely going to be something else that’s going on. Yeah. And like you say, once you start reducing your calories too much, then you’ll start seeing other things that happen. And that’s that certainly something that happened with me and it’s so typical in the weight loss surgery community that they should actually say you are going to suffer significant hair loss between months three to six and then it should start coming back month six to nine. But it’s so typical. But it interesting actually that it seems very typical in the keto community. Now. Do you think that that’s just a byproduct of natural calorie restriction because people often tend to end up eating fewer calories when they’re eating ketogenically because their appetite goes down? Or do you think there’s another mechanism going on there too? 

There’s a lot of chicken and egg issues here. One of the things that will signify your body to make cost savings and those cost savings will cause your body to stop growing here. Telogen effluvium where all the hair that is probably going to fall out over the next year decides all to do it in one week. Um, you know, all the follicles. So, uh, all of those things happen when you have an energy shock. Now when you first go ketogenic, you are not fat adapted, but you’re not giving you body carbohydrates. So you are actually giving it a shock. You’re actually giving it not enough energy. So it has to adapt. 

Oh, right. So it’s not so much about the calories, it’s just the shock to switching that fuel source. 

Yeah. It doesn’t happen to everybody. Some people are able to, some people are more adaptable. 

It does seem to happen a lot. 

Yeah. But if it doesn’t happen to you when you first go here to check then you know, seven, eight, nine months down the road when you hit your plateau and then you decide, well, I’m gonna reduce my food intake because you know, I’ve been increasing my food intake as I got closer to my plateau, which is, this is Steven Finney’s argument. This is his four charts. This is what he’s saying. As you get closer to your ultimate plateau, you start to eat more calories spontaneously and he’s explaining how the homeostasis works to alight you on that plateau. If you then decide, “Oh well, I mean obviously eating too much, I’m going to eat less” and then you eat less and now you have an energy deficit. If you didn’t lose hair in the first days of Keto, that’s when you’re going to lose, a lot of hair and you know, your fingertips will be cold. And you know, I’ve heard of people with toenails and fingernails falling out and all sorts of uh, lack of energy. It’s just, you know, and then fertility cost savings, women stop their menstruation and men lose their sex drive. And you know, there’s all these kinds of things that happen when your body is in an energy deficit in an emergency. essentially it’s a three alarm emergency. 

And you talked about eating to satiety and you seem to have that dialed in very well. And it’s something that I struggle with and I know a lot of people do and I think that’s where you potentially have to start looking at restriction, but not really restriction of calories, but restriction of certain food types. Because as soon as I dial in a stricter diet, which is not an, I’ve counted the calories, it is not low on calories at all. But when I stick very much, probably cut out things like dairy, things like nuts, nut flours, treat type things with sweeteners in if I eat very basically, and really nice and high fat, just protein and simple vegetables and lots of fat. I do find my appetite comes down a little bit, but those calories are up there. I doubt I come in at less than 2000 today, but yet my weight will start coming down. So it is sometimes, I think, about being a little bit restrictive but not actually with the calories actually about different foods. 

Totally agree. We can be mindlessly eating food that has a little bit of carbohydrates in it and if we eat too much of it, we could be any more carbohydrates than we really know about. And so that’s why if you’re in that state and you want to work out what’s happening, it’s always a good idea to start a food diary so that you’re mindfully eating and that way you keeping track of things. But you know, we tend to sort of fall into this trap as humans of trying to find magical molecules or in terms of pills. He’s a magical molecules or magical foods that you can eat as much of and not gain weight. You know, celery has negative calories, you burn more calories chewing. So people eat. It’s horrible stuff, you know. But we tend to get into this situation where we think, Oh, you know, they must be good foods and bad foods. 

They must be magical foods that have a high satiety and must be foods that have a low satiety. One of the things that has the highest satiety is just getting enough fat. Energy. It’s highly satiating. Or ketones exogenous, ketones are extremely satiating. And the reason why is because we have energy at the cellular level, so we’re not energy deprived at the cellular level because ketones, we can get energy from no matter what our insulin status is. Another example is when I wake up and I’ve been fasting three days, I am satiated like nothing else. Waking up, eating nothing, you know? So where does nothing sit on the satiation index of satiating foods? Nothing is the most satiating, one of the most satiety foods that I’ve ever had. But it’s all in context. I mean, satiation is not an emergent property of food. It’s an emergent property of humans in a particular context. And this context is having adequate energy at a cellular level. 

And fat just gets picked on because it’s so much more calorie dense. You know, it’s more than twice just a bit more than twice the calories of the equal amount of carbohydrates or protein isn’t it? So it always gets picked on and you will see in certain groups, well, you know, you need to start reducing your fat, you know, don’t eat fat bombs and don’t put fat in your coffee. And things like that. And to a certain extent, I do agree with that, but not for the same reason. I don’t agree with reducing it because of the caloric content. It goes back to the food group things. It goes back to making it a little less palatable when you make it really palatable by adding sweetener to fat and making fat bombs and flavors and things like that. So it basically becomes sweets that are just delicious that you can pop for ages if you just give somebody a lump of butter. And also actually to a certain extent, putting it in a drink, it goes down in a different way. 

Yeah. Liquid calories have a different mechanism for satiation. 

Yeah,exactly. But eating fat when it’s attached to a pork chop or you know, eating lumps of butter, you literally can’t do, it’s not that palatable is it? I mean it’s delicious, but it’s not palatable in the same way as when you’ve turned it into a sweet. 

You’d be surprised there’s, there’s a lot of people on the internet who think that there’s a whole bunch of people out there drinking pure butter. 

Yeah. It’s actually, we’re literally putting these sticks of butter in the coffee. I love that meme that has a stick of butter, literally sticking out of a cup of coffee. And the first thing that I think when I look at that, well that’s not a hot cup of coffee. 

Yeah, exactly. I like adding butter to vegetables. I follow Sara Halberg’s principle of never eating vegetables without some fat. 

It’s making them palatable. 

Yeah. But you know, I don’t need a lot of butter. Although I did have Hollandaise today. I made myself some protein, bread company pancakes and I made little pikelets. So pikelets are about sort of like English muffin size. 

Yeah, they’re like squished crumpets, aren’t they pikelets? 

Exactly. And I had two of them for dinner. One had ham, a poached egg and Hollandaise. That was an eggs Benny and the other one had spinach and salmon, poached salmon and a poached egg and Hollandaise as well. So that was an eggs Florentine 

Nice. What’s it called when there’s salmon’s  on it, it’s not a royale or something?  

Eggs Florentine. Oh, might be Royale. Yeah. Cause it’s spinach…

When the salmon’s on there. Florentine is the spinach but I’m not sure what it is. When it’s the salmon. I do eat a lot of butter, I have to say. I do eat a lot of butter. I love it. In my scrambled eggs, I slather it on vegetables. But um, yes, it’s all about the context for me. It’s what you’re mixing it with. Absolutely. Obviously intrigued. Actually I will let you go in a minute. That lupin flour and I’ve been reading about this and trying to find out what the carb content of things is quite big in Australia, isn’t it? Yes. It’s one of these new emergent low carb flours. 

Lupin is a legume like peanuts. It’s closely right here to peanuts. And so people who have peanut allergies can often have allergies to Lupin. But Lupin is aflower that’s used in the protein bread pancakes I was talking about. And there are three varieties is a European variety that’s been the French variety that’s been eaten for thousands of years. And there’s a South American variety as well. And then there’s Australian variety of sweet Lupin doesn’t actually have sugar in it. It’s just called sweet because of the flowers. The Australian variety is slightly less allergenic. Australia has really high peanut allergies. We have more peanut allergies amongst kids than almost anyone anywhere in the world yet.  You know, we have very high rates of asthma and a lot of these, autoimmune diseases, but Lupin is a less allergenic than South American and European versions. But, somebody I just posted on Facebook a nice breakfast, so I had, and I got called to task about promoting lupuin. That’s one of the reasons why I don’t want to be a Keto dude anymore because I was just having breakfast. You know, I wasn’t promoting Lupin and I don’t have a problem myself with allergies. And so, you know, anyway, it was a delicious breakfast. 

It’s reminded me, actually, I do have a jar. It cropped up in Lidl, it was Spanish week, so presumably they’re Spanish lupins, but not the flour but the actual lupins in a jar. I used to love tuna and butter bean salad. And so I’m envisaging making a similar thing with these lupin beans because they do seem to be very low in carbs. And I don’t know what they taste like. They might taste disgusting, but I must crack open the jar and see what they’re like. 

So I uh, I’m in the process of making some ham stock from the ham we had over from Christmas and I’m going to use French blue lentils with that to make a ham and split pea soup using French lentils.

French blue lentils. What so not green lentils then what are blue lentils? 

I don’t know. They’re just the lowest calorie legume that I can find. 

Interesting. 

They’re not quite low in uh, actually not low in calories,  but low in carbohydrates. 

Oh, I’d be interested to know. I’ve never heard of them considering I’m in France. Ah, probably lentils are the things that normally crop up, but uh, blue lentils. Right. I should be straight on Google now cause I do like to have those things occasionally. They’re the kind of things, before I started keto, when I was more moderate carb, I would have a few things like quinoa and lentils and things like that. I do potentially like to have them occasionally. 

[I have just asked Google and there appears to be no such thing as French blue lentils. French lentils are what I think of as Puy lentils. They are indeed relatively low in carbs and stay nice and firm when cooked. They are very popular in France and you can usually buy Pet lentil salads in the supermarket which is basically lentils cooked with some onion and maybe garlic, bacon, stock, etc.]

Right. Well, thank you very much. Fabulous having, this extra bit. 

You’re welcome. Daisy. It’s a pleasure, as always.

This transcript is brought to you thanks to the hard work of April Ihly.

Welcome back Annette, to another ask Dr Boz where we will get to the ask Dr Boz question from the get go. 

Absolutely. I’m so happy to be back. Thanks for having me back. We will tackle questions. We will not tangent onto a Dr Boz-Daisy duo. 

Well don’t make promises you can’t keep because I’m sure we will end up going off on tangents, but we’ll try and keep on track at least to start with. 

Perfect. 

Okay. Shuffling my papers. So this is back to April where we started last time with the story of getting some help for her mum who has early onset Alzheimer’s and that was a really good development and that’s happening now. She’s getting them and by all accounts it’s a good thing and it’s helping. But April’s questions, she has a few. “Can a small fatty umbilical hernia self-repair on Keto. I feel like mine has improved since I started.”

Okay, let’s talk about umbilical hernia. So again, a hernia is an opening or a defect in the lining of a space in your body. So we’ll use the word inguinal hernias. And those are mostly associated with males. You can have an inguinal hernia as a female, but it’s much more rare and you can have an umbilical hernia. The inguinal hernia is the space where the testes actually left the abdominal cavity and go into the the genitals during birth. And if that lining gets too much pressure, it will pop open a connection between the scrotum and the abdominal wall. And I use that as an example to explain what happens with umbilical hernia because it’s much easier for people to visualize these two spaces having a connection. 

When it comes to umbilical hernia, you’re supposed to have a seal all the way around the inside of your abdomen. When you were in your mother’s womb, you were getting your nutrients and food through this vein and artery combination through your belly button. That cord got sealed and was supposed to completely adhese and scar off any opening. But if your tummy got big, if you have a weight problem, and you can even see this in little babies, if they have those cute little full tummies. If the scarring didn’t happen at the time of birth, you’ll see that the edge never could find its partner to seal. In their umbilical hernias, we worry only if the tissue comes through that opening and get stuck. So it’s actually safer to have a large umbilical hernia as opposed to a small one. A small one, if the tissue kind of pops through this little tear or this lack of adhesing, of sealing, and then the tissue on the other side gets kind of irritated and happens to swell too big to pull back into the tummy, that’s when you have a problem. 

I’m a big proponent of the less surgeries you have in life, the better you’ve done. So when I look at the need for an umbilical hernia, if you’re a swimsuit model, we can help you. If your hernia is stuck, it’s super painful, like it’s going to cause gangrene and die, it’s going to be an emergency, so it’s not like, oh, it’s a little tender. Nope, it got stuck as the tissue left the abdomen and got stuck on the other side of that opening. So when we look at can an umbilical hernia improve or repair, let’s just unpack that a little bit further. As the mass inside your abdomen gets less with the weight loss associated with the Ketogenic Diet, you’ll see that the pressure pushing through that little opening is now much less and the hernia will kind of retract back into the abdomen.

Will the scar ever seal shut? 

No. That time it’s torn. There’s nothing stimulating it to connect back together. But is it an emergency? Should you have to go under the anesthesia to get your umbilical hernia repaired? For your brain’s sake, I would say no way. I mean, every time, especially a patient with high inflammation, so if you’ve had an overweight tummy enough to cause an umbilical hernia, if you’ve been struggling with high insulin states of Metabolic Syndrome or God forbid, full diabetes, your brain doesn’t need any help with destroying or putting stress on those brain cells. Anesthesia, every time we do it, you have a cognitive hit. I don’t care what age you are, but if you’re inflamed, if you have high inflammation in your system, the cognitive hit is higher. So I would not sacrifice brain cells to repair an umbilical hernia unless your whole income comes from being a swimsuit model and you need that little bulge to not be there. That’s how I would answer that question. 

So yes, basically, yes, it’s not ever going to repair, but it’s going to get significantly better. 

Right. Good answer. Way To summarize what I just rambled on about. 

Okay. Another problem she has, although by all accounts from her update, it has got better. But I think this is an interesting one and this is a question I see from other people, so I do think it would be interesting to address it. When I fast, I feel great and the longest was 40 hours. The problem is that I feel awful when I start eating again. I’ve been slowly incorporating foods back in after a fast that no matter how slow or what foods I try, I always feel horrible for days. It’s only when I start eating again and not while I’m fasting. I want and need to fast, but I’m developing a fear of eating again afterwards. What might be causing this? And I know from my own experience, I don’t have as much of a problem as that, but certainly when I start eating again, I how should we put this politely? Have to run to the bathroom? And that always happens with me always when I start eating again and it’s something I know that’s going to happen, so obviously I plan for it, but this, I can see how this going on would just become a self fulfilling prophecy, if nothing else. But I have heard many other people saying the same thing. The fast is great. It’s when they start eating again that they have problems. 

There’s a few things, I’ve seen this multiple times as well, and here’s the advice I give folks. First of all, I would start with, as you look at a GI system that’s been shut down, which is what happens during fasting, it really slows down the movement, the gas, all of the secretions are much slower. You’re going to restart it when you start eating again. And the first wave usually does end up with an urge to go to the bathroom. One of the better ways to do that is to make sure that that first bit of food is high salt and warmth. So I recommend leading that first moment of breaking a fast with warm, salty broth. That nutrients is great, the salt is great, it tastes really good. And that kind of leading syndrome of there’s a lot of bone broth that does really does get absorbed before it ever gets to that large intestine. 

So you can see, even though the wave of peristalsis starts to send the wave down the gut, it’s much less if they lead with that. Second of all, you can talk to many of the people who’ve had gastric surgery for weight loss that they will have, I wouldn’t call it a full dumping syndrome where it’s a lot of diarrhea, but I would call it like a high like reflexive trigger for their peristalsis when they start to eat again. And I haven’t seen anybody successfully train out of that. So you’ve cut the nerves when you did that surgery and there’s a part in there that’s going to have this high almost reflex. And when you start eating, when you’re eating all the time, the reflex gets worn out and it’s not, you don’t have the diarrhea, but when you’ve had a pause and then you restart it, the wave goes from top to bottom and they end up at the toilet. 

That may fit to some people, but that, uh, is not uncommon. The third thing that I’ve seen that’s really important when thinking about what do you do to break a fast is consider whether or not what you’re eating is something you’re allergic to. And specifically, I point out lectins, I didn’t even know what lectins were before before the ketogenic diet, but you know, from bell peppers to peanuts to even jalapenos have some lectins in them. If what you’re eating are these wonderful ketogenic foods, but they are high in lectins, I have been amazed at how many of my patients when they cut out lectins, and really they did carnivore for about a month, so almost no vegetables, no peanuts, said my diarrhea went away. And so what I’ve reverse engineered is to say it is essentially an intolerance for lectins. And many of my celiac patients or gluten intolerance, even if they’re not full celiac, really have an insensitivity to when they consume a lectin, they get very loose stools and they get more of a spasm in their gut and they do a beautiful kind of movement and absorption process. 

