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

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

Thank you Daisy. I’m actually doing really well. It’s hot here. It’s the middle of summer in Australia. I got a really bad sunburn the other day and it’s about 11:00 PM at night and I’m drinking scotch. So I’m fine.

Well, it’s not so long ago we were literally sitting across the table from each other.

That’s true.

I still haven’t quite gotten over that surprise.

I’ve actually visited chez Daisy. Very few people have. I think myself and Louise Reynolds are the only guests who’ve been.

That’s true. Out in the middle of nowhere in the woods. You said the Uber driver was a bit worried about dropping you off, wasn’t he?

He was scandalized. Because we started out from Toulouse which is about two hours’ drive away, so it was a two hour Uber trip. And the roads… at one point we came up to a barricade, which was just a, a toll booth for the freeway and it was covered with people with protesters with the yellow vests and they were all like…

Oh, the gilets jaunes.

Yeah, the Uber driver was really worried.. They waves us through and said that the government is paying your toll for the day. So they were literally manning the barricades. The French really do know how to protest. But anyway, we started on a major freeway and then it got down to a smaller road, and then sort of like a country road. And then there was like, at one point… Roads? We don’t need roads where we’re going. It was just like into sort of like a green undergrowth, and just into a general area, general direction, and the Uber driver’s like, I’m not going to leave you here. You can’t speak enough French to be able to… for me in all honesty, to just leave you in the middle of nowhere. And then I saw your name on the letterbox and I said, ah, I know where I am. So yeah, I finally made it. But yeah, Daisy literally lives in the middle of nowhere.

Yeah, it is properly down a track in the middle of the woods, isn’t it?

Yeah, totally. And a track full of salamanders, orange and black salamanders.

That’s right.

We don’t have salamanders in Australia, so that was really kind of weird.

Yeah, they’re really cool. They seem to come out… I must look it up, but it’s a specific temperature range it seems. They tend to start seeing them about November, and they like it when it’s wet and they’re obviously nocturnal because you see them at dark. But I haven’t seen them recently. I think maybe it’s got too cold. I go out and… and they’re… they don’t all have names, but there’s one that usually hangs around the front doorstep called Sydney.

Okay. Well I hope I didn’t step on any by accident. My apologies if that happened.

But they’re pretty cool, aren’t they? But yes, you do see them, you see them on the roads a lot. I think they hang around under the leaves that gather at the edges of the roads. But they’re pretty cool. They’re very striking, aren’t they?

Yeah, absolutely. Remarkable. So yes, I’ve been to Chez Daisy; I’ve met the dogs; and I’ve slept on Daisy’s hearth…literally.

Yeah, I put you in front of the fire. The warmest spot in the house.

Luxury.

I didn’t know whether the dogs would dessert me and all pile on you seeing as you’re in front of the fire, but they stuck to their routine. I think they came and jumped on you in the morning, didn’t they?

Yeah, they absolutely did. Did you tell your listeners what we did? Louise basically stitched you up. She was telling you, oh, I’m coming to visit you Daisy. And you were running around sort of cleaning up the place.

Yeah. Thank goodness! Thank goodness! Yeah, she told me she was coming because the house was an absolute tip. So yeah, it gave me the push I needed to give the house a clean. But yeah, it was the updates all the way through. So she was like, yeah, I’m stuck at Amsterdam. I missed something…

That was me.

I’m like what on earth are you doing at Amsterdam.

I missed my flight.

And yeah, she came up with this whole ruse about how she’d got flights in a Black Friday sale, so hence why she’d sort of gone via… because why on earth would you go via Amsterdam to go from London to France? So yes, there was a great story for all of it, so she managed to keep it all going. Yeah. Yeah. I’m in the car on the way up and yeah, so am I going to meet you at the junction of the motorway? No, no, I’m coming all the way to… How did you manage that? Oh, I sweet-talked the driver and that’s it. None of which I put past her, so it was all very believable.

So a lot of changes have happened for both of you and me in the past couple of weeks.

