Episodes

PHC Conference 2019

May 24, 2019

Daisy’s latest extraordinary women, Louise and Suzie, return to the podcast to chat about the recent PHC conference that was held in London.

Louise

Louise Reynolds is a military wife to Andrew and mum of three adult sons. In her working life, she was the first Australian female paramedic to gain a PhD and has spent the last 15 years teaching university paramedic and health science programs in Australia and now the UK. Since 2015, she has been using low carb/keto to maintain her 130lb (60kg) weight loss. In her spare time, she is strength training at the gym and planning overseas travel.

Twitter @drloureynolds

Suzie

Suzie Edge is a former NHS doctor and medical molecular biologist. She trained in the department of orthopaedic surgery but left recently to set up her own business, helping others in real-food health with their digital media marketing and social media content, an area she worked in before being a doctor. 

Suzie has been through her own health and weight loss journey, discovering low carb and the keto way of eating through the work of Gary Taubes and Robert Lustig. She now spends her time thinking about how we might get the messages of low carb and real food out as far as possible.


At home Suzie is a Mum of two girls whose diet she is finding harder and harder to influence. 

Twitter @edgesuz

Facebook @EdgeAgainstTheGrain

Instagram @doc.edge

What If Health podcast

Support Suzie on Patreon

PHC UK

You can find videos of previous year’s presentations on the PHC YouTube Channel. Watch that space too for the 2019 presentations which should be released within a few months.

How about a fun day out for all the family where you can meet with like-minded people who are into real food?

Low Carb Denver videos

Zoë Harcombe What About Fibre?

David & Jenn Unwin Behaviour Change “In a Nutshell” & Picking Our Low Carb Battles.

Louise’s Top Tips

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Siobhan Huggins & Dave Feldman

May 17, 2019

Daisy’s latest extraordinary people, Siobhan and Dave, talk about what n=1 experiments they have been up to lately and quitting diet soda addiction.

Siobhan has lost nearly 80 pounds over the course of about 2 1/2 years, using a combination of a ketogenic and carnivorous diet. Along the way she’s also found the diet improved symptoms of depression, and keratosis pilaris as well as resolved her hypertension, eczema, and chronic joint and back pain.

She now works with Dave Feldman full time, studying lipid metabolism and the immune system, along with plenty of n=1 self experimentation.

You can find her at CholesterolCode.com, at her sideblog dentritica, or you can follow her on Twitter @Siobhan_Huggins.

Siobhan’s presentation at CarnivoryCon 2019.

Siobhan’s presentation at Ketofest 2018.

Dave is a senior software engineer and entrepreneur. He began working with programming and system engineering at a very young age and has always enjoyed learning new mechanistic patterns and concepts.

After starting a low carb diet, Dave found his cholesterol numbers increased considerably. He then began reverse engineering the lipid system through self-experimentation and testing, finding it was very dynamic and fluid. He has now demonstrated this multiple times by moving his cholesterol up and down substantially. in a matter of days. 

Find Dave at CholesterolCode.com and follow him on Twitter @DaveKeto.

Dave’s presentation at CarnivoryCon.

Dave’s presentation at Low Carb Salt Lake.

Siobhan’s Top Tip

Dave’s Top Tip

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Bec Johnson – Transcript

1
May 10, 2019

This transcript is brought to you thanks to the hard work of Cheryl Meyers.

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

I’m doing really well. Thank you Daisy. Thanks for having me.

Loving the conference?

It’s awesome. I’m learning so, so much, my brain is full.

Mine too. It’s, it feels like there’s a little bit of space there left to maybe squeeze some more knowledge in, but I was just saying earlier before we started, I sometimes feel have this sort of limit to how much you can stuff in, in a limited period of time. But you made the comment and I think that’s absolutely true that they’ve got a really nice pace with different presentations going on that that just stops you having that overload effect.

I agree. I think that they’ve balanced the high level public health content with the getting down into the weeds with the technical stuff really well. So you can come through a technical presentation and just have a little bit of a break and zoom out and take on something that’s a bit more big picture. I really like the way they’ve balanced that.

Yeah, me too. So tell us a bit about you.

I am 35 years old. I’ve had Type 1 diabetes since I was 17. I’ve been eating low carb for about 17 and a half years. So seven or eight months post diagnosis, I switched to a low carb diet and have been Keto since about 2012 when I started experimenting with a Ketogenic approach for endurance exercise. I’m also the CEO and one of the founders of the Type 1 diabetes family center in Perth, in Western Australia. And that’s a facility and service of which I’m immensely proud. 

We’re now supporting more than a thousand people impacted by Type 1 diabetes in our state. And we very much have an holistic and food first approach to diabetes management encompassing not only nutrition, certainly, but insulin therapy, being versed up on all the tools, the technical tools and devices that you can use to manage diabetes, but also mental wellness, peer support and very much that wraparound social support element that I think is needed for a life well lived with a chronic disease like diabetes.

I think it’s really important to take that holistic approach.

Absolutely. And I think that we’ve had a very medical model of care for Type 1 diabetes that’s really focused on insulin therapy and insulin delivery devices. And I feel that zooming out and looking at all the different pillars of good diabetes care and good health and nutrition, exercise, mental support, and indeed family support. That’s why we called ourselves the Type 1 diabetes family center as far as I’m concerned, Type 1 diabetes is a team sport. Every person in a family is impacted by a diagnosis, and every person needs to be knowledgeable, compassionate to the person living with diabetes but also to themselves because it is a long journey and it can go on a lot of different directions and the family center is there to help people through that.

And it’s great this working together with the patient and their family, which is really important, but with the medical care they’re getting. I was talking to Belinda Lennerz earlier and she was saying that there’s often this mismatch between the patient and the practitioner they’re working with and that they’re quite often feeling really alone because they’re going out on a bit of a limb getting involved in this way of eating and then not feeling supported. So it’s really nice to hear that there are more practices at least embracing this approach even if they can’t necessarily promote it, but it sounds like you’re able to take it more to that level to actually promote it and suggested as a way of eating and a lifestyle to adopt that’s really going to help manage the lifestyle for the Type 1 diabetic in question.

Yes, we are, we believe that a low carbohydrate approach should be on the table as one of the first line therapies in relation to Type 1 diabetes management. Obviously it’s always going to be adjunct to good insulin therapy. However, we’re not afraid to talk about it. We feel that it is not that controversial. It’s just eating real food. And it is certainly central to our approach to care. If patients want to come in and talk about it, then we’ll have the conversation because at the family center, we believe that people with Type 1 should be supported to transition to or maintain a low carbohydrate approach with solid dietetic support. They need to be meeting their micronutrients, they need to be meeting their energy requirements. And I think that not everybody does it well alone. And if we’re able to provide them that clinical support, then that’s what we’re here to do.

We are not necessarily leading with it. We lead with the holistic approach that I think the patient-centered approach is really what we’re about, in that when patients come into the family center, the first question they’re asked is what are your goals? And we really work with those because if somebody comes in and, HbA1c isn’t their goal and it’s not their focus, but perhaps weight management or exercise or managing hypos is, then we’ve got to go in building a relationship on what they need, rather than necessarily going away and say, well HbA1c is the marker of good diabetes management. That doesn’t necessarily serve them. So, that’s what we do.

And what are the most common concerns that people have when they come to you? The primary concerns, the things that are impacting their lives in the most negative way that they’re trying to fix or find strategies to help, you know. What are the most common problems that people are asking for help?

In relation to diet and Type 1 diabetes or more generally?

I suppose generally, because you take that holistic approach in just managing their Type 1 diabetes. What are the biggest issues that they have that really impact living a quote/ unquote normal life?

Before we opened the family center, we ran a whole series of focus groups asking parents of kids with Type 1 and adolescents and young people with Type 1 what they needed. And the theme that came through most strongly was connection. They said to us, we feel isolated. We feel alone. We feel unsupported and underserved by not only the medical community but by the community at large. People don’t understand our disease. It’s invisible, which is in some ways a blessing and in some ways a curse, because the general community doesn’t see it, doesn’t understand it. And the power of connection is transformative. And that’s why we have very much led with a peer support approach. 

We’ve set up online communities that are thriving with parents of kids with Type 1 and now adults, and they’re running through closed Facebook groups. And as you’re known as someone participating in the social media world in relation to Keto and this way of eating, it’s just a live dynamic community. And so we’ve set those up. We have hundreds of engagements every day through our online communities and we also have a lot of face to face connection and events. So that’s how we have tried to build a community in Western Australia, our own people with Type 1, because we want to make sure that people don’t have to live that lonely road, and that they, they can feel connected. And I think the value of connection is not only in the sense of not feeling isolated and alone, it’s also the information exchange that happens when you’re part of a bigger community, the hive brain that you can tap into of hundreds of people that have experienced what you’re experiencing and can offer insight and advice and knowledge. I think there’s huge value in that as well.

That’s a really big difference, isn’t it? I can remember when I had my first weight loss surgery and I was just completely isolated and just couldn’t do it, wasn’t getting good information from the bariatric team and there was just nowhere to access the information until I started finding online groups, you know, and that surgery didn’t go well, but when I had the revision surgery, I had access to all these online groups and the difference was incredible. Being able to make contact with people who are going through, have been through the same thing. It’s just worlds apart from dealing with the theory of it from someone who hasn’t experienced it. It’s just so much more reassuring to be able to, to talk to your peers in that situation isn’t it?

It absolutely is and we’ve made that central to the philosophy at the family center in that nearly every member of our team is personally impacted by Type 1 so it goes all the way through to the people. I truly believe that people with Type 1 diabetes should be working in diabetes organizations because there is that sense of, again, connection. You can drop your shoulders when you walk into the family center because everybody there gets it and that ocean deep compassion, that’s the stuff. That’s the stuff that changes the trajectory of people’s Type 1 diabetes management that helps them come to terms with it, to make peace with it because they see others who are living with it and working well with it. And I think that’s what we aim to create.

I’d be really interested to hear more about your personal experience about when you got your diagnosis. What led up to that? What led up to you know, you obviously realized that something was going wrong, there was a problem, but I’d just be interested to hear more about that.

It was interesting. It came off the back of it very, very stressful year. I had finished my final year exams and I was the goody two shoes over achiever at high school who was the captain of everything. And I had, I believe that maybe that lead in of that sort of eight to 12 months of high stress in my final year at school, was possibly one of the triggers of my diabetes diagnosis, which was in April the following year. So I got a really unwell over a series of, you know, short months and lost a lot of weight. I think I lost 12, 14 kilos over a couple of months. Started—the thirst is just indescribable, and I remember I would wake up through the night and probably I drank the worst thing I possibly could have drank. I still couldn’t, I couldn’t even go near a glass of it today. And that was apple and guava juice. I went through liters of the stuff! And indeed I remember being at a wedding, and that night I was so thirsty, I drank five carafes of lemonade. I mean, and I, I remember the fellow I was with thinking, what is wrong with this girl? 

And I was just making my sugar level higher and higher and higher and getting thirstier and thirstier. I had every symptom in the book, blurry vision, sores that wouldn’t heal, leg cramps—and finally my mom dragged me to the doctor. I had, she had made several appointments for me, which I had canceled cause I hate going to the doctor. And I went to see my GP who did a finger stick. And, actually no, he did a blood draw and I got a phone call the next day and I’ll never forget his voice. He said, ‘Rebecca, you have diabetes.’ And it was his very final sentence. And my heart sank. I didn’t really know what that meant, but I knew it was bad. And he basically said, get to the hospital asap. And I went there and I was diagnosed and it was just this whirlwind of three or four days. I was admitted. I was given my first insulin injection, which made me feel instantly better, which was wonderful. 

But then I was given the education and I will never forget again, they gave an brought in an orange and a needle and they made me practice learning how to inject with the orange because it’s the same sort of texture as flesh, apparently. So I injected a number of times and then they gave me a fresh needle and said, okay, now it’s your turn. And that was it. That was the start of five to seven injections of insulin every day. I think on calculation I’ve probably had around 45,000 injections in my life. It was the start of eight to 10 blood glucose finger pricks every day. And it was the beginning of the counting, the endless counting of carbohydrates, fats and proteins, plugging that into complex insulin to carbohydrate ratios, which change in my body four to five times a day. The string theory that you have to do to manage insulin dose calculations. And I guess the beginning of that fear, which lasted in a very intense way for the first eight months, of administering a hormone that is so powerful, it will kill me if I get the dose wrong in what back then was in really quite large amounts and had me afraid to take a walk around the block.

That’s incredible.

Or to go to sleep or any of those things that are normal life we should be able to do without thinking. And that was the beginning of my journey towards finding a solution.

Yeah. So what advice were you given when it comes to diet?

Eat according to the Australian guide to healthy eating, which was, you know, 8 to 12 serves of starchy vegetables and grain based carbohydrates every day. Limit fat, lots of fruit and I did, I dutifully did that for the first eight months. It was cereal and toast for breakfast. I had sandwiches for lunch, I had fruit for snacks. I had pasta for dinner and every meal, my blood glucose surged high and then crushed low because insulin is a woefully blunt tool. Synthetic insulin in any case, it is not even close to the sensitivity of a physiological insulin response. So I was trying to deal with these tsunamis of glucose charging into my system with, you know, great big wads of exogenously delivered artificial insulin and a lot of guesswork.

That’s what strikes me—that the calculations are just fraught with danger because they can only be guesstimates at best.

They are. And I think that we’re given this advice as people with Type 1 that here is this thing called the insulin to carbohydrate ratio. And if you count your carbs accurately and you weigh them and you’d do the ratio, then your dose is going to be good. And I really genuinely think that many members of the medical profession believe that works. It’s not sound science, it’s much more art than it is science because there are so many factors that influence not only the carbohydrates and the rate at which they’re absorbed into our system, but also how fast insulin is absorbed. I know from years of practice that if I put my needle in my stomach it’s going to work a lot faster than if I put it into my arm. And if I put it into my bum, it’s going to work in a different way altogether. 

And so even just the basic where you put your needle in is going to impact how fast the insulin works. And then there are myriad other factors around absorption of tissues at the site, you know, how active you’ve been. I think wonderful Adam Brown has isolated 42 factors that impact blood glucose and a lot of them are food and obviously insulin related. But it is, it is just such a complex beast, and the advice that you’re given that here’s the formula, go forth and conquer. It just falls flat. And yet I think so many people, it raises this false hope that “We’ve got, we’ve got a tool, we have a formula,” and it just doesn’t work like that.

There are just variables at every level, every turn. But yet you’re being told that this is quite an accurate linear equation that you should be able to master. So if things aren’t going quite right, which I imagine is probably the norm or certainly not going right all the time, the logical conclusion of that is well, I must be doing it wrong.

Absolutely. And there, I think the feeling of I am a failure is a very familiar feeling for people with Type 1, because you know, we’re set up to hope and believe that with the formulas and with the counting, you know, we’ve got this control over diabetes and that doesn’t work. And then when we go in to see practitioners around it who aren’t compassionate to the daily experience of living with Type 1, it can feel like you’re a naughty kid being dragged in front of the principal. You know, they’re there. I remember going in to see my endocrinologist and he would flip through my diet, my book, you know, there’s apps for this stuff now, but I used to write down all blood sugar levels and, and I might have fantastic control for weeks, but then he’d flipped back and he’d point to the hypo that I had on the 7th of April, which is months before, and he said, what happened here? And the whole appointment many times would be zero in on something that went wrong and reverse engineering that. And so there is never a sense—well there wasn’t in my experience—it wasn’t a sense of congratulating me or celebrating me for the things I did right. It was more around, okay, how do we hone in on the risks and that and the stuff that I didn’t do right. 

And I think the hard thing about Type 1 is that it’s all on me. All of those calculations, all of the discipline around food, around exercise, around managing those myriad factors, it’s all on me to manage. There’s no other thing I can blame. And so when it goes wrong, it does feel like my fault. And that can be a really hard thing to deal with. And learning more recently around self-compassion, and building that resilience and, and compassionate self-talk and behavior has been a really important piece for me and a relatively new thing. But we have to be compassionate to ourselves because there’s a lot of management that goes into diabetes at any given moment. 25% of my brain space is taken up with calculations.

Got to allow some room for other things. What triggered, led you to start looking for something else? A different way of managing all this?

There wasn’t a particular incident. I just woke up one morning and said, I can’t live like this, I’ve had enough. I there has to be another way. And I think I went, it wasn’t Google then, I went online and found the Dr. Bernstein “Diabetes Solution.” I wish I could remember the search terms that I plugged in to find that, but I saved up, I was working in a video store as a student at the time and I was earning $11 an hour and I had to save up, I think it was about $68 to buy this book and pay for the shipping. And it took weeks to come from America. There was no Amazon or Book Depository then. And I read it, I devoured it and it made so much sense in indeed I had already been restricting carbohydrate in the lead in to getting this book because I just couldn’t cope with the high, the feeling of my high blood sugar. And then reading that was very much validation. 

So I took those high level principles I felt much more confident about it and implemented them into my life. And almost immediately everything changed. My insulin dose has dropped by 75%, and they still remain very, very low. So my error margins dropped significantly because I wasn’t, dosing myself with industrial doses of insulin anymore. My hypos became mild instead of completely brain frying, you know, shaking, sweating, terrifying things. And everything became so much easier. My roller coaster blood glucose levels smoothed out and I have maintained that way of eating, with a few blips, admittedly, for the last 17 and a half years and maintained A1Cs in the low fives and high fours. I think my highest A1C ever was 6.6 for the majority of that time. It has completely changed my trajectory, with this disease and my ability to live a rich and full and active life with it.

Yeah, and I can just sense that switch from despair and I just can’t do this anymore to one of hope and potential of happiness and normality.

Absolutely. And people say, Oh wow, but isn’t eating low carb hard? I think it might take a bit of discipline. I find it extremely easy now, and a bit of creativity in the kitchen.

It takes some discipline to start with.

Yeah, I agree. It takes, you know, build your knowledge base, get committed, be disciplined around navigating your food choices and you know, get creative. Although it’s getting easier and easier now. It wasn’t easy then because they were no low carb conversations happening. I was very much out in the wild. But it is something that we can do and we can thrive with. And you’re absolutely right. Once you have that foundation and that base laid around the confidence and the skills to eat low carb and navigate food, then it becomes so much easier and life does feel more hopeful.

I was at a party last night, Pamela Zorn had laid out a wonderful array of food and we were just laughing, you know, joking saying this, this way of eating is so onerous. There were two or three different kinds of crackers, there was a delicious smoked salmon dip. She’d made cultured butter, cultured truffle butter, poppers, prime rib, smoked chicken.

Where was my invitation?

Is so hard. How can anyone think eating that is onerous in any way? Yes, the transition is difficult because apart from anything else, you know, most people are just fighting that carb addiction. But once you’re through that and you can just revel in so many things that we’ve been told for so long are bad because they’re full of fat, but they’re delicious.

Yes, yes.

But you’re a swimmer, a competitive swimmer.

That’s right.

Tell us about that and how that all the implications of that with the Type 1.

I love swimming. I’ve been swimming since I was a kid. And I’ll dial back a little bit into sort of transitioning across into Keto because it has been, I had to take a long hiatus from swimming until I really got Keto right, because for various reasons there were difficulties, technical difficulties around testing my blood glucose in the water. But also the transition across to Keto in 2012 was around endurance exercise. Generally. I was doing long distance mountain bike racing at that point and triathlon and the conversation around ketogenic diets and becoming fat adapted sort of came across my radar with Steve Phinney and Jeff Volek’s book, “The Art and Science of Low Carbohydrate Performance.” And that really changed my thinking around how I could become a better endurance athlete by becoming completely fat adapted.

At that point I’d probably been low carb, and eating above the Keto threshold. When I read that book, I dropped my carbohydrate considerably and change my macronutrient ratio and found myself racing around mountain bike courses with a big smile on my face and endless energy. And that really helped me feel safe and confident to come back to swimming because I felt having watched my blood glucose stay completely stable while I raced and trained on land, I felt confident that I could get back in the water. And at that point, because I was not able to test my blood, I could still trust that it was going to stay stable. So that was really the push that I needed and certainly wanted to be able to get back into swimming. And I have since gone on and done the Rottnest channel swim twice now, which is a 20 kilometer swim to an island off Perth.