And then the fourth one is what I do, which is when I’m done fasting, I feel the need to celebrate. So I will eat too much. And even though I’ve gotten a lot better at it, it probably took me like 50 times fasting to say you do not deserve a celebration. It is not that big of a deal. You are going to be fine. So the amount of food at first, try not to celebrate after a fast. And again, this is a goal, so keep working towards it. But if you celebrate with fasting, by eating a large volume of food, you’re going to pay the price. Your gut is just not goingto handle that as well. 

Yeah. Interestingly, I find it a good way to reset my satiety signals a bit, actually. I’m the opposite. I can’t eat much. The first meal I have is always a lot smaller than I would normally have, so I go the other way. But yeah, I know for some people the temptation is to eat all the things. 

If you’ve ever done one that’s been like four or five days, that’s the ones where I really mess it up and like I’ve only done that a few times. Usually I do a 48 hour, maybe a 72 hour, but 36, 48 are much more normal in my life and I’ve don’t have as much celebration. But boy, the times where I’ve pushed it, you’d think it was like a wedding or something.

It’s funny how our brains have to compensate. Yes. Okay. This is the big one, really. This is the main one. “I’ve around 200 pounds to lose. I’ve had some great non-scale victories, but Ihave lost no weight at all.” That’s got to be really frustrating, right? If you’ve got all this weight to lose when you’re over a certain size, that’s the assumption that you think that the weight is gonna drop off fairly quickly. At least to start with. “I’m not in it just for the weight loss and while my inflammation is down, it’s still really bad. I’m under 20 grams of carbs a day, at least 95% of the time and always under 30. I know I need to be patient and stay the course, but what are some potential reasons why I’m not losing the swelling and inflammation?” And I’m going to go on with along update now. 

That was her original question. I’ve pulled these questions from a list we had way back when we did the first ask Dr Boz and so I got an update from April to see where she’s at now. “My main question is why are my blood sugars still so high and why am I not losing the inflammation and weight, although that’s not my entire focus, after being Keto for so long?” Because of course she’s now, she’s been doing it for quite awhile. “I’m 46, menopausal and have severe sleep apnea and use a CPAP machine every night. I average about seven hours a night during the week on the weekends I often end up sleeping 10 or 12 hours to make up for what I’ve missed during the week. I don’t set an alarm. I just naturally sleep longer. I know I need more sleep during the week, but I always wake up around seven hours. 

There’s been a lot of stress in my family over the last two years. There hasn’t really been a break between incidents. My dad passed away three days before Christmas in 2016 from stage four renal failure, liver failure and diabetes. His heart gave out. My mom had not yet been diagnosed with Alzheimer’s but could barely take care of herself, so my sisters and I took that on. It was a huge source of contention for awhilewhile we figured out how to move forward. In the meantime, one of the family members was getting more and more toxic and dealing with them became an unavoidable nightmare. I’ve done what I can to remove them from my life, but they keep dragging out things that I have to be involved in, so I’m not completely free from that obligation. Mum was recently moved into a care facility. It’s a good one, but there are still stresses in dealing with that. 

Work isn’t really stressful, but there are times when it is. I’m also switching careers, so I’m dealing with learning a completely new career while still doing my current job. I started Keto in April, 2017 or what I thought was Keto. I think it was more low carb than Keto. I was told eat low carb and low fat because I had a lot of fat on my body. I started real Keto in June, 2018 after finding and devouring all the 2 Keto Dudes episodes. I had a relapse over the holidays. I was depressed because I had hardly lost any inflammation. My blood sugars were still ridiculously high and of course I hadn’t lost a single pound. I recommitted in January this year and purchased a ketone glucose meter to start tracking. I attempted fasting but my body didn’t respond well after the fast when I started eating again. Eventually I got over that and was able to fast without too many side effects. 

I tried to get the optimal Dr Boz ratio, but even after fasting for 69 hours, I was still way off. I went mostly carnivore in February. Still couldn’t hit the ratio. Ketonesrarely went over 0.5, they were at 0.1 or 0.2 most of the time and blood sugar still in the high one nineties regardless of how long I fasted or what I ate or the time of day. Recently I started an experiment. I eat only beef, usually ground beef or steak, butter, salt and water. I got a host of labs done beforehand, fasted. Waiting for the results to come in. My insulin a couple of weeks ago was 19.2 which is in range, thankfully. I plan to do labs periodically to compare. So far this seems to be helping as I’ve lost eight pounds in 12 days and my GKI is slowly improving.” She believes that cortisol is to blame, at least in part for her constantly high blood sugars. 

“I get a 40 to 50 point spike in the morning around two hours after I wake up and take my first reading. The result is the same whether I’m just driving to work or laying around the house relaxing.” She does tend to eat late in the evenings, but she’s tied to that because of her work schedule, sometimes doesn’t eat before 9:00 PM. She knows this is detrimental, but she doesn’t believe it’s the only cause, but she is trying to make changes so that she can eat a bit earlier. So that’s a long update, but quite a bit of information in there that I thought might be useful. 

Right. I took notes, so I was trying to keep track of what my thought processes were. So you can tell she’s watched some of the videos on my channel because she knows about checking those blood sugars with the blood ketones. She’s clearly making ketones, which is powerful to just reassure this is a better metabolism than she’s been at. And then to know that there’s a 200 pound excess mass on her body. To hear the words, I have sugars in the one nineties after multiple hours of fasting and when I checked my blood tests and I only had an insulin of 19 as I was fasted, which is in this normal range, I would actually tell her that she has undiagnosed diabetes. So whether she knows that or not, I don’t know if that’s part of the journey. I didn’t hear that in her presentation. But when your body has diabetes, it has, the efficiency for processing the glucose is broken, which is what causes the brain to deteriorate, the heart to deteriorate and the scramble inside the body to find a place for glucose. That when you have a blood sugar of 190 and your body’s only producing that lower amount of insulin, that is a mismatch. The insulin should have been higher in her case. You’ll say, but doc, the range of say, you know, if you can get it below five, you’re doing great, so 19 isn’t awful. Like those are with normal blood sugars. You should have produced more insulin to put away that sugar to get it out of the bloodstream, because that sugar is what is inflaming your system. It is what it is aging your blood vessels in your brain. So when I look at what would I do in a case like this, I would look at an A1c. 

I bet you it’s, she’s not making enough insulin anymore. Her cells for producing insulin have either fatigued or just cannot produce enough insulin for the mass of her body. So what do you do? She’s doing a lot of things right, like to reset and to encourage her, is her metabolism really is the key to fixing this. Running her body’s metabolism on a fat-based platform as opposed to a glucose based platform, she’s heading there. Looking at weight loss in a diabetic, it’s difficult. That is almost the taboo. We say you can’t lose weight. You’re a diabetic. Now, that’s not true. But it’s so hard when they do not understand their own glucose ketone ratios, that without monitoring that you will be so frustrated. You will think I’m doing everything right. I’m doing all the rules correctly. I can’t fix the problem. I can’t lose weight. I don’t know if you’ve watched any of the videos I’ve done, but there’s a type one diabetic that I followed on my show and again, so she doesn’t make any insulin and she comes with an average sugar around 300 at the beginning of this journey. 

Now her sugars are around 100, 110, but if she fasts, which she’s done the last couple of months now, it’s the only time she’s been able to lose weight and she’s like, why is it that when I fast, I can do that? Number one, we cut her insulin in half because we don’t want her blood sugar to drop too low. But number two, the ability when you lower insulin, especially if you’ve been given the same dose everyday, everyday, boom, you drop it down, you now give permission for those fat cells to open up and release their stored energy. You’ll say, well, you know, why can, you know, what is it about producing a ketone that has to do with insulin? The state your insulin is at is goingto be pretty stable. Yes, it goes up and down when you eat, but the average number is going to be plus or minus 10 and your pancreas will keep that level at that certain range until a sudden drop in food or a rise in energy demands happen. 

When the sugars change, the insulin can change and that drop in insulin allows your fat cells to provide the ketones, to provide the source of, you’re trying to lose weight, the weight comes from emptying a fat cell. You cannot empty a fat cell when the insulin stayed the same. You have to drop the insulin. So in a type one diabetic, we dropped the insulin during her fast and she’s able to lose weight. Well, doc why don’t you just drop her insulin the whole time? Because her sugars would be too high. It’s a very difficult thing to navigate to help her with the weight loss and then keep lowering the insulin steadily over time to match what her glucoses are. In a case like what you’ve described, the first thing I would start with is, there’s a drug called metformin and it’s out there. 

If you’ve been in the Keto world awhile, you’ll hear that it’s gonna have some impact on mTOR and cancer prevention and longevity, but it’s a diabetic medication. That’s what it was first put on the market for and it’s not insulin, but it does improve the efficiency of taking sugar from the blood and putting it inside the cells. So in a case like this where she’s doing all these things right, I would augment her body’s ability to do that with a prescription of metformin. I sometimes use that in people who say, I just want to help the sugars be better controlled. And even if they make plenty of insulin and they’re not, metformin, it doesn’t hurt you, doesn’t lower your blood sugars too much. It just gets them from the bloodstream inside a cell easier. And that’s really where she’s struggling. 

The next thing I would consider is really getting her a continuous glucose monitor for a two week experiment because it would be very powerful to see what is the range of her sugars. And if the sugars are all hanging out between 150 and 200 or 150 and 250, you’ve got to get on board with an internal medicine or primary care family practice doctor to address the lowering of the sugars with added insulin. And that’s gonna sound like the enemy at first. But trust me, you gotto control the sugars in order for the inflammation to be better. If she was trying to avoid that, avoid being an insulin dependent, and this would be a type two diabetic even though it’s from fatigue of insulin production that we’re kind of stuck with here. We look at matching her cortisol. I mean that is incredible amount of stress. 

Her stress level is powerfully overriding the production of releasing glycogen, releasing sugar from storage. So that’s part of where all of this sugar stuff has come from. So what I would say is she knows what I’m going to say cause she said, I already tried this. I know I’m doing this wrong. So especially women over 40 and I do this because I get a ton of messages from them saying, Dr Boz, I’m at a stall, I can’t lose weight. And you know that woman over 40 I’ll say, allright, you see what time the sun comes up, you have eight hours to eat. And it’s because that sun comes up and your brain sends a signal to release cortisol, which tells the liver, give me some of that stored sugar called glycogen. And your sugars go up and the energy in your body rises while you’re asleep and that’s what wakes you up in the morning. 

You will have a churn of extra cortisol for the next six to seven hours after that. So we say sunrise plus eight hours is your eating window. Even if you say, but I don’t eat in the morning, I fast. I’m like, yeah, but you didn’t tell your brain and your liver that, you didn’t tell the sun that. And so keeping the calories low during that time is a great way to burn those sugars. Have black coffee, continue to fast during that time, but set the timer to say, I need your big meal to be before that eight hours is up. What she needs, she’s like, well I can’t do that with my work. I’m like, get a doctor’s note. Find a way that you’re not eating after that. Because what’s happening is even if she’s eating the most ketogenic meal, she is still producing cortisol every time she eats. 

And like, what? Like she’s in a high stress state so she is churning another wave of cortisol by eating, you know like, okay, so I need only one wave a day. We can’t stop the sun from coming up. So that’s goingto be the one wave of cortisol we use and as that wave takes its time and goes up and down by the end of that eight hours. That’s why I like them eating in the middle of the afternoon, that two to three o’clock when they’re stuck with a stall, I need them to eat. I need them to have high fat. I need them to eat to satiety. They’re fully satiated and then I need them to have none after that. That is difficult. It is a social time to eat. It is a very challenging goal. So to wake up tomorrow and ask her to do this is kind of unlikely, but if we say, all right girl, wegotto back it off the edge. 

You’re going to start with, thereis no food after seven o’clock at night. Even if you work the night shift, I need you to respect that. You gotto find a way to get the food in before seven o’clock. If you don’t, find a way to fast until the next morning. My husband teases me because I tell him when he wants to eat late at night, honey, your clock will reset and he uses this against me whenever I want to do that late at night, your clock will reset, but it will. If you can push through that wave of hunger after that seven o’clock hour and once you’ve mastered seven o’clock, then we’re going to back you to six o’clock and we’re going to keep going back until you can get your eating to be within the eight hours after sunrise and you will reverse the problem. 

You will start using energy as fat cells. You see it already in the times where you’ve successfully fasted and I would contend that that has been your lifesaver. I mean that by you’re not, I mean to have the body mass that, that you’ve struggled with and then to see that your sugars have been in the 190 long enough that we have some sort of insulin production fatigue, like the insulin is not meeting the demands of your body. It says the algorithm is advanced. We are at the later stages of a diabetic journey. We can help with Metformin, but nothing will be as powerful as her honing in the hours that she eats. Fasting is one of those way`s she can do that, but putting the food to match the sun is going to be super important. 

Yeah. As you’re speaking, I’m trying to think of a practical way that she’s going to be able to do this. She obviously has this problem. I think she finishes work maybe around seven. This is why by the time she’s got home, yeah, and even prepared something quickly, it’s difficult, but I’m thinking so, okay, so what is the solution here? Obviously weekends, no problem. Can follow a plan at the weekends where you’re saying, so really all her food needs to be in before, what, three, four o’clock in the afternoon? 

That would be amazing. But again, if you start her there, that could be too heavy of a goal. 

Yeah, absolutely. And I get what you’re saying about moving it back. All I’m thinking is that during the week that’s not goingto be possible, even from that 7:00 PM. But what I’m thinking is maybe, especially if she could incorporate some fasting days during the week, that obviously completely solves the problem, but also potentially being open to maybe going for the breakfast and lunch option. I think it might be difficult to have much of a meal at work, so maybe the big meal being the breakfast. I don’t know, I mean it’s a real massive change isn’t it? It’s a big jump to go from one thing to the other, but maybe.

Here’s a couple things I’ve done, because I’ve actually had this same scenario in my clinic where I’ve said, all right, let’s fail upwards. Let’s improve upwards. 

I’m thinking of that push back. I’m sort of sitting in her position saying, well, I don’t get home, I don’t leave work until seven how am I supposed to eat my meals before seven you know, what can I do? 

So, right. Yeah. Planning and having that break at work to eat your meal at work those are great ideas and they could work, but it is a different approach. What I would contend was if she gets to 7:00 PM and she just cannot imagine not eating, I would encourage her to do exogenous ketones. I would make a shake of ice and ketones and sip on that. It is fuel. It will enhance her metabolism. It is not sugar that goes in with, I mean she’s got plenty of sugar happening. That’s the problem actually. She’s got really high sugars. So when we fail upwards, if we add ketones to her situation and say, okay, we want you not eating anything at all, but if you’re goingto put something in, we’re going to add something that over the next couple of days you will have a stronger metabolism because you put more ketones in to burn for your metabolic health than you wouldhave had, had you, I mean, even if she wouldhave fasted, her ketones will still be at a lower level until she gets that metabolism rising. So when I say fail upwards, it’s not perfect. I would love a whole script and put her into like a, you know, calculate what she should do and follow the rules specifically. But when the enemy is us, you say, allright, what could she do that would feel good to her? And you know, those exogenous ketones, mix them with a little cream if she needs to have, you know, some fat with it. If it happens to be MCT, it’s even better. So now she’s got two ways her body’s adding ketones. It’s going to be the energy or the fuel she needs and it will become this mindset that says, if I want to eat, I have to do that before seven o’clock. 

Or the only option I have left on the table is to add ketones without food. And that has worked amazing. Like I have two people. I’m thinking in mind that it did improve. It took about three weeks for them to say I figured it out, but I only figured it out because I did it with that messy version where I couldn’t not eat, I wasn’t strong enough to fast, but I put in ketones and by about the fifth day they start thinking in a different way. They start strategizing and the next choice was better and the next choice was better. Now they don’t do those exogenous ketones at all, but for bridging that, it really did help her. The two I’m thinking about saying, oh look at that. You got home from work, you did not carb crave. You did not even like ketoglutton, you know like they’re, everything I eat is Keto, doc.And like I know, but you’re putting in so much mass, I can’t get to tap into the stored fat cells that you’re trying to lose for weight. And if you want to do that, we have to shift the metabolism. So fail upwards and that will shift it. 