They have. They really have. It’s been a whirlwind. I haven’t been glued to my computer and the Internet so much for a while, but I’ve literally been plugged in trying to learn how to do all the things. How to edit, how to produce the podcast, where to put it, who to put it with, who to, how to… Oh, yeah my brain is starting to leak out of my ears. But it’s all very good fun as well. I must admit I’m enjoying it, but it’s that case when there’s so much to do, and not enough time to do it, and you go into a bit of a head spin, but it’s stimulating and fun at the same time.

Definitely an opportunity, yeah.

A bit like Ketofest. That was a whirlwind of hard work and getting really tired and stressed out, but such fun and really enjoyable at the same time. It’s that balance between the two, isn’t it?

Yeah, I liked it. For me it’s really meeting old friends for the first time.

Yeah, I love that phrase. It’s perfect. It really sums it up, doesn’t it?

It does, absolutely.

And what about you? A few things are changing for you. I’ll tell you what though, we’ll get to that. We’ll get to that. Let’s go back. I want to hear about the Richard behind the 2 Keto Dudes. A bit more about you and where you come from and what led you to the place. We’ve heard the story about you getting to the point where you were potentially going to lose a toe and that led you down a path of investigating how you were going to fix yourself. But what led to that? What was the build-up?

I was working in America. I was a software developer and during the Y2K era, software developers were highly sought after. An American company approached me in 1998 and asked me to come over to work for them in Florida, and so I worked for them in Florida. Then I was poached by another company on Wall Street. I worked on Wall Street for two years, from 2000 to 2002. A third company in Las Vegas poached me to run their business, be their Public Executive. It was a software company with a hundred developers. I sort of transitioned out of being a line developer to a senior manager, to be an executive. At the same time, I started to notice that I wasn’t feeling very healthy. When I was living in New York I was walking up and down five flights of stairs every day and I was feeling okay, but when I got to Vegas – because Vegas is in the middle of a desert, 50 degrees Celsius outside, and you just go from one air-conditioned room to the other – I started to become really unfit. I went to a doctor and the doctor said, you really should try to lose some weight and I’d just given up smoking – I was at a two-pack-a-day cigarette smoker for many years. So I’d just given up smoking, you put on a little bit of weight when you do that. And the doctor said, you really should try to lose a bit of weight. Why don’t you do meal replacements? And I said, what are those? And he said, well, instead of eating a meal, you eat this stuff in a can and it’s called Slimfast. There’s a lot of different products.

Groan….

Exactly. And this stuff is just pure sugar. It’s just nothing but…. it gets all of its energy from starch and from sugars. I went back to the doctor. I was having trouble seeing. I had to increase the size of the font on my monitors to almost half an inch in size. And I went back to the doctor and I said, what’s wrong? I’m going blind. So he said, well, we should get you a blood test. He did a blood test and it turned out that I was prediabetic. My glucose was 350, fasting glucose. My triglycerides were 1,111 milligrams per deciliter. These are US scales. I had 10 grams of triglycerides in every liter of blood in my body. I guess we have five liters of blood so, I had 50 grams of fat running around in my veins. As well as high glucose and what was actually happening…the reason why I couldn’t see was because the concentration of glucose in my blood supply was higher…or at least, actually the concentration of water in my blood supply was lower than the water in my eyes and it was sucking water out of my eyes. So I was trying to see through raisins! That happened to me while I was in Vegas and I’d had a good career and I’d been successful, but I was basically prediabetic and I went on an Atkins diet and that basically reversed the prediabetes back to a non-diabetic state.

I decided I wanted to understand why my body was falling apart, so I retired at 40 and moved back to Australia. I moved to a place called Batemans Bay, traveled around Australia for a year in a Winnebago to find this place, Batemans Bay. I didn’t have to be anywhere immediately, so Jules and I went around with Black Dog in a Winnebago for a year, basically interviewing every potential town to see whether it’s going to be a new hometown. We ended up settling in this place called Batemans Bay, and what I wanted to do was to research to work out what the heck was going wrong with my body. I went to a gym. I went to a personal trainer four times a week. I was a cycling a hundred kilometers a week to try and get fit, and everything seemed to be going well.

I was feeling a little bit healthier, a little bit better. But then a doctor noticed that my LDL cholesterol – my LDL number, the cholesterol carried in my LDL particles – was above 200 milligrams per deciliter, which is really a point above which doctors like to put you on statins. So the put me on a statin, and that made me diabetic.