We’ve got a few big plans to do a double crossing next year. So that would be a pretty major achievement that I’d really love to tackle. But we do a huge amount of training, so squad sessions, sessions in the river, sessions in the ocean every week in the lead up to these races. And yeah, fueling it with a ketogenic approach. It’s quite remarkable when I see my swimming friends who are taking on carbohydrates every 20 minutes while we’re training and gel shots and we’re having to drop drink bottles with PowerAde right up and down the beach when we do our long sets and they all remark, you know, how do you do this without any fuel? And I think I’ve got enough fuel in my left bum cheek to swim to Madagascar and it feels wonderful and very freeing to not only be able to feel like I have an endless source of slow burn energy, not have to eat because—eating while swimming, I don’t know if you’ve ever tried it. It’s not an easy thing to do—

I can’t imagine it would be, no.

—when you’ve got a salty tongue and you’re tried to ingest something while you’re treading water because you’re not allowed to hang onto a boat that’s against the race rules. It’s, it’s not a fun thing, you know? And I’ve got mates that ate peanut butter sandwiches and all sorts of ridiculous things out there and they’re great. I’d rather just keep swimming, thanks. But also finally to trust that I can, my blood glucose is going to say stable. That’s the holy grail of exercise formulas for someone with Type 1. So it’s something that ketogenic diet has very much enabled me to do and, and to do well, which I’m really happy about.

I can still remember my mum used to drum into me that I wasn’t allowed to swim until at least an hour after I’d eaten. So I think I’d constantly have that voice in my head. Well, you can’t possibly eat and be swimming at the same time.

You’d have to take a little rest, a siesta floating on your back. I don’t actually understand.

I don’t know where that has come from either. But it was just something that was this really strict rule.

Yeah, I’ve heard that too as a kid. So I don’t know about that.

Presumably then you must have seen quite a difference with the practicalities of how you were organizing that your swim before and after Keto. It sounds like you’re not having to take on any fuel at all, you know, in the competition swimming or do you have to take on some?

I could very easily do it completely fasted. I guess the only reason why I need or I would refuel during a long race is if I get a bit hungry or to lift my spirit. Because if you’re face down in murky green water for hours and hours on end with no one to talk to you and just inside your own head, sometimes it’s nice to take a break and having something nice to eat is, or take on board is just something to do. I think the other reason why I might take some nutrition in is to keep me warm and that does actually really help. Yeah, there’s no real need for it. I can run on ketones and feel like I’ve got perfectly stable energy levels throughout long swims.

But you did need it before, pre-keto?

Pre-keto, I was doing a little bit of swimming, but I think that at that point I had a lot less knowledge and the skills weren’t there in relation to how I manage diabetes and I wasn’t doing particularly well, which made me sort of avoid swimming to a certain extent, the testing regimen was a lot more onerous. Now I wear a Freestyle Libre, which is the little sensor I can put the receiver in a waterproof phone bag and just scan myself in the water so I’m totally self-sufficient. Then I’d have to stop and dry my fingers and get warm and test my blood and it was just fairly onerous to do. So I think that combination of the technology and the ketogenic approach is really just allowed me to do swimming with the freedom that I want to do it with without having to constantly think about or be anxious about blood sugar levels and how I’m going to test them next.

I remember Richard Morris telling me about the practicalities. You have to have the insulin you potentially need floating out there, accessible for you to use when you need it?

Yes. So, when I race, I have a paddler, a support paddler and he would have my hydration, nutrition, insulin or preprepped, my glucose monitor in the Libre. And when we stop to do a blood sugar test, he will throw me Libre. I can’t touch the boat. I’ve got to tread water, scan. If I made insulin, he’s got the pens, he has to throw that to me. It’s got a float on it so that it doesn’t sink because I can’t even be passed something because that would be a disqualification. I have practiced treading water and injecting insulin. It’s not as difficult as you might think with a pen in particular. And yeah. So all of those transitions have to be practiced before race day to make sure that we’re doing it right. I’m not going to be disqualified and I can do all the diabetes management tasks that I need to do.

What’s the distance? How long are you talking about with these races and the time that it takes?

We would do 10 kilometer swims regularly on the weekends and the distance for the race, this recent one’s 19.7 kilometers. So what’s that? About 12 and a half miles, I think. The first time I did it was horrific. It took nearly 10 hours. I got stuck in a horrible current and I swam over the same rock for about two hours, at one point I think it was soul destroying.

I was going to say, that sounds like the ultimate in frustration.

It was awful and I was seasick and I didn’t know that I got seasick until about 10 k’s in, when I started being sick and my heart just sank because I thought, oh my gosh, I’ve got a long way to go. If the only thing that’s going to fix me at this point, because I can’t keep anything down, is being on land and I have 10 kilometers to swim. So that took me six hours, that last 10 k’s of that race because of the current issue. And because I had to stop every 15 minutes to puke. But if not for keto at that point, if I had of been a carb dependent athlete and I needed to have nutrition going in every 15 or 20 minutes, that would have been my swim over, you know—and I trained for six months for this race. 

But the fact that I didn’t have to take anything on board as I was being sick, that was something that I was thinking far out, I’m so glad that I’ve adapted to this approach because I just don’t need to have the fuel. It’s awful vomiting, but I can get through that. The second time I did it, which was last week, it took me seven hours. So I took three hours off my PB, which I’m really happy with. You don’t do that every day. And it was a brilliant swim, I had a great time. I had a tiny little bit too much long acting insulin on board, which I started to really wear in the last couple of hours of the race. So I did need to take some glucose on to counteract that. But again, first 14 k’s was a breeze. I had half a YoPRO yogurt, which was three grams of carbs just so that I could take some medication on board at the 10 k mark and more sea sickness tablets. And that was all I would have needed if not for that tiny little bit too much insulin. So I felt a lot better through that race.

So you’re out there apart from your support team, you’re out there on your own. Multiple people are racing but yeah. So all on your own

Yeah, the Rottnest Channel Swim is an iconic event in WA [Western Australia], they have about two and a half thousand participants, not all solos. There’s about 300 odd solos that attempt to do it each year and the rest of doing it in duos and teams. So it’s a busy race. It thins out a bit in the middle, but very congested at the start and the finish, I don’t think I would swim to Rottnest just on my own. I like the safety in numbers concept as you may know, WA is also the shark attack capital of the world at the moment. So I think that I’m, I’m happy to be in the mix there, but it’s a lovely swim. You can see the bottom the whole way. And it really is a stunning environment.

You’ve mentioned a few times how things were when you were first diagnosed and the technical advances in things that are available to you to help you manage and monitor this. Perhaps you could just share a little bit about the change that you’ve seen over the years that you’ve been dealing with this.

When I was first diagnosed, it was obviously a blood glucose monitor. That’s the only technology that was out then. And I used that for many years. Indeed, I still do when I had to take breaks from the Libre or CGM. And obviously that’s evolved to continuous glucose monitoring and the Libre Flash glucose monitoring devices. I think both of them have been absolute game changers in Type 1 diabetes care. Unfortunately they’re not as affordable as they need to be for the Type 1 community. And that’s something that they’re suddenly changing to a certain extent in Australia. They are now federally subsidized for people under 21 and fingers crossed that they subsidize them for adults as well. But the visibility of blood glucose levels is something that when we work with people at the family center, the lights go on when they see the blood glucose surge that happens after they eat carbohydrate.

It’s instant. When I was diagnosed, and indeed even now, the advice, I still hear that people are told this, I was actively discouraged from testing my glucose after meals. I was told test before, so before breakfast, eat your breakfast and then don’t test again until before lunch. And of course in the meantime, my blood glucose would have gone up to 15, 17, 20—and it would come back down very nicely into range and I might be 5.6 before lunch, but meanwhile I spent three hours with my blood sugar level out of range.

What was the reasoning for that then? It doesn’t seem to make any sense—you would’ve thought you’d need to know what was going on in-between?

Well, the rationale would be it’s going to happen anyway. And if you know about it, you want to correct it with more insulin and if you correct it with more insulin and you end up in a hypo because there’s going to land in the safe range, it be all right.

That is obviously that linear equation, again, that doesn’t exist…

Well it just disregarded the three hours after every meal that I would spend outside of range. And if I didn’t know about it then I couldn’t even act on it. And at that point, the only, apart from reducing carbohydrate, I could change the time I took my insulin, take it a little earlier. So it married up with the carbohydrate curve perhaps as a mitigating strategy. But I wasn’t even given access to that information. And it took me becoming an overzealous blood glucose tester to the point where I had to have letters written by my doctor to the National Diabetes Services Scheme, justifying why I needed so many blood glucose test strips because people thought, I think they thought I was selling them on the black market or something. Because I was doing 20 tests a day cause I just needed to understand.

So CGM—now people, it’s visible. You know, we’ve got 288 glucose readings a day and it’s just sensational information. And I think that people really have the tools now to be able to act on that and change their management strategies to adapt their food and their insulin therapy due to better manage diabetes. That’s glucose monitoring technology. Obviously the insulin pumps have come a long way. I don’t use one, but I see their benefits particularly in children. Kids need that flexibility I think around being able to manage insulin and basal rates according to their very sporadic levels of activity. I think as adults we can be a little bit more structured about activity choices. Whereas kids, I think, you know, type Type 1 diabetes already feels like a straightjacket if they can run and play when they feel like running and playing and we can just drop their basal rates, I think that’s fantastic. 

The other thing I think the benefit is micro bolusing. The pumps give the ability to bolus and indeed run basal rates at much more sensitively fine-tuned doses than you can get with a syringe or a pen. There are real benefits to the pump. That said, there are also the downside. Wearable technology has mechanical issues, you know, pump fat failures, bubbles in the line. All the things that happen that come along with pumps that people need to think about as does CGM. It’s very intrusive if you’ve got a phone or a device alarming at you all the time, especially if you’re trying to run really tight thresholds, you will hear alarms often. It will interrupt your day and your sleep and your thinking. And that’s one of the pieces that I think that we don’t do very well in Type 1 diabetes care is prepare people for the psychological burden of the wearable devices. The very active wearing a piece of space junk our kids call it on our bodies and getting the questions and the curiosity from the community at large and have to explain diabetes over and over again. That can become a real drag. So there’s light and shade around technology, and I think we have to be really careful in the way we talk about it because in our diabetes community pumps are almost incentivized. I hear this thing of when we get to the pump, like when we graduate to a pump,

Yeah, this is the goal for everybody.

Yeah. And a pump is just a glorified insulin delivery device. You know, it might be snazzy, but it isn’t going to change the fact that you’re still making all the decisions. We do have closed loop technology that is just starting to be released, which was really exciting. So that means a continuous glucose monitor is talking to the pump and automatically adjusting basal rates. The person still has to think, they still have to do meal announcements in exercise announcements. So they’re actively managing those variables.

Yet the tendency is to think that it’s all just going to be automated and they can, the worry goes away because the responsibility is taken on by these interacting machines that are just going to manage it all for them.

Indeed. And that plays out both in the community at large, where people, every time there’s a big news article, Oh closed loop technology, somebody rings me up and goes, they’ve got an artificial pancreas now—your problems are all solved. And you know, that’s absolutely not the case. And then within the Type 1 community, when we see the research plays out, when you put people on pumps, their A1Cs in the first 12 months often going up because they themselves think, ah, I’m on a pump now, it’s all automated. And so, and that’s a bit of a hard reality when they realize, Whoa, actually I still have to do the inputs. I choose not to use a pump primarily because there are no pumps that are waterproof. So that’s a little bit of a struggle for me. But also because I’ve found a really great regimen with the insulins that I use and I feel like if it ain’t broke, don’t fix it.

Interestingly, I have a retro thing going on with the insulin that I use. So when I was first diagnosed, there wasn’t any rapid acting insulin. I was put onto regular human insulin, which is now considered so old school, you know, pharmacies don’t stock it. When I asked my GP for it, he looked at me like I had grown a second head. You know, why do you want this old insulin, over the years, over the time I progressed to the newer analog insulins for a period of time there. But I’ve since come back to using R, the regular insulin, in the last few years because it’s remarkable in how the time action profile and the peak of R insulin marries up with a protein glucose spike that I get. So protein spikes my glucose after four to five hours and that is exactly the time when R peaks. So, it’s really interesting that you know, we can actually look to the older insulin technology and find it useful in this new way of eating.

That is interesting. I found it interesting as well what Jake Kushner was saying about how potentially these automated systems with the insulin pump, how it potentially could work particularly well if you were eating low carb because you had, the blood glucose ranges were moving in a much tighter band.

Yes. And the increases are not as sharp. So if you’re eating a mostly protein and fat based diet, you’ll have sort of these mild peaks and that’s something that the pump can keep up with so that the pump can actually automatically adjust a basal rate rather than requiring a big bolus of insulin in order to keep up with that protein and fat curve. And I think that, I mean that is really the ultimate hands-off diabetes management. I mean, you’re not actually having to actively put meal announcements or food announcements into that pump, which is almost, I mean, I hate to say the word cure, but it’s certainly lightens that mental burden, which is one of the hardest things to bear with diabetes.

Yeah. So it feels like, instead of having to do that micromanaging throughout the day, if you more macro manage, pun intended, I guess, with your overall diet. And look at focusing on that. But that’s not having to look at the details all the time. I can see that being quite freeing. Obviously you’ve still got to carry on paying attention, but you’re managing it with more broad brush strokes and maybe this technology and equipment could take care of those finer details.

Absolutely.

It can free you up a little bit more for day to day living.

That’s the ultimate application for the closed loop system. And indeed are you familiar with the We Are Not Waiting movement?

No.

The We Are Not Waiting movement created a technology initially called Nightscout. It’s open source. It’s created by citizen scientists, mums and dads and people with Type 1 diabetes around kitchen tables around the world where they hacked continuous glucose monitors and firstly worked out a way to bounce the information to phones for remote monitoring. Awesome. Especially for parents. The next step has been the development of the open artificial pancreas system and the loop system. So these are again hacked systems where people are essentially running the closed loop type technology and have been for a number of years now well before the companies have released it. I have a friend at home, Kyle Masterman, who is a sensational athlete, low carber and he’s running an open APS and he has messaged me a number of times and says, I haven’t given myself a bolus all week.

And the system is just running in the background and managing things for him, and it’s giving him these micro boluses of insulin as he eats a big protein meal, you see the insulin start to catch up and his blood sugar level is insanely good. The thing I think the system hasn’t quite adapted to, is exercise yet, and that’s the next piece. But the idea that the food variable and the insulin variable can run in the background. That is awesome.

Yeah, I think that sending the same way when we haven’t spoken too much on that, but the tendency is just to look at food. But it sounds like looking at your activity level is hugely important.

I’ve worked out over years of experimentation than any exercise that spikes my heart rate over about one 80 beats per minute is going to raise my blood sugar level. So I actually need to take insulin in order to do high intensity interval training or spin class or anything where I’m going to do sprints. That’s so counterintuitive. I need insulin to exercise. Hang on a minute. The other thing that causes my blood sugar level to go up is glycolytic exercise, like lifting. Then the opposite effect happens if I’m doing longer, slower endurance stuff. If I’ve got the formula in my basal insulin dose right, and keeping in mind that I inject that, you know, I’ve got, I’m committed for 16 to 18 hours of a certain activity level once I do that. So sometimes it’s seven o’clock in the morning, I take a certain dose and I do a different activity than I anticipated in the evening. And sometimes you can get that wrong, but if I’ve got my basal conditions right, then my blood sugar level with endurance exercise normally stay stable.

If I’ve got it wrong, sometimes it will drop off a little. So that seems to play out as a general assumption for most people with Type 1. High intensity—blood glucose spike, low intensity—blood glucose is stable or drop. And bringing that into play is really important. , because when you’re dosing insulin, you’re not only dosing on what you’re about to eat, you’re also thinking how much activity have I done in the last three to 24 hours and how much activity do I anticipate doing probably in the next three to eight hours. And so as you say, you’re bringing in another set of variables, the duration, the time, and the intensity of activity or another few variables if you want to really drill down into it that you have to consider.

It sounds like you have to be super organized and good at planning.

Absolutely. I think that’s something that diabetes has taught me. It’s not my strong suit, but amongst a whole lot of other lessons, being a good planner. And I think almost to the extent where that too for a while it took over my life about planning and routine and I would become very anxious if my routine was interrupted and started to try and build a little bit more, I guess being able to be a little bit more relaxed about changes to the plan has been again, a more recent project.

Well, I could go on talking to you for hours. We’re being ushered and nagged by—interesting enough, the room needs to be set up for an exercise and movement session. I like to round off the podcast with a top tip, which can be anything you like, but I think maybe it would be nice to give your top advice for somebody who’s just been diagnosed with Type 1.

Connect with community. Clinicians took me some of the way—the community took me the rest of the way. If you have access through online groups or face to face support, other people who are walking a mile in your shoes, the information exchange, the support and understanding that you will get is the key to not only understanding diabetes well, but making peace with diabetes. And I feel that that community is transformative. It’s absolutely essential.

Well, thank you so much. It’s been a great pleasure for me and really interesting. I’ve been fortunate enough to be able to interview a few of you who have Type 1 or involved with Type 1 and it’s been very interesting and an education for me and hopefully will be for the listeners as well. So thank you so much. It’s been a great pleasure.

Thanks for taking an interest in people with Type 1. It’s important to us and thank you to all your listeners for being interested also.

Bec Johnson

May 10, 2019

Daisy’s latest extraordinary woman, Bec, talks about how she lives a life with no limits as a Type 1 Diabetic. She has twice swum solo across the 20-kilometre Rottnest Channel, sailed across the Atlantic, and become a SCUBA dive guide to prove it! 

Bec is the CEO of the Type 1 Diabetes Family Centre in Western Australia, an Australia-first centre for people with type 1 diabetes. Diagnosed with type 1 in 2001, Bec believes that there are no limits on a life with type 1 diabetes, and she has twice swum solo across the 20-kilometre Rottnest Channel, sailed across the Atlantic, and become a SCUBA dive guide to prove it. 

She manages her type 1 with multiple daily injections, a low carbohydrate diet, frequent connection with the type 1 tribe and plenty of active living.

Bec holds qualifications in Law and Arts, a Masters in Public Health, and a Diploma of Business (Governance). She is an Adjunct Research Fellow at Curtin University, a Fellow of the Australian Institute of Community Directors and a Fellow of Leadership WA. She is the only Australian to have been selected as one of the 100 Fellows of the global Facebook Community Leadership Program.

Links

website

email

Dr Bernstein’s Diabetes Solution Richard K Bernstein MD

The Art and Science of Low Carbohydrate Performance Jeff S Volek PhD RD & Stephen D Phinney MD PhD


Bec’s Top Tip

End Quote


Tracey, Ashlee & Dr Jody – Transcript

May 3, 2019

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

Welcome to a very special edition of Keto women podcast. I have here with me today not one guest but three. Ash.

(Ashlee) Hi

Tracey and Jody, welcome to the keto women podcast. How are you all doing today?

(Tracey) Very well. Thank you.

(Dr Jody) Wonderful to be here. Nice to meet you.

(Ashlee) I’m feeling awesome.

And Ash is my youngest ever extraordinary woman on the podcast. So, we’re here really to talk mostly about you. So let’s hear from you, tell me a bit about you, your story.

(Ashlee) Well my name is Ashlee. I am a type one diabetic and I have been for two and a half years. I am eating keto, which is low carb. We started a bit before I was diagnosed except it wasn’t completely keto. A few meals we had every now and then were keto, but we really started doing the real low carb one month after I was diagnosed.

And you enjoy eating this way?

(Ashlee) Yes, because we can have alternatives for different foods and meals and yeah,

I just had a squizz at the contents of your fridge and you got quite a few tasty looking things in there.


(Ashlee) Yes, they are very yummy. 

So let’s hear a bit from Mum and just elaborate a bit on the story and you know how it all came about. Must have been very worrying for you, the diagnosis and the treatment and what’s been happening.

Well Ash was diagnosed on the 25th of August, 2016. She was sick leading up to it. She actually was sick. She had chicken pox about maybe two months before that. Um, she seemed to have got better from that, and then a couple of weeks before that she was sort of just was a bit lethargic, not feeling very well. So, I packed the kids up and went up to Queensland, which is nice and sunny and I thought we’ve just got to get away from this cold winter. We went away, everything was fine.