Yes, because ultimately like you’re saying, if you’re goingto ride that cortisol wave and eat while you can, and if the only time you can eat at home and have that meal is breakfast, ultimately that’s going to be your goal is fasting and breakfast during the week with meals into the afternoon at the weekends. But you’re right, it’s just that massive jump. But if you can bridge that gap and then get to a place where you’re doing something that works, even if you thought it couldn’t work into your schedule, but if it’s goingto get you where you want to go. You know, this is a big problem that she’s got to solve, isn’t it? 

And it’s not uncommon. 

There’s only so many ways to do it. 

It’s a great question because she’s doing everything right. She’s invested to understand her own body chemistry and she can see that there’s a problem. She has sugars in the 190 range. That’s diabetes. There is a break in metabolism. If I could get a reign on this, if she could get the numbers down, if I could get her to fast for a month, okay then we’d be fine, but that doesn’t fit life. Look at all the stress she’s had. Look at the lack of sleep. You know her support system is obviously good enough to do as much as she’s doing. So asking her to be the perfect results. That’s ridiculous. There’s no chance for longterm success by saying, oh honey, if you just fast for the next 40 days, you’re going to be fine. 

She can stay off of insulin longterm, if we can shift her metabolism to a higher ketone base and essentially what she’s going to be doing is we want her using the calories stored in those fat cells so it will become a lower calorie ketogenic diet is what will, because she’s already keto adapted. As long as we can keep the ketones burning, the size of her meals will get smaller and those are conscious choices, but also subconscious because she feels good. That does play a part. I don’t usually talk about a calorie restricted ketogenic diet unless I’m talking with seizure patients, cancer patients, or in a situation like this where I really need a metabolic boost in her system to keep her off of injectable insulin. So pushing to bridge that eat during the cortisol phase and once you kind of find the rhythm that you’re now eating in that eight hours after sunrise, that’s when we would talk about now we want your meal sizes to be smaller. And the reason why is I need to tap into the calories you’ve stored as fat. That’s how get the weight loss gone. That’s how your insulin needs will be less when your body mass is less. It’s a three step process here. 

Well, hopefully she can see a way through this and start seeing a change because I really feel for her. I’ve seen how hard she works and as you’ve seen, you know, she’s a smart cookie. She’s worked out a lot of these things for herself. She knows where the issues are and she works really, really hard at it, you know, and is prepared to be very restrictive in what she eats to work really hard to do the work with the tracking and all sorts of things. And it’s just must be so, so frustrating. I really do feel for her. 

Well, I do hope she’s got a support system of people encouraging her because that, I mean, had she not taken on Keto in the last chapter, she wouldhave been in an ICU somewhere with a completely failed pancreas. So she needs to know that the choices she made to make this shift have been life altering even though she can’t see the disaster that would’ve happened. I’m certain of it. 

That’s very true actually. Yes. That’s a very good perspective, is to actually see what feels like such small steps forward as actually really massive leaps. 

From where it shouldhave been, right, where she was headed. 

Right. Okay, so this is another one that’s in the ballpark of where we’ve been talking and I know is something that you’re really passionate about and that’s brain injuries. This is from Sarah. Sounds like they’ve been a bit unlucky in their family. “I have so enjoyed your episodes with Dr Boz. With her experience with brain injury, it would be helpful for me and my family if she could address concussions and how Keto helps them to heal. I have had at least two in my life. My son had a serious concussion a few years ago when he was 16 and now my daughter also. She has just turned 16. They are both soccer players. I watched the brains of addiction video you posted. Thank you. Does a concussion leave defects in the brain such as the ones in the pictures you showed? Does Keto help heal these holes over time?” 

I love this question. I do this workshop called Brains of Addiction: From Trauma to Repair. And the foundation of that format is an 8 to 10 hour course, which sounds like a lot, but people are so hungry for this exact question. And it may at first sound like I’m goingto talk a lot about addiction, but I really spend time talking about the traumatic injuries to our brain and what we know about healing them. There are many parallels to addiction, but her kids at 16 and 16 having concussions, she is near and dear to my heart for, for being passionate about, how I think of the job as moms is, it’s my job to develop your brain to the highest level and make sure you’re not in my basement at 30. And I think of that as what is the, what are the foundational rules for brains and repairing them, as you guide your teenagers through these injuries. 

Because when they have a concussion, there is very good evidence you can see on those videos that I’ve talked about, that the brain no longer conducts messages through the sections that are swollen or concussed and as long as that swelling repairs and completely goes away, you can see that brain awaken. But if you want the biggest enemy for a concussed brain, there are two that are so common in our teenagers today. Number one, they have an unstable bedtime and it’s too late. They are pushing their brains to be awake too late. They are stimulating their brains with screens for at least two hours before going to bed, and the depth of sleep needed to repair the brain, specifically making something called BDNF, brain-derived neurotrophic factor. That protein is what repairs our brains. And if you’re not getting that good teenage 10 hours of sleep, especially after an injury, you are inhibiting the brain’s ability to repair.

Because they’re forced to get up early as well, aren’tthey? I’ve heard people talking about this, we should really be starting teenagers at school much later. 

I would actually say that it, shifting that to an earlier bedtime is just as easy for our society to do and actually probably plays forward in the neural programming better than starting their school day later. I say this as a mom of teenagers where it would be perfectly easy for me to have them start later, but I’m saying I want their brains to play forward with the best neuro programming and that really does say getting their head to bed earlier, showing them the respect needed for repair of a brain. But the other major enemy out there is sugar. And when watching a teenager’s brain go up and down in sugar production, unbelievable how damaging that is for a scar that’s already swollen in their brain. 

In that brains of addiction video, you’ll see a picture of a diabetic and that diabetic hasn’t, doesn’t have an alcohol problem, they don’t have a drug problem, they haven’t had concussions, that is simply from their diabetes. And it is the swelling that happens in their brain and stops the conduction of messages going through because of the repeated swelling from high blood sugars. So to get that concussed brain to repair, pushing their brain to use ketones over glucose, very important. Number two, bedtimesof the whole family. If you want a teenager to do something, telling them to do it without doing it yourself, good luck. So now you have 16 year old brain injured teenagers who are going to be moody and irritable because that’s the journey they’re in. But I would contend that their moodiness and irritability grow worse every time you stop the maturation or the maturing process of their brain, which happens with a concussion. 

But it also happens when they have poor sleep, when they have excessive sugars go up and down. My youngest son is a wrestler and between him or his buddies, whenever they have concussed brains, I’ve had consults in the homes of his friends saying, all right family, I know this is hard, but all screens need to be off by seven o’clock at night. If you have something you need to watch, you can put it off till tomorrow. No screens in the bedroom. Everybody’s phone goes in the basket at seven o’clock. 

Wow. That is hard. 

What is powerful though is, and some of them did the Ketogenic Diet. Others supplemented the ketones to get the family onboard and then has actually graduated to a very sustainable ketogenic lifestyle for that family. But it wasn’t easy at the beginning. And that commitment to say, when you see the suffering that happens longterm with concussions, it’s powerful how many brains don’t return to normal because they aren’t given the six months time to repair. So you say, well, how long do you have to do this? If it’s a teenager, it’s a six month process of getting that inflammation out and allowing their brain to return back to the normal growth pattern and for heaven’s sakes, don’t let them get another head injury in the meantime, so that can mean a limited amount of the sport activity until they graduate. I can’t emphasize enough how powerful it is when the families choose to engage in those treatment programs versus not. In that first couple chapters of my book, I talk about these brains of kids who had seizures and then years later, you know they get put on the ketogenic diet because they’re the misfits. They didn’t fit the treatment protocol, they didn’t respond to the prescription medications, and we have a couple of autopsies from these seizure kids that are now in their seventies or eighties and they’re at autopsy. Their brains are beautiful. 

That’s not how it’s supposed to be. That environment of low inflammation, specifically fed by a high fat diet is a powerful repair process for the human brain. Getting those kids to journey onto that type of eating, they have temptations at every turn. It can be really difficult. So showing them the process and the progress by sharing some of the stories from that book or looking at some of those youtube videos, that’s how these moms motivated their kids to get on board. Because what they were saying was ridiculous and no, no way. But just looking, saying, hey, you’ve got a brain that had this injury. If we want it to repair, here’s the rules. We need really good sleep and the sugars have to be low. You can’t be carving up day after day after day. It’s gotta be a Ketogenic Diet. Very good question, though, because I get that a lot. 

So there is hope then. 

Yes. 

You know when you’ve seen these scary videos with all these pictures of holes, what you’re saying is that you can heal them.

Absolutely. And I think that’s the part that when people say, why would the average person look at a doctor Boz ratio or what, you know, getting that glucose and dividingmy ketones, why would you look at these numbers? That sounds kind of geeky. I give them affirmation that says, no, you have a really important repairing process that’s happening every day in your brain. And some of the injuries we don’t know about, they’ve led to chronic depression because the scar never healed from that injury long ago. Andyousay, well doc, it’s been 30 years. Can I do anything about it? Like yeah, stay in Ketosis for three to six months as an adult and watch what happens. And you’re like, what? No cheat days. I’m like, no, no cheat, that we’re repairing a brain here. And again, if I, if I have that as the leading conversation with somebody who going into the ketogenic diet, I can often lose them. It sounds impossible, but once people have been keto adapted and they really feel the positives and the energy and the focus and the improvement they have with a Keto diet, and then they say, are you saying that if I do a really good job of this for three to six months, that my old brain injuries have a chance of healing? And I’m saying yes, but it has to be a steady chemistry environment for them to repair. And that wins the conversation. 

Right. And it all starts becoming more feasible and doable, doesn’t it? When you start feeling better. You know a lot of people start Keto and they think they could never eat this way for the rest of their lives, but they actually start doing it and realize how delicious it is. And yeah, this could be a lifestyle. This is not just a diet. And I feel great to boot. 

And if you ever didn’t remember that, you felt great, itt’s that first time where you binged saying, I have done a great job for several months and then they have, you know, carb up and you’re like, oh, I’m heavy, I’m swollen. I can’t get my ring off. I just feel my joints hurt again. It didn’t take long for all that to come back and then suddenly you say, well, it wasn’t that bad of a list of foods. Actually they were pretty good. So if you’re saying that I could journey in that direction and feel that good, now you have other reasons why they stay the course and they hop on the bandwagon quicker and yeah.

Well that’s why people tend to stay. I find a lot of people start from a weight loss perspective and might see it as short term, but they start to feel so good and that’s what keeps them, that’s why they stay the course, is for the health benefits. 

Absolutely. And that is a real improvement in the conversations that even were happening at the time where I was first writing this book where I couldn’t hardly find anybody to sit still and say, no, no, no, this is my plan for a life. Is that safe? And now you hear all the evidence of improved telomere length and improved longevity and brain function and you know, repair. You know, you look at the of national sports physicians that attend these metabolic health summits or conferences because they want to enhance the repair process of their athletes on the team. That’s the difference between and win or lose, is how quickly they can repair and nothing beats the anti-inflammatory state of a ketogenic athlete. You can hardly find a national athletic league, from my standpoint, that doesn’t at least talk about the ketogenic diet being part of a good option for their athletes. 

Right. I mean you could call it, that could be another name for keto couldn’t it? Anti inflammatory diet. 

Yes, andin fact my husband does not like theword ketone. He thinks it’s too sciency and so when I was writing writing the book, he’s like, you’ve got to come up with a better name than Keto. It just sounds like chemistry. And I’m like, it’s because it is honey. 

That’s not a bad thing. 

So one of my options was, well I can call it the anti-inflammatory diet, but that’s just so many syllables over and over again, I don’t think it works. So I agree with you. 

This is a question from Shelly and is about tinnitus. It’s short and sweet. “Do you have any experience of healing tinnitus with Keto?” I can instantly tell that she hasn’t read my book because I put together a list of things that surprised me when I had implemented the Ketogenic Diet in my internal medicine practice and done it for other reasons, but I had the first two patients that came back and said, you know that ringing in my ears that I’ve had forever and ever and you gave me these meds and we tried this and that and nothing really worked? I was afraid to tell you because I thought it would come back, but it really is gone. And that really landed in their journey about three months into the real journey. And I say that importantly. At first they were a little bit Keto, meaning they’d checked a couple of urine Keto strips and they had turned pink and then they fell off the wagon and then they went back on and then they carb cycled where they did good job during the week but had a bunch of beer on the weekend and then something, in each of their stories it was different, something pushed them to say, all right, I just need you to give me three months of not screwing this up. You can do this. It’s better than anything else we have. And if this doesn’t work, we can take you to surgery. So they manned up, girled up, whatever, and did it. 

And they took their doctor Boz ratio, meaning they’dcheck their sugars and their ketones and really monitored that they were in ketosis and it wasn’t that great of a ratio. They had a Dr Boz ratio of like under 120, so not terrifically wonderful. Just pretty good. And it was constant. 

I was going to say, it’s that consistency thing that you were talking about before, just being in Ketosis for a block of time. 

Right. And you know, it’s, it’s that same thing. What would you pay to take away that buzzing in your ear? And it’s haunting. I mean I have spent hours and tons of time just trying to crack the puzzle of why it happened and what, and really, I have come back to after years of, you know, struggling with this, is they have kind of an arthritis, if you would, in their ear. 

I was goingto ask you, isn’t it one of those things, is it difficult to pin down exactly what it is, what causes it? 

Right. So you’re conducting a sound when it’s not supposed to conduct. So I always tease my kids which substance conducts sound the best? Air, water or a solid? And sometimes they’ll get it right. Sometimes they won’t. And I said it’s a solid and if you put your ear on the railroad tracks and you could hear the train coming. You remember how they used to do this and that? Okay. Put your ear on the railroad tracks. Is the train coming? You could hear it on the rail long before you could ever hear it in the airwaves. You look at telephone wires. I mean they conduct sound. So you look at your ear and the same thing happens. 

It’s got a fluid that sound conducts through and that’s inside the inner ear conducting the sound, moving that energy into a nerve that gives you a sound that your brain knows what it is. If you now crystallize that or it gets a hardening, now the sound conducts quicker and faster at the slightest movement. That’s why sometimes you can say doc it seems to be my pulse. Like, yeah, the movement of that blood creates a vibration and sound is a vibration. So I need you to stop conducting that sound. I need you to block that out. But they can’t. It’s signaling too high from their baseline. So to undo that means the swelling in the other parts of the ear need to reduce. So you need to remove the water and remove the inflammation from the inner ear. Well, you can’t unless you’ve got the whole body’s anti-inflammatory, or removal of inflammation happening. 

And in some people they get lucky enough where if there is some crystallized or hardening or calcification that’s happened in the inner ear, the swelling now isn’t surrounding that crystal. And so the solid crystallized compartments don’t touch anything else and that’s when the sound stopped. It’s super sciency and kind of gets into a microscopic level. But I hope you can imagine like as soon as there’s nothing conducting the sound, as soon as you separate the water from the crystal, you have no more ringing in the years. Well that is, that’s a advanced level of your removal of inflammation. It’s on the inner part of your ear. So we had to keep them in Ketosis for several weeks in a row. I didn’t do it for that reason. We were doing ketosis three months for other reasons and they came in on their own saying, guess what? And like no way. And then then I’ve had a few other patients do the protocol. They have to stay in that zone, they have to stay in ketosis. And then of course, like anybody, a couple of them fell back off. The swelling came back. Boom. 

I was just gonna say, I bet it comes back full force.

Oh yeah. You look at those kids who had the seizures and they stayed on the ketogenic diet because every time they weren’t on a ketogenic diet, they had a seizure. It was forced compliance. And so when people say, oh, shucks, like if I go off, I have my ringing in my ears back. I instantly compare it to that. I’m like, this is nothing compared to a seizure. You can do this. And it gets a little easier. Besides, if they get their autophagy, there is a chance that they can recycle those crystals, recycle that arthritis. And I don’t over promise that, but I’ve been very impressed with, the longer they’re lean with ketosis, the less orthopedic surgeries I am referring for. 