Nice. Great. That’s really helpful, isn’t it? Nice little side effect. Thanks.

Yeah. Which at the time we were only just starting to get studies showing that this was going to happen in 10% of all men and 15% of all women who took this statin called Atorvastatin, or its commercial name is Lipitor. So anyone who took Lipitor and became subsequently diabetic, there’s a good chance that that contributed to tipping you over the metabolic cliff.

So it was specifically that type of statin that had that side effect, was it? Why did it do it? What’s the mechanism that that made that happen?

Yeah. They don’t really know what the mechanism is that causes that. What a statin does is it poisons the metabolic pathway that makes six or seven really useful metabolites – one of which is cholesterol – but it also makes CoQ10 which is used as part of your electron transport chain. It’s important to the heart muscles. There’s all these things that it’s messing with in terms of how you generate energy. The specific way that it causes people to lose their glycemic control, people don’t really know, but the statin manufacturers aren’t incented to find out that mechanism. What they do literally is, when they do a test to people with statins, they exclude anybody who has an oral glucose tolerance test value at the beginning of the test. So, if you’re on the edge, they don’t want to have you in the study of being diabetic.

That’s called cheating.

It’s called stacking the deck in your favor. Yeah.

What I was getting at and asking about your time before and what led up to the prediabetic and then diabetic state, would you say that way before that, I mean growing up, I mean now that you know all that you know – diabetes isn’t something that sneaks up overnight. Was this something that was brewing for a long time? Looking back, were you healthier and fit as a child? You love cycling and all the exercise, was that something you think that maybe staved off for a while and that’s what tipped it over the edge with that move from New York to Vegas?

Yeah, I think that one of the things that happens is the older you get, the more insulin resistant you become generally. And I think it was a factor of age as much as anything else. Plus by gaining weight by reducing smoking, would have contributed as well. So, there was that. Plus I had had an abnormal liver function test when I was 21. I was 35 by the time I was working in New York, so that’s like 14 years later. I had an abnormal liver function test at 21 and basically went off alcohol for like, almost five years, and then only came back to drinking rarely after that. There was something in my makeup. Genetically I was prone to becoming Type 2 diabetic. My grandfather had Type 2 diabetes. One of my paternal uncles has Type 2 diabetes. My father has the beginnings of Alzheimer’s as well. So it’s a predisposition in my genetic heritage to become diabetic. Then over time I did silly things like drinking Slimfast two meals a day. I replaced two meals a day with sugar. Absolutely horrible.

I’ve done the Slimfast. In fact, it wasn’t Slimfast, but the first diet I did – aged, I think, around about 14, 15 – was Herbalife, which is basically like Slimfast, except they throw in a few supplements as well to make it healthy. But dreadful thing. And I’ve done Slimfast, or the like, a few times over my life and it’s a shocking thing. And what is absolutely dreadful is that it is still recommended as something to do. It’s often something that’s recommended by doctors as the pre-surgery diet when you’re going into weight loss surgery for example, they’ll put you on Slimfast-type shakes to get your weight down and shrink your liver. Yes it will do that because it’s just a calorie restriction, but you could go on a keto diet and do the same thing and not turn yourself into a stabby monster because you’re having to consume these awful shakes. But they are, aren’t they? They drive you up the walls.

Yeah. I’ve never really had a problem myself with weight, so that I didn’t feel like I needed to diet because I’ve got a build that can carry a lot of weight. I was a rugby player for many years. I spent nine years as a rugby player and I’m fairly solid. I think I went on Weight Watchers at one point, in the late nineties with Jules. We were both trying to lose some weight – she convinced me that I needed to lose some weight – but other than that Slimfast was the next time that I actively really tried to lose weight, and that was under the doctor’s recommendations, so you’re right, that that is what they recommend.

It’s crazy and it does come down to perception. And I think that’s something that comes with getting older as well. When I look back at pictures of the actual size I was when I was convinced I was fat and I needed to diet…

You weren’t, were you?

I would like to slap myself multiple times about the face and say, don’t be so ridiculous. When I got to twice the size I am now that was when I was overweight, not when I was… that’s when I did to start losing some weight. Not back then. I mean it’s just crazy isn’t it? I’ve heard you talking about it and you’ve just said that you have the kind of build, the kind of frame that naturally carries a bit more weight, but it’s your perception. What do we care? Why do we have to fit some kind of image that somebody else has set up. Your healthy. All your health markers are perfect. You feel fantastic. You can cycle all day.