When we came back I started to notice little differences and I thought they were girly hormones cos we just cry over something or we’d do something. Never in my wildest dreams would I have thought that this was signs of type one diabetes. But looking back now, there were signs, it came to a couple of days, It was about a Thursday. She had um, a year seven orientation. She was fine, she was happy, she was great. By Saturday morning she was starting to not feel great and I thought we’ve just had a big week, have a sleep. She slept all day again Sunday. By Monday she was, “Mum, I’m not really well” and I thought  something’s not right here. Like you’re never really this sick. So I booked a doctor’s appointment for Wednesday cause that’s all I could get in. Never thinking we should rush this.

By Tuesday afternoon she wasn’t crash hot. She wasn’t really talking to me. I’d have to say her name very clearly like “Ashlee“, and she’d wake up and she’d look at me and fortunate enough, my husband is in army reserves. He came home that night on the Wednesday night, thank goodness. And we would just sort of sitting, chatting in bed about what he’d been up to and she got up to go to the bathroom and she missed the bathroom because this is a sign of, ‘cos you drink so much water when you’re in the state of being diagnosed with type one. And she missed the bathroom ‘cos she was unaware, also too ‘cos her bloods were probably sky high. 

By Thursday morning when we woke up, her breathing was odd. I cannot explain to you what it was like to listen to her breathing. Um, her eyes were rolling in the back of her head when I was speaking to her. So, my first thoughts were going through like, she’s got meningococcal meningitis, diabetes, just never, we didn’t know anyone with diabetes. Um, I had never come across, we don’t even have type two diagnosed at that stage in our family. We rushed her up to the GP because we’d had that appointment, thank goodness that I made. However, he had no idea what he was looking at when we got there. And he said, “I think you need to go to the hospital.” And I said, “Well, if you don’t know, we need to go find somebody that does”. Annd off we went to the hospital driving.

I kept saying her name to her as we were in the car ‘cos I was so scared because she’s sort of passing in and out. Um, we got to the hospital and it was just very thankful that the nurse behind the counter knew what she was looking at and she goes, is she a diabetic? And I went, I don’t know. She yelled out she needed a glucometer and it came quickly. She pricked her and the next minute there was a bed. Ashlee’s thrown on a bed and she’s being rushed up the whole way. Pete’s grabbed the other two kids. Lucky he’s like six foot five and he’s got these kids under his arm and we’re just running after Ashlee, and I was sitting in this room with about 12, nine to 12 doctors and nurses.

She had tubes coming out of everywhere. Machines were beeping and buzzing tests were going on and I had no idea what was happening, people going she’s a diabetic, and I went, what does that mean? The only thing I knew about diabetes was amputation of limbs. So of course. So then I started panicking and then after that she got much better cause we had insulin and things like that. And, and then I had a dietician come around and talk to me about the fact that I’m, now that Ashley has insulin and we know this beautiful thing that she was hiding from us. “She has diabetes and now she’s got it, she’s got insulin, everything’s gonna be fine because she can eat whatever she wants, she can even have Mcdonald’s”.

Oh, okay. And I stood there and thought, this is odd, Mcdonald’s? She’s the sickest child I have but now you’re telling me I can have Mcdonald’s. So, things like juice, jelly beans, chips, all this carbohydrate foods started coming home because, well, one, I was told I needed it. And so you’re very, uh, you’re taught so much about Hypos, um, hypoglycemia events that you stress out about the thought of saying the word. So, I had, you know, massive jars of jelly beans ready for these horrible events. Children doing meltdowns on the floor because well if Ashlee gets one, we want one. And I, I was losing my mind because here is a mother trying to give nutrition to my children, having a type one diabetic and needing apparently needing these foods.

So eventually, after a horrible event where Ashlee’s glucose levels just dropped one night, I decided I needed to go on a, I needed to go back to my roots, which was food. And we started low carb, which was really good. Um, we were doing really well until her HBA1 C’s started going up and I thought, well, this is what, what’s, what’s going on here? What am I doing wrong? I’ve changed the food. Then I worked out after elimination and things that we don’t actually know what insulin is. What is insulin? What does it do in the body? What does she need it for? And so many times I’ve been bullied by endocrinologists, laughed at by doctors, nurses, because why bother teaching me? I’m just a mom. You should just listen and do as you’re told. I’m not that kind of person. This is my baby here. I need to know what’s going on.

For months and up to a year. I had no help, nothing until my wonderful dad, bless him, he watches all his, I call them his Keto gods, but he has these beautiful people that he watches and he’s learnt so much for himself. He watched an episode with Mike Mutzel who runs high intensity health and it was on this wonderful type one diabetic specialist that he met, I think in his father’s town, and  He did an interview with her, my dad, myself, and Ashlee because dad had come down for Christmas. We sat on the couch and we just think I had tears and I think my eyes almost popped out of my head and Ashlee just sat there and she goes, “I want to talk to her”. And I went, “Okay, let’s make this happen”.

I got straight on my phone, I booked in an appointment, a 20 minute get to know you session. And from then on, it’s just been onwards and upwards because I met this fantastic, beautiful women Dr Jody, who’s just taught me, I mean, our first session was on the importance of Basal Insulin. My knees went weak. I just, I’m sitting there, I’m looking at my husband, I’m going, Oh my God, Oh my God, we’re talking about insulin. I need to know this. And I was there with my pen and paper like I was, you know, ready to go into university. I’m studying and I, I still remember our first session together. It just gave me so much hope, but someone was teaching me, someone was finally teaching me what my daughter was diagnosed, and I had this feeling of I can actually be her Mum again for a whole year, I felt completely lost that I couldn’t be her Mum, but she was given to me. How can that be? How can I be given this beautiful child who’s now going through this horrible thing, but I can’t be a Mum. So that’s where we are and we’ve now 18 months or almost 18 months, and we’re just, we’re all thriving. I’m a Mum of four children now to a type one diabetic to the other three and we’re just, we’re bopping along. She’s got an HBA1C now 5.4. And I’m really proud of her. She’s amazing.

Well that’s fantastic. There was something I just wanted to ask you about, just to go back a little bit, when you said going back to your roots and the food and that’s what you know about and the low carb so this is something that you’d been involved with before, you know, how did you know to go to that? What led you there?

When I was about 13/14, I became anorexic. I was obsessed with food and wanting to be really healthy. I was into sport and I went down a very dark path with food, um, more so it was just, I wasn’t eating enough. And after I was diagnosed, my father said to me, that’s it, you’re not swimming. And that was my life. Swimming was my absolute life. And I thought, well, I’ve got to get myself better. How am I gonna get better? I’ve got to work out a relationship here with food. So, I turned those horrible thoughts into a passion and that’s where I’ve just myself have been learning what fuels me, what fuels my body. And I’ve done that for years and years and years. When I was 18 I was in a very stressful household. My mother was very stressful. Um, I ended up getting sinus infection after a sinus infection and I then started researching and looking into natural medicine things.

And so I combined my love of food and natural medicine and I’ve just sort of always criss-crossed those paths on my own. Just reading. I mean YouTube is an absolute blessing. I love listening to podcasts, watching YouTube videos because I can learn on my own accord. But six months before Ashley was diagnosed, my father started watching sugar videos, things about sugar and then he put two and two together and you know, oh my goodness, carbs are sugar. And we, so we sat down together and worked out some recipes. I love to cook. I’ve always loved to cook since I was about seven, the kitchen and I were just best mates. And so, he called me and said, “Let’s work out some recipes”. So, I started dabbling into what low carb foods was, what it meant, meals. And so  I thought this is great, I can incorporate it into our family. And so, I started learning about low carb through more of a metabolic syndrome type two diabetic approach.

But I just knew that night when I was really upset and I knew I went back to my roots, I knew I needed to go back to food because food has always been that really important part of me, I’ve always understood that.

Yeah, really interesting. And so, to go now to the woman who, it sounds like, has had a major influence on your life. And I can see now listening to you talking about the way you like to learn and really drive your own knowledge and how that influences your life and I can see how it really appealed to you to, to reach out to somebody like this. And I think we’re going to have to have you back on a podcast, a separate podcast just of your own to hear your story ‘cos I bet that’s going to be an interesting one. But for now, to just talk about your involvement with this family and the different things that go on it at a lot of people. And we’re here at the conference and it’s type two diabetes predominantly that that gets talked about and type one gets sort of left in the corner a little bit, although coming much more up to the forefront. You know, I’ve been talking about it with people like Jess Turton, there’s a lot more, research and an understanding about it in the low carb community isn’t there? So, perhaps we could hear from you now then Jody.

Absolutely. So, I’ll just say my name again. My name is Dr Jody Stanislaw and I was diagnosed with diabetes in 1980 so almost 40 years, which is surreal cause I don’t even feel 40,  and I knew the only diabetic I knew was at summer camp because there was no internet, there was no, I mean there was no connection with any other type ones. So, um, it can be very lonely. And once I became a teen, I started asking my doctor a lot of more challenging questions and I’ll never forget the day that when I asked my doctor about blood sugar level with exercise, he just patted me on the knee and said, oh, it’s too difficult for me to explain it to you, you would never understand. And I’m quite certain that he actually didn’t know the answer.

And that’s what I’ve realised is that the majority, hands down of family practice docs or just general medicine docs absolutely are not skilled to truly give a type one the care they need. But the sad thing is, is I’ve also found that many endocrinologists who are supposed to be the experts and diabetes, um, many endocrinologists are also not adequately trained. And I just truly think that the training is not out there. I mean, I’ve been asked, you know, what textbook for type one did you use in med school and I was like, oh, there’s, there’s not a textbook. Everything I’ve learned is really from my own experimentation.

There are a few other type one medical professionals that have written books and they’re just catered not to med schools, they’re catered to patients. So, all of us type ones, we have that bond, where as soon as, even if I see, you know, somebody wearing an insulin pump or a CGM in public, suddenly I’m like, Hey, hey, hey, you know. So, there’s this a really deep bond. And I, um, I learned so many incredible valuable things about how to get better blood sugar level just from my own experimentation over 20, 30 years that I, I went to med school and I also am a very adventurous person. So, I didn’t want to be in a classic, you know, standard hospital job. So, I created an online virtual practice. I have patients in 10 countries and all over the U.S. and I’m so lucky that Tracey and Ashlee found my video. It’s truly a miracle. I mean, I was a little teary when you were telling the story because this is my job to help change lives and help improve lives. And it’s so needed. And we, you know, after a year of being on Skype together, we just met face to face today for the first time ever.

That must’ve been quite an incredible experience. I mean, I met you two. Ash and Tracey, and you are so excited Ash, weren’t you, waiting, waiting to meet this woman. I remember seeing you in your face and you just, you just kept looking, looking at the door, looking at the door. She come yet, is she here, is she here? Uh, yeah. It must’ve, it must’ve been quite something to all get together. I’ve experienced that. We’re talking to people online, but the actual, when you, when you get to meet them, when they’re there in front of you, it’s something else, isn’t it? 

Yeah, very special. So, I feel very fortunate that I get to help people like Tracey and Ashlee and my big passion now is to really help millions or I don’t know how many type ones are online. There’s, I mean there’s only, they say maybe 10 million in the U S or I’m, I mean in the world in the U S it’s anywhere from one to 2 million. Sometimes I hear 3 million, but people don’t really know. The reality is hands down, the education for type one is very poor and standard conventional recommendation is eat as many carbs as you want and take more insulin and this is devastating.

This is absolutely, it creates such poor health for the children it’s very dangerous because they have to give such high doses of insulin that then you can’t necessarily know exactly how much and when you need the insulin, you’re always guessing when you give a shot and if you give too much insulin you can go into a coma and die, you know, and then the high blood sugar levels are creating blindness, heart disease, kidney failure, strokes, gangrene, Alzheimer’s Moodiness. If a child’s blood sugar level is high, they have recognised that you can be excused from taking an exam because the brain doesn’t work. So here they are saying eat as many things as you want and take as much insulin as you want. But the reality is they’re at risk for dying from a low and slow death from highs.

Now I understand why they say that though because before that it was an incredibly strict diet. I weighed and measured every bite of food I ate my entire childhood and so eating disorders are much higher risk of eating disorders when you have type one and so they are justification for why they say, oh, you want to eat like all the rest of the kids is to avoid that. But it’s still, you know, it’s just the pendulum has swung from strict to nothing and neither extreme is good.

Perhaps you could explain exactly how it works and how the whole system works with dealing about your food intake and judging how much insulin you need to inject and when and how the whole system works.

Well, I normally work with people for three months to answer that question, but the conventional doctors will say, count your carbs and for every one unit or for every approximately 15 grams of carb you eat, you need one unit and 99% of type ones, that’s the full education that they get. So, if you eat 30 carbs, you need two units, 45 carbs, three units, like that. That’s it. But the reality is you also need a background dose of insulin.

That’s the first thing that I worked with Tracey with on day one, because your liver is actually putting glucose into your body all day long. So you actually need, I did a seven day water fast once and I still had to take insulin because you absolutely have to have insulin to be alive and your liver is actually feeding your glucose. Insulin, I like to say is the pickup truck for glucose, once you eat, the glucose is absorbed into your bloodstream and then insulin is needed to pick up that glucose and feed it to yourselves, right? So without insulin, the glucose stays in the bloodstream, which is not good, and your cells starve, which is not good.

The first thing I work with patients is just figure out their baseline need, which is to counteract the livers glucose. So we haven’t even talked about dosing for food yet. You have to figure out that first. Then we’re going to look at, there’s many aspects to how to dose a meal. Carbohydrate is one of them, but if you’re going to have a banana versus black beans, it could be the same amount of carbs, but you’re going to have to change the timing, right? Because what’s a banana gonna do? Immediate Spike. A black bean, not immediate spike. So you have to think about glycaemic index.

Then if you’re just eating protein, protein itself actually can raise blood sugar. So many patients think they can just have, you know, all this protein and they don’t have to worry about it. They have one little piece of bread and they think, oh, I only need one unit because I only had 15 grams from the bread, but protein actually can turn into glucose, so I have to teach patients how to dose for protein, which is very different than dosing for Carb, and then actually fat can have an effect on glucose as well. So that is just food.

The size of your meal also is dependent on your dose because the timing, right? You could have this many carbs, but if you have this huge holiday meal, it’s going to be digesting for hours, so you’re going to have to spread out your dose over hours, right? So that’s just food. Stress raises blood sugar, getting sick raises blood sugar, hormonal swings  raise blood sugar. Then there’s just life. Insulin can go bad, it can get too hot and then people are dosing. Then they go high and they don’t know why. Well, your insulin was in the sun, right? Absorption when people dose a really big amount, if they’re eating a lot of carbs, absorption from day to day can vary, especially the bigger dose of insulin you given any one time, the less consistent the absorption.

So these are all the fine tuning details that I teach patients that truly I don’t see, yeah, it’s life changing because all we’re told is dose one unit for 15 grams of carb. And if you go, low eat sugar,

It sounds mind-blowingly complicated. I have to say, I’m feeling overwhelmed and stressed as listening to the thought of, you know, the thought process I’m going through and I’m just, you know, with everything you’re saying, I can just see potential issues with all of it. You know, I talk to people about not completely trusting labels and they’re you know, they’re always going to be an average of the contents. I always cite the packs of Bacon that I buy, you know, and it lists how much protein and how much fat is in there. Well that’s an average. I always pick the ones that’s got a load of fat on it and leave the ones that are really lean. But you can’t tell me, the macros are the same. The macros that are written on the nutritional information on that pack well they can’t possibly be the same. And uh, you know, and that’s the same for everything, isn’t it? So you know, what size is your banana? And it can vary, an apple can be different sweetnesses, and when it’s off season, I mean..

Exactly. 

So presumably it’s only going to be a sort of a guesstimate at best.

Every time and this exactly is where low carb comes in. So the biggest driver of high blood sugar is carbs. So you can see this whole array of conditions and variables that we have to manage every day that if you just reduce your carbs, your job’s going to be a lot easier. It’s still a lot of work and I still go up and down, but my life is so much easier. If I’m going to have a chicken salad, I’m like probably need a unit. I might need another unit later. If I have pasta and bread, I’m like, Oh Gosh, do I need 10 units now? And then I wonder if though, what if they all hit at once and then I go low. So, but then if what if I go high later, well then, if I have a high carb meal, I will only have it at lunch because there’s so many variables for hours after you eat carbs that you have to be on your toes to manage. Are you going to go low, are you going to go high? If you go low you have to eat more sugar. If you go high, you need more insulin. Dinner is always, if there’s ever, I allow myself treats every now and then and I try to always have him at lunch because I don’t have to worry. But yeah, low carb, it just makes sense. And this is not conventional medicine.

Well that’s the thing, logically to me it absolutely makes sense. Just thinking about those highs and lows, that anything you eat is going to cause a rise of some kind instead of having those, you know, nice rolling hills, you know, you have these huge great mountains spikes that and I can see how very difficult it would be to treat those because as we were just saying is it’s really difficult to get the right dose and whenever you go up high you’re gonna come down really low. So, so tricky. Logically it just seems the perfect way to eat.

Diabetes camps, summer camps for kids. They completely embrace, eat whatever you want. I’ve been to diabetes. I mean I’m on staff diabetes camps cause it’s, it is such a huge life changer but unfortunately now I have to kind of, you know hesitate before I recommend them because all my families are low carb. Right. And then they send their kid to diabetes camp and they serve them every carb you can imagine.

I was going to say with the, the swings, the blood swings, they, it’s not only, you know what like for a parent having to watch those blood swings and correct them and change them and do it, it also does mentally challenge and physically challenge your body. Ashlee if going into lows, t’s so draining, it’s exhausting. And even the highs, the body goes into stress mode as you’ve taught us. After you go into like once you pass blood glucose level 10 the body starts going into this mode where it’s going to pee out the calories because it wants to get rid of that sugar that’s now in the system. That sends, the body doing things that it’s got to, quick, we’ve got to get rid of this, we’ve got to get rid of this.

And those highs and lows, those swings, it’s not just the bloods that you worry about, it’s mentally too because they, you know, she feels low, she can’t go and play, she can’t, and then when she’s high, she’s still can’t go play. She can’t go swimming, she can’t concentrate and she gets frustrated with herself. So it really upsets me when I see these bloods because I know from a mum side of things what those little children are going through or anybody with type one, watching them go from a high to a low to a high..

And that is the majority of type ones. That’s how they live their life. 

Very tricky. And what about you Ash? How have you adjusted to this complete life change and it must have been a massively steep learning curve. 

(Ashlee) Mm yeah sort of.

Sounds like you’re the kind of person that really just takes it in your stride. 

(Ashlee) I kind of just go with the flow, you know.

Yeah, she’s got a good Mumma, helps her out. 

(Ashlee) Yes. Mum does a lot of work. She tells me when to do insulin and how much I need most of the time at school and whenever I’m home alone or something like that, I normally do it myself. But whenever Mum is near me or around me, she will tell me what to do. 

That’s so great. 

So specifically what was your involvement with these guys? Just educating them a better way to be doing it.

Exactly. Yeah, so I work virtually, so anybody listening they can find me at website and sign up for a free call. In the free call I assess are we a good fit? And then, um, I do series of Skype or phone calls. So I do a minimum of three hours with patients. So that could be three one hour calls or six 30 minute calls. I think we did six one hour calls or something like.

Yeah, we did fortnightly one hour sessions.

One hour every two weeks. Yeah. I always encourage people to really invest in a minimum of three months of working with me because in the past I would give as much as I could in an hour and nothing, it was too overwhelming. Nobody, then we’d have our second appointment and it’s like I just said everything again in appointment number two. So, I’ve actually changed it to 30 minute calls for majority of people now and I spread them out over three months. There’s so much to digest.

And you need to adapt and practice what you’ve learned, then come back and probably reinforcing those lessons, but then gradually learning new things as you go.

Absolutely. And, as a holistic physician, I am not only interested in how their blood sugar level is doing and that they totally understand insulin. I want to know how you’re feeling and you know, how are your bowel movements and what supplements are you on and what are you eating? And are you exercising? I mean, I truly, I’m a holistic physician, which means I want to take care of the whole of you.

I became the kind of physician I was wished I found, which I still have never found. I want somebody that takes care of all of me and asks me how I’m doing. Maybe have an appointment where we don’t even talk about blood sugars. We just talk about, oh my gosh, this is a lot. It’s overwhelming. I know. You know, and it’s so beautiful that I have type one because I have that immediate bond with my patients. There’s a lot to work on. 