Oh, that’s really interesting. You start to worry that you’re gonna sound a bit like a broken record though, don’t you? Because it’s like any kind of condition somebody mentions Keto, but seriously, if any condition is an inflammation disorder, it’s going to help isn’t it? 

Yes. I look at my clinic and think what would it not help? Because it does, it sounds like a panacea. You’re over promising, this is never goingto work. And you’re like, no, no, really. You just have to link it to inflammation for the science to be broken down. And the longer I do this, the more I see. Yup. That has an inflammatory component as well. From brain health to heart health to arthritis. Yep. Inflammation is in all of them. And it speckles not just an internal medicine clinic, pretty much every clinic for primary care. That’s why you see more physicians saying, alright, teach me how to get my patients wrapped around this. And the more we can educate them, the better the outcomes have turned out. So I highly encourage the woman who wrote that in to go check that chapter out in my book. I do write about that story of the patients in that book because it was shocking to me. Like who knew? 

Yeah. Wasn’t something you were expecting. I forget which speaker it was. It might have been Dr Westman, at the conference at Denver. And he was talking about all these different parts of medicine and how not necessarily Keto specifically, but changing sort of health and lifestyle certainly in that direction should be a primary care, because it impacts all these different branches. 

He is one of my heroes, Dr Westman. He is internal medicine as well. So he has this kind of sorting of how he thinks about problems that matches the way I think about problems. And if you talk about beacons and leaders in my world, he is one of my favorites. So I just would say any lecture where he’s been talking about sorting of improving the health of your body, check it out on youtube because I’m gonna bet it matches what we just talked about here. 

You absolutely have to get to the conference at Denver. I thought of you while I was there. It was just, it was amazing. It’s the first time I’ve been to a conference like that that’s so full on turnover of speaker after speaker after speaker. You know, hard and fast, sort of half an hour presentations and I thought, wow, my brain is just going to shut down because it’s going to be overload and I’m just gonna have to zone out by about two o’clock cause they start really early as well. 

Yes, we internists. Any physicians, you have rounds, and early, absolutely. 

So the day kicks off really early and also the clocks wound back. So it ended up being like ridiculously early on the Sunday. I was actually fine with it because of the jet lag. So I was fine being up early but I really thought it would be just too much. You know, for someone like you, you’d love it. But actually it was fine. They really got the pace of thelectures going well. So it just, it was so stimulating and interesting. I could see you there really, really enjoying it. So you must, you must go next year. 

I’m looking forward to the next year. I truly have been in hiding waiting for this decision from the medical board saying I just, I don’t want to have any reason to take any media or take any attention. And so hiding was safest, but I was envious of, and waiting for the lecturers to come out on YouTube so I could watch them myself and have not been disappointed. Very, very powerful presentations and conference. 

Absolutely. I really enjoyed it. It was fantastic. I guess you’re going to be all the conferences next year then?

I’d like to be, yes. I told my husband I’m going to become a Keto junkie starting now. 

There are worse things. Well, thank you so much. We still have some questions, but they’re going to have to wait for another episode, but I will keep them here and I will try and get you back soon to go through the rest of them. 

Well, Daisy, I just want to say thank you so much for having me on your podcast. I really find the format of the discussions and just the tone of how you connect with people very attractive. So thanks for including me on your list and I look forward to more episodes. 

Well, thank you for coming back and I look forward, too. Thank you Annette. 

You betcha.

This transcript is brought to you thanks to the hard work of Michelle Richter

Welcome back Annette to the Keto woman podcast, how are you doing today?

Daisy I am so happy to be back on your show. It’s great to hear you and see you again.

It’s really nice to see you. What the listeners don’t know is we’ve actually spent the last two hours together trying to sort out an absolute catalogue of disasters when it comes to audio.

I think I’m cursed. You know, the process of recording my own voice has become a sabotage in my own universe, like at least 50 times since the last time I’ve spoken to you. It’s me. I swear it’s me. 

It’s me too ’cause I’ve had audio problems this last week or two as well, so I’m hoping that we’ve hit our quota now and things are gonna turn around the other way. 

Nothing better to forge a friendship than to struggle together, so we are good. We are besties. 

Absolutely. Well why we’re talking about things turning corners, congratulations are in order. Well done for finally winning the battle and getting your license back. 

Right you know, the season of having a journey that your perseverance is tested and your stamina to stay the course and not be brushed away by a storm that just seems to just rise month after month, it is a time of deep breathing for me that says, okay, let’s forge forward. I think your audience was the first at.. Your audience was the first place I spoke of my challenges to fight for my medical license, and it is remarkable to be able to say that I had 12 felonies reversed….. removed, and in that process, I actually did keep my medical license the whole time. It’s what is un…. It’s difficult to explain to the world, but in the process of the judicial system, I did say, nope, this has nothing to do with the practice of medicine and this is not justice. And by a year and a half, oh gosh, we’re four years later from that moment. This past month, the medical board did not just reverse all of the claims that the attorney general’s office was pushing for, but I mean all but apologized for like, there is no ding on my license. There are no patient complaints. The month before this happened, they ordered me just to leave the state and I was prepared to do that. Just, okay, just give me a chance to start over, this is too heavy. And you know, I walked into a board hearing that is super scary, not allowed for public viewing, which to me seems even more frightening with the story that I’ve been through. And at the beginning the attorney general said, we want her license, we want it completely. And when we walked out of there, the medical board said, nope, you can’t touch her license. There’s no harm that should come to her. She doesn’t need to leave the state. Some of the other goofy demands that they were asking were all denied by the board and I was allowed to walk out of there, actually, I ran out of there saying go! So it is, you know, as a physician who is committed to educating my patients and really pouring into the intimate journey that is the privilege of being a physician. I really think God knew what he was asking me to strengthen in these last few years to say, I’ve got a different path for you than I would have taken had I not gone through that stress. 

I wrote a book, first of all, I was never going to write a book. That takes a much slower pace, you know that protected time to mentally process and write down and edit and think. That doesn’t happen in a busy practice that the story happens to be lifesaving for my mother. Yeah, that’s a blessing that I’ll take that. You can take my medical license. I’ll take the story that I’ve had in the last few years and watch what strengthens me as an educator, as a provider, as a daughter, as a mother, as a wife. And those moments couldn’t have happened if the pain of what was in the backdrop hadn’t forced me to look at a different direction. And so you say in this silver lining is a path forward now that yep, I have a clear medical license and now I get a choice point to say, well what is it that I want to do at this stage of my life? And that’s a gift.


Yeah, I just can’t imagine the overwhelming nature of it. This sounds like a silly thing to say and it is a silly thing to say, but I was taken to court once to a tribunal for my dogs allegedly barking. And it sounds completely trivial in comparison and it is completely trivial in comparison, but the only reason I mention it is that was massively stressful for me. Massively stressful. And that was a tiny little thing in comparison to what you’ve been through for so long. I mean, that was, you know, a relatively short, a few months out of my life and it was constant migraines and constant stress. I couldn’t sleep all the rest of it. Well, this is everything about your life. This is you, this is part of you and it’s been going on for years. I mean, I just can’t imagine you must be sort of in this place where you almost can’t, you don’t know how to feel I must imagine. There must be a massive sense of relief, but also this sort of sense of purpose in this battle that you’ve been going through is suddenly over. And I can just imagine you being a bit sort of lost at sea and I don’t quite know what to feel. 

There’s a boogeyman that’s been looking over my shoulder watching every moment, you know, I’m not exaggerating when I say I’ve had black vans outside my house for the better part of four years on and off and that does something to you. I have kids I’ve had.. I’m almost afraid to tell the stories because it sounds ridiculous, but in that I have really learned that there is a foundation of strength that comes from my faith, seeing I can’t see where this is going, but I know that there is a bigger plan and that I wasn’t given these talents to waste them. And if it means that I’m supposed to change course and my medical license goes away, I’ll find a way to use the skills that I’ve been given and honour that gift by using it. I don’t think I could have said that four years ago. I know I couldn’t have, I would’ve said, oh, somebody’s coming after me? Why I haven’t done anything wrong. And then so it doesn’t matter, here’s how life plays out and the stress is something that, you know, I have three sons who went through some very formative years in the last four years because of their age that they witnessed, this is what it looks like for a marriage to make it through a difficult chapter. This is what it looks like to keep a unit of a family together and the whole world seems to push or exploit or stress the family and say… It would have been easy, and I did have days where I’m just like, I’m staying in bed nothing. I mean, I’m just going to stay right here. But that was rare. Most of the days I got up, I found strength in my purpose and my faith to say, nope, I have a purpose. I am supposed to use it and if I don’t use it, that’s when the enemy really wins. And I can’t even express that the last, I mean it’s only been a couple of weeks, mind you, the three and a half weeks before that, I was scrambling to get licenses in any other state. So to now not be ordered out of the state. It’s almost like, I’m not sure where I told myself don’t make any decisions for two months. Just pause, I’ll keep going for the license in other states in hopes that I have options. But I will tell you I just was planning that there would not be a medical license at the end of that. The hearing wasn’t supposed to happen for several weeks. I mean we were planning on a medical license because the hearing was going to happen after I got a medical license in another place.

So we got this 10-day warning, 13-day warning that says, nope, prepare your case. Be ready to present, it’s a trial in front of the medical board. And yeah, we had lots of layers of protection around us for all the right reasons. And I’m super excited to just move on to the next chapter and I get to carry with me the blessing of becoming an expert in the ketogenic diet. Not because I had this fore planned journey, but because it landed right here in front of me and I embraced it, I was incredibly curious, I dove deep. So now I get to go forward with that talent, that skill on top of having a medical license. I mean, there’s just a lot of authority that comes with that, that I don’t know which way I want to use that, but to remove it without honest cause. So yeah, to have that assignment or that, burden without a cause was what really said OK, there’s bigger injustices in the world, I’ll find a journey forward. So, to march forward with the skillset of being an expert in the ketogenic diet and being an internal medicine physician licensed in the United States, there’s lots of opportunities. There’s lots of places I can find a rewarding path forward.

You did laugh at me. One email I sent, I said I guess they’re not going to actually apologize. You did laugh.

Like my resources and four years, you know, it’s actually longer than that but since the arrest, it has been four years. 2014 was when I was arrested, it’s 2019, so five years. Gosh, who’s counting I guess. So five years since the arrest, four years since the trial and yeah, it totally changed the trajectory of my career forever. You can’t undo that,

But like you say, maybe for the better. It’s cost you an awful lot of money and an awful lot of stress and heartache. 

Yeah, if you would have said to me, Dr Bosworth, what would you pay to prevent your mother’s death , to restore her life completely. I couldn’t have found a number big enough. So when I look at the price paid, it still is this journey that says I became an expert because I was caring about the most important patient in my world, which was my mom and God had provided me the space to sit still and serve that one patient completely. And now because of that, the ripple effect of the number of people that have read my book, read her story, seen the way I explain the science to her and what we needed to do for her. It’s helped more people than I could have ever helped in that many years. So yeah. What a blessing.

Isn’t it strange how things work out sometimes.

Yeah. I think it’s also the look like I have had other colleagues go through some serious tragedies in the last few years, you know, addiction affecting their families and you know, despite them knowing how to help them can course correct, burying children. And you say, you know in all that midst of pain, can you find the motivation to look for the opportunity? And I really have to give my husband the, I mean cause there are days where I was like, forget it, I’m going to go like I don’t even know what, like I grew up on a farm, I guess I’m going to go do hog chores, I mean I was returning back to the primary thinking that I had as a 10 year old girl and it was his guidance, his words at a time where the depth of sorrow and pity and patheticness was very all consuming saying, are you going to choose this answer or are you going to look around and say what other opportunities find it, fill it. I do think no matter what you’re going through, it’s tragic, but can you stop and say what is the purpose for the pain and when you can find that there’s life in that there’s life. I don’t mean like a martyr. That’s not it at all. It’s saying, okay, I’m here. What could I do? And it’s those types of paradigm shifts that make the heroes of our world saying despite the tragedy, it would have been easy to give up and say you win, I’m done. Instead I wrote a book, I pushed publish, which was the bravest moment, probably the whole event saying, can I show people what I’m thinking? I’ve already been chastised for that in respects to standing up and saying our community needs a different voice of people creating healthcare for the underserved, for the people in my community, let me add my voice to that and to look at the push I got to say silence, discredit her and then to come up with, oh by the way, this is going to be outside the normal stream of medicine and we’re going to ask you to stand alone because there’s not a lot of people saying this message and then do it with the confidence to say no, look what it did to my mom. Number one person that I will show you a story where she wasn’t young, she wasn’t spry, she had all kinds of problems and yeah, just this last month she has for the first time at now today’s her birthday, so 75 years old. She has normal white blood cell count. 

Wow.

Yes.

That’s a nice birthday present, take that.

Yes, off of chemotherapy has been and and she feels amazing. So that’s a win. I’ll take it.

That really is win well, nice News. Yes. Well, after that emotional catch up. 

Yes heavy, I’m so glad I did it without tears.

We’ve been wanting to get you back on the show for another Ask Dr Boz episode or two. I get asked all the time when you’re coming back on and I know how busy you are, so thanks for coming back on to give us an update and to share a bit more of your knowledge with us.

Excellent, I’m happy to be here. This is my favourite, favourite dialogue. So thanks for inviting me, Daisy. It truly is an honour to be on your show.

Oh, thank you.
Well, I thought we’d start with a message from April. She’s got some questions, but she’s had a really good update of late too. so I’ll just read out what she says. First, you’re amazing, Dr Boz. I’ve listened to your book and have been recommending it. My sister is taking your recommended pages to my mom’s doctor who has early onset Alzheimer’s. So this was a while ago, and there’s actually a really positive update to this story because the carers were refusing to give April’s mum the exogenous ketones that you’d recommended that might help and I think you sent her some studies or an article or some such to give to the doctor to help try and persuade them to write a prescription basically. Following your advice and using the information, they got a doctor to effectively write a prescription, so she is now being given exogenous ketones by her carers. Isn’t that great? 

Oh my goodness that is amazing. You know, the brain process of how much we’ve learned, you know, really was one of the first places that got my curiosity. There was kind of this collection of listening to a doctor, Dom D’Agostino explain seizure patients and preventing seizures for scuba divers. And that coincided with a patient whose mother was being treated for a brain tumor and she was trying to say, what can I do to help her? So those two parts were the first inklings that I used to get my curiosity started in the ketogenic journey. And then it was a much deeper dive of watching the repair of a brain from concussions to chronic migraines to memory problems. And you know, I look at the articles that were needed to help her providers see what is in the literature. But I mean, I’ve been that physician so busy that I didn’t take time for the latest updates because how could you possibly keep up with them all?