If I need to, yep.

You can do all the things, so why do some people still insist on judging you by your size and what size trousers you fit into?

That’s going to be their problem, not mine.

Exactly.

I look at it this way – and I might leave this actually as a top tip later on for the end of the show – if you have lost a large percentage of your body weight, if you’ve lost more than say, 10% of your body weight – and I’ve lost 33% of my body weight – and then you stall, count your blessings because you’re not putting back on that 33%, or 10% or whatever it is. You’ve reached a new homeostasis. If I could get inside people’s heads and make them feel better about themselves, about how far they’ve come…that’s probably what I tried to do in Keto Dude’s podcast to explain to people, just because you are in an overweight category doesn’t mean that you’re unhealthy. It used to mean you’re unhealthy when all of your other biomarkers were bad, but once your glucose is in control, and your insulin is in control, and your lipids are perfect, and you’re otherwise quite healthy, being overweight – if you are – actually predisposes you to live for longer than people who are underweight. Take advantage of it.

Exactly. And so you actually came to this with a slightly different perspective. A lot, and I would say possibly most people, end up approaching keto from a weight loss perspective, but you very much that, although that had been mentioned by the doctor and okay, it was something potentially to address, that wasn’t your focus, that wasn’t your perspective. It was things like, to start off with your eyesight going. It was all about health markers and then the diabetes, and you trying to figure out the mechanisms and what was going on. So pick up back where I diverted you. You were back in Australia and you were going to the gym but things weren’t working as well as you wanted them to.

You can actually see on my blog the progression from 2011 to 2014 when I went on keto. 2011 was when I started on the statins and I progressively became visibly very sick. But if you look at my blood markers, a cardiologist will say the man in 2011, who was merely overweight, was really unhealthy because he had an LDL of 200. And then if you look at as I was the day before I started keto, I had put on almost 40 kilograms of weight – 80, 90 pounds of weight – and, my LDL had dropped from 206 down to… I think it was 76 was my lowest… or certainly between 70 and 90 was my lowest, for about a year there. A cardiologist would look at the actual numbers and say, clearly the person with an LDL of 96 is much healthier than the person with an LDL of 206.

But blind Freddy can look at the two photos and say – clearly the guy who’s 40 kilos heavier, and severely diabetic – that guy’s clearly unhealthy. It became obvious to me that we don’t know what we’re talking about when it comes to metabolic health. I had tried Atkins back when I was prediabetic in America. I had an ingrown toenail that was going sideways, and I went to the doctor in the emergency room – this is what got me to go keto – and I thought I was no longer diabetic and he looked my ingrown toenail and he says, you have a problem with glucose. And I said, I used to have a problem with glucose. I should be okay now. He tested it and my fasting glucose was 20 millimoles per liter, which is 300 and something milligrams per deciliter.

And I said, yeah, wow! I really do have a problem with glucose. He said, if you can’t control your glucose, and based on your numbers I don’t think you can, you could lose that toe because we can’t find an antibiotic that is able to have an effect on your healing. He said to me, I want you to go on this new drug called Januvia. I looked into some studies of Januvia and there are cadaver studies that show that people who died of unrelated diseases like strokes and what have you, who were on Januvia, had a predominance of pancreatic duct tumors growing. And I said, I’m not sure I want to go on Januvia if it’s causing people to have pancreatic duct tumors. I said, give me three months. I have an idea. I’m going to try something out, give me three months and I’ll see if I can change my glucose and if I can then will you decide against maybe putting me on this horrible drug. And he said, sure give it a go. He didn’t expect that I would get anywhere.

Can you just explain – because this is obviously something that’s really, that stereotypical image of when your diabetes gets so bad that you end up literally losing limbs – what is the reason for that? Why does that happen? Why is it so bad to have too much glucose running around your system?