That’s what I loved about Jody so much is that she could connect with me, talk to me about everything, but she also could connect with Ashlee, which is something I can’t do. There’s this little small part. I’ll never, I’m not a type one diabetic, and it was so nice to have someone that I trusted to be able to be there for my daughter. And the best thing, I still remember clearly, I think it was about session three we were cold, which is not cold to doctor Jody because she’s has snow, we don’t in Canberra, so were all rugged up in our blankets and Ash was just sort of sitting there and the last 15 minutes of our session, it was all about, Jody just brought it into Ashlee, “How are you feeling? How’s school?” We were talking about some stress levels at school. It wasn’t really anything to do with diabetes, but Jody made it all about Ash, which was just perfect because that’s what it needs to be.

I mean I need to learn. I really do. I’m the mum. But Jody remembers that Ashlee’s the one with type one. Ashlee is the one dealing with this day in, day out, you know I can go and have a shower and forget about it for five, 10 minutes. These two can’t. It’s always there and that was what was really special for me is that Ashlee has someone she can turn to that I trust that can help her with any stage of her life.

Sounds like a really important resource you offer. 

Thank you. 

We were talking a little bit before we started recording. Can we talk about that then? This new Facebook group and the potential that has to reach so many more people.

Right. 

Cause obviously you deal with people as you’ve explained, working one on one, but the power of the Internet is often to be able to extend that reach massively. So perhaps you could tell us a bit about that ‘cos it sounds really exciting.

I’m very excited and it is, I’m so passionate about helping people really, you know, have the transition and the transformation that Ashlee and Tracey have in just a year or two. I’ve had patients that have had this transformation as well, but they had diabetes for 40 years and it took them 40 years to find me. So, year after year of just hearing how much my work has changed lives, I was like, I need to reach the masses. So I’ve spent actually the last two years recording videos and making handouts, and then I had to re-record all the videos and then I made some new handouts and I’ve put my heart and soul into these online courses and they’re actually available now on my website.

Which is?

It’s Dr Jody ND [drjodynd.com] – so that’s d r j o d y n as in naturopathic and then d as in doctor. There is a membership tab there. All the courses are there. I have a course on getting off the blood sugar roller coaster, what to eat and how to dose mastering your blood sugar level with exercise, how to stay positive and avoid burnout because that’s a whole other topic when it’s just like too much and people give up. The three essentials of lowering your a1c, I do group calls. Um, I also have an annual retreat in Sun Valley, Idaho.

But yeah, the Facebook thing is going to be launching in I think it’s March 14th, which is like in a week and it’s basically a monthly subscription for $20 a month and you get access to all of my courses. There’s two live calls a month and I do a weekly live video and I can’t give you details to where to go because the page doesn’t exist yet. But if you go to my website.

Presumably yeah, though there will be updates on your website. 

Yeah. Well if you just go Jody A Stanislaw on Facebook, that’s my Facebook page and then drjodynd.com is my website, so you can definitely find me in those two places already.

And then presumably with this Facebook group you’re going to be building a community. 

Yes

That’s the beauty of it, I mean that’s what I love about coming to conferences like this is the community and making that connection and obviously you’re going to be there to help and teach people, but there’ll be that comradery and the community where the people can help each other as well. 

Exactly and I’m sure Ash and Trace feel like, I mean I feel like I’ve already known them for a year ‘cos I have known them for a year. Although we just physically met today, it certainly doesn’t feel like we just met today. You know, that’s the beauty of the Internet. And so that would be my goal. My goal is to have a thousand people in that membership program within the next three months and then 2000 and I mean given the millions of type ones. My goal is that it’s that easy.


A million by the end of the year. 

Yeah, that’s it, right. 

That’s your challenge! 

Right? I’ll take it. I dream big so,

Well, it’s been really wonderful talking to you three, my first ever four-way podcast 

Okay. 

And my youngest ever extraordinary woman

14. I don’t think we ever said her age.

(Ashlee) Yeah, I’m 14. I was born December 31st, 2004

I’m a December baby too. Well I traditionally wrap up the podcast with a top tip. So as I’ve got three of you, maybe I can get three top tips. Who wants to go first? So a tip for the listeners, it can be anything you like. 

If you know anybody with type one please have them reach out to me

As a parent of a type one, don’t be afraid to keep asking questions and keep learning. Just because you’re a parent, just because you may not be a doctor or a specialist, that doesn’t mean that you can’t learn.

Tracey, you know more than most endocrinologists now

As a teenager and a type one, what would your top tip be? Think of it this way. What would your top tip be to fellow teens who had just had a similar diagnosis?

(Ashlee) Try Low carb. Low carb is the best. It’s healthy, that one. And also ,for type one diabetics, it’s easier to manage bloods.

So yeah, just like we were saying earlier, it actually just makes your life easier.

It makes sense.

And it tastes so good.

It’s much easier for Ashlee when she’s at school because she’s by herself. She’s dealing with things, you know, going in and out of class. She doesn’t have to add up these copious amounts of carbs. She just actually, most of the time at school, she just, what we call like sugar surfing. She just eats morning tea and lunch and then she just watches her CGM. I mean with, thank God for CGM’s.

Continuous Glucose Monitor

She just watches her glucose monitor and she just doses accordingly as she needs to throughout the day and it makes her life. She can just be a teenager and bop along as her bloods are bopping along.

Well. Fantastic. Thank you all very much. It’s been a great pleasure and wonderful to be sat here with you all, not just across the computer screen which is what I usually do so, thank you very much. 

Thank you. 

(Ashlee) Thank you.

Thank you.

Tracey & Ashlee Kimberley & Dr Jody Stanislaw

May 3, 2019

Daisy’s latest extraordinary women, Tracey, Ashlee & Jody, talk about Ashlee’s diagnosis and treatment of Type 1 Diabetes plus how Tracey and Ashlee, who live in Australia, came to work with  US-based Dr Jody Stanislaw.

Tracey is a mother of 4. Ashlee was born on New Year’s Eve 2004 and was diagnosed with Type 1 Diabetes on the 25 August 2016. They had a horrible first 18 months with no help or guidance and even got abuse from specialists. 

After watching Dr Jody on YouTube and her interview with Mike Mutzel Tracey and Ashlee knew they had to contact this amazing lady and learn from her. 

A year later, after working with Dr Jody, they finally got to meet her in Denver at the Low Carb Denver conference. 

Dr Jody Stanislaw received her Doctorate in Naturopathic Medicine in 2007. She is a Certified Diabetes Educator and a Type 1 Diabetes Specialist. Having lived with Type 1 Diabetes since the age of seven, she has dedicated her career to helping others with Type 1. From her 30 plus years of experience, she teaches life-changing information about how to successfully manage Type 1 that most patients have never learned, and also supports patients with diet, exercise, emotional health, as well as overall well-being.

Patients from over thirty states and ten countries have had transformational experiences with her, via her virtual practice, yet there are millions around the world still struggling. To tackle this gap, she has created the first-ever type 1 diabetes virtual training course, covering what to eat & how to dose, how to get off the blood sugar roller coaster, how to master blood sugar and exercise, and how to stay positive and avoid burnout.

Links

Tracey

Facebook

Twitter

Instagram

Email

Tracey’s presentation at Low Carb Down Under in Australia, October 2018.

Dr Jody

Website

T1D Academy

Facebook

Instagram 

LinkedIn

YouTube

Jody’s interview with Mike Mutzel (High Intensity Health).

Dr Jody’s Ted Talk

Tracey’s Top Tip

Ashlee’s Top Tip

End Quote

Jennifer Reichow – Transcript

4
April 26, 2019

This transcript is brought to you thanks to the hard work of Trish Roberts.

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

I’m doing really great, Daisy. I’m so happy to be here talking to you today.

Oh, it’s nice to be talking to you too. Why don’t you tell us a bit about yourself and your journey?

I think I had a fairly regular childhood. I kind of like to start with that. I was a fairly…I’m using quotation marks, although you can’t see that…normal weight up until I was about six years old. I have a picture from when I was in kindergarten and I looked like I was at a…again, quotation marks…normal weight. And then after that I started getting a little bit chunkier. I like to say I was a chubby child, an overweight teenager that grew into an obese adult. And just as I went from high school, I was overweight. I wasn’t terribly overweight, but I was probably about 15 or 20 pounds overweight. And when you’re a teenager you really… it could be a hundred pounds. It feels the same even though it really isn’t. Since I got older and I had the full-time job and started having the children and you’re just kind of gradually gaining weight over time.

I ended up being about 300 pounds and that was just before the birth of my last child. I was 300 pounds. And even after I had my baby, I still only lost about 30 pounds. So I was about 270 pounds. I’m only five foot two. So, I felt that I looked pretty awful and I wasn’t feeling very healthy and I had looked into weight loss surgery because I felt like I had tried everything and just really gotten nowhere. At the time, here where I live in Ontario, Canada, they did not offer any kind of weight loss surgery, that wasn’t paid for by the government and otherwise you had to pay for it out of pocket. And it probably runs like $10,000 or $15,000. If you qualified, you could go and have it done in the United States and they would pay for it. But again, it was a huge process and I was a bit worried about going to another country to have surgery. So after a couple of years they did end up offering surgery here. They really made a very big program into it and quite a process because they recognized that short term it was less expensive for the government to pay for a surgery, than for me to develop diabetes and heart disease and have to have acute care somewhere along the road.

Where were you with all that? Did you have, you know, any health issues, apart from the obesity obviously, but usually there are other things that go with it or was it actually just like I had… really, I actually was fairly healthy from a metabolic and blood work point of view, but it was the practicalities of it that I found very difficult. And I wanted to ask you just going back a little bit, how you found both your pregnancy and then the stresses and strains of dealing with a young child when you were that size. Because, snap, as far as the weight was concerned, that was the weight I was. I’m a little bit taller than you and I know how limiting it was for me and how hard work it made, everything. So I can only imagine how it must have been for you with a baby.

When I was at 300 pounds towards the end of my pregnancy, it was quite awful. I was swollen everywhere. I could barely stand. I could barely walk. I had to leave work about two months early just because there’s no way I could cope. And then after I had the baby, I was still fairly limited in what I could do because I had no strength. But I bounced back pretty quickly, because up until then I’d been a fairly healthy person. I hadn’t had any major health issues other than being overweight. And I think that’s where a lot of people are, that they don’t have a lot of issues and people are almost fatter younger because of the obesity epidemic. I think when I was in my twenties and thirties there really wasn’t that many obese people and now…or at least it didn’t seem like it anyways…and now it’s much more common to see people in their twenties and thirties that are morbidly obese.

And so I think that having a lot of healthy, overweight people – and that it’s a good idea from a government perspective to try and get a handle on costs – to look at trying to help these people that are otherwise healthy before they start developing other issues. And I think I was very lucky that way, that I hadn’t developed any blood pressure or diabetes or heart disease or anything like that. I think I was quite lucky that way. But otherwise, I’d always been fairly healthy. I was strong. I went to the gym quite a lot. I had a physically demanding job, so that way it was, it worked out well for me that, going into the surgery, that was my only issue, was being obese.

So as far as the process went, because it sounds a bit like a similar process to here in France and I know in the UK…I’m not so familiar with the States, but again, I should imagine somewhat similar. It’s a process in differing lengths that you have to go through and you have to tick certain boxes to be eligible for that surgery. Unless of course you’re paying out of pocket and then you can do what you like. But if you’re reliant on some assistance from the government, there’s this process that you have to go through. Did you have any issues with ticking all the boxes or did it just purely come down to you’re a certain weight and so that automatically puts you through? Which was pretty well the case for me actually…I went in and he had his sort of dial that he worked out my BMI and he said, right, this is the surgery for you. And it was literally just because you’re overweight.

That was pretty much the situation for me as well. Here in Ontario, they have what they call a bariatric registry. So you go to your family doctor, you tell them you’re interested in having this surgery, they refer you to this bariatric registry, which then refers you to whatever the closest hospital is in your area that does the surgery, their clinic contacts you, and then you start a series of appointments. You see a social worker. You see a nurse. You see a nutritionist. You see a resident. You meet the surgeon. And this is usually over the course of several months. You have to have an ECG. You have a gastroscopy. You have an abdominal ultrasound so you go through all of this preparation work. Oh, you may or may not have a sleep study to see if you have undiagnosed sleep apnea. You answer a lot of questionnaires. You do blood work.

So it’s quite a process because they want to make sure that you’re relatively healthy going into it. Yes, you do have to have a certain amount of weight on you. From my experience and from what I’ve heard from other people, they go by the BMI, which isn’t the greatest indicator, but that’s generally what their guidelines are and have other co-morbidities. So I mean there’s always the potential to develop diabetes and obviously high blood pressure, heart issues when you’re carrying excess weight. So you’ve pretty much got those co-morbidities down to begin with if you’re morbidly obese. So the process can take anywhere from about nine months to a year to get through all of this.

It’s a lengthy barrage of tests isn’t it? I had the same here put together a dossier of various appointments.

Yes, that’s right. Yeah. I do wish though that in hindsight, I wish that they had done a little bit more emphasis on the social work, mental, emotional aspect of it because I think that that would have been a really big indicator going forward, how I would have managed after the surgery. I don’t know that I ever would’ve been able to manage losing weight without the surgery, but I think that I could have maximized my abilities afterwards if I knew a little bit more about myself as a person and why I had gained the weight to begin with. Because I don’t think people just gain weight in a void. Most people gain weight for a reason. And if I’d been able to understand that going in, I think I would have done much better after. As it was, I struggled for several years with losing weight.

I lost probably about 70 lbs right off the bat, which was great. It put me under 200 pounds, but then I kind of yo-yoed with about 20 pounds here and there, kind of getting down to about 175 at one point. And then I was up to about 220, so I kind of yo-yoed back and forth. And then I had sort of settled around 200 and I just wasn’t able to lose any more. And then I had actually gone back to the bariatric clinic to ask for a revision. I had the vertical sleeve gastrectomy, which is a surgery where they basically leave your digestive system intact. They just cut away the bottom part of your stomach, which is the biggest part. Your stomach is shaped like a banana – essentially how they leave it. And I had gone and asked if I could have a revision to a surgery called a bypass – they do a lot of moving things around and making your stomach into teeny tiny pouch about the size of a golf ball or a tennis ball. And it’s so that you cannot absorb a lot of your nutrients that you’re taking in and that’s how you lose weight.

Yeah, because they bypass part of the digestive tract…part of the intestine is bypassed. That’s literally how it gets its name, isn’t it?

That’s right. Yeah.

You’re not absorbing everything. Just to go back a little bit, two questions. By the sounds of it, they offer different operations. So presumably when you went in, were you given any kind of choice with the operation you had, or were you told the operation that they thought was appropriate for you? What was that initial choice of operation process? If there was any.

What they do here is they generally do the bypass as kind of the gold standard, because that’s the surgery that they really have the most studies on, and long-term data to understand that it’s the one that’s the most successful for most people. The other surgery, the vertical sleeve gastrectomy, is being done a little bit less. It’s a little less invasive and takes a little less time and there are a little less complications with it. And that was the surgery that I was interested in, but understanding that they would probably want to do the bypass, I actually wrote a letter to my surgeon asking him about getting the sleeve. Because I have migraines and I have to be able to take Ibuprofen, and when you have the bypass they discourage you from taking Ibuprofen because long-term use of Ibuprofen, you have the potential to develop ulcers.

And when you’ve got a bypass, getting an ulcer is a bad thing. Especially if you get it in the portion of the stomach that’s been, effectively, sutured off or stitched off. So if I got an ulcer in that spot, they would never be able to see it on an endoscopy if they were checking to see what was going on. Why was I having all of this pain? So that’s why they discourage using Ibuprofen. But with my migraines, that’s the only thing that I could take that was effective for me. I tried with other medications. I couldn’t find anything really that worked as well as Ibuprofen. So I asked him if I could have the sleeve just so I could be able to manage my migraines and he was agreeable to that. And that’s why I got the sleeve. I think they’re doing the sleeve a little bit more now than what they used to.

Maybe because they find that people are having good results with it, or that there’s less complications. I’m not really sure, but it seems to be about half and half – the people that I am in contact with that have had surgery. Some of the people are getting bypass and some are getting sleeve. So it seems to depend on the surgeon when they get in there. Sometimes if the person’s had other surgeries before, they have a lot of adhesions and scarring and things like that, so they prefer to do the sleeve as opposed to doing the bypass, which is a little bit more intensive.

And what advice were you given? Well globally, but for what you should be eating post-op?

The nutritionist at the bariatric clinic that I go to, they advocate a moderate diet in all food groups. Now Canada has this wonderful Canada’s food guide and they advocate a certain number of servings of this and a certain number of servings of that. And that’s kind of what they have to go by because they are a government funded clinic. So they kind of have to follow whatever the government guidelines are, which at this time advocate eating from all the food groups. So they want you to have a certain number of calories. They know right after surgery, you’re not going to be able to eat much. So they advocate getting your protein in, but as the weeks go on, you’re supposed to increase your diet and have a certain amount of carbohydrates, a certain number of fats, a certain amount of protein, protein first always, but they’re still advocating that you should be able to eat moderately from all food groups. And that was difficult for me. So, I just did not get on well after the surgery. I lost a bit. I mean, you’re going to, because for the first few weeks you really just can’t eat, so you’re going to lose weight. So I lost about 70 pounds fairly quickly. But after that, I really struggled because I just could not maintain that moderate diet that the clinic was advocating.

So from a macros point of view, you would see if you were to look at a graph, say, that the protein percentage would be probably the highest macro to start with because of the quantity you can eat. So because of the “protein first” mantra, you’re having to take up most of the available space – most of what you physically can eat in a day. If you’re going to eat your protein first, you’re going to quite often find that there’s not much else you can eat after that. And is this something they were really strict about enforcing because I know it’s something that I came across a lot that they hammered home that all things in moderation – actually from the get go I was given in hospital…bearing in mind, I was in hospital for quite a long time. They had me in for eight days in total.

I nearly went rather bland. Most of that was post-op. I was actually only on liquids. I think they had me fasted properly for the first day post-op and then I was on liquid for a day. But then straight after that, I was actually on pureed or minced up foods. They actually had me ahead of the schedule that I’ve seen in other places. You know, other places are on liquids say, for two weeks afterwards. But the point I’m making here about the macros is that I was given the balanced macros, if you like, so I would have this minced up spoonful of meat, and minced up spoonful of vegetables, and minced up spoonful of mashed potato, or pasta, or whatever it was. They would insist on me eating regular meals. So I was having something like six small meals a day and as those alternate meals between what you think of as the standard meals, were like something like a yogurt or something. It was usually a dairy based sugar – of course, it had in it – snacks in between. It felt like they were feeding me constantly. I just didn’t want the food. But, my point is I certainly didn’t have that protein first. The whole “protein first” mantra I got actually, was from information online in forums and in Facebook groups and things. But were they quite forceful with you about doing that? Was that the message you were getting from your nutrition team?

Yes, absolutely. It was protein first. They were very, very hard and fast that you had to have your protein first.

So even if you could eat nothing else, if all you could eat was your minimum requirement of protein, then that was all you ate in a day.

Yeah, because right after you have the surgery, they give you what our group calls the Bible. So it’s a handbook of what you’re supposed to do, what you’re not supposed to do, and guidelines for each week and suggestions for food. So week one you would be having your protein shakes kind of thing. Now they’ve changed a bit since I had the surgery, they are pushing people along faster. I guess they’ve found that people are recovering from the surgery faster and so can start eating more. I think it’s actually better the way that I did it because I think I did like two weeks of shakes. Then I did like two weeks of full fluids, and then a week of soft foods or puree. And then moving onwards. But yes, protein was absolutely first, but then they would have your carbohydrates. So they would have cream of whatever, soups, cream of mushroom soup. They would want you to have protein, so like your shake. And then if you needed to have chicken or something you would like blend it in a blender and add broth to it, or whatever.

But then they still wanted you to have your other foods, your other carbohydrates, and cream of chicken soups, and oatmeal, cream of wheat, soft cereals like that. And then moving on, when you’re getting to real food – things like Melba toast was okay, and chili. Going to one of the fast food places here that serves a good chili seems to be on everybody’s, the first thing I’m going to do when I get to that week, I’m going to go to this fast food place and get their chili, seems to be quite the thing. And as long as you don’t get the bun, I guess its okay. Not that I think that it’s okay, but I think that they really need to sort of look at those guidelines again to weed out some of these things like Melba toast, which for me was a major trigger food. I can’t just eat one Melba toast but I guess some people can and that’s good for them, if you can eat in moderation. But if I think if I had known a bit more that I couldn’t stop at one Melba toast and looked at it from a different perspective, I think I would have done much better.