And so you have your sources where you try to, you know, get the summary points of, you know, what they shared at the conference or what’s the latest literature. But summary points don’t necessarily really motivate you to change behaviour unless it’s got some pretty promising stories. You’re going to be using this frontline, please convince me that this is the right thing to do. So to somehow think that you could take a problem that I’ve told patients for the better part of two decades, hey, you can’t reverse that memory problem, she’s stuck. And now I’m saying, wait, wait, wait. We now have evidence that says we see the energy gap for people with dementia, especially if they’ve been overweight, if they’ve had high insulin, if they’ve had metabolic syndrome. And I’m telling you as an internist, practically every one of my 80-year-old people has had a chapter of that, unless they’re really lean. And even some of those have had it, but most of the folks have had a season of being overweight. And when you look at their fuel for their brain, it’s all glucose. It’s all sugar. And your brain can’t make fuel. It has to haul it in. So the little receptors, the little trucks at the blood brain barrier are pulling in the glucose and then your brain runs only on glucose. So as soon as you get that two-hour, three-hour mark, while you’re not sleeping to ask your brain to work, you’re going to sink, you’re going to have the munchies, you’re going to have that shaky feeling. That’s brain saying, hey, I need some fuel. I’m trying to send you a message. When we saw that in as little as four days, of a strong high amount of ketones in that blood, the blood brain barrier, will take those ketones along with glucose. Glucose is one truck that’s getting pulled over the blood brain barrier, but ketones were also being transported into the brain and within four days we dropped the need for so much glucose and we took ketones from a zero need, up to a majority of the brain was processing and using ketones. Four days. That’s remarkable. I had no idea we could do it that quickly. The study was done where they practically put them in a jail cell to get them to eat this really high fat diet like it’s more of an advanced ketogenic diet than I probably have ever done. It is the prescribed level for a seizure patient, so it’s like super advanced and in the real world you’re going to have a tough time getting people to do that, especially when they’re going from carb fuels to ketones. They’re going to have withdrawal. But when we could see their brains uptake that quickly, anybody in the industry said, oh my goodness, put the ketones in the blood and watch what happens. And as I’ve used that for my patients with memory, I mean, they’re in nursing homes and you say, okay, what’s the worst thing that’s going to happen If I give you a supplemental ketones for the next two weeks? Maybe they’ll get a little diarrhea when we first started. Okay, let’s do it, bring the patient back in two weeks and I cannot tell you the heart stopping transformations of people that I just had assigned to the rest of their lives to be in a nursing home that adding ketones improve the quality of their life, improve their memory. That two weeks was the first awakening where their depression was less, their concentration was better, their energy was better. And what the studies have continued to say is when we see memory problems, one of the major thought patterns throughout their brain studies and biopsies at death and you know lots of people looking into what’s going on is there’s an energy deficit that we’re just barely meeting the needs of the brain’s energy by only using glucose.

And of course with that two hour window, the danger of a two hour window is, and especially in some way with memory problems, is you’re going to constantly be running out so the brain will just shut down when you added Ketones, not just for a one time dose, but now you’ve got a body who’s burning them most hours of the day, you end up with a whole awakening of their mitochondria, of the metabolism inside the brain that was offline. It was done like we don’t have any fuel, we’re shutting down, and they did, they just barely trickled that metabolism alive. So it’s like a dormant Mitochondria. To wake it up and then fuel it for a good five to eight hours on a ketone as opposed to the flash energy of a glucose. These brains stuck in memory problems, have a new lease, have a new return, and what a rewarding moment as a physician, but also as community members for people who I know have suffered with that, just loneliness of what happens when you get dementia. It is a tough road from the moment they get that until they die and it’s lonely. It’s really hard to understand what it’s like to not have that memory and to restore that even in a partial way, and I’ve had two of them return out of the nursing home back to their homes. That’s amazing. Right? The rest of them, you know this literature, I actually really was able to master the, and ask some of the questions before I started advising it to patients when I was at the metabolic health summit and that was in January, February of 2019 and it really has changed my approach to those who are struggling. In addition to that, there’s other like places where I’ve had a couple of moms coming in. Life is hard, husband’s struggling, been put in a treatment program. Now she’s running teenagers, single parenting wondering what’s gonna happen with their marriage. Really stressful times, right? And she wants to be on an antidepressant. I know I took it probably 15 years ago after I had one of the kids and I took it for probably six months and it seemed to help and I just need anything. And I’m like, you know, here’s the prescription. We can try that again. But it’s going to take two weeks for that prescription to start working to improve those brain chemistries. In the meantime, take exogenous ketones and watch what happens to the energy in your brain. And I’ve had that story probably six times since February since I got home from that conference and not one of the six ended up on the antidepressant. They were taking exogenous ketones and the restoration of their mental focus, their mood and their energy was so much better on an over the counter supplement that they chose not to add the antidepressant and it’s there, they can fill it any time. It’s not going to hurt to have both of them, but wow, that’s freedom to say, look what we can do in such a quick time what we changed the fuel of your brain, and this is somebody who started out saying, mom, I don’t know if these exogenous ketones are, right? You should just make your body make them. And I think a lot of people in the space said those words and so I adopted it as well. But you start to see some of the literature on what we can do to change the cell metabolism and this is just the organ of the brain. There’s now evidence that the heart uses ketones, and again that was something I was told no, the heart uses glucose. No cardiac cells are using when you tag the ketone in a pet scan, if you would, you can see that the cardiac muscles are using those ketones for fuel. And again, that was news to me. So, what a great time to be in this space of stopping more prescriptions than I start. That’s awesome. 

Yes, it’s interesting actually the podcast I’m editing, I always do it behind the cut and I completely forget where my timeline is with what show’s going out and what show’s been out and where I am with it, so I just say it how it is in the moment rather than trying to remember where I am. But the podcast I’m editing now, which in my timeline is going out tomorrow, but which would have been out before this one comes out, is a guy talking about, that’s his passion, talking about heart disease and working with ketones and how that all works. That just made me think of that when you were talking about it just now. So I think you’ll find that interesting but I find the whole subject of exogenous ketones a tricky one.

Yes.

Mainly because a lot of the examples I see it is in the weight loss side, which I think it’s actually counterproductive for, but I’ve always thought they have their uses and particularly with this question of dementia, you know, I’ve spoken to people who’ve got elderly relatives and they really want them to start eating Keto and producing their own ketones, but easier said than done. And it seems to be a really typical thing for people with dementia have really strong cravings for carbs, which presumably because their brain is starving for wanting that glucose all the time, it’s driving those cravings and being not in a good frame of mind, literally, it’s almost impossible for them to stick to that way of eating. So that’s a prime example of a good time to start pumping in exogenous ketones to get you into that place where you might actually then be able to start producing your own as well.

Absolutely. 

Then you know, if you can be pumping them in to get them to the level you need them and then start producing them endogenously as well. Well, that’s got to be a perfect storm.

Right, I mean, I look at the approach that as an internal medicine doctor, our team, our tribe of internists, we are about the long game. We are about chronic health problems and how do you get out 20 years and see that we did make an improvement. You know, how do we prevent problems? How do we take a chronic problem and undo it? And it is not uncommon where you show up in my clinic and there are so many disasters unfolding at once that that’s where the prescriptions become easy. You know, take blood pressure. We know this has to be controlled in order for your brain to not be swollen under that high blood pressure, that the risk of a heart attack has to be controlled in order for us to reverse the risk. So we write the prescription, but it is not meant to say, okay, now you’re on the prescription for the rest of your life. No, it was meant to say, let me prevent the danger that you’re in that you’re walking into and now let’s work on getting you healthy. And I think those last few words have been lost in the practice of medicine. You give me 20 minutes to take care of all the disasters you’re about to fall apart. Maybe I get 40 minutes on a good day with you. I barely can assess what chronic problems we’re talking about and then how do I use the prescriptions that have the evidence base to get you the most improvement for the quickest amount of time with the least amount of side effects. We don’t even get to the part that says, now how do I make you better? There’s no space for that, but that is the core. That is what we are trained to say. What can I do to say, now I’ve got the disasters, I’ve got a you know, finger in the dike that is not going to flood over and kill the patient in the next few weeks.

Now how do I get them better? And I really look at that kind of parallel when I’m looking at exogenous ketones. Take the woman who’s got depression, overwhelmed with stress, you know, more things on her plate than she was ever signed up for. And I say, Yep, we can use an antidepressant, I can see you’re stressed. We’ll make sure there’s nothing else that’s causing this with some lab tests. But oh, by the way, let’s change the fuel in your brain and within three to four days, you’re going to feel a difference to ask her to change her diet, take out the carbs, remove the cravings. Yeah, you gotta just sit in that room. There’s no way I’m going to ask her to change her diet today. She has way too many other things to deal with. And you know, in that respects of understanding the science, there were two other studies presented at the metabolic health summit that specifically talked about when ketones were available for the blood brain barrier. When they were present, the brain began to prefer them. And again, that’s backwards from what I was told, glucose is the primary fuel for the brain. Glucose is what your brain needs, you can’t live without glucose. All of that stuff came from the metabolic health of brain and heart cells. So you look now that says, oh, you are wrong. We see that they metabolize ketones. In fact, when the ketones were available, the brain preferred the ketones. Again, that was new news to me. But how it plays forward in my practice is to say, we got a lot of work to do. Let’s get you feeling better. Let’s stop the up and down of your emotions because your fuel goes on and off with that insulin resistance that’s at your blood brain barrier. Let’s fuel you with a steady supply. And then we’re going to walk through how do we lower the carbohydrates? How do we clean out those cupboards? How do we change the way you think about fat versus carbohydrates? And had I started with that, they would have walked out the door saying, nope, can’t handle it. But if you start with saying, I can make you feel better in as little as four days as according to the evidence and now I have you feeling better. And we say, what can you handle next? What can you handle next and those cravings much easier to handle when your brain already has been practicing using ketones before I take away the chocolate cake at night and you say, well, are you saying that they can have ketones and chocolate cake? And I’m saying, absolutely. That’s how we start you to hauling that fuel into the brain. And then once the ketones are available to the Mitochondria, they are preferring the ketones, once they begin to metabolize them. Once the ketones were inside the blood brain barrier, they got metabolised, they got used, they got burned as energy and that was the first little on switch for that specific mitochondria. Tomorrow when you add them, he’s going to use them and maybe his neighbour. And then you’ve got the stable fuel that’s not going up and down. Suddenly saying no to bread is not such a ridiculous ask. You’ve got a stable brain fuel as a platform to build off of these other changes. And this is again, mind blowing for people. You know, I don’t even feel, I look back and say, where did I get a negative taste in my assortment of tools for exogenous ketones? And it was the literature I was reading when I first wrote that book, which was, Yep, we can do this. There was a fight over, is it racemic or ketones or non-racemic and can you use, it was kind of all this science that they were all excited about fighting over it and nobody really talked about improving symptoms really well. There was a battle going on. I wasn’t sure what it was talking about. As I continued to listen and I watched two experts debate the case, I’m like, yeah, I think you guys are fighting over something that never shows up in my clinic. Just come to my clinic. I have depressed women, I have people whose brains aren’t working well. I have people whose hormones have been turned off for years because they’ve been on a low-fat diet and there’s been nothing to make those hormones from. If you’re telling me that I can use a supplement to get them on the right path and then I have supplement until you get this mastered and then we can stop the supplements. That’s a plan that says I get them feeling better, I get them eating better and I lower their inflammation, maybe not as dramatically as I would want to do it in a perfect utopia, but utopia was long gone for many of these patients and the option to change their thinking. I mean most people aren’t going to go to my YouTube page and spend 20 hours watching all of the information. They’re going to say, what does she recommend and then follow it and if you don’t get them feeling better in short order, they won’t stay at the post. I look at other things that I’ve, you know when you first went on the ketogenic diet where you perfect for the first year?

When I first went on it, when I’m still on it, I am the most far from perfect person you’ll ever meet. But the thing that I’ve been thinking about as you’ve been talking about this, I struggle with exogenous ketones and the reason I struggle with them is because certain companies and the way they sell them leaves a bad taste in my mouth, that’s the element that I struggle with. There is an element to them, the whole racemic debate, you know how our body responds to it. That I also am a bit concerned about and I don’t know what’s gonna happen with long-term studies and all the rest of it. That is a bit of a concern. I’ve never had an issue with using them as treatment for something like Alzheimer’s, I’ve always known that that’s a very good use. What’s been interesting going on in my mind as you were talking about these women coming to you depressed and wanting to go on antidepressants, well, I mean, as you note, depression is something that I struggle with a lot and it goes up and down and it’s been a struggle for me the last month or so it’s been quite difficult and I know that when I start pumping out enough ketones, I will start feeling a bit better. It won’t necessarily completely sort out the depression, but it will help and, I know that and I know it takes a certain amount of time and I can usually force myself into that if I’ve gone off the wagon a bit, if things have gone wrong for me, if everything’s sort of gone into a spiral, I know how to start turning that spiral, or the other way is to start producing ketones. But it is difficult and the only reason I pushed through it I suppose is because I have the experience multiple times of knowing that it will work. But I know how difficult it is for me being in that frame of mind, having the experience and the knowledge to know that it will help to eat a certain way. But for someone who’s feeling all those things, who someone tells them, oh, you could feel a lot better, you know, your depression could be a lot better if you started eating Keto. Well it’s true, the chances are I probably would. But if you also understand how that person is feeling, just like you were saying, they can’t do it right, they can’t do it. It’s the same conversation I’ve had with you and other people about the weight loss surgery, the place I was in, of course I could have done it without, but in the place I was in, I couldn’t. And it’s the same with depression. So if you’re looking at exogenous ketones, the way you’re talking about using them is this short term emergency medication, if you like, that’s just going to lift you up to the place where you can start handling lifestyle changes that will then start seeing you through for the years to come for the rest of your life, but you start talking about those kinds of changes now and it doesn’t seem that much. Oh, you know, is it really going to kill you to stop eating bread and to stop eating cake and all the rest of it? What actually at the moment, yes It feels like it would kill me. You’ve got to be in the right frame of mind to be able to handle that and if giving someone exogenous ketones could just, like throwing someone a buoyancy ring out there who’s drowning, if it can just get them up high enough to start making those changes, then yes, that’s something I can on board with.

Right. So the other place that I look at that is, you know, take my journey beginning of this podcast shared an incredible depth of struggle and I am a very disciplined person. I know the science that would say if you fell off the wagon, if you’re not feeling good just fast for a few days, you’ll be back on the wagon. And I’m like, no, I can’t do it. But as soon as I would add exogenous ketones and especially since I’ve been reading the evidence over the last year when I would find myself having a glass of wine, it would really slow down my thinking for the next day and part of that is just being in a slump for as long as happens with the story. But then knowing that when I would take some exogenous ketones, it would at least give me three hours of really good mental focus and what I found was at the end of that mental focus, you know, ketones are an appetite suppressant so I wouldn’t be hungry. I get why the people are using them for weight loss. They are an appetite suppressant. I didn’t take it for those reasons, but do I use food to comfort me when I was sad? Yes. When I was scared, did I use food to like be the soothing agent because it’s easy and accessible and there are currently no laws against that one. You know, of course. Unfortunately having been insulin resistant, like most of the women my age, that ignited the return of inflammation, the return of a sluggish brain and it didn’t take but three or four days of not following the rules. Now I’m off the bandwagon. It’s just, it’s too hard and I can’t find the energy to get back to the right place again. At first. I know I looked at every single one of these exogenous ketones has a sugar substitute in it. They’re kind of a nasty taste without that, they’re a salt. And at first that was, the sugar substitute that I kept pushing against. Like okay, I could have the ketones, but I wouldn’t want the sugar substitute with it because it would make a sweet taste. And once I have a sweet taste and I want more, at least that’s what I told myself. But then I started doing okay, I have some on supply that when I feel like I’m in a slump, I’m gonna mix it with a little bit of cream and ice and I’m going to sip on it. Just a few tablespoons worth. And I would check my blood ketones and they would be like 5.6 like I never got that high ketones when I was fasting, or at least not a 48 hour fast or something. But what would happen is that it wouldn’t just help me for that moment, the rest of the day I would have less cravings, I would make better choices with my food, and then the next day would be a little easier and the next day it would be a little easier. So if I look back at the perfect Keto diet, it would have black coffee instead of coffee with heavy whipping cream. Well, I liked the heavy whipping cream. I like the butter in my coffee. It tastes good to me. And that satiety is something I needed to practice for the first, I think, I mean, I still do that, but amazingly, that’s become my comfort now. And I don’t think I could have completely arrived at satiety from these high fat foods had I kept those sugar substitutes too heavily invading my world in my first year of a ketogenic diet. But I would make the exception with exogenous ketones because of how much it did shift my metabolism. It did improve my energy, my mood did get better, and then it wasn’t just me. I thought, okay, maybe that’s just me, and you go to the conference to say, oh my goodness, look, they studied that. It wasn’t just me. Yeah. 