There’s a bunch of things happen there. One of the things that Professor Noakes talks about is the fact that diabetes, at its core, is a disseminated vascular disease. Essentially what he means by that is that you get more heart attacks because you get more atherosclerosis, your small capillaries that feed the periphery of your body and keep the nerves in your body fed, start to clog up. All of a sudden, not only do you not have adequate circulation to get to your fingertips and your toes, but you’re losing all the nerves in them. So you could be walking along and you could stub your toe and rip a hole in the bottom of the toe and not even know about it because you’re diabetic. I know Type 2 diabetics who cannot feel anything below their waist they’ve been in a horrible state for several decades.

That’s what happens and you can’t feel anything, so you can’t know that you’ve done any damage. And when you do do damage, bacteria feed really well on glucose. If you have high glucose in your blood that’s being pushed into all of your tissues, your bacteria is going to find that to be a wonderful food source. Plus you don’t have circulation getting to that area to bring immune defenses in. There’s a lot of reasons but peripheral neuropathy, which is where your peripheral nerves start to die off, is the primary cause of lower extremity amputation.

It’s an awful thing. And like you say, it’s progressive. I know somebody here who literally had started to have trouble driving and he actually drove me once back from the hospital and it was terrifying because he couldn’t feel the sensations in his feet properly. So obviously his feet weren’t as responsive as they should be on the pedals and the car and it was terrifying. He shouldn’t be driving.

No. It’s like somebody driving in high heels or stilts. Somebody’s driving and trying to do everything with stilts on. Diabetes is a horrible disease. It takes your eyes, it takes your kidneys, it takes your limbs, it gives you a heart attack or a stroke. And your kidneys of course. Eventually, if you’re lucky you’ll probably die of a heart attack before you really have some of the really horrible complications set in. Gangrene is not a good way to go, for example, but it’s a horrible, horrible disease. And the thing is, it’s progressive. Everyone told me as soon as I was diagnosed, everyone said, right, that’s it for you, it’s only going to get worse from here.

This is what you’ve got to look forward to.

Yeah. All you can do is slow the progression. And this is how we medicate people. We medicate them to slow the progression as much as we possibly can. I remember going to a group in Batemans Bay – this was a certified diabetes educator who is on rotation – she basically swings through all of the local towns, sort of once every month she goes to Batemans Bay – and they have a group there and they talk to you about appropriate foods, portion sizes on plates, and it’s all about reducing your portion control because…there’s this crazy post hoc logic fallacy that people become overweight and then they become diabetic, therefore being overweight causes diabetes. If we can stop them being overweight their diabetes might be as bad.

Which is entirely not how it works. But all these diets are really horrible, calorie restriction, but they’re feeding you carbohydrates and making sure that you have enough carbohydrates so that their drugs work to lower your blood glucose. I remember the certified diabetes educator, I said to her, look I remember Atkins back in 2004 really helped me reverse prediabetes. And she said, no, that’s not possible. She said, diabetes is not reversible, it’s only progressive. If you have had prediabetes there, it’s getting worse. You’re just not aware of it. And I said, well I’m pretty sure that my endocrinologist at the time said, whatever you’re doing, keep doing because it’s reversing your disease. And she said, well he probably doesn’t know what he’s talking about. For the record, this guy was a Professor of Endocrinology who discovered that insulin is pulsatile, and was like the first person outside of the inventors of the Insulin Assay to do an Insulin Assay.

I thought he didn’t know what he’s talking about. And they keep feeding you the carbohydrates, because otherwise the drugs they’re giving you have the potential to send you in a hypo. So of course you’ve got to have the carbohydrates or it could be really dangerous.

That’s right.

They spin the whole, well be careful, the whole hypo is dangerous – could kill you – so they breed this fear.

They put me on an 1800 calorie a day diet with 306 grams of glucose in it – starch and glucose. I said to the CDE – the dietitian essentially – this is crazy, the Atkins diet did help. And she said, if you tell anyone about the Atkins diet in group, I’m going to kick you out of group, and I said, don’t bother I’m out of here and I never went back. I found out later that she’s just retired with Type 2 diabetes in a caravan down at Batemans Bay. I could help her. It’s really sad. This is the reason I really got angry and I was getting a bit militant on Facebook at one point…everything they’re telling you about diabetes is wrong. They’re lying to you. It can be cured. And that’s how 2 Keto Dudes happened because Carl Franklin, who’s been podcasting since 2002, heard me saying that. He’d just been diagnosed diabetic and thought, I’m going to give that a try. If I can eat bacon and eggs, I’m up for it. The rest is history.