I would actually argue that the majority of people who end up having weight loss surgery and actually probably the majority of people who end up morbidly obese have an issue with moderation.

Absolutely.

Because otherwise where would be the problem? And well, more so a problem with moderation with certain foods because we all know when we eat the right way for us having to moderate becomes less of an issue. It’s certain foods that we have trouble with when it comes to control and moderation, and I think it’s going back to what you were saying about going through that process of tests and interviews and appointments with the lead up to surgery; there should be much more emphasis on finding out how and why the person in question that’s on the receiving end of having to have all these tests, got that way in the first place.

That’s right.

And then if you decide that surgery is the right course of action, then tailoring the program afterwards. The two things really that are going to have the most influence as far as that goes, is tailoring their diet to address that, but then also tailoring if it is part of it, the emotional issues that go with it, and the habits that have been formed over years, and why those habits are there.

I think that’s absolutely right, but I think the issue from the bariatric clinic or even the health care system in general, is that it’s going to cost a lot more money than doing the surgery and turning people loose. Because if you want to be completely honest, and people always say I’m an emotional eater and what they really mean to say, but they don’t want to say it out loud is, is I’m a food addict. I’m a carbohydrate addict. Because saying that you’re an addict is a negative thing that people don’t want to admit to. Saying I’m an emotional eater sounds much better, but it’s the same thing. If you’re an addict, it’s because you have this compulsion to do something that you know is going to have a negative outcome. So if I go and I’m upset, I’ve had a fight with my husband and I go to the refrigerator and I get a quart of Haagen-Dazs and I know I’m going to feel like crap afterwards, but I eat it anyways.

That’s an addiction. It’s no different than as if I took a beer or I smoked some crack or whatever. It’s exactly the same, but it’s harder I think to admit to because somebody that doesn’t think that – oh, I would never do anything like that. I’m not an alcoholic. I’m not a meth addict – are going to have to cop to, I’m an addict. And it’s a lot easier to say, oh, I’m an emotional eater, than I’m an addict. But sometimes you have to get a little bit hard with it. You have to look at the truth. And the truth is, is that you cannot control your eating. And even after you’ve had the surgery, you cannot control your eating because they’re not doing surgery on your brain. They’re doing surgery on your stomach. And at some point, even if I’ve had the surgery, my brain is still going to say to me, ooh, I want carbohydrates and therefore I’m going to eat carbohydrates.

It doesn’t make a difference whether I’ve had surgery or not. I think some people need to have surgery. I needed to have surgery. Even if I had done keto I don’t know that I still wouldn’t have been able to stop eating carbohydrates. I don’t know. I don’t know for sure, but I think that definitely there’s a place for surgery, but at the same time people regain weight all the time with these surgeries. All the time because they don’t get that chance to overcome that carbohydrate addiction because they are being told that you should be able to eat moderately.

Yes, I absolutely agree with that and I think it’s the biggest failing of the system and I think just like with any other trap that people fall into, it’s the same almost as something like Weight Watchers or any kind of plan that somebody adheres to and has some success with weight loss, and then something goes wrong and they regain. What they’re told is it’s not the program’s fault. There’s no problem with the program. The problem is with you. You’ve messed up. You failed. You failed to adhere to it. That’s where the problem lies. But that is the biggest flaw that I see of weight loss surgery because basically the message that I see coming across is, we are going to impose on you an enforced restrictive eating plan – that’s basically what it is – we’re going to make you, because we’re going to adjust your body so that it is physically impossible for you to eat more than a certain amount.

So it’s like you going on your calorie controlled diet, going to Weight Watchers, going to whatever. It’s a bit unfair that I always mention Weight Watchers, but I forget the names of all the others. Use Weight Watchers as a global term for all these diet programs. But the problem is, if you could stick to that kind of program, if they were sustainable, then there wouldn’t be a problem and the exact same thing happens with weight loss surgery. This is the problem I see coming from people who’ve had it, who all of a sudden think this is amazing. I can suddenly eat in moderation. Problem solved. I can do exactly what people have been telling me to do all these years. I can do exactly what my surgery team are telling me what to do.

It’s fine. It’s easy. This is going to work. This is going to be me for the rest of my life. I can still eat cake. I can still eat ice cream when I want it. Everything’s wonderful. Except it’s not, is it? That wears off. It might take longer than one of these programs that you’ve gone to that involves you using just your willpower and sticking to it. You know, think of this as someone’s enforcing that willpower on you, but it does not last. Apart from an absolute tiny, tiny minority, it doesn’t last. And so if you don’t address those problems, if you don’t address and change your way of eating, you’re going quote unquote, fail. But it’s not you who’s failing. Again, just like with so many people who’ve been on this podcast who’ve had that lightning bolt moment when they’ve read someone like Gary Taubes who says, it’s not your fault.

Well it’s the same, except these people are going back. These people are working on another level because they’re going back just like you did, and we’ll come back to that, with me going off on this tangent, but you going back – and they ended up going back – and having revision surgery. So they have a second surgery. And I’m one of those people. The problem with my first one was it was the band, which is just a nightmare surgery that fortunately is happening less and less now. But a lot of people have the sleeve and then go on to have a bypass, or DS – a Duodenal Switch. Of course, that’s how it started the sleeve, wasn’t it? It was the first stage process for the DS surgery. And sadly I think a lot of surgeons still actually do have that attitude. And I have heard people whose surgeons have said to them, we’re going to give you the sleeve, but the chances are you’re going to be back in a couple of years for revision surgery either to the DS or bypass. That I think is criminal.

That’s right, yes. When I first got onto the idea about addiction, which was I think a couple of years ago, I thought everybody that had had ever had to have weight loss surgery was a food addict. And then after sort of seeing some more people in my Facebook group, or with my weight loss surgery Facebook group, and there are a lot of people that, they have their surgery and they are able to eat moderately, and they are able to lose weight, and God love them, I wish I was one of them. And after thinking about what my perspective was on food addiction, and then when I got into keto as well, I came to the conclusion that there’s a lot of people that they’re using food to smother their feelings, they’re emotional eaters. At some point or another they worked through whatever it was.

Maybe they had problems with their husband or their wife, or whatever. They worked through it, but they’re stuck in that addictive carb cycle, and they can’t break free of that carb cycle. They have the surgery which breaks them free of the carb cycle, and then they’re able to eat moderately. They go on their merry way, they lose weight with the surgery and they’re good to go. And then the rest of us, I think either we’re still dealing with the emotional issues – we’ve just kind of never worked through them completely or we’re just too stuck in that carb cycle. Because they do say that carbohydrates are as addictive as any kind of opioid and maybe we are just kind of stuck in that’s the way that we’re going to be forever. Whether we’ve got still got some underlying emotional issues or not. And yes, people will regain and then they try and go back or a second surgery, which I did.

I went to see if I could get another surgery because I was stuck. I wasn’t losing weight. I went back to the bariatric clinic. I asked them about getting a revision. At that time though – they go by the BMI – they said, no, your BMI is too low, we won’t do another surgery. I was pretty upset by that afterwards. In hindsight, I’m glad that I didn’t, and I’m glad that I’m addressing the other issues because maybe I wouldn’t have got to that place where I needed to see that there’s other things going on. This is why I can’t lose weight. So I’m glad in hindsight that I didn’t get the other surgery. But I think from the get go they sort of need to look a little bit deeper into why people are needing the surgery to begin with.

And doing a second surgery – when somebody comes back to them – that’s when they really need to say, okay, you had one surgery, you’re not making it work, what’s going on? Don’t just automatically sign them up for another surgery. Maybe some people will need it. People that are 500 pounds – here anyways in Ontario – they will do the sleeve as the first step. It’s planned to do the DS when they’ve lost like about a hundred pounds. When it’s a little bit safer for them to be under the anesthetic for the longer period of time that it would take to do that surgery. So sometimes it’s a plan to step surgery, but other times people are getting it because their weight loss is stalled. And I think that that’s when they need to do a little bit more intensive digging into why aren’t you losing weight?

Like let’s look outside of the box. Let’s look at what you’re eating. But then it kind of goes back to – a lot of people have talked about this – the current healthcare systems don’t want to admit that they were wrong about the carbohydrates. That it’s not an essential part of your meal plan – there’s no such thing as essential carbohydrates – but they don’t want to admit that because that goes against everything that they’ve been saying for the last what, 50 years or so. And that’s not what our government supports, so we’re kind of stuck.

Sometimes it is the case obviously, that people do need to go back for the second phase of the operation. That happens, especially for people who started off at a much higher weight. But yes, that’s exactly why they started doing the sleeve because they found that a lot of people were having so much success with it. It’s that first stage of a two stage operation, and they weren’t needing to go onto the second stage when they started using it a lot more. But, yes I think you’re right. I think at that point when someone goes back for a revision, or goes back to say that they’re regaining weight, and why they’re regaining weight, there shouldn’t be that assumption that they’ve done something wrong and the way to fix it is another operation. Just to go back to the whole moderation thing.

I think there are echoes with this. It’s not just with people who’ve had weight loss surgery that these principles apply. I think there are lots of people who start doing keto who it’s almost like that magic switch that is switched by having the weight loss surgery. Suddenly you can do everything in moderation. Suddenly your hunger and satiety signals start working perfectly. And you hear lots of people saying this. Richard Morris is a really good example. When you hear him talking about how back in the carbie days, he could eat vast quantities, but now he is doing keto, once he’s full, that’s it. He stops eating. He doesn’t have cravings. All is hunky dory. But there are some of us, if we still have these addiction issues that they’re not completely fixed by keto. Just like they’re not completely fixed with weight loss surgery, and although those signals they tune back up much better, we still have to combat those other issues that are going on.

Oh, I absolutely agree with you on that. They really need to start looking a little bit more at what’s going on in your mental and emotional state rather than just, what are you eating and why aren’t you eating hundred grams of carbohydrates, and thinking that that’s the answer. Because it’s not. But I mean counseling is intensive. Not everybody wants to do it. They don’t want to dive into those kinds of issues, but they would rather go and have another surgery and think that’s going to fix them. I do have a lot of people say; I’m so hungry all the time. And I’ll say, if you stop eating carbohydrates, I promise you, you will stop being hungry.

And then I tell them the story – Dr Fung likes to use this, and I’ve heard Megan Ramos say it on podcasts before – they use this wood analogy where carbohydrates are your fast burning wood and fats are your hardwood that takes longer to burn. So if you’re going to go out, and you’ve got your fireplace and you want something to burn in it, and you’ve got all this lovely hardwood that you’ve been stocking, and instead you throw in an old dining room chair that’s made out of softwood that burns in 15 seconds. And in 15 seconds you need more wood for the fire. Well, that’s kind of your body. Your carbohydrates burn off instantly and you need more carbohydrates. So that’s why you’re always hungry. Your body is just screaming out for carbs.

But if you give it fat – you give it that nice hardwood that takes longer to burn – then you don’t feel hungry. So that’s the kind of the analogy that I use – and that’s Megan’s analogy, not mine, I never take credit for that – because I think it’s something that people will understand – that if you give your body something that’s going to take longer to burn, and if you listen to your body…that’s key too, is you have to listen and understand why am I hungry? Well I’m hungry because maybe I haven’t eaten in 18 hours, or maybe it’s because what I had an hour ago, like I had a bowl of pasta, has already burned off. So if you just kind of eat nice fats and protein, and not have any carbohydrates, you’re not going to be hungry. At least your body’s not going to be hungry, and maybe your head’s still going to be hungry, and that’s a whole other story that we’re talking about as well.

Well that’s the problem, isn’t it? It’s this interference that goes on between your body and your brain. It’s the interference that goes on between that’s the problem. You mentioned before about how it often comes down to potentially a cost, but I would have thought that the extra cost of tailoring the program a bit more, tailoring it nutritionally and adding on counseling, is a lot cheaper than revision surgery. I think maybe part of the problem is having to admit that the nutrition advice they’re giving is not correct, and having to change that; and they can’t go back on that.

That’s right. Especially with us being government funded, they can’t go and say, oh no, we don’t want you to eat carbohydrates when our Canada’s food guide – the latest one that just came out – is almost entirely plant based. And I mean it’s nothing but carbohydrates. So they can’t now suddenly turn around and say, no you can’t eat carbohydrates. And not only that, but the numbers of people that are going through this program are just unbelievable. The number of people that they’re trying to get through and have the surgery… it’s taking months and months, not just because it’s so time intensive with the appointments, but because there’s so many people that they’re trying to get through the system. The clinic is running at full speed all the time and the wait lists are phenomenal. It takes months just to get that first phone call, to start with the orientation and learning more about the program, and then getting in through the appointments.

If you try and even call the clinic if you’ve got a question, it takes a long time for them to get back to you. And after the surgery you’re supposed to go in for one week check-up. Well, sometimes you don’t get in for two weeks. Or your one month check-up will be two months later. Or your six months check-up might be a year and a half later just because they’re overwhelmed with the number of people that want to have the surgery. So unfortunately stuff like that just falls by the wayside for sheer numbers.

Absolutely. And it’s definitely a sign of the times to see how long the waiting lists are. So you went back to ask for the revision surgery and they denied that. So how did it come about then that you started looking at changing the way you were eating. How did you find out about keto? What led you down that path?

I was actually at my local public library and I happened to see Dr Fung’s book, “The Complete Guide to Fasting”, which I picked up and I started reading. I was fascinated and it was one of those lightning bolt moments where I realized, wow, it’s not my fault. I am not able to lose weight because of this whole carbohydrate insulin cycle. And what really impressed me about the book in particular was that it didn’t seem like your common diet book. Every chapter had references to studies and medical journals. And I felt, well, this is somebody I can trust that knows what they’re talking about. So after I read that, his co-author on that book was Jimmy Moore. And so I went on the internet and I was looking at Jimmy Moore, and I happened to see that he had all of these podcasts, and he had these books.

So I started listening to Jimmy Moore. And then I think from Jimmy Moore, then I found the 2 Keto Dudes. So I listened to them. And then from the 2 Keto Dudes, they had the episode that you were on, and Liz, I think, talking about weight loss surgery.

Louise and Donna, yeah.

So then that’s how I got listening to you as well. So it was sort of a chain reaction that I started with Dr Fung’s book, and I started listening to all of these podcasts, and I heard about Nina Teicholz and Gary Taubes, and I got their books and I read them. So I think at this point I’ve probably listened to hundreds, if not thousands, of hours of podcasts, and watched all of these videos and read all of these books. Immediately though, after I read The Complete Guide To Fasting, I started to go low carb.

Of course, I did this completely backwards. I don’t even think I had been doing it for a couple of weeks and I thought, oh, I’m going to do a fast. Let me do a fast. So I actually did a six day fast, which probably not even fat adapted at that point. I actually managed and I wasn’t hungry. And things that I noticed – of course I did lose weight right off the bat because you’re losing all of that water weight, not eating carbohydrates -was not being hungry was fantastic. It was just unbelievable to me that I could go so many hours without eating. Whereas before, and with the bariatric clinic, and what is kind of common, nutrition guidelines, you’re supposed to eat every three to four hours, which I probably was doing. But I wasn’t hungry and that I didn’t need sugar. Like if I was going to go and have coffee before, I had to have all of this cream and sugar in it.

And tea. I could not drink tea without sugar. So when people were talking about bulletproof coffee or putting heavy whipping cream in coffee, and I started that and I didn’t eat sugar. And that was like a revelation to me. It really was. That I did not need sugar in my coffee or my tea, which kind of sounds strange, but it just seemed so unreal that I did not need sugar and I did not need sweets. I did not need to eat dessert. I just lost all of those sugar cravings, which, you know; it was just such a relief not to have those sugar cravings. And I did lose weight. I lost about 20 pounds fairly quickly. So that was great. Unfortunately I did end up regressing and it was because I had not addressed some of those emotional things that were going on in my life, and I had a lot of stress.

I did end up gaining the 20 pounds back because I was really kind of stupid. And I thought to myself, and I remember this very clearly thinking, okay, you’re going to have stress. You’re going to want to eat. So why not go for it. Which in hindsight sounds really dumb. I should have really just tried to work through it a little bit better. But I did end up gaining the 20 pounds back, and at the beginning of the year I really recommitted back to being more strict with my keto, and I have lost almost half of that. I’ve lost 10 pounds. So that’s been great. But more importantly, I feel so much better. When I was kind of letting myself go with the stress eating, I felt like crap all the time. And I knew that I felt like crap, but I was stuck already in that – it doesn’t take long to get stuck back in that carb cycle where, even though you know you’re going to feel horrible, you still keep eating it.

I think it really kind of took me hitting the bottom of that barrel. I just feel so awful. I’m waking up every morning with a headache. I have no energy. I need to get back to doing this. And instead, I think when I had been doing my keto before; I was really trying to still eat the 20 grams of carbs. And now I’m probably closer to zero. I’m really eating more meats and dairy and eggs and very little actual carbohydrates in the way of vegetables. And I find that that works so much better for me. I am hardly hungry. There are days where I really have to push myself to eat so that my metabolism doesn’t bottom out.

Do you still employ some intermittent fasting? Because that always seems the sensible thing that, if you have days when you don’t feel like eating, instead of not eating very much is to actually harness that opportunity, and say, okay well I’m going to have a day when I don’t eat anything.

I do, I really do. Or I will have like one meal a day and trying to go along with, what is your limit of fasting? Because you’ll see some people will say nothing at all, like just water or black coffee or with a splash of whipping cream if you want, but like no substantial calories. And some people will say, oh if you have less than 500 calories, that should still be okay. I don’t know. I think the jury’s kind of still out on all of that. And then you’re kind of getting into when does autophagy kick in, and all of that.

I always go back to what Terri Lance says. I’ve seen her talk about it on quite a few posts when people ask that same question, you know, what counts as a fast, and is this a fast, and is that a fast? And the important question that she says you need to ask; is what are your goals? So if your goals are weight loss, then having a few of those things that have some calorific value aren’t necessarily a problem. If your goal is more the autophagy side, then you need to potentially be a bit stricter about what you’re having. And you know, it’s only water or maybe some coffee and things like that. So it’s really important just to figure out what your goals are, but also of what you’re capable of, what you’re happy with and, and what you feel good with. And there’s often a difference between what you do when you start out.

Megan Ramos talks about training wheels, doesn’t she? That there might be some things, like you might need a little splash of heavy whipping cream in your coffee, or some broth, or things like that. If they’re going to get you through while you’re getting used to fasting – because I think everyone agrees that its consistency is what is a good thing – is to get into that routine of fasting. Now if when you start doing that, you need a few of those things to get you through – to get you into that habit, to get that habit formed, and what you can probably find is that those things get dropped off as you get more used to doing it. It all comes down to the individual and what works for you and what your goals are, I think.

I think that’s right and you have to definitely find what works for you, and if you just want a couple of eggs and a couple of slices of bacon, then that’s good. I don’t think you need to worry too much about it. With having the weight loss surgery, I can’t eat like…I would like to have one meal a day where I ate 1200 or 1600 calories, but I physically can’t without making myself sick. So I do tend to eat twice a day, like once in the morning and once in the evening. And it’s hard though, when you’re not hungry to make those calories count because you have to balance – again, eating enough so that you’re keeping your metabolism going. Or not eating anything, so you’re keeping your metabolism going. You don’t want to consistently eat only 600 or 700 calories, and then your metabolism slows down to account for the fact that you’re not eating enough. It’s kind of a tricky spot just to find the right combination that works for you for whatever your goals are. It depends f your goal is weight loss, or if your goal is metabolic healing, or if your goal is autophagy.

Absolutely. Just going back to what you said right at the beginning, about your choice of surgery and part of what drove you to ask for the sleeve as opposed to bypass, was the fact that you suffer from migraines. Well, I’ve certainly seen a big improvement in my migraines, so I was wondering if you’ve seen a positive change in yours?

Oh absolutely. And there’s been times where I’ve almost kicked myself because I think that weight loss was definitely a part of that. I think a lot of my migraines were hormonal in nature, so getting older sort of took care of that. But if it was even just from a pure weight loss standpoint, sometimes I’ve kicked myself, like I said, I could have had the other surgery, the bypass, and maybe been more successful with it, and still not had the migraines. So it’s been kind of a catch 22 you know, like you can maybe have the surgery that you’ll lose weight faster and you still won’t have migraines, but you’re kind of taking a chance. Maybe you’ll still have the migraines and then you won’t be able to take the medication that you need for the migraines. But yes, definitely I did see an improvement almost right away that I didn’t need to take any medications for my migraines. So you don’t know what you don’t know, right?