It’s really hard and I still really struggle. I still really do struggle with them and I think it comes back to the sales methods of some companies and the claims that are made and, and that’s always going to be a problem for me, but if I hear stories of people using them in specific intelligent ways, there’s someone I want to interview who’s doing research into the use of a specific type of exogenous ketones, I believe for treatment of Migraines, obviously that’s something else that interests me. So it’s there use it. If it’s used in a particular way, then possibly I am open to that. I still, I do. I really, really struggle just because I see so often it being sold as this magic pill, take these things and you’re going to lose weight, take these things and so many people take them and gain weight because ultimately, you’re just pumping this extra energy source in there and so you’re not going to lose weight. But somebody else, like you were saying, can take it in a certain way and it helps them. Oh, it’s, oh you can tell can’t you. Yeah. You can see the expression on my face, I really do struggle just because I suppose it’s also having been that person who is so vulnerable to that being sold that magic pill and a very expensive one at that. I’m the kind of person who will grab onto that. I think I might’ve been one of these people who bought Raspberry ketones. Remember those things that were sold because they told you nothing to do with exogenous ketones. Completely different thing. But because I was sold the hype that I would lose weight by taking them and it was just another thing and I know exogenous ketones are a different thing, but it still falls into that category a bit and a lot of people are sold them and take them and for nothing. Oh, and I don’t like that. 

Here’s the perfect, as you’re speaking, what I have in my head is I imagine the woman who comes in and says, Yep, I’m new to the community. I would like a new doctor. I’ve been on Prozac for 25 years and I introduce the idea that Prozac was never designed to be 25 years of anybody’s life. It was meant to help you in a season where you are having a difficult time and as soon as that season was stable enough to help you work on the ways to restore your neurochemistry to its optimum production, we should have done that. As many times as I’ve had that conversation, it’s almost tearful that the woman says, nobody told me that. Nobody told me that I was done with it or I could be done with it. How do I do that? And I see the same errors as, and I did it to like quickly filing exogenous ketones as this gimmick, like you should do it the hardcore way. I look at my heroin patients and say, you shouldn’t use the suboxone to get off of heroin. You should just suck it up and suffer. And you’re like, yeah, they’re going to fail. They’re going to return to their addiction. It is real. And you say, let me help you. Not for the rest of your life, but for a season for this chapter that says, I’ll show you. But that really becomes the responsibility of those who are talking about it, educating about it, saying this wasn’t meant to be the rest of your life. It is meant to say. If you think you’re going to go from no carbohydrates and no alcohol for the rest of your life, I’m here to tell you no human on Ketogenic Diet does that. You’re going to have times where you relapse, where you have struggles, especially after you felt how good life can feel when you are following the process. Let me get you back on board as quickly as possible, not for the rest of your life. And I think that voice of educating correctly is my responsibility as a physician who is rooted in how do we take the science and apply it to these chronic behaviours to change one behaviour in the next best level. And then we take the next behaviour to the next best level. And that’s the root of internal medicine, improving chronic disease with the steady sustainable outcomes. I see them as a tool for people struggling for people screwing it up for people having mental slumps. And for the folks who are saying, let me just see what it would be like, how would I feel if I was on a Ketogenic Diet? And I tell them, I want you to sip on exogenous ketones for two weeks. Don’t change anything about the way you eat. And they come back saying, all right, how do I do this Keto Diet? Cause this was the best two weeks of my life. Usually it’s like a week. They’re like the, this past week has been amazing. You know like welcome to the Keto Diet. Let me show you the rules. 

Tricky. I am open to be persuaded in certain cases, but again I guess like you say, it’s not something that, not something that you’d recommend to everybody. It comes down to the individual doesn’t it? And working out what the best way forward for them is and yes, if you put someone in front of me and you could 100% guarantee that the only way that they would be keto in six months was to spend two weeks taking exogenous ketones. Yeah, I mean I would take that option. Right?

Yeah. I look at that saying, I don’t want to take blood pressure medicine. I don’t want to take, you know, I’ve had this conversation. If you think doctors aren’t salesman, you just haven’t been in the exam room long enough to say, I know don’t want to take a pill, but let me show you the risk you’re taking. I can help you get there. Not Today, it’s going to take us time. You have this thing called human behaviour and that doesn’t change on a dime. It changes gradually, one notch in the right direction. And there are rare stories like my mom who said, okay, I’ll do this, and we did it together. She changed on a dime. She’s now three years out and in the best chapter of her life. Honestly, that’s the rare story.

Yeah, absolutely. And I do think that endogenous is always going to trump exogenous.

One of my other major things I tell you about the brain, the anti-seizure and those, plenty of experiments done on exogenous ketones there. But when you look at how can we, you know, repair Alzheimer’s, can we prevent Alzheimer’s? Can we take that brain injury from a concussion 30 years ago and do the best we can at, you know, fixing what we could. And that gets to the whole art and science of autophagy. Well, we don’t have evidence that autophagy can be as predictable with exogenous. That needs to be your own system. But that comes with even more of saying no to food and fasting and watching your ratios, watching those glucoses and those blood ketones to say, could you get there? And if you open with that discussion, you’re going to lose your audience. They’re going to say, forget it. It’s just a wacky diet that I can’t do and it’s off and then they’ll be disparaging and off they go for never to enter that thought again. So, you know, I look at it as I do with any patient that comes in struggling with the chapter of life. My responsibility is to understand the science and to bridge it with their life and to not have expectations that they can do some kind of magical fairy dust and make everything perfect but improve one thing and then watch how that improves the next thing. And those moments add up just like the other ones do, where they did one tough decision, then they made another bad decision and now they got 15 bad decisions they’re making every day. We’ve got a ways to go. So I look at that as this journey gets better. How can I help you with the first few steps and sometimes telling them what the last few steps look like. Saying the word fasting to some of my new patients. I’m like, don’t do that. You’re going to scare them. 

No, don’t do that.

So yeah. 

And it’s also that it’s not something, you know, is being clear both yourself as the person who’s talking about it, but for the person who’s potentially taking any of these supplements, that it’s not something that you should be taking for a long time. I mean, you’re talking to somebody who was on Prozac for 20 years for what? For nothing. You know, it was no good at all really for me. And the same with these things that seemed to work really well for say two weeks. So the automatic response from a lot of people is what are just stay on that then.

Right? 

Forever.

Yeah.

Rather than, no, this is to get me to a place where I feel capable to do the harder work to make it long-term sustainable. 

Yeah. Because if you go back to the chapter where you were taking Prozac for 20 years, had someone said to you, Hey, are you ready to stop it? I usually don’t hear people saying, oh my goodness, I have to be on it. Usually they’re like, oh, that’s a thing, I can do that? And that education I think is the key to successfully navigating and not being stuck. I don’t want people on exogenous ketones for the rest of their life. I want their bodies working better. I don’t want people on Prozac, Paxil, Zoloft, any of those for the rest of their life, but when they are super depressed, if that was all I had, I’m going to help you with that and then say, all right, now let’s work on your sleep now let’s work on your nutrition now let’s work on your boundaries. You know all that you know, life things that are not in a script but are super important for the long-term outcome. I think it’s a great discussion to have though, and I find the Gal who we are talking about, whenever I put the videos about the brain science on my YouTube channel or wherever I’m talking about them, if you’ll look in the corner, you’ll see the author, you go to Google, you type in that author, you can have the access to the article too. That’s what she did. She printed out the article and took it to her doctor. I’m like, this isn’t my idea. I’m just being the conduit to explain it to you. Why would we care about this? We do care about this. It is a powerful transformation for taking folks for the last 30 years that have been inflamed with a chronically sinking mental function and giving them some hope to say, can we awaken those cells to burn a different fuel? And the answer is yes. Don’t make them lift the whole burden by themselves. The first step out of the gate.

Ah, interesting discussion. It’s not where I saw this going actually.

Well, sometimes science does that to me too. Like, oh, I was planning on this outcome and here’s what I got. 

Well, you know what’s gone and happened. I haven’t even gotten to April’s question yet. We’ve gone on a massive tangent and come to what is going to be the end of the first ask Dr Boz, except we haven’t got to the ask Dr Boz bit yet. 

Well I will contend that even if we didn’t answer her question, we will get to it in the next one and know that this discussion that we just had is the root of so many of the questions that come into my Facebook and my YouTube page and I have failed to respond to them. So, uh, I do think you’re going to see an audience who gets educated by the conversation and we will definitely address the question in the next recording. 

We will do so. Thank you very much for that and we’ll see you back here next time. 

God bless you. You Bet.

This transcript is brought to you thanks to the hard work of Dawn Michelle.

You’ve spoken a bit before about how Will cooks up all these tasty things. And I’d forgotten actually when you mentioned just now that last year at Ketofest it was just those samples that you were bringing that you hadn’t set up the company at that point. I’d completely forgotten that. I was thinking in my head that you already had it then, but how did you come to that? Was that part of the supportive process, him experimenting with making foods for you to have, is that how it all started?

Absolutely. I feel like some people would take the carnivore, purist approach and they’re like, well, I can be the healthiest by eating just meat and vegetables. And so, I’m not going to risk anything. Perhaps I’m a little bit of a risk taker in that sense because I know that I have a sweet tooth and I used to have a pretty serious food addiction that I let run my life. So, I don’t want to ever go back there. But, if I can have tasty things that I can enjoy and let my sensual pleasures, you know, really, indulgent without going nuts and getting back into food addiction, then doesn’t that enrich my life? 

Do I need to be a purist in aesthetic and deny myself pleasures for no reason? I don’t think I do. So there are some healthy ways that I found to add tasty things back into my life besides not saying that the meat and vegetables is not tasty, but I really like a good Keto ice cream if I can enjoy a good Keto ice cream without messing up my health. So, for instance, Halo Top, you’ve tried it, right?

I have never tried Halo Top, actually. The only ice cream that I’ve tried in the states is Rebel ice cream at Ketofest last year. I’ve never tried Halo Top. I gather it’s got some not-so-great ingredients in it.

It does have some not-so-great ingredients in it. Now, the founder of Halo top was actually a Redditor, participant on the Keto sub-Reddit. So, I felt like I personally chatted with him on there. So, I did try it back in 2016 and sure, some of the ingredients were sketchy and the ice cream wasn’t a hundred percent great. Now I understand it wasn’t like a ton of sugar, a little bit of sugar, but it wasn’t awesome. 

And so, there were some things that, I was curious about, sweeteners that I felt did not have any sort of negative health impact. Actually, this was a problem because as a part of diabetes and monitoring my blood glucose. I could see that a lot of the supposedly okay sweeteners out there that weren’t counting as sugar, were actually terrible for me. These people are lying. Sorbitol, maltitol, mannitol, isomaltitol, isomalto-oligosaccharides, all these things listed under the sugar alcohols category. Most of them, I could see spike my blood glucose. Erythritol was okay, erythritol was fine.

That seems to be one of the universally accepted by most people not to give them digestive issues and things like that as a one that’s available to most people. Most people seem to get on okay with erythritol, don’t they?

Yeah. Yeah. I think erythritol is okay, and the taste is pretty good. I mean, it’s not exactly sugar and it doesn’t cook like sugar.

No. That’s the problem with it. And a lot of people don’t like the cooling effect it has on everything. I find that in some things you make, you don’t get that cooling effect. And I actually don’t mind it that much, but I know that’s a complaint that a lot of people have with it.

Well, it’s okay.

Exactly, it’s okay.

And then sucralose, Splenda, aspartame, saccharin, all these chemicals, I researched them, and you know, there’s nothing saying that they literally cause cancer. Okay, there is a little bit, but not much. But there are plenty of research showing that aspartame is linked to migraines. Sucralose and saccharin are linked to leaky gut, intestinal irritable bowel disease. If you use them on a regular basis, then your chances of developing these conditions seem to go up, or at least, there’s lots of research showing that they’re linked. And then even petri dish research showing that they do cause the epithelial lining cells to develop gaps, which is literally leaky gut disease. So, I don’t want any part of those. I mean occasionally a little bit, whatever, it’s not going to kill you, but still not healthy.

That’s the thing. It comes down to what you just said is the regular use thing, isn’t it?

Yeah. I think no one’s going to die from having the occasional bit, but regular use, daily use, definitely have been shown in some research. Not a lot of research, but some research to be problematic. And then I’m not really a big fan of the taste of stevia.

No, me neither.

I like monkfruit. Have you tried that?

I haven’t. I’ve never tried it. No, it’s not something I can get here.

Oh dear. Well, I like monk fruit. It’s not exactly the taste of sugar, but it has a nice kind of clean sweetness to it, which, I find pleasant. It’s not a sugar, you can’t cook with it.

That’s often the problem isn’t it? You actually, for most things you’re making, unless you’re sweetening something like coffee, for example, you need that bulk. You need the actual mass of sugar, in inverted commas, in whatever you’re making. That plays a part every bit as much as the sweet flavor does, doesn’t it?

Well, in fact, I mentioned that I was corresponding with the Halo Top founder, Justin Wolverton, on Reddit and I was asking him, why do you put sugar in your Keto ice cream? It seems to defeat the purpose, right? He’s like, well, originally, I started with a very Keto purist sort of a recipe. And he’s driving around with his little sample pints to different places and trying to find a place that would manufacturer the ice cream for him. And the problem was that his mix would freeze in the lines, which I think as you know, like you try making a Keto ice cream with erythritol or swerve or what have you, and you put it in the freezer, and it freezes solid as a rock. You know, if you have any leftovers after you’ve made your batch. Sugar alcohols freeze solid. And he said the property of sugar that is essential for the ice cream is that it lowers the freezing point so that it stays soft in the lines of the manufacturing equipment but also then in the freezer. So, you don’t want to have to have a pint of ice cream that you pull out of the freezer and have to sit on the counter for 20 minutes.

Although, I have to say this is one of my slight bugbears with people who go on about ice cream freezing solid, which I have to say it is a thing with erythritol. It freezes really solid. But, you can take it out and leave it in the fridge for half an hour and then by the time you come to eat, it softened up a bit. But, people talk about this being completely scoopable from the freezer. Well, my favorite ice cream has always been Haagen-Dazs. That was my Achilles heel. That was the ice cream that I always used to have. Now, that is not scoopable straight out of the freezer. I’m not sure freezer is on a low, or shall we say high, I suppose setting. It comes out solid. You watch the adverts for Haagen-Dazs and even on a lot of the containers they recommend you have to take out and you have to leave it sitting on the counter for five to 10 minutes before it becomes that sort of perfect scoopable texture. So you know, it isn’t just a Keto ice cream thing. Although I have to say that I’ve been making a vanilla chocolate chip ice cream with allulose. You’ll be pleased to hear it was the very allulose you brought to Denver for me.

Excellent.

And, I have to say, you’re absolutely right. It is perfectly scoopable straight out the freezer and it’s very delicious. I have been enjoying it every day since ice cream season.

I think that now that I’ve gotten into the business, there’s just a number of properties of sugar and also allulose that I’ve come to appreciate. Lower freezing point, crystallizing, are just the tip of the iceberg really. Providing that crystalline structure, for instance. We’re trying to make fudge. The consistency of fudge is hugely important. Well, forget trying to do that with erythritol. It’ll come out in sort of icy shards.

It crystallizes, doesn’t it?

It does. And you know, you’re not going to do it with sucralose. That would be disgusting. Or stevia or anything like that. But if we can crack allulose fudge. We’re going to trial a couple of things at Ketofest this summer. We have actually started making a nut bars using allulose caramel. And allulose caramel, wow, it’s so good. And it provides this nice kind of stickiness that, makes these nut bars just delightful. I haven’t quite figured out how to package them to be honest. But, right now we’re just using craft paper bags and a little parchment paper and I’m distributing them at our local farmer’s market and people are just mad for them.

That sounds delicious. How did you end up at allulose? You started saying there was this progression of different sweeteners that you tried. How did you end up at allulose because it wasn’t, and it’s become a bit more known now, but presumably, I mean, when you first stumbled across it, you must’ve almost stumbled across it? How did you find out about it in the first place?

It’s sort of my hobby to, become on top of the literature of, sweeteners and their health impacts because I wanted to know for sure. Because I used to drink sweetened diet sodas, instead of water all the time. Diet Coke, Fresca all these different things. And I wanted to know what health impact they had. And a lot of people said, you know, if you follow the science that there is no problem, really. Its people who say these chemicals are bad for you, they’re just chemo-phobes but there’s no solid science behind it. I’m like, well, you know, I’m not sure. 