So you said, well give me three months to turn it around and we’ll talk again. And of course that’s what you did.

Yeah. My HbA1C, which is a three month marker of average glucose, went from 8.5 down to 5.5, and then three months after that it went to 5.2 and it’s been at 5.2 for four years since.

That’s what astounds me. For something that can have been plaguing somebody for such a long period of time, how fast you can start turning it back the other way.

Gary Fettke says it happens the next day. The next day after you go on a low carb diet your glucose is in control, and then HbA1C just takes three months to catch up to reality. It’s remarkable.

How far would you say, realistically, people can reverse their way out of a situation when it’s progressed to the extent that they’re starting to take insulin? Is that something that you can come back from? I know people have, but…

90% of people on the Virta study were able to totally reduce their insulin – of people who were insulin-dependent Type 2 diabetics, when on a ketogenic diet managed by Virta through their remote application on the phone. You’re doing daily ketone tests and the like, and 94% I think, reduced or got rid of their insulin entirely. It depends on how good your pancreas is. The process of Type 2 diabetes is essentially your pancreas is fighting a war with insulin resistance and the rest of your body, and it’s trying to make just enough insulin to be able to do the job, and the insulin resistance is ramping up in the rest of your body. So the pancreas has got to make more and more. Eventually it starts being unable to keep up.

It’s complicated because pancreatic beta cells are being killed off by large amounts of glucose in the body. At some point the pancreas is unable to further keep up and then that’s the point that people get given exogenous insulin. The thing is that your pancreas may still be able to make enough insulin for you if you don’t need a lot of insulin. So how do you get to that point? You don’t eat glucose. You don’t eat sugar and starch and you eat enough protein to be able to support your body’s protein turnover, and whatever protein requirements you need for making new glucose. And you get all of your energy from fat. All of a sudden your body doesn’t have to make a lot of insulin. Here’s the thing. If the amount of insulin that you need is less than the amount that your pancreas can make, then you’re laughing. You don’t need any insulin. If it’s below, then you probably do need a little bit of insulin. It depends how long you’ve sick really.

That’s the thing, isn’t it? The point is, it can be dramatically improved, if not reversed. It never ceases to astound me the stories that I read, and how quickly it happens. It seems miraculous when, in the context of being told that this is a progressive disease, that there’s nothing you can do, and yet time after time after time, hundreds and thousands of people are reversing it in a matter of months. It seems crazy. If you could hand somebody a pill and that happened, there’d be no more problems. The sad fact is that some people, regardless of being able to see the evidence for themselves, just don’t want to comply and would rather stay with the medical establishment’s progressive pathway.

Yeah, the standard of care. We know that there are four ways to reverse Type 2 diabetes. And I get into arguments with a lot of people about reversal because the American Diabetes Association essentially said that as long as you can’t eat a balanced diet, as in a lot of carbohydrates, then you haven’t truly reversed your disease. They’re just saying this because they want to have been right when they said diabetes is a progressive disease. They don’t want to admit that it’s possible to reverse it. But depending on what you eat, it is certainly possible to reverse the disease. Certainly possible to reverse all the symptoms

That’s the problem with all these guidelines, isn’t it? To actually change them. That to me seems to me to be the fundamental problem. To change the guidelines, somebody has to say that they were wrong.

You need an expert. Somebody who is an expert in the subject matter to rip out pages in a textbook that they wrote and say, I was wrong about that. And those people come along very rarely. That’s the thing, really for the anger about that is what motivated me to get into podcasting and stuff. As I say, there’s four ways to reverse this disease. The first way that I ever heard of was bariatric surgery. Essentially people become non diabetic in the first day after gastric bypass. Our friend Donna Lordi, her glucose was totally normal glycemic that afternoon of the operation. So that certainly works.