That’s interesting then that you found an improvement just with the surgery. Interestingly enough, I did see a period of about three months when I first had the sleeve where I didn’t have problems with my migraines and I thought it was potentially just down to the operation. With hindsight actually I think it was probably because I was in ketosis without knowing it at the time. The combination of what I was eating and how much I was eating. Although I wasn’t eating ketogenically, I think just by the fact of how little I was eating probably got me down, if not in ketosis, down closer to that state, and that is what was helping. Because it only lasted for those few months and then they came back again. And it was only a couple of years later…I did start doing low carb fairly soon after that…or a moderate carb I should say, because it wasn’t low enough to impact significant change. But it was only when I dropped it down to a ketogenic level that I started seeing real success with my migraines. That’s why I was interested in knowing the difference with you, whether they improved straight away or whether it wasn’t until you switched to fasting and keto that you saw that improvement.

That’s interesting because now that you’re saying that, I’m just thinking back to the fall when I was stress eating and eating a lot more carbohydrates, and I did notice that I did have a couple of migraines where I don’t think I’ve had like a really bad migraine in a couple of years. So that’s interesting that you say that it’s probably been a combination of the weight loss and being in ketosis that has really taken care of the migraines. For anybody that suffers from migraines, you know how horrible they are.

We have kind of addressed that question. I think it’s something that we probably not only get asked by other people, but we ask ourselves. And that is, if you’d known about keto and fasting before you went for the surgery, would you still have done it?

I think if I’m really honest with myself, would I have lost weight without the surgery? If I’m really honest, I’m going to say no. because in the period leading up to the surgery, because it does take quite a while, I said to myself, I’m going to do my utmost best to lose weight and I could not shift a pound. Even if I had known about keto, would I have been able to stick to it. There’s a certain element of willpower to any change. Not just changing what you’re eating, but committing to any kind of change in your life. There’s a certain amount of willpower because instinctively I think most people don’t like change because it can be a lot of hard work and I don’t think I could have stuck to it.

I don’t know if it would have been thinking well, surgery is on the horizon, I’ve got that to fall back on. Or I just didn’t have the willpower. Or I was just too stuck into that carb addiction cycle. I don’t know. But honestly, I’ve thought about it a lot since I kind of discovered keto and when those 20 pounds dropped off last year – fairly quickly – I was really like, I wish I’d known about this before I had my surgery. But then I really thought about it and no, I really don’t think I could’ve done it. Now to kind of qualify that. If I’d had some coaching or some counseling along with the keto, then maybe. If I’d had a bit more insight into what was going on with me, maybe then. Maybe then I would have been able to do keto and lost the weight and not had the surgery.

But just by itself, it’s a nice thought. It’s a nice thought to think that you can do it. And I’m using air quotes – normally – because you’ll hear people say that, oh, why don’t you just lose weight the normal way without having surgery? I mean, it’s nice to think that you wouldn’t have to go to the lengths of having surgery to lose weight because losing weight seems like something…it sounds like it should be simple, but of course it’s not. We know it’s not. But I think it’s probably the perception of a lot of people that don’t have weight problems, that’s what they think. Weight loss is simple. I can lose five pounds tomorrow if I wanted to. But of course it’s not that easy. And if I could have done keto and lost the weight, that would have been fantastic. I really don’t think I could have, if I’m honest.

It’s a very interesting question, isn’t it? I’m not sure either. I think part of the problem certainly for me was all that interference I spoke about before – those habits of food addiction, the depression. The habits I had of eating carbs to not only numb the pain of depression, but also that would get me into this eat, sleep cycle, so that basically I just didn’t have to be awake more than I had to be because it was just not very pleasant to be awake. So I don’t know if the benefits of keto would have been able to kick in quick enough and to be strong enough to get all that interference down to a low enough level for me to be able to do it long enough to really start affecting that change. I really don’t know. And I think that’s what weight loss surgery did for me is, it forced me into that position for a certain period of time.

And I do know that if I hadn’t have found keto, I would probably be heading back towards where I was to start with. So I do know how important it has been for me, but I struggle with it. I struggle with that, and I struggle with…and I don’t know how you feel about this, both coming from yourself, but potentially from what other people have either said directly to you or about people who have weight loss surgery in general; and that is you’ve cheated. You haven’t done this the hard way like we have. You’ve taken the easy way out and you cheated. How do you feel about that? Because I bet you’ve come across that.

I haven’t. To be honest, I haven’t personally ever had anybody say that. I’m in a Facebook group for the people that have had surgery at the same hospital that I had, the same clinic, and a lot of people have said that they’ve had people that to them, and it’s really one of those things that I just kind of have to take it with a grain of salt. I tell people that’s how you should take it. Because you can’t know what it’s like to be a morbidly obese person unless you’ve walked a mile in their shoes any more than I could know what it’s like to be a person of another race, or another sexuality. Until you’ve walked a mile in that person’s shoes, you just can’t judge. And they come from a position of not being informed, not having the understanding. And it’s easy to say, oh, just let it go, because they don’t know.

But ultimately, that’s what you’ve got to do. Unless you want to try and educate the person and say, you know, this is what my life was like when I was morbidly obese and I could not for the life of me control my eating. But I don’t think you need to get that personal with a random person unless you really want to. I think people just don’t understand. You can’t. You really can’t understand. It would be like asking an alcoholic; why don’t you just stop drinking or somebody that’s addicted to any other substance. Why don’t you just stop? Or people that smoke? Why don’t you just stop smoking? I don’t smoke. I’ve never smoked a day in my life. And even I wouldn’t say that to a smoker. Why don’t you just stop? Because I know it’s not that easy. It’s not easy when you’re stuck into that behavior that’s so addictive and so compelling and so compulsive, that you’ve got no control over it.

And it’s all the same. It doesn’t matter whether its food or tobacco or alcohol, it’s just the same difficulty to stop. And I think actually food is harder, because I don’t have to smoke a cigarette. I don’t have to drink an alcoholic drink, but I do have to eat and there’s not the same level of compassion I think, for people that are obese as there are for people that smoke or people that drink. People don’t say to an alcoholic…they don’t push people. If I’ve identified myself as an alcoholic, nobody’s going to push me to have a drink or nobody’s going to push me to have a cigarette. If I tell people I just stopped smoking, nobody’s going to do that.

But people will push you to eat, you know, just have an ice cream. It’s not going to hurt you. One’s not going to hurt you. But it’s funny, if I was a vegan; people aren’t going to push me to have a burger. So I don’t know why people that if I identify myself, oh, I don’t eat carbohydrates or I’m a low carb…why would people push me to eat, or have a piece of bread, or, oh, you can have a bun with your burger. It’s kind of an interesting comparison I think, that people don’t have the same compassion for things around food and obesity. It’s interesting.

It certainly is. And complicated. And like you say, it’s not something you can ever really understand until you’ve been in that specific position yourself. And then even then you’re going to have different thoughts about it and a different reaction. So you said that your day to day keto these days is looking pretty like carnivore by the sounds of it?

It’s pretty close. Actually there are days where I am a full on carnivore. My son, he actually started doing keto not too long ago. He’s 17 and he just kind of wanted to drop a few pounds. So he was interested in doing keto. When I’m making supper, he still has some vege, and the other day I just popped a piece of broccoli in my mouth and I thought, wow, when was the last time I actually ate a vegetable? And I couldn’t really remember. Because I’ll have bacon, I’ll have eggs, I’ll have whatever meat that we’re having for dinner. I don’t usually have the vege that I’m serving with it. I have dairy. I’m terrible with cheese. I love cheese. I’m kind of glad I’m not there in France with you because I would never lose weight. I’d be eating all the cheese. Every once in a while I’ll go and buy like a really good piece of cheese and it’s like gone in a day. I just love cheese.

I think that’s the best way to do it actually. Well, it depends. And that’s where the whole addiction thing comes in. If you can…and I can do this with cheese. If I was to do it with sugar type foods…if I indulged, it would be a slippery slope, and it would just turn into a full on binge. But then there are these foods that sort of start getting closer into that addiction circle, if you like, but they’re close enough to the edge that they’re the kind of things that I can indulge in every now and then. So like you, I will buy a couple of bits of cheese and have a cheese board or something, and then I would just accept the fact that I’m going to pick at them and I’m going to indulge them and they’re going to be gone in a couple of days. But that’s okay.

It’s a great keto food. It’s very low carb – sometimes even zero with some of the cheeses I choose – and so it’s not going to do a huge amount of damage. I feel indulged. It’s not going to start some slippery slope where I turn into a cheese monster for two weeks. So it’s interesting isn’t it? There are different categories for these foods that we do find addictive that they can’t necessarily be of our daily lives, but they can be an every now and then food without causing too much damage.

I think you’re right. It’s just knowing yourself. Like am I going to be able to have a piece of cheese and maybe I eat it for a day or two and then I don’t have any for another couple of weeks or whatever. Or, am I going to go back the next day and buy another block of cheese. So it’s just knowing yourself. It’s having that self-assessment, okay, I finished this block of cheese, am I going to go get another? Nah, I’m good. I’ll be good for a couple of weeks and maybe I’ll see another block of cheese…something different in the store a couple of weeks from now and then I’ll do the same thing. So it’s just kind of doing that self-assessment piece and self-analysis, if you want to call it that, and just knowing yourself and knowing what you’re going to do with yourself.

But generally I think I kind of am a little bit more carnivore than completely keto. Kind of coining the keto carnivore phrase that’s going around where you’re just making sure that your fat macros are still on the higher side than the protein. I don’t really overly track, but I do try to eat the fattier cuts of meat. Or if I’m making something lean like a chicken breast, then I’m cooking it with some butter and maybe adding some cheese on it or something like that. I feel great.

I never cook chicken breasts, I just don’t eat chicken. But I’ve never particularly like it. I have always been someone who likes the full fat versions of things. I’ve never bought low fat mayonnaise or anything like that. And it’s the same with meat. I’ve always liked the fatty cuts. I’ve always liked the dark meat on a chicken. I’ve always loved the chicken skin. I’ve always loved the fatty bits of bacon, the fat on lamb. I’ve always loved that. So keto is just heaven. I don’t have an issue with that at all. I know some people don’t like that visible fat on meat, but I love it.

I do enjoy the dark meat on the chicken, or the turkey, or whatever. The issue is actually budgetary because I don’t know where you are, but the dark meat…if I was going to go buy a chicken thigh it’s actually more expensive than a chicken breast. And I don’t know how that works exactly.

Oh, isn’t that interesting? No, it’s the opposite here. The cheapest chicken I can buy is a kilogram tub is what I tend to buy from Lidl of chicken thighs – that is the cheapest form. So I lucked out on that. Drumsticks are more expensive for some reason. But chicken breast is the more expensive. So I have it the right way round.

I tend to buy in bulk and then portion things out and put them into freezer bags. So if I go to a market that they do their own butchering and they’ll have like big bags of giant chicken breasts, and I can buy a big bag of those when they’re on sale, and those will do for like a couple of week’s worth of meals. And to buy like the chicken thighs, I wouldn’t even get half as much.

Wow, interesting.

So when you’re watching your budget you just have to go with what you’ve got. So I’ll just try and make it a little bit more fatty by cooking it in butter or cooking it in bacon fat, because I’ve always got lots of bacon fat. Or putting some cheese on it and I find that that’s fine for me.

I don’t want anything else. I was cutting up some melon for my kids the other day…I popped a couple pieces of melon. Now before, I would have eaten like the whole thing, but I was quite happy just having one or two really nice cold juicy pieces of melon. I found that I was a little worried, because afterwards I was like, do I feel that sugar craving? And…I’m okay, I’m okay. But even that. There’s a lot of sugar in melon, but it could have spiked that sugar craving, so I feel that its better just not to even go there. If I’m going to have vegetables like broccoli, they’re not sweet, so you’re not going to have that sugar craving.

So it’s just better really not to go there in whatever way that you’re eating. If you know you’re going to be triggered by something, just don’t even go there. Like with the weight loss surgery we were talking about earlier, in the second or third week, they said that you can eat Melba toast. Well you can. Do you want to? Should you if that’s going to be a trigger food for you. If before surgery you could eat a sleeve of crackers…that used to be one of my things…I could eat a whole sleeve of crackers with cheese whiz or peanut butter. Then maybe crackers isn’t a good idea for me. Even if you want me to eat moderately, sort of pairing up the idea of what caused you to gain weight in the first place, and now that you’ve had weight loss surgery, sort of incorporating what you know about yourself and making that model work for you for maximizing your weight loss. So if carbie foods are a trigger, then you’d better not eat them. Not until maybe you’ve lost a lot of weight and you feel comfortable that you could eat them without being triggered to overeat.

And that’s the power of the Internet, I think. Because that’s certainly what I was able to tap into. Interestingly enough one of the things that was also on my meal plans was to have these…I’m trying to think what they call it here…but it basically looks like slices of mini toasts as your Melba toast type thing; that I used to have with cream cheese on. And that was something that was recommended as a snack, and it was one of the things that sent up a red flag for me is: why can I eat more than they’re saying I should have, and I’m still hungry, but then it’s just inducing these cravings that I want to keep going back. I want to go back and have some more half an hour later, and more half an hour later. And I could just be, just like you, I could just be on and on and on at that all day.

And that was one of the first things that got me thinking, hold on, something’s not right here. And that’s when I started tapping into things online and hearing about the experiences of other people and starting to question the wisdom of what I was being told by the surgical team. So sometimes we do have to go against what we’re being told to figure out what’s going to work for us. And I know a lot of people don’t necessarily want to do that, especially if it crosses paths with having to accept that they’ve got addictive type tendencies. It’s possibly a lot easier to just say, well, my team knows better, I’m going to do what they say and then deal with the problems when they arise. It’s been fascinating talking to you today and, and throwing around this topic of weight loss surgery. It’s not something that I’ve talked about with somebody else on this podcast in more depth and I’ve been looking forward to discussing this topic with you. I know there are a lot of people out there who are about to go through it or who’ve gone through it and run into problems.

And it is something that is sometimes shunned a bit in the community and people feel like they need to keep it a bit secret. But I definitely feel that keto is something that works very well as a way of eating after you’ve had surgery. It certainly has for me.

I think I have to agree with you on that. And I think I have heard in the United States there’s more bariatric clinics that are recommending the keto diet, which I find is fantastic. And I know amongst the people on my weight loss surgery Facebook group, there’s so many people that are discussing regaining and they’ve come to me and asked me about keto, and I’ve pointed them in the right direction. And that’s when I’ve heard people say, I’m so hungry all the time; even with the surgery, I am just hungry. And I’ve said, well, this has been my experience with keto, especially when I stopped the carbs; I know that I’m not hungry. And if that’s your challenge, then this is going to work for you I think. And I really hope that it does work for them. I think that a few people have already seen some good results with it. And I hope they continue on that.

And I just put myself out there and I’ve had numerous discussions with people saying, you know, our clinic says that we shouldn’t do fad diets. I try not to get into that whole argument about is it a fad diet? To me it’s a way of eating. It’s not a diet; it’s a way of eating it. Just as being a vegan is not a diet, it’s a way of eating. So is keto or low carb, or whatever, or being a carnivore, it’s a way of eating. Often too, when talking about keto, people will say it’s not sustainable. And it’s absolutely sustainable.

And people will say, I will miss this, I will miss that. And I want to say, tell me whatever it is you think you’ll miss and I will tell you a keto alternative. Because there’s so many people out there, so many people doing blogs and websites. Everybody’s developing all of these recipes that you can replace anything – crackers or breads or ice cream – there is a low carb version of it. So you’re not missing out on anything. You want on a birthday cake? You can have a low carb birthday cake. I don’t think you’re going to eat it every day, but you can have it. It’s there. You’re probably just going to find you’re not going to want to eat.

Sometimes I think there’s a fear around low carb as well. And I feel a little bit that the bariatric clinic – ours in particular – pushes that a little bit…that you still have to eat carbs; that low carb is bad. And so I don’t know if that’s the perception that anybody else has ever had with their weight loss surgery clinics? You know, being low carb is a bad thing. But I think that they still do get that. So I’ll get some argument, oh we’re not supposed to do low carb. Low carb is bad. And you try and challenge them. Why? Why is it bad? Tell me what’s your evidence? Where’s your science? And that’s the thing I absolutely love about keto, is that everybody is super knowledgeable about it. You go on to any of these websites – Diet Doctor, the Ketogenic Forum, the 2 Keto Dudes, and yourself – you all have all of this information at your fingertips. And people that do fad diets, they don’t know anything. They couldn’t answer a why question if their life depended on it. But I could ask anybody that’s serious about keto why something, and they’ll know. And if they don’t know, they’ll go and find out why. And they’ll tell you why and that’s the way I am too.

If somebody asks me a question, why this, why that? I’m pretty sure I know the answer at this point and if I don’t I can probably find out. And the second piece that I really like about keto is the self-assessment. Everybody’s very much into doing these N=1 experiments to see what works for you and what doesn’t work. Nobody is saying you have to eat this or you have to eat that. It’s like, well try this and see how it works. It might not work. You might not feel better, or maybe you will, and if that doesn’t work, then try something else. There’s no cookie cutter, one size fits all diet, the way that the weight loss clinic surgeons and dietitians would have you believe. You have to find what works for you because we’re all different. We all have different metabolisms, and all different body structures. We’re all different. You need to look outside the box. You need to experiment. So that’s what I really like about keto. Nobody is so stuck in the mud…it’s all written in stone…you have to do it this way.

Yes, exactly. I think that’s right. That’s what I was saying before about the biggest flaw I see about it is, them trying to put us all in one box, and that’s never going to work. It’s been great talking to you today. Perhaps you could round us off with a top tip.

I was thinking about that and there’s like so many things that I think would work so well, but kind of going off off…I saw one of your other interviewees was saying…they we’re talking about making a plan, and having goals, and I think that’s when you…how does the saying go? Failure to plan is a plan to fail. So if you can have a goal in mind. Somebody in the group had their action plan, and sleep was their goal. So if sleep is your goal, for example, make it measurable. So if sleep is your goal…I want to improve my sleep – that’s kind of nebulous. So how am I going to determine if I have reached that goal? If you make something measurable, and you make yourself accountable to that, I think you’ll do better. So first just using sleep for an example, I can improve my sleep when I have three hours of deep sleep according to my Fitbit or whatever. You know, or one of those nice Oura rings that people have been getting.

Then I would know my sleep will have improved. Make it measurable. Don’t have these up in the air goals or objectives. I want to lose weight is a great goal, but it’s kind of nebulous. Drill down a little bit. Like what is it that you’re really after? And make it measurable and make it attainable, and really look at what steps…like for sleep, maybe painting your room a different color or putting room darkening blinds…like there’s a lot of different things that you could do for your goals if you make it very specific. It’s much easier to research and see how you can attain that goal.

And then with that, to make it time specific – time that you’re going to work on reaching this goal. Like if you’re going to work on it for a month, then the really important piece, I don’t think people do…talking about self-awareness and self-assessment. Do that evaluation…okay, has this improved? Have I reached my goal? If I haven’t reached my goal, then what do I need to do to reach that goal? How have I not reached it? Have I completely failed? I think that person with the action boards that she hadn’t been looking at it for months probably because it wasn’t specific enough. It was too vague. It was too, you know, like unattainable. There was no timeline. So if you set yourself up something you can succeed at, you need to sort of plan it. We have your plan, you have your objective, you have your action steps, you have your evaluation. But if you make things very specific, I think it makes it easier to succeed at it.

Yes, especially if they’re nice little bite size steps that are attainable, and like you say, you can then re-evaluate when you’ve got to that point and change up that plan if you haven’t managed to achieve the goal, you set out, re-evaluate, and work out why it was difficult in this instance to get to it, and change it, and reset it, and then work towards that next step and so on. I think that’s a very good point, is taking it away from these sort of vague sweeping statements and drilling down into something really specific. It’s more actionable, isn’t it? When it’s specific?