I tried it actually a couple of years ago, I went on a sweetener moratorium for two weeks. I am dropping all the sweeteners out of my life, zero everything, just coffee, black coffee, water, tea. But nothing that has any sweeteners. And I was checking my blood glucose the whole time and it had a huge impact. I didn’t realize, I mean, not huge, maybe five to 10 points on my baseline blood glucose. And it dropped. And I lost weight. So clearly these sweeteners were having impact on me and I didn’t realize it. Even though they’re supposedly zero calorie and supposedly safe.

It’s not all about the calories though. That’s where it comes down to, isn’t it? Or even sometimes the immediate impact on blood sugar, it just goes to show that all these other things that they can potentially have this ripple effect that could end up causing you to gain weight or not lose weight or whatever it is. That’s the issue you’re dealing with.

Absolutely. There’s a lot of other issues and it’s not just blood glucose or insulin. Also, they talk about cephalic phase insulin response. Well, if something just tastes sweet or you’re thinking about something sweet, you’re going to get that cephalic phase insulin response, for sure.

The other thing I find is that it stimulates appetite too.

Absolutely. After I did this two-week sweetener moratorium, I talked about it on my Facebook page and some of my friends were like, you know, that’s very curious. And I’m like, how about you all, do two more weeks with me and I’ll go two weeks more. Once I got past the first 10 days, the first 10 days were rough. I was super addicted. Daisy, I was like struggling. I was thinking, oh God, I really want MiO in my water, or I really want Diet Coke. And I was biting my nails. I was gritting my teeth, but it got easier. And after those first two weeks, I was like, I’ll go another two weeks. 

So, I got a bunch of friends to try it as well, and they were also type two diabetics. So, they gave it a go and two of them couldn’t do it. They dropped out right away. They were like, no, I love my Diet Coke, can’t give it up. One of them dropped out after three days because she got dehydrated. She realized that without the stimulus of the sweetness driving her to drink, she wasn’t drinking, and she got dehydrated and her electrolytes are messed up. So, she had to go back to it. So it wasn’t that she was addicted, but it was more of an electro-chemical imbalance that her body had just become adjusted to, I guess. And then the rest of them stuck through the whole two weeks. And what they found, about half of them found, that it did drop their baseline blood glucose by 5-10 points. And half of them found that it had no impact except to deprive their life of the pleasure of diet soda drinks. So, they went right back to it. 

So, I think it’s very individual. I think some people are going to see a reaction if they cut the sweeteners out. But I think it depends on the sweetener too. So, I started doing more research back to allulose. I’m like, well, obviously there’s more to the sweetener thing than I thought. And I started learning about all the different kinds of sweeteners and high intensity sweeteners versus bulk sweeteners, sugar alcohols, different sugars. And, I did find this new sweetener, well not new, allulose. Allulose is a rare sugar. It’s been around. It occurs in nature and so they’ve been doing research on it for decades and interestingly in 2015, they figured out a way to produce it commercially using an enzymatic process. So now it’s similar to erythritol. Erythritol is produced from cornstarch. They take cornstarch and they do a series of chemical reactions and you get erythritol.

Sometimes it comes from birch bark as well. Is that right?

If you buy it commercially, do you honestly think that there are giant factories out there stripping birch trees of their bark?

I don’t think there are giant factories, no. I have noticed that the occasional product does say it comes from birch as opposed to the usual. The usual is cornstarch, isn’t it?

Yes. I don’t know if anybody is actually out there stripping birch trees of bark, Daisy.

No, I mean it kind of seems a bit of a laborious and not very helpful for the birch trees.

Cornstarch I think is where 99% of the stuff comes from. And I don’t know about the other 1%.

There are some very naked birch trees somewhere. That’s the 1%.

The erythritol birch orchards in southern France I hear are beautiful this time of year. So allulose is found naturally in figs and jackfruit and raisins, maple syrup. And I suppose, prior to this discovery, the way they made it was by squeezing figs or jackfruit and then refining from there. But now they have discovered a way to make it from corn syrup. So, using corn syrup in a series of fermentations and refining and whatnot. So now it’s commercially available and the research on it, unlike the research on sucralose, the research on sucralose is all about does it really cause intestinal bowel disease, or does it just make the symptoms worse if you already had it? It’s all bad, there’s nothing good. 

But the research on allulose is crazy good. We’ll see it being used in a much larger way over the population. Maybe some people will end up having negative reactions. But right now, the research is on people and also dogs, rats, tapeworms, planaria. The research is 100% positive. It increases insulin sensitivity. It decreases postprandial blood glucose response. It helps people lose weight. It helps people with their hepatic fatty liver deposits. It seems to be a health boon in almost every way. It increases GLP-1 secretion, one of the talks at low-carb Denver got into the incretin hormones. And so GLP-1 secretion is good, it’s sort of a counter hormone to insulin. The important thing is it tastes just like sugar. I mean almost, its 70% as sweet as sugar. But the chemical properties that it has in terms of crystallization and freezing point and bulk and various other, mouthfeel and and aftertaste are very similar to sugar. The fact that it’s less sweet is a problem.

I actually quite like the fact that it’s not as sweet as sugar. So this ice cream recipe that I been playing around with over the last few days is actually just an adaptation of a Mary Berry recipe. I’ve made a few tweaks, but I’ve pretty well just subbed out the sugar for allulose at the same amount. So that has effectively made it 70% as sweet. It’s not as sweet as the original recipe. And actually, less so because I changed some of the quantity ratios so effectively it was even less than that. But that I think is a good thing for most people, especially people who’ve been on Keto for a little while. Their sensitivity to sweet increases quite a lot. 

So actually, having something that’s a bit less sweet, 70% is quite a nice sort of drop in sweetness. Isn’t it? I think anyway that’s what I find. I find the problem with quite a lot of Keto products, especially things like cookies. I found the ones I’ve tasted anyway are so ridiculously sweet. They’re too, too sweet. You want to drop that sweetness down because when things are too sweet, you can’t actually taste the flavors of the ice cream or the cookie or whatever it is you’re eating. Can you?

Yeah, I agree. I feel like I’ve just had a mouthful of sugar alcohol and that’s pretty good. Yeah, it’s interesting. I’ve been doing a lot of direct sales every weekend. I’m going to the local farmer’s market with Will and we’re giving away samples and trying different recipes and seeing how people like things. And these are people that are farmer’s market patrons, so most of them are not Keto, although I’ve been very happy to meet some Keto people there that are just delighted to meet other Keto people. We could do the secret Keto handshake. And they buy lots of my stuff and they love it, which is great. But just the general populace, I pitch this as healthy, all natural, mostly organic, vegan and soy free, dairy free, gluten free, etc. So, it appeals to a lot of the general populous there that go to the farmer’s market and they are not used to having something that’s natural and sugar free. And so, when I say that they’re a little suspicious, they’re like, so is this going to tastes like crap?

Yeah. Cause that’s the usual payoff, isn’t it? That’s what usually happens. It ticks all these boxes. It’s really good for you, it’s good for the environment, it’s good for all this, but it tastes like pants.

And that’s what they expect, to taste like pants. And then their eyes light up like, oh, this is really good. Is it really, is it really sugar free? There’s gotta be sugar in it. I’m like, no, it’s really sugar-free. So, it’s great having that feedback. I’ll ask them for like their critique, would you change anything? Well actually, I really liked it. It’s not as sweet as I was expecting. I was expecting it to be really sweet, but it’s not, and I really like that. So, I think even the average American consumer, at least the people that attend the farmer’s market are wanting things that assault their taste buds at a lower intensity.

That’s true actually. I think, yeah, a lot of it is just a case of that’s what’s available. I have a friend I cook for quite a lot. One of the things he really likes about the desserts that I make, that they are less sweet. It’s something he always comments on. He said, you know, I really enjoy the things you make because they’re not overly sweet. I can taste the chocolate, I can taste the coconut, I can taste, the flavors that are in it. And he really likes and comments on the fact that it’s not as sweet as something he’d buy it Tesco’s or whatever. So, I think you’re right. I think actually that most people wouldn’t complain about things being less sweet in general.

I think the only problem with allulose from my perspective, well it’s expensive. But also, people do have, depending on their gut biome and the amount of allulose they eat, some people do seem to have, I’ve experienced this myself, just literally explode. Something you mentioned, erythritol is pretty well tolerated. Some people have a reaction to erythritol.

I think that’s true, actually. And I think if you haven’t had any for a while and you go back to it, that happened to me with the first batch of ice cream that I made. I hadn’t really had any sweetener like that for a while. And I don’t know whether it was that or whether it was something else I ate, but I didn’t feel at all well. Actually, I was sick, and I wasn’t well at all, but have been fine with it since. 

I’m the kind of person that will push through it when it comes to ice cream, I’m going to test it the next day. I’m not going to believe that that ice cream made me out. I’m gonna try it out the next day. If maybe I’m ill three days in a row after eating the ice cream, then I might decide to drop it, but when it comes to ice cream, I’m going to keep pushing through and it’s been fine since you’ll be, you’ll be pleased to know. In fact, I had it for breakfast this morning. That’s the only problem with me when I make things like that, and I can’t make them too often because I do tend to overeat them a little bit. But yes, I can certainly attest it that it works very well in ice cream, incredibly well actually, at least in the recipe that I made.

Excellent. I’m really looking forward to Carrie Brown coming out with allulose ice cream recipes. I know she’s been experimenting.

Yes, she’s right on the brink of, I don’t know what it’s going to be. I don’t know whether it’s going to be a general adaptation that you can use in all her existing recipes or whether it’ll be a whole new bunch of recipes where it’s different for each flavor. I’m not sure yet, but apparently, yes, she’s right on the brink of, of having perfected. I know when she first tried just subbing the allulose for the xylitol in it, it didn’t work. She said it tasted okay. It was the texture. She said it was kind of crumbly, an odd sort of texture. And you know what a perfectionist is. So, she’s not going to put it out there until it’s right. But I know she’s been working very hard on it because a lot of people don’t like using xylitol. So, she’s been working very hard on allulose alternatives.

Yay! I can’t wait. Will makes allulose ice cream for us and he has sometimes really just hit the money, where it tastes to me just as good as Haagen Dazs. But his flavors are vanilla or chocolate. And, Carrie’s are Baskin Robbins, Haagen Dazs and Ben and Jerry’s, all one excellent chef woman.

Incredible range of flavors. I’m very simple with mine as well. I usually start with vanilla, but I did put some chocolate chips in. It’s very delicious. I will send you the recipe when I’ve perfected it. I will share it with everyone. Like I say, it’s not really my recipe at all. It’s Mary Berry’s recipe that I have Ketofied, but it is delicious, and it absolutely stands up to Haagen Dazs, and as Haagen Dazs connoisseur, I think that tells you something. We need to know where to find you and all your delicious candy. And presumably, I know you send your candy out mail order, presumably these other products that you’ve teased us with are not at that stage yet by the sounds of it.

I invite everybody to hit me up on Facebook either, be my personal Facebook buddy or our company Facebook page is Moons Grove Farms. We’re also on Instagram and I have a website, it’s moonsgrovefarms.com. We’re on Amazon, Etsy, and that’s it. Well no, there are a few stores that are stocking us, but nothing nationwide yet, although I have dreams.

What is only been a year, less than a year.

Much less than a year because after Ketofest I got my butt in gear and started putting the company together. But wow, there’s a lot of work involved, and it took me awhile to get everything all in order. I don’t know if we have time for a story about Amazon.

Well I was just gonna ask you actually, because I know you had some hideous problems with Amazon, didn’t you?

I did. Now 50% of all online commerce goes through Amazon. So, I knew that if I’m going to sell anything online, we gotta be on Amazon.

Yeah. You’ve got to be in bed with them, really haven’t you if you want your products out there on a big scale.

So, I went through all the proper steps. I got FDA approval for my products. We have a commercial kitchen, we have packaging and nutrition facts labels and professional photographs, the whole thing. An Amazon representative helped me set up and everything was good. We flipped the switch, we started selling. The first couple of days people love this stuff. We’re getting five-star reviews. And then my account’s been suspended, and it was right before Thanksgiving. I’m like, but there’s people that need my candy for their Christmas presents and stuff.

That is the worst possible quarter, isn’t it? That’s the quarter that everyone goes on about. That’s when you make all your money.

So, they say. And my Amazon representative is like, well, I don’t see what’s wrong. I’m sure it will be resolved really quickly. I’m like, okay, I love Amazon. You guys are the best. You will fix it. Okay. So, a few days go by and I get no notice. Well, we’ve permanently suspended your account because of extra high cancellation rates. I’m like, I haven’t had any cancellations. So how could it be an extra high cancellation rate because my cancellation rate is zero. And the sales rep said oh, they must’ve made a mistake. I’m sure they’ll clear up. 

Another week goes by and nothing. And then he said I’ll talk to my boss. And the boss tried talking to the boss, the other department that did the suspensions and the boss was like, I don’t know, they won’t return my email. So, they went back and forth another couple of weeks and now it’s Christmas. Well, this is all messed up. And then the guy he’s like, well, I’m sorry, I don’t know what to say. So, I hired a lawyer. In fact, I read a story. It was in the New York Times about how Amazon was doing wrong to sellers, which still continues, and how sellers have had to resort to different means to try and get Amazon to treat them right. And one of the people in the story was a lawyer in Atlanta who has fought with Amazon on a number of occasions. So, I contacted him, and he took me on and he happened to have a direct connection to Jeff Bezos. So, he wrote Jeff Bezos, and it took a few weeks to get a response, and we never got a direct response from Jeff B. But I got a call from the Amazon suspension department. They are like, hi, Jeff Bezos asked us to look into your case and you’re un-suspended. Good luck selling on Amazon. So, I don’t know what I did wrong, if anything.

So, no explanation and it took that kind of wrangling to get switched back on.

Yup. About three months and a lawyer and Jeff Bezos’s personal intervention.

And you miss that fourth quarter of sales.

Totally. So, I don’t know. But I’m happy to be on Amazon, so, thank you Jeff, I guess.

Thumbs up to Jeff.

It gave me a very deep appreciation of today’s economy. They got the power.

Absolutely. Yeah. That is the problem, isn’t it? There’s nothing much you can do when computer says no. So, you’re going to be at Ketofest with your candy. Well, I suppose it would be difficult. It won’t be like the local farmer’s market. You won’t be able to bring fudge.

No, you’re wrong about that. I’ve been talking with, our Ketofest organizers and, the local health department and there won’t be a problem. I am definitely bringing some new products to Ketofest. Hopefully we will have the fudge recipe down. We have a fudge recipe down. It’s just not shelf-stable. It has to be refrigerated. It’s amazingly good. You don’t have to worry about eating too much of it because it’s so rich, you have like a little square.

That sounds like a challenge. Your candied ginger, what is that supposed to be? Two servings.?

Three actually.

Well a bag easily is just one serving for me, and I can easily do two bags. You’re talking to a little bit of a greedy piggy when it comes to things like that. So, I’m not sure one little square with fudge with suffice for me.

By the way, we’ve changed how we are making the ginger and the orange, number of the peels actually, in response to getting some more experience making it and selling it. So, I think it’s much better now. And if you tasted the ginger or the orange before, I’d be really curious to get your reaction this year because I think it is loads better. Will says he is ashamed.

I think there was a difference in some that you very kindly sent me home with a huge amount of candied ginger, which I won’t embarrass myself by telling you how quick that can seem to go, but there was a difference. Some of them were a lot sort of thicker cut and juicier, I think that’s what you were saying. It’s moved more towards that. Yeah, definitely brilliant.

And they also seem to be hotter.

Which is not a problem for me. I was speaking to Karen Ogilvie and I don’t think she can eat more than one or two pieces, they’re too hot inside now. Love it. I tell you what does really temper it, what I’ve discovered if you eat, I’m just showing myself out now to be such an absolute pig. But if you eat the candied ginger, and I love it hot, I don’t mind that it absolutely sets my mouth on fire. The hotter, the better as far as I’m concerned. But if you eat it with super dark chocolate, the chocolate tempers the heat. I don’t know why there’s some kind of synergy between the two that it takes the heat out of it.

Nice. I gotta try that.

I can’t explain why it tastes very good. I mean, chocolate covered candied ginger is just delicious anyway, but for some reason it takes the heat out.

We’re working on that.

Yeah, I remember you saying that.

We’re working on incorporating the dark chocolate covered orange rinds and ginger.

Very delicious.

So, I figured out we’re going to change the packaging on the ginger. We’re going to call it nuclear ginger and put skull and crossbones and flames. So, people really understand we’re serious. This is spicy ginger.

And a lot of people like that. They like the challenge as well, don’t they, or eating hot? And funnily enough, I’m actually not the kind of person who likes, I like a bit of heat in a curry say, but I don’t like the super-hot curries. If it’s too hot for me, I can’t taste it. But when it comes to your ginger, I just love the heat in it.

I made a small child cry at the farmer’s market. We were giving out samples and the mom tastes it. She was like, oh, this is really good. She gives a sample to her kid. The kid starts crying. Oh God.

I hope you didn’t video that one.

I’m like, I’m so sorry. The four-year-old won’t come back and buy any candy from me anyways. So that’s fine. And I laugh about it now, but yeah, we’re gonna re-label that nuclear ginger. And the lime, if we continue making the lime, we’re going to call it lime jerky because we can’t make those lime peels soft and chewy. There’s just no way. We’ve tried different things. It just doesn’t work. So, it’s hard jerky-like candied lime peels. I don’t know. Some people may love the flavor. So, when I proposed that we stop making it, they’re like, “No!”. But a lot of people aren’t expecting it to be so tough and it’s really, super hard. So, I don’t know. But the nut bars are incredible, and I can’t wait to bring them to Ketofest and let people sample them there.

Oh, I cannot wait to sample them. I shall let everyone know what they taste like.

Excellent. It’ll take a while for me to wrap up and get FDA approval and do the nutrition facts labels and the packaging and get them on the website, but I’m happy to be able to take them to Ketofest and distribute them in person.

Yeah. Well something for us, Ketofesters to look forward to.

Among other things. I can’t wait. Bacon bar!

All the things.

All the things.

Yeah. Hog roast. The plaza square on the Saturday is just going to be full of all sorts of delicious things to eat.

And demos. I’m actually doing a cooking demo with Karen Ogilvie.

You are? And what have you finalized on? You’re doing muffins, aren’t you?

We’re doing muffins. Actually cupcakes. I’m not sure of the technical difference between muffins and cupcakes.

I’m not sure, icing maybe.

Icing, that’s it. So, we have muffins where we’re going to be including diced candied orange peels from Moon’s Grove Farms. Of course, if people want to make it without that, that’s fine. But then we have this lovely dark chocolate allulose fudge icing that we’re going to be swirling on top of those things. And also, we’re still tinkering with the recipe for either a sour cream lemon or sour cream lime cake with a cream cheese icing on top. Frosting, buttercream, cream cheese, something like that. Anyway, we’re playing with it right now. When I say we, I mean Will is playing with the recipe right now. And we are really excited, Karen and I, to do this cooking demo. It is going to be a lot of fun. Karen and I are actually, in theory, starting a podcast. We keep trying to make time for it. It’d be Keto book bookclub and if we can get that launched before Ketofest, I will be thrilled to, pleased as punch to hope that people have a chance to listen to it. I think a Keto book club is something whose time has come.

I do, I’m very excited about it. We’ve been talking about it, haven’t we behind the scenes for a while. You told me about it quite a while ago. And yes, I think it will be a great format. Like you say, it’s not something that’s out there already. It would be a great new podcast I think for the Keto universe.

I’m excited about it. And now that Karen’s schedule is freed up a little bit, with her son not being in school, she has less errands and running around and PTA business to do, so we’re gonna hit it pretty hard, in theory.

Perfect. I can’t wait for that. That sounds like you’ve laid down the gauntlet there. That will be nice to be telling everyone at Ketofest that it’s launching.

That’s right, Karen. Karen and I are both psyched and we both have busy lives so it’s hard to fit it in. I have no idea how you do it, Daisy. You are a super woman.

I was just going to say, yeah, obviously I know what it’s like in it seems like a huge challenge and it is very daunting when you’re starting because there’s so much to organize to launch it in the first place. That’s the thing. And there’s this other element that holds you back a little bit because you know that once you’ve started, you’ve got that commitment. If you’re doing a weekly podcast, as soon as you put the first one out, that means you’ve got to be putting one out every single week. And yes, it is a big commitment. I mean now that I do every part of it myself, I’ve worked out that each episode takes a minimum of a day and a half, probably closer to two days really, to produce the hours episode that you listened to, and all the things that go with it. So, all the social media and the show notes, everything that goes into producing and promoting that episode. Yeah, and it’s the best part of two days’ work. You’re taking on quite a lot. I mean it’s good when there are two of you, obviously you can share the load a bit and as everyone knows by now, I think, I’m a bit of a bit of a perfectionist nut job when it comes to editing. So, it probably does take me a lot longer than it does for other people.

Maybe. I’ve certainly heard some podcasts out there that clearly have not had professional editing of any sort. So, maybe a certain amount of sloppiness is acceptable.

It’s finding the balance. Yes. It’s that whole don’t let perfection be the enemy of good thing. It’s the finding the balance between the two. And I’m getting there, I’m getting to the point where I’ll leave in a lot more of the things that I used to just get so super-involved in taking out.

I don’t think I’ve ever heard bad sound on your podcast, at least to the extent that like I’ve been like irritated by it or anything.

I should hope not. I had good training. I was brought up in the Carl Franklin and Brandon Wen school of podcast editing, so very good training. Absolutely.

Very cool. I’m just delighted if we can get this podcast launched and I say if, because both Karen and I do lead busy lives and have obviously other irons in the fire. I think that terrific fun and I love reading books about Keto, as does Karen. So why not help other people?

And as does the community, I think. It will be very needed. I not sure if needed is the right word. Do we ever need anything? I think it’s a podcast that people will be very interested in and will also enjoy being involved in as well. That’s the thing with the book club, isn’t it? That the listeners can become involved in it and be part of it.

And we can have discussions about what does this part mean? Did you try this recipe from this Keto book? Is this Keto author insane? That kind of thing. It’ll be fun.

I think it’s a fantastic idea. And you know, good for the authors as well. It works in all different angles, isn’t it? Promoting their books to the community, getting feedback from the community. Everyone wins. Can’t wait for the Keto book club podcast.

Yeah. I’m psyched. Did you hear that, Karen? Let’s do it.

She’s gonna love you for this.

We’re going to have a great time together, Karen and I.

You are, absolutely. Obviously, I do my podcast on my own, but I do like the dual presenter podcasts. It’s interesting. Obviously, they have their guests on, but it’s interesting seeing that synergy between between the two hosts and often that’s entertaining in itself.

Well, I think Karen and I have different perspectives on things. So, we can inform and engage each other and hopefully our listeners.

Absolutely, can’t wait. So, we’re at that point in the show where I ask you to leave us with a top tip.

Okay, my top tip is if you have not tried intermittent fasting, try it. Trying to get more in touch with my body’s signals for when I’m actually hungry and when I actually want to eat has been an incredible change in my health and my approach to food. Divorcing myself from eating because it was expected and there’s food available. It’s time to listen to my body and say, I think that I don’t need to eat because I’m not actually hungry, and then not doing it. It has been so empowering. So, if somebody is looking to take their Keto practice to the next level, they should try it. It is almost as hard as just starting Keto in the first place, to take control. Not really change how much food I eat, but just listening to my body about when I eat it and saying this is what hunger is, this is just emotional, I want something in my mouth. It has been a real game changer for me.

Yes, I do think it does really help dial in those signals. I found the same. I’m definitely a bit of a grazer, especially when I’m at home and I know the difference, because I can be out gardening on a job all afternoon and I don’t feel the need to be eating all the time, yet when I’m at home and the fridge is there and just, oh, I’m hungry. But I’m not hungry, I know I’m not hungry, I know it’s just I want to pick, because I know there’s some cheese in the fridge or there’s some ice cream in the freezer or whatever it is. Yes, to actually go for period of time without food and to really get properly hungry. It does really help I think if you’re one of these people that struggles with head hunger versus real hunger.

You know what it is for me? I realized eating something feels vaguely productive. Like I have done something, I’ve accumulated resources for my body. So, at a kind of emotional intuitive level, it lowers my stress level a little bit because I have packed on some more resources. So, I’m not going to starve. Nothing to do with physical hunger, just emotional satisfaction because I’m not going to starve today and it has to do with maybe food insecurity or something, but it doesn’t have anything to do with physical hunger. So being able to tell myself I’m going to direct that need to do something productive into a different thing that is also satisfying. Maybe doing a little house cleaning, maybe, buying something on Amazon, doing some gardening that also satisfies that.

It’s weird how you have so much time on your hands when you don’t eat as well, don’t you? I mean, I found that a bit when I was doing my carnivore experiment. How much more time there was, and I can remember when a friend came out to eat, he obviously wasn’t eating carnivore, so I had to prepare some vegetables and things for him and it was like, blimey, this all takes so much time. My rack of lamb ribs or something, it was just a case of taking it out of the fridge, putting it in the oven, taking it out the oven, eating it. The extras that I had to do for him. But obviously it’s a whole new level when you’re fasting, you’re not eating at all. And I know that whenever I do fast, I’m not very good. I need to get a fasting routine. It’s those days when you’re not eating, it’s like, oh, this extra time on your hands when usually you’re either preparing, cooking or sitting down and eating that food. It actually takes up quite a chunk of your day, doesn’t it?

Yeah, absolutely. Or I’ll be out on a business trip with colleagues who obviously are not Keto or fasting. And it’s a good third of the day that’s spent sitting, eating, getting food, going into a restaurant, whatever it is. Even more than a third of the day. And if I say, you know, guys, I have to make up an excuse, so it doesn’t sound weird but I’m not eating with you. I’m just going to go back to my hotel room and get some work done. That gives me back so much time and I need it. Because I’ve got a lot going on in my life, Daisy. Woo. So, it works out pretty well.

Yeah. Busy women just as you were saying, you’re just going to try adding a podcast to that. Good luck finding the time.

Better time management. Of course, I cannot neglect my partners or my family or the garden or the pets or anything. So, it’s a matter of priorities.

Yeah, I have the advantage there. I just have my dogs and cats really. I don’t have to think about entertaining other humans. Now I do keep forgetting to ask people, so I will just throw it in at the end here. What your Keto looks like on an average day when you’re not fasting, obviously.

Definitely. Black coffee or sometimes with a little bit of heavy whipping cream. And about the coffee, I’m serious about coffee. I’m nuts about it. We have our own home roasting machine. We import beans from either Costa Rica or Tanzania. We got some lovely Tanzanian peaberry right now. So, we roast our own beans, grind them. We have an espresso machine.

Because the roasting is important, isn’t it? Sort of the temperature of the roasting and how long you roast it all really affects the flavor, doesn’t it?

Absolutely. So, you have different roasting profiles that change the temperature of the roast throughout the roast cycles. Fresh roasted is totally different than stuff that was roasted a week ago. If you’re buying stuff in the stores in little bags, it might’ve been roasted a month ago and wow, that’s very different. So, the fresh roasted beans changed my life. I’m fully caffeinated now, Daisy.

So, when you say its worlds apart flavor-wise, but what is that difference?

Well, it actually changes if you have coffee that’s been roasted within the past 24 hours. The notes of the coffee are more floral, more bright, has this dimension to it that goes away. A lot of the essential oils evaporate within that first 24 hours. A lot of out-gassing so, it’s less acidic after 24 hours. It’s different. The chemical composition is different.

So just like wine then really, it’s the difference between having a Beaujolais Nouveau to having something that’s been aged for however long.

That’s it. Exactly. And some people will say, some Beaujolais are too young, or they don’t have that depth of character. So, it’s not always the case that fresh roasted is better. It’s different and sometimes I really love it, but sometimes letting the roast sit for at least 24 hours to out-gas and mature a little bit. Then that first 24 hours to a week period. I think that’s where you have the richest flavor and then maybe after a week a lot more of the oils have started to either mature or evaporate a little bit. So, the flavor is less intense. 

Anyway, that’s how my day starts. Cup of fresh roasted coffee and water, tea. I have 20 different kinds of herbal teas that I love. I don’t do soft drinks with any of those nasty sweeteners. We have seltzer often; I love seltzer or other kinds of naturally sweetened things. Not naturally sweetened, naturally flavored, like little bits of lemon juice or lime juice or whatnot. And then food wise, a little left over from last night maybe for lunch if I feel like it. Or we have chickens, so eggs are pretty common for a meal, either hard-boiled or scrambled. Or I’ll make a quick frittata. 

And then dinner, Will has usually cooked some large piece of meat that we’ll slice. He just roasted a smoked brisket, nice chunk of beef brisket on hickory wood, also a rack of ribs. So, he’ll come up with something and sometimes he gets super creative and comes up with some crazy dish. He did Indian butter chicken last night with cauliflower rice and a salad and a Keto coleslaw sweetened with allulose. But some days it’s just burger, patty of ground beef with cheese and bacon, then the salad. And honestly that’s the best.

It sounds pretty handy having a live-in chef.

It really is. I highly recommend it.

So, I mean overall, as we mentioned earlier. Fairly simple really, it sounds like you’re a two meal a day as well, that that seems to be the most common pattern. I think two meals a day.

Generally. Yes. Sometimes one, sometimes none, but generally two.

And so, when you fast, do you have a regular fasting routine? You talk about intermittent fasting and for how long do you fast?

Generally, I will do food-less Mondays. Where I just hate Mondays. So, I don’t want to sully Mondays by doing anything pleasant like eating. I just want to have full, pure hatred for Mondays. So, that’s it. No food Mondays and then, generally I’ll eat, either breakfast or lunch, but not both. And then dinner. That’s it. Nothing fancy.

One of the things that is quite often leveled against fasting is that, you know, I’ve heard the argument that people just make up for it. They compensate on the days they’re eating and eat twice as much. But I found the absolute opposite actually the day after. If I fast, I tend to fast for either 24 or 36 hours. And certainly at least the first meal I have is probably half the normal size. I tend to find that I eat less on the day after I’ve fasted, not more.

I think that it kind of re-calibrates my appetite and stomach to not eating. And so, you can’t really just go right back in and have a huge meal. I’ve done five-day fasts on a number of occasions. I think for health purposes it’s great to really get that deep into autophagy. So, I think maybe once a quarter to do that, but not for weight loss purposes. Because I did find that, after five days of fasting that in the weeks afterwards that I did have a heightened appetite. So, I don’t think those longer fasts, for me anyway, helped me lose weight. But a short fast, food-less Mondays, skipping breakfast or even skipping breakfast and lunch sometimes. That doesn’t seem to move the dial for me one way or the other, it just helps. I think it keeps my system more insulin sensitive to do it occasionally. Sort of like exercising, which I should do more of. I have a treadmill desk. I work from home; I use the treadmill desk every day. And I love it. I highly recommend it. That’s my other top tip. Intermittent fasting and get a treadmill desk if you work from home.

I’ve never heard of treadmill desks. I’ve heard of standing desks, but I have not heard of treadmill desks.

Standing desks actually don’t do that much good for you because you’re just standing still. You’re just standing. I mean, it’s maybe a little better than sitting, but maybe not. Because you’re still just standing there, still. It’s not natural. It’s not natural for people to be sitting or standing in a still position for long periods of time every day. Walking is natural. So, I have a treadmill and I have a hutch that goes over the treadmill and my laptop sits on top of the hutch. I don’t do super concentrating work there. So, if I’m working on software and coding or writing, no, I have to sit down cause you need to concentrate. But for surfing, answering email, doing Facebook, the treadmill desk is perfect.

Interesting. I’m going to be imagining whenever I read one of your Facebook posts, while she was watching this, she was walking on her treadmill desk.

Very frequently.

Well, it’s been wonderful catching up with you and finding out a bit more about you. Thank you very much for sharing your time with me.

Oh, I thank you for sharing your time. It’s delightful, you’re one of my heroes and, I’ve just been squeeing inside this whole time. I love what you do, Daisy.

Thank you very much. And I look forward to that hug at Ketofest.

Me Too. Me Too.

See you soon.

See you soon.