Yeah. I think when you make things very specific, they do become much more actionable and much more attainable. One other guest said about keeping it simple, silly. So if it’s something simple, something actionable, something attainable; I think you’ll be much more successful in the long run. And doing that self-assessment piece, the self-evaluation. And don’t be afraid of it. People fail at things and you need just to learn from your mistakes. And don’t swim around in it. If you’ve had a failure, that’s okay. You can still pick yourself up and move on. Just don’t get bogged down by failure. Everybody fails at something. You just got to learn from them and move on. Get back on that horse.

Absolutely. And then it’s not a failure, is it, if you’ve learnt from it. I think you’re right. I think getting specific about something forces you to really look at it and set those goals. Because it’s very different, isn’t it? Saying I want to lose weight, to saying I want to get into that pair of jeans that’s the next size down. And being specific about your goal makes you actually figure out and work out what is a realistic target, and what is a realistic timeframe for that. So yes, I like it.

Well thank you very much for talking to me today. It’s been a pleasure.

Thanks so much for having me on Daisy. I’ve really loved this. It’s been fantastic.

Jennifer Reichow

April 26, 2019

Daisy’s latest extraordinary woman, Jennifer, talks about her experience with weight loss surgery and how keto fits into the picture.

Jennifer was born and raised in Ontario Canada and is married with two kids. She has worked as an RN for the past 20 years.

She started gaining weight at around 9 years old when her parents split up. She started her first diet age 11 and subsequently tried every diet under the sun.  When she finished high school she was probably only about 20 lbs overweight but it felt like it might as well have been 100.  

Over the next 20 years with working full time, getting married, going to college while still working and having 2 children she continued to gain weight despite diet and exercise. She finally considered weight loss surgery but at that time it was not a common surgery done locally and she would have had to travel out of the country for it to be covered by insurance. It was a few years later that Ontario started a fairly extensive program for bariatric patients and she had the sleeve. 

After losing about 70 lbs fairly quickly Jennifer’s weight loss stalled as she struggled with the clinic’s ideal nutrition guidelines which was to eat healthy whole foods in moderation. She got stuck back into that viscous carb addiction cycle and spent several years after surgery regaining and losing the same 20 lbs.  At one point she even spoke to her surgeon requesting another weight loss surgery but was denied because her weight was too low.  

In February 2018 she stumbled across Jason Fung’s book Complete Guide to Fasting. It was a revelation that being unable to lose weight was not her fault but rather the failure of a system that still clings to beliefs about nutrition that are out of date and just plain wrong.  She quickly fell down the rabbit hole devouring books, podcasts and YouTube videos.  

She lost 20 lbs very quickly on keto but unfortunately regained when her addictive tendency to smother stress with carbs reasserted itself.  As she has continued to learn more about herself it’s become easier to manage and she has now lost 10 lbs of that regain. More importantly she feels great –  body, mind and spirit.  

Jennifer’s Top Tip

End Quote

Starting Keto – Part 2

April 19, 2019

Daisy’s latest extraordinary women…

Kim

Kim Howerton struggled with her relationship with food from the time she was 8. As the years went by and her health problems mounted, she felt at the mercy of her body and out of control with her weight. A dedicated seeker of pleasure, she realised that life in a body that was always in pain was no way to live; that a pleasurable life starts by living in a body that feels good.

Enter Keto – a life that has brought together her love of satisfying, delicious foods in a way that makes her actually feel good. She now shares her love of all things Keto by creating recipes, running a Facebook group and with the upcoming podcast Keto Life Support.

Kim’s website is TheKetonist.com

Carrie

Carrie is an ex-professional pastry chef, turned cookbook author, recipe developer, freelance photographer with a crazy, four country, three continent-spanning resume which includes such things as a chocolate TV show, a chocolate cookbook, and making pastries for the Queen of England.  She trained at the National Bakery School in London and has now turned her pastry chef talents to creating scrumptious keto/low carb food to help the world eat smarter, live better, and put the healthy back into healthy.

She has published 5 cookbooks and shares her tales of food, travel, and adventure from her splendid single life in the sane lane, as well as her trials and triumphs with Bi-polar Disorder, Adrenal Fatigue, Lyme disease, a massive E-coli infection, a myriad of food sensitivities, and her journey back to slim and vibrant on her blog CarrieBrown.com.

Carrie also shares her love, skills, passion for delicious healthy food, and humor in a Facebook Group – The Keto Kitchen with Carrie Brown – as well as bouncing around all the usual social media platforms as The Real Carrie Brown.

Carrie’s buddies say of her…

“Carrie can often be found in the kitchen, surrounded by her four-legged friends, concocting, devising, developing, and figuring out how to make the impossible very possible (and affordable). And we love her for it.”

Happy Healthy Keto

You can find out more about Kim and Carrie’s program on their website or take a look at my Starting Keto page.

Kim’s Top Tip

Carrie’s Top Tip

Daisy’s Top Tip

End Quote

Starting Keto – Part 2 – Transcript

April 19, 2019

This transcript is brought to you thanks to the hard work of Cheryl Meyers.

Welcome back to Part 2 of the go-to place for where you need to go to start keto. Welcome back Kim and Carrie to the Keto Women podcast.

[Carrie] Hello.

[Kim] Thank you. I’m happy to be back.

I’m very excited to be back. I’m very excited that there was so much stuff we had to share that we had to come back again

and would you believe I was actually holding back?

How do we deal with those cravings? I suppose particularly, well not particularly, but two different things, in that first week when they’re really strong and at the forefront of your mind and then as you go and they just sort of crop up every now and then and can really take you by surprise when you think you’re doing really well.

Yeah, week one everyone. If you haven’t started keto, you might be pleasantly surprised, but you should be prepared for the fact that you are giving up what is essentially a drug and each it will be hard. That’s not a reason not to do it. Doing hard things is important, but being a little bit for warned can be helpful and having maybe some strategies there can be helpful and I would suggest your first week or even two weeks depending on how it goes for you, do not concern yourself with limiting your food. Only concern yourself with limiting your carbohydrates if that means an enormous bunless burger with some pickles and no bun, no fries, you know, for lunch followed by in the evening and enormous stake with you know, some broccoli and butter on it and enormous quantities of keto friendly foods that first week so that essentially you’re too full to eat any junkie carbs has been a very successful strategy for many people. I find when people initially that first week or two they’re like, but I don’t want to go over my protein macro and I don’t want to eat too much fat because I want to burn the body fat, dahdahdah. Like they’ve heard too many opinions.

Oh and what about calories? Because they could have probably been coming from this place where they had to be concerned about calories. Right? Yeah. The last thing you want to do is to do everything at the same time.

And we can totally worry about those things later. But the first important step is just to get off the carbs, whatever that looks like. Get off the carbs. Being hungry your first week or two is probably one of the worst things you could do. The cravings are going to get you anyway and cravings like mental cravings plus hunger is like Disasterville, so don’t be hungry and then over time we’ll adjust the amount of food you’re eating down to a more, maybe an energetically appropriate level for you, but by then you’re through the hump of getting off the carbs.

My best advice for dealing with cravings is to really do a good job when you’re starting out of clearing out all the carbage from your house. Because if it’s not there when the craving hits, you have no option but to eat something keto because that’s all you have in your house. I find it incredibly difficult–or I did–find it incredibly difficult to get through a craving if there was something in my house that would fuel it, this was years ago. If I’m having a craving and the something carby in the house, I’m eating it. So the best advice I can give you is to, when you start this journey, wherever you are on this journey, get rid, clear all the carbage out of your house so that when the cravings hit, all you have, all the choices you have are quality proteins or fats. That’s it. There’s no carbs to choose from. You’re going to eat what’s there and we’re good with that. We’re good with you eating more. We just want you to stay off the carbs.

I will offer an alternative because, Carrie, your cats don’t set the shopping list in your house, right? But many of us live with non-ketoers. And so that can pose an issue potentially. And this is true of me, my boyfriend–not keto. I know that’s shocking to many, but it is true and I am not the boss of anybody but me. So it’s not my job to make somebody else eat the way that I eat. It’s just my odd job to offer information and they make their own choices.

And cook him delicious food that you hope that he’s going to enjoy.

And he does. He does, he loves it. And he’s also very metabolically healthy. There are a certain percentage of the population that can do so while including carbs. And I try not to hate them. But that being said, my house is full of things that I don’t eat and I choose not to eat. But I do have a few important details on that. You know what your trigger foods are, right? Like for me, I can have a freezer full of ice cream, non-keto ice cream. I won’t touch it. It does not call to me. There are certain brands of cookies they call to me. I cannot have Milanos anywhere in my vicinity. I will want to eat them, but then, like, I don’t know. This other brand of cookies, they don’t really call to me. So I make strategic purchasing choices and or rules about what comes in my house that those foods that we all have that speak to us. You know these foods, right? If you’ve ever been a binge eater, they’re the ones you buy. I don’t bring those foods into my house now we’ve got chips, we’ve got cookies, we’ve got cream. I’m sorry, I’m triggering all sorts of people now.

We’ve got all sorts of those things in my house. I’ve specifically directed the purchases towards the flavors and brands that I’m more like, man, I don’t know that I like oatmeal raisin. You have to know where your boundaries are and then if you’re somebody that lives in a household with non keto eaters, it’s probably doubly as important to have your foods at the ready. You don’t want to get home from a hard day’s work and your husband, partner, children, somebody has been like, well, I made this totally carby food for dinner and you don’t have dinner stuff ready and you have to go to the store and dah, dah, dah, dah, and then you’re like, ah, screw it. I’m hungry and tired and I, I’ll just eat the carby food. If you’re potentially going to be surrounded by choices you don’t want to make, you need alternative options because if Carrie gets home and is like, I’m hungry, but if I open my fridge, all there is is some lamb and I dunno…

Roll mops!

I don’t even, what’s a Roll mop?

Pickled herrings.

Oh yeah, no, I would go hungry. I don’t like herring. But she’s going to be like, well, if I want to be not hungry, I’m going to eat these things, but if you have other foods in your house, you actually have to be twice as strategic and know that when I open my fridge, there is something that I can eat in five minutes if I need to, rather than chowing down on that carby meal somebody else made.

There are these different layers aren’t there? If you live on your own or if you can completely dictate what is in the house, then the easiest thing really is to, to clear it out.

What are you saving it for, there’s no reason to have it.

Exactly. And that’s, that’s what it’s like here. If I had any of those things in the house, I would probably eat them. So not having them is the easiest way. But there are obviously these people, like you say, who have to share a house with carb eaters. So it sounds like you’ve come to a compromise with your partner where there are certain things that won’t come in the house.

Right.

So yeah, you can have ice cream and you can have the cookies, but just don’t have these particular brands and he’s okay with that. But then there are going to be people, and I have heard of these people and to be honest, I think it’s, I do think it’s unfair. I do think there should be some compromises made and when someone says their partner or the rest of their family refuses to make that compromise and will continue having those things that are really, really difficult for them to avoid in a house, I actually do think that’s unreasonable. I think there should be a compromise, a meeting in the middle where they would at least agree for a certain period of time not to have those things that are the extreme trigger foods for that person because they should be concerned enough for their health and well-being to make that compromise.

I totally agree with you. You know, you have to find the appropriate level for you. For me, this level works. Keebler does not call my name right, so I’m not worried about that. If you’re triggered by any of those foods right? Some people are just like cookies. It doesn’t matter if it’s a crappy brand. I’m, I’m very, I’m snobby, right? So I’m like, wow, I wouldn’t touch that brand. I think then I have had this discussion. You know, it’s like every relationship is different and this is about what we’re talking about here is a lot about relationship. And so having a conversation with your spouse, partner, children, whoever, roommate, I dunno, that is like, hey, this is too hard for me and I need to talk to you about it, because I’ve had clients who are going to die if they eat these foods.

Maybe not today, but within a year, you know, they are super sick and you know, they’ve had to have that conversation with their family members. Like, I’m trying to save my life here. And the fact that you being able to bring these things into our home makes you feel happier today versus me trying to save my life. Like there’s no equation. This shouldn’t be a hard conversation to have. Right. This shouldn’t be a hard decision. Actually, I should say. It might be a hard conversation to have because we’re, we are crap at communicating, but it shouldn’t be a hard decision for your partner to say, you know what, I shouldn’t bring these things into the house.

Because ultimately they can still eat them. You know, I’ve, I’ve had people say that their partner has a stash that is in their car or somewhere.

They go through the drive thru and feed their addiction somewhere else. Yeah.

It’s gone by the time they walk through the front door.

Right. And so this is, this is something you as an individual need to determine where your boundaries and limits are. Absolutely. And no one is going to die because they didn’t get Doritos.

No, that’s right. They’re really not. And actually what you might end up doing is improving your partner or the rest of your family’s health in the process anyway. So you know, there’s that. So we put these strategies in place to try and avoid giving in to these cravings. But ultimately most of us at some point or other probably will give in and fall off the wagon sometimes softly, sometimes very heavily, sometimes for one meal, sometimes for a few months. So what do we do if and when that happens?

I think a lot of it is based on going back to what are your goals and what’s the reason you’re doing keto. Falling off the wagon for one person versus another person. You know, it can be very different. For me, one of the things that I work very hard to try and denormalize in a way is first thing that will happen when you cheat or fall off the wagon or eat something that you don’t think you should be eating is the world will rush in to say, ‘That’s all right. Everyone does it.’ And though what I actually think, I think that’s a horrible thing. I’m just going to say it because what those people are trying to do is eliminate any discomfort you’re feeling.

What I think they actually mean and what I think would be a good thing is to say, please stop beating yourself up about it. It’s done. It’s done, past. We’re moving on, we’re focusing on the future. The only reason to look behind you is to know what happened, why it happened, and how to avoid it next time. If you’re looking behind you at the wreckage of what just happened for any other reason than that, you’re just beating yourself up. You’re using it to make yourself feel bad. That’s going to make you more likely to fail again. So if something happens where you ate something, you didn’t want to, I mean you did want to, you put it in your mouth. It’s not an accident, it’s an on purpose. It’s an intentional thing. So one, take responsibility. And when you take that responsibility, you can be like, hey, I had a piece of chocolate cake. Why did I have that? Was I sad, was it an emotional thing? Did it look really good?

Had I been restricting myself on food quite a bit and I was starving? What went into the decision? Because I made a decision to eat it because it went in my mouth. What happened along the way? What was the path of that decision? And anytime you start heading into, I’m a bad person, I have no willpower — any of that negative self talk, stop it. Just stop it. It’s not helpful.

I love the way you say that, “Stop it!”

I think I stole that from Bob Newhart. There’s a clip, but evaluate why it happened and know you made a choice somewhere along that route, find that choice point and evaluate. Was it a good or a bad choice in terms of your goals? Did it support? See it’s so easy to go to judging–good, bad, right? Support or not support. Did it support my goals, did it not support my goals? And so looking at things through that lens. But I really do want to say like a little internal discomfort is not always a bad thing. That internal feeling of like, oh, I did something that I didn’t mean to do. I don’t think you want to completely squash that feeling that things went wonky because when you start every time you make a mistake or you do something that didn’t support your goals, if every single time you’re like, that’s okay, everyone does it, it’s fine. Don’t worry about it. There can be a way that you won’t grow and it’s all about growth, not about enablement.

I absolutely agree with just with looking at it from a much more analytical perspective. Just take the emotion out of it a bit and just look at it from an analytical perspective and just figure things out. Because then like you were saying, Kim, you can come up with a strategy for when that situation happens again because it will whatever it was. So you know, whatever that choice point as you refer to it was that something that happened, something that triggered you in some way to make that choice. That’s going to happen again. It might be someone you don’t like very much, who said something personal about you. Whatever it is, it’s going to happen again. So if you’ve got a strategy in place, you’re more likely to be able to deal with it.

Again, it’s choices, right? We’re not children who are bad or good children. You know, we’re making choices and those choices are either in support of or not in support of what we want in the world, in our lives, in our health. For me, if my primary desire is weight loss, then I’m going to look at it through the scope of did it support or not support my weight loss efforts as a whole. But for Carrie it might be how do I feel now after I eat this food?

I think it’s an important discussion to have is to really hone down on why you’re doing this. If you really figure out your why, that can be really helpful when you have those moments because you’ve got that in your mind. Right?

And Carrie had a really powerful why. So we should ask her.

I think, everything, and I think deep down we know this, but on a day to day basis, we forget that it’s all about our why and the bigger a why you have the easier it will be to stick to it. For a lot of people, how they look is a very, very, very big why. For me, it was not running the risk of becoming suicidal. That was a huge why for me, I suffered from bipolar disorder for my whole life. Although I wasn’t diagnosed, I was misdiagnosed and treated with the wrong things, which didn’t help but wanting to get out of that nightmare. I don’t use that word lightly. The nightmare of suicidal episodes and being hyper manic and being depressed and feeling no joy was a big enough why for me and is still a big enough why for me to eat things that are going to support a joyful, happy life. You can’t use someone else’s why and you have to be really, really, really clear about why you’re doing it. I think if you’re doing it for someone else, you’re probably going to struggle. If you’re doing it for reasons because you think you should, you’re probably going to struggle, so I would highly recommend that you really think, not just for a minute, but really think about what it is you want to do, what you want to change and why because you will be more or less successful based on your answers to those questions to yourself.

You do need to build a really detailed picture. Too many times people just say, I want to lose weight. That’s my why is to lose weight because whatever, it’s a mythical thing. Everything’s going to be better when I lose weight, but there will be a detailed why you’ve just got to find it. That’s exactly like what you’re saying Carrie, is to really sit down and think about it, make some notes, brainstorm it and think, well actually why I really want to lose weight is so that I can keep up with my kids running around the park. Something like that, something a really detailed picture that probably has some kind of emotional attachment to it and then that will really lock in to remind you when you’re faced with that food craving that’s in front of you.

Right. I think one of the things that is important when you look at your why is that it stands up to some scrutiny. So if you told me your why was to lose 50 pounds, I would say, well what would that do for you? Right? What would that give you? What would that mean to you? And then looking at those things, you’ll go deeper, right? Maybe it’s, you know, if I lose 50 pounds, I can fit on an airplane seat and I’ve always wanted to travel and I’ve never been to… you know, when you, you start to paint this bigger picture and you get to something actually deeply meaningful. A number on a scale doesn’t do anything. It’s a marker but it doesn’t impact your life in and of itself. So you need to go a layer deeper. If you’re why is simply to lose weight or, and this is what exactly what Daisy said, or you know, to weigh this much or to fit in this size. Well what does that mean? What does that mean to you? Go a layer deeper.

Yes, absolutely. I really agree with that. The more detailed a picture you can have, the more it means to you, the more likely it is to shout a lot louder than the tub of Häagen-Dazs or whatever it might be for you. That’s what it used to be for me.

And write it down and post it–get pictures that represent it and post it on the fridge door and write it so that it’s on the edge of your computer. So you’re reminded on a daily basis of why you’re doing what you do. And then in those moments of weakness or emotion or whatever it is, your why is right there in front of you. You don’t have to struggle or dig around like why am I doing this? Like you never have to have that conversation because it’s right in front of you all the time.

And I know another thing that’s been very, very important to me and I think it’s going to be important to everybody. It’s something that you mentioned right in the beginning, Kim, with your new podcast and finding this life support is finding your tribe. Finding a support system. That’s made a huge difference to me. I can’t tap into one locally. Really. I’m out in the middle of nowhere in rural France. My support system has been online and that has made a massive difference to me. And you know I’ve been lucky enough to meet a lot of you now. That’s been huge and I think it has to be one of the biggest things that you should put on your to do list when you start this. What do you think about that?

Yeah, I absolutely agree. I also think this ties into something that will happen, though, is finding the right support network rather than finding all the support networks! [laughter] Because there are a lot of keto groups on Facebook and there are a lot of keto podcasts and there are a lot, there are a lot of sources and I think it’s good to sample and try, but you know what your people feel like. Find those people, find the people that make sense to you. Don’t let yourself fall into too many crowds because I think it tends to confuse more than support, but I do think it’s important to find, you know, one, two or maybe even three depending how much you can multitask groups or support networks that really feel like home to you.

I think it’s important that you don’t stay in groups that just don’t make you feel good. I mean in any way. If they’re emotionally draining or they’re hard work or you can’t ask a question without being yelled at or made to feel dumb or you know, whatever, just don’t, there’s plenty of great groups out there. You don’t have to be in groups that are not there to really support you on your journey. There’s a lot of groups out there that will support you as long as you’re following their journey. But that’s not what you need. You need to find a group of people who will support you in your journey, even though that might not look exactly like their journey.

Absolutely. You won’t be able to Google keto or go into certain groups without being offered quick fixes by certain products, exogenous ketones. I certainly know what I think about those kinds of products. What do you think?

Um, I think it’s so hard to be nice when you disagree. So I think it goes back to your why and your goals. Okay. So anytime you’re being offered a quick fix or a product that makes a promise, you kind of have to look at what is it promising? Well, first can I believe what it’s promising? And the answer is actually, usually, probably not, but specifically about exogenous ketones. When you are seeking a ketogenic diet, you’re seeking it for some reason. For many of us, I would say it’s probably improved metabolic health, right? Weight loss included in that, but not the only thing in it. But it may be that you have some dementia issues in your family you’re trying to avoid. It might be that you have a traumatic brain injury. It might be that you have cancer. It might be that you have depression issues, right?

So why you’re ketoing is a very important detail to know how you’re going to evaluate products that make promises specifically with exogenous ketones. You have to look at what they do. So exogenous ketones, for the most part, they’re supplementing beta-hydroxybutyrate, though there are some esters that have some other forms. If you’re going to supplement beta-hydroxybutyrate, you have to look at what does supplementing beta-hydroxybutyrate do, right? What is the effect? Well it puts more of that ketone in your system. What’s the benefit of having the ketone in your system? Does that support your goal? If your goal is fat loss, I will tell you right now 100% it is counter-productive to your goal. Why is that? You’re like, wait, but I was promised you know all of these things. Yes, that is the marketing. Adding ketones to your body does not cause fat loss.

Making ketones from your body fat causes the fat to be used. That’s what you want. It’s the effect of producing ketones that supports weight loss. Now in and of itself doesn’t cause it, but it is a supportive in the process of it having net fat loss. Whereas if you’re simply adding those ketones to your body, you’ve now skipped this step that causes the fat loss, so that’s not good because ketones have oxidative priority. They are burned first before you burn body fat, before you burn, maybe the minor carbs you’ve eaten. Therefore you are adding into your system the very thing you are trying to get out of your system.

Exactly. You’re adding an energy source that you’re going to use before using the energy that you really want to use, which is the fat on your body.

Right now, I understand why people are confused because they’re made a lot of promises by some of these, what I would call predatory companies and you can’t listen to that. There’s actually a very funny Q&A online where a keto expert is at one of the conventions of one of these companies that sells exogenous ketone products. And this woman gets up in the audience and says, you know, I don’t even understand it. My client said that she started on a ketogenic diet, was losing weight, everything was going amazing, and then she started taking our product and she started gaining weight. And the expert very honestly said, yes, that’s what’s going to happen. And everyone was shocked because that wasn’t the marketing materials they were given. That being said, if you’re ketoing for something like traumatic brain injury, you’re trying to use it as an adjunct therapy for cancer, there’s some dementia issues. There is some evidence that potentially supplemental ketones can be of benefit. And so in those cases I would say there might be a reason to experiment with them, but if your goal is fat loss, stay far, far away.

What was your point you made earlier about the ketones in your system? If you need to bump your ketones up to a certain level for some kind of therapeutic reason and you can’t do that through food alone, then that’s pretty well the only way you’re going to be able to do it. But if you’re doing it from a fat loss point of view, and that’s the bit about the marketing that I can’t stand is one is a weight loss and also it’s a way to rectify a cheat.

Oh right. “Get back in ketosis in under an hour.” Yeah, high ketones and high glucose are not something that should happen. You do not want that. And so there are potentially very negative repercussions that we don’t even know about from making that happen in a body. And I think it should be avoided.

I think we’ve made it pretty clear what we think on that. But it’s something to talk about because it’s something that will come up. It’s something that will be offered as a seemingly magical fix. And I think any of us who have been in a position of particularly wanting to lose a lot of weight, if someone says there’s a magic pill that’s going to do it really quickly, we’re probably at least going to want to give it a go.

Oh, I get it. I want the magic pill. Sadly, it’s not what it’s cracked up to be.

The magic pill is to stop eating carbohydrate.

Yeah, it’s true.

I want a more magic pill.

There is no more magic pill!

I want to be like Sabrina on, what is that? I just wiggle my nose. And you know, it instantly changes.

The number one driver of ketosis is absence of carbohydrates. That’s the number one driver. So if you’re doing anything else to drive ketosis, that’s not that, then you’re missing the main route to get you there.

There are no shortcuts.

And you’re going to be poorer financially and you’re not going to get what you want if you try and do these other quick fixes. So trust us when we tell you don’t, just don’t, just focus on the things that actually work.

We talk about levels of ketones and a lot of people find it useful, but it’s certainly not necessary, but it can be useful of testing those ketones. What do you suggest on that score for someone who’s starting out?

Well, I think Carrie mentioned earlier that she used the pee strips, which can be useful initially. I tend not to recommend them long-term, not because they’re not that expensive. So it’s not that big a cost investment, but over time they don’t work very well because what the pee strips test is Acetoacetate. And Acetoacetate is downregulated by the body. You still have it, but what is spilled in your urine is the access and your body gets very good at, well, some people’s bodies, get very good at downregulating the amount they’re producing slash using, so there’s not as much excess. So they’re now peeing on a strip that’s not changing color or not getting dark purple anymore. It’s not actually an indication that you’re no longer in ketosis, but that’s what people assume. And so the reason that I don’t recommend them is they cause people heart attack. I mean, not literally. They caused people a lot of agitation and anxiety where they probably don’t need to have that anxiety. There’s three basic methods of testing. There’s pee strips, there’s breath acetone meters and there are beta-hydroxybutyrate blood tests. Those are the three methods of testing. Of those, as I said, the pee ones for some people are never accurate. For other people, they become less accurate over time and for still more, they stay accurate. The problem is, I don’t know which one of those categories you fall into.

They’re quite good to start with, you know, fairly cheap. Quick seeing a color.

Yeah. Except I did not test positive on a pee strip one time. So for me, they were not a good indicator. But then when I went to blood testing, I did find that that was helpful for me. But for a lot of people, the pee strips are very helpful initially. So it’s more that I want people to go into it knowing that the pee strip is not god, it’s not going to necessarily tell you everything accurately. Take it with a grain of salt.

And for the other two. Both are going to be a fairly large expense.

Right. So, so the beta-hydroxybutyrate blood tests, in the United States, there are currently, I think now there are four, but there are two that were primarily used for diabetic testing that are very expensive. You can get them without a prescription, but they might be a little harder to get your hands on. All the meters that test ketones in the United States also test glucose. They’re called dual meters. But you’re looking at things like, my favorite is the Keto Mojo and that one, I like it because I liked the company. I like what they stand for. They’re specifically geared towards the keto market. They test both glucose and ketones through specific strips and that will give you your level of Bhb, beta-hydroxybutyrate and glucose. And I liked that one because it tends to stay a little bit more stable.

And it’s kind of the gold standard test, so when you read keto studies, if you read keto studies, that’s the marker they’re usually measuring. It’s probably about a hundred bucks a upfront costs to get started. And then ongoing would just depend on how often you’re testing. And then the third option are the breath testers. Those test the level of acetone you’re putting out through your breath. There are a few good meters. They’re expensive. There are a few cheap meters, they’re not very good. So I don’t know that those are worth the costs. They’re kind of along the lines of the pee strips. They may work, they may not work, they’re not well calibrated. I don’t know what this means. And they might cause more confusion than they’re worth.

Yeah, I certainly thing that blood testing is probably the easiest. And like you say, you can test the glucose at the same time and that can be just as useful, but neither, neither, neither nor all three, are necessary. They’re just useful if you find that kind of data useful, they can be very useful for tracking what impacts certain foods have. But you can just use your noggin, can’t you? You can track yourself by how you feel and how you’re doing and you can, you can just use that as your gauge.

Again, we come back to goals, right? Is your goal to have high levels of beta-hydroxybutyrate? Well, maybe if you’re looking to treat a disease, it is. It’s one of your goals, but if your goal is to lose weight, are you? That is your best check versus what is my Bhb level, right? One of those is goal oriented and the other one maybe not. So it’s not a necessary thing for most people’s general goals, but you know, it’s situation specific.

Carrie, I don’t think you haven’t bothered testing after the pee strips have you? You don’t test your, your blood or your breath.

I went through a little phase where I got to Keto Mojo because I was curious and I just wanted you to see. And so I went through a little phase where I tested and then after about a month I think, oh, I think I packed up my house and moved across the country. And the Keto Mojo is still in a box somewhere. And so it just, but it was never really a big thing for me. Once I got the hang of how I felt on keto, then I just go by that. And again, I’m not, if I feel great, then it’s all good. I know when I’m going sideways and I can course correct without having to measure it, without having to see a number. But I understand that not everybody’s like that. And of course people that are doing it for different reasons, will have a different motivation or maybe they’re just trackers and they love to see numbers and see trends and it makes them happy. And that’s awesome. Just because that’s not me, that doesn’t mean that I think nobody else should do it. Whatever works for people is what I want them to do. As I say, I was curious. I tracked it with the Keto Mojo for a month, but I know from how I feel, how it’s going, I don’t feel the need to track. I guess I’m just giving permission for all the people who are going like, oh my goodness, I have to track? No you don’t.

No, you really don’t.

I’m giving you permission not to, but if things aren’t going your way, you might want to track for a little while so that you can uncover why it’s not going your way, you know, so it’s not like an all or nothing proposition. You don’t have to decide I’m tracking or I’m not tracking and then stick with it. You can track, you can not track, you can go back to tracking. You can track different things. You can, you know, whatever works best for you to get you to your goal is what we want you to do.

Well hopefully, we’ve covered just about everything we can think of to get you started the best way possible. However, sometimes people feel they need a bit more help, they need a program and some coaching that’s going to help them through those first couple of months. Or perhaps they need a reset and just feel they need advice. And I happened to know that you two have the perfect program, so perhaps you could just tell us a bit about that. If people feel they just need a bit more help.

Well, first, I think I should point out that a program is not a necessity. It’s not something that you need. It’s perfectly possible for you to reach all your keto goals on your own doing the things or doing some of the things that we’ve described in this podcast. But we have found that a lot of people do do better when they have a structure or they have a framework or they have something to hang their hat on. Particularly something that involves a community. So programs are not necessary, but if you do better in that environment or you want some help, maybe because you’re the only one that’s keto in your household or you just want some community, you want someone to share your successes and your not-so-successes with… Keto does take a bit of time to work out, you know, switching like what am I going to eat? A program such as ours just gives you the framework to just get started straight away without you having to spend days or weeks or months trolling the Internet to try and figure out how to do it, if that makes sense.

I think for me, you can absolutely do keto by doing your own research, your own food plans. You know, you can do all that work. The only reason in my opinion to pay for a program is because you’re like, look, my time is valuable and I would like you to do it for me, please. Right? We can’t do the work in terms of your life for you, but giving you the real deal, tried and true, what actually matters, what actually works, streamlining your experience. So you don’t have to do like kind of what I had to do when I went keto, which is spend several months doing it wrong so that I could figure out what was right, what was wrong, what does that mean, why is this happening? People who’ve been there before you and can guide you through some of those choices so that your experience will be more successful, more streamlined, lot less effort, and a lot less confusion then if you go it alone.

And so for me, that’s kind of the main reason I suggest a well-structured program to start with is because it takes a lot of the guesswork and the anxiety out of starting. Or maybe you’ve fallen into kind of a place that doesn’t feel as structured anymore and you used to have a lot of momentum and it feels kind of gone and you need that again. I feel like that’s when a program can be very helpful.

Yes, because you’ve got a mixture of those people in your group, haven’t you? You’ve got people who are starting from scratch, but you’ve also got people who just need that bit of a reset and reinvigoration.

Recommitment, yeah.

And from a recipe perspective, because of course all I do is think about food all day–from a recipe perspective, the Internet is a nightmare. There’s so many terrible recipes.

People would be like, just go to Pinterest and you’re like, Pinterest is a mine field.

There are several problems. One is that a lot of people are trying to get hits on their blog so they call something keto and it actually isn’t. When you’re new is very easy to get sucked into that. Oh, you know, typing keto and you know, whatever it is you’re looking for and coming up with all of these hits and you’re just assuming because you know you trust people that nobody would put a recipe up there if it wasn’t actually keto. But you’ll find, and unfortunately as Kim said, a lot of trial and error and wasted money and wasted ingredients and wasted time–you’re going to find out that a lot of the recipes on the Internet are either not keto, don’t actually work and/or taste nasty. One of the main benefits from my perspective of getting a program like the one that we offer is that you know ahead of time that all the recipes are going to be keto. They really are. All the recipes are going to work, all the recipes are going to taste fabulous and all the recipes, because this is something that I always focus on, all the recipes are going to be capable of being made successfully by even someone that’s really never spent time in the kitchen. Cause there’s a whole generation of people who have never had to learn to cook because there’s been enough packaged and pre-prepared meals available that they’d never had to do that. So one of the goals for this program was that anybody with any skill level would be able to come in the kitchen and make truly fabulous, truly keto recipes, meals for themselves that would be better than anything they’ve eaten before.

And we’ve got those recipes structured into various different combinations of meal plans. There’s a whole book that’s got the recipes and the meal plans, but also all the science involved and various bits and bobs. What else can we expect in this plan?

When you sign up for the program and the program starts, you’ve got a really comprehensive guide. It goes through pretty much everything that’s going to come up along your journey, including the science of it, the why, the how. A lot of the things we talked about on today’s call. We go into great detail on plus more things and then we go into giving you meal plans. How do you follow them? What are these ingredients about these recipes like Carrie was mentioning, we also have more interactive elements. We have videos for specific topics that you want to delve a little deeper on. We’ve also got, like Carrie said, the group. We have this very, very, very active Facebook group that comes with a program so that you can go deeper, get your questions answered, get that support, have people celebrate with you. Somebody the other day posted that they went down a shoe size, you know, these really, you know, amazing, funny, non-scale victories, scale victories, all sorts of victories. And then on the flip side, the places where people are struggling and getting that community support in those spots.

The group that Kim’s talking about is a private group that only has the people that are part of the program, it only has the program enrollees on it. And the power of that is that everybody’s on the same page. Everybody’s cooking the same recipes, everybody’s following the same meal plans. It’s an eight week program. So everybody’s going along on this road together and it just makes it, the camaraderie that has been built up. And the support that is generated in that group is just, it’s really magical. It’s actually become my favorite place to go now because it is so–even when people are sharing where they’re struggling, it gives Kim and I the opportunity to one on one, you know, help them in a way that not only helps them but helps anyone else who might be struggling who’s seeing the same problems. So we have the opportunity to go in and help people in the moment when they need us, but also we get to see their successes. We get to cheer along with them and we get to high five them and it’s just–it has, it’s become my favorite place on Facebook

And we also do some coaching calls along the way where we will get on a live video where we talk with people and can work through where they’re at, what’s going on and give them a little bit more personal attention.

And people love those. They’re really useful to watch everyone else’s questions and answers, aren’t they?

Yeah, I mean there is a reason that group programs are so great is because you don’t just get to learn the questions that were in your head. You get to learn the questions you might have later because somebody else asked them and now you’re way ahead of the game.

That’s actually the good bit of Weight Watchers, I think. I was having this conversation with somebody the other day and they were saying the one good thing they got from going to Weight Watchers support groups was the support group. That was the element that worked well for them. And it is very important, isn’t it?

Yeah, absolutely.

I think the support group is key. It’s a wonderful community and I see a lot of people just really being able to be themselves and share themselves and know that there’s no stupid questions and nobody’s going to yell at them and they’re going to get all their questions answered. So I think the program is really, it’s for lots of people, but it gives a brilliant framework for someone just starting out, okay, here’s how you do it. Without spending months researching like Kim had to or trialing and erroring on recipes, spending a lot of money and time making things that don’t work and don’t taste delicious. But it’s also for people who have maybe got a bit off track or maybe they’ve had a hard moment in life and they need to get refocused. People who are experiencing a stall. So we have people from all of those categories. We have people who just want to get re-immersed in keto. We have people who are brand new. We have people who have stalled, we have people who have just got bored with what they were eating day in, day out, and they’ve come to get a refresh.

We also have people who have reached their goal and are saying, I don’t know how to live this life. Now my goal has shifted. How do I reconfigure my thoughts about all of this and how do I live this just as a lifestyle?

Hmm. Good point.

And as I said, anybody can do keto without any of this, but a lot of people find that they are happier and a lot more successful when they’re part of a program that involves all these elements that we’ve put together.

And we’ve got a new intake coming up, I believe at the beginning of May, but you can sign up from beginning of April.

Yeah, absolutely. We will be accepting enrollees starting in April. And so that program will begin in May. And if you’re listening to this a year later, it might not be the same month, but it will be ongoing so you can check out when the next group starts.

You can and you can find out all about it at start.ketowomanpodcast.com and we really hope to see some of you there. It really is a great program that I’m obviously getting behind and I’m sure some of you will too, so perhaps we could wrap up in the usual fashion with a top tip. Who wants to go first?

I talked so much. Carrie, do you want to go first?

I have lots of top tips, but if I was only given the opportunity to give you one tip, it would probably be you do you. Don’t get bogged down in listening to all the voices and all the things and choosing someone else’s path that you hope is going to work for you. In the groups, I see one of the big things that derails people is the confusion that’s caused when people are looking at other people’s progress and trying to make that work for their body. And then someone else will come along and say the exact opposite and then say, well, that worked for me. And then you’re sitting there going, okay, so now I don’t know what to do. My best top tip would be find what works for you. If what you’re doing is working and getting you towards your goals, keep doing that. And then when your body heals and that starts to change, reevaluate, but always do what’s working for you rather than follow someone else’s thoughts about what should work for you.

Kim?

I think probably what I want people to know is that when you start keto, I think a lot of us don’t put enough stock in the fact that we have potentially been using carbohydrates to manage our mood for several decades. And you start keto and you’ve taken away your drug of choice and you may not even have associated yourself as an addict up until this point and then suddenly that crutch that you were using, the thing that you use to pick up your afternoon, the thing you use when you were having a hard day, that thing you use to celebrate with friends, carbs were like your number one tool. And now you’ve taken that away. And so I just want people to know that it’s okay and pretty normal to feel a little bit emotionally adrift to maybe deal with some unusually strong emotions that you aren’t used to dealing with because you’re not self-medicated in the same way that you were. I don’t want you to think something’s wrong if that happens. It’s simply your body going through this change where now you’ve taken away this thing, this crutch that you used to lean on and it’s maybe time to find some healthier, more actually supportive ways of managing your moods. And so it will get better. There is support if you’re having a hard time in this arena. And I just want everyone to know that it’s not unexpected.

It’s true. I certainly used to self-medicate with carbs. I used to literally numb everything and then go to sleep with the carb crash. So it was just an alternating …

Knock yourself out!

Exactly! That’s exactly what I did to deal with my mood. But of course one of the things that keto is done is improved that mood. So I don’t actually need that self-medication as much anymore. So things change, don’t they? I did have a top tip written down. Mine is almost the same as Carrie’s, but it’s something just like Carrie that I feel very strongly about and mine was focus on you, your goals, your life, and what you can make work for you. It doesn’t matter what other people think you should be doing. You are the most qualified person to become your own expert. Because it’s such a bugbear of mine. People who think they’re more of an expert on you than you are–because they’re not all are they.

In my little world, there’s nothing trumps how I feel. Although I must say that since I’ve been keto, I am much better at feeling how I really feel. I’m very, very–because my body is so clean now–I’m very sensitive to how I feel and it doesn’t matter what anyone else tells me, like carnivores. I’ve tried carnivore. It works brilliantly for a lot of people. I don’t feel as well as on carnivore and it doesn’t matter how many carnivores tell me that if I would just eat carnivore, I’ll feel better. I’ve done that experiment and I don’t, and so there’s nothing trumps how you feel. If you’re doing something that even somebody you really trust says is good for you and you don’t feel better, don’t feel obligated to keep doing that.

I think it’s really empowering. One of the things I really like about keto is that it empowers you to get really in tune with your body and confident in knowing what works for you.

Yeah. Once you’ve cleared away the health hijackers that give you bad intel. You know, then you can start to really listen to what your body’s telling you.

Yep, absolutely. Well, thank you so much. It’s been a great pleasure. As always.

It was fabulous.

Wow, we’re good at talking.

We chatty!

We are!