And then the second one that I heard of, which was a dietary one, was from a professor Roy Taylor from Newcastle University in the UK. He and Michael Lean have a technique of using…what they’re doing is they’re removing the ectopic fat in your pancreas and your liver, by putting you on a crash diet – it’s essentially 800 calories a day for eight weeks – is enough to remove one gram of fat in your pancreas which is enough to get it to make more insulin. So that’s one of the strategies. I spoke to both Professor Lean and Taylor in Zurich this year – well last year – about it. And I spoke to Professor Lean about my own treatment which was the ketogenic diet. But the problem, I believe with that way of doing things is one, it only works if you’re only recently diagnosed with diabetes. If you’ve had diabetes for quite a long time, it just can’t make that effect. And the other thing is that the underlying cause of Type 2 diabetes is too much insulin. And what they’re doing is they’re dramatically reducing the fat in the body, hoping to get some of the fat out of the pancreas to enable the pancreas to make more insulin. And the problem is not that you’re not making enough insulin for a Type 2 diabetic. That’s again, just treating the symptoms. So I suspect that 10 years down the road, a lot of their cases of remission will be that they’ll be back in Type 2 diabetes.

I was going to say that that’s often the case with any kind of quick fix like that, unless you do something to maintain that fix, you’re going to end up back where you started.

Absolutely. So the third way of doing it, which is the way that I did it, and we know that this works from the studies by Virta, Sarah Hallberg’s studies, have shown that in her cohort – they’ve now been doing it for two years – they’ve had remarkable success at reversing Type 2 diabetes, and that’s with a ketogenic diet. And so the point there is, if you can reduce the body’s requirement for insulin and as much as possible by just not eating things that require insulin, not eating things that cause a glucose stimulated insulin secretion, then, your body needs to make less insulin. But, if you are not eating enough glucose for your brain, then your liver then becomes responsible for managing the glucose in your body because it makes it on demand. And so instead of having a broken pancreas that’s unable to make enough insulin to keep glucose down, instead you’re relying on their livers – which work really quite well – to keep glucose up whenever it goes low. It’s like a backup mechanism for getting glucose homeostasis working. So that does work. Sarah Hallberg’s – I think they’re published but not yet had review of the studies for their two year stuff, and they’ve been authorized to go to five years. So there will be a five year study into Type 2 diabetes remission with a ketogenic diet coming out in three years’ time.

You have to get to five years to be classified as long term. Is that right?

No. Two years.

Oh, just two years. Right.

24 months is sufficient to be long term. After this study is peer reviewed then published then nobody can ever say that there’s no long term studies into ketogenic diets. It’s there, two years. Done. But a five year one would be nice little…sort of tie the bow on it and nobody can ever say it doesn’t work. And then the fourth way is…Jason Fung has just published case studies in the British Medical Journal on using intermittent fasting for remission of Type 2 diabetes. And it doesn’t work as well as ketogenic diet, but a ketogenic diet plus intermittent fasting is certainly… we’ve anecdotally seen a lot of people in the forums supercharge the effect of their ketogenic diet by using time restricted feeding and strategies like that. That really is like the next tier low-carb ketogenic diet.

Exactly. The two go so well together, don’t they? A lot of people come in and see so many people talking about it. They say, is this a mandatory part of keto that I have to fast? And of course it isn’t, but so many people end up just naturally falling into it, in some shape or form.

Yeah, absolutely. What happens to all these people is that they lose weight and that’s their visible mechanism that they say, I’ve obviously had some success. But in fact, they’ve probably added 20 years to their lives. Diabetics die young. Diabetics die in their sixties and seventies. My paternal grandfather passed away at 75 – heart attack in his sleep. I didn’t know this, but for the last five years of his life, he was diabetic. What I now know, probably for the last 25 years, he was sort of getting slowly and slowly more diabetic, and then a heart attack took him at 75. His mother was diabetic, so it came down his mother’s side, but his father lived into his nineties. And so, that could potentially lost him 15 years because he was diabetic.

Exactly. My great aunt, I don’t know exactly how she died, I was always told she died in her sleep. So probably the same thing, died of a heart attack in her sleep when she was 70. And she certainly seemed to me at that age – I think I was about 10 when she died – she seemed full of life. And for somebody to die so young like that. Yes, knowing what I know now and the kind of woman she was, she would have fully embraced the ketogenic diet and extended her life. It’s sad isn’t it when you think of people in your life that could have had a different ending. But there you go, that’s what happens I guess. So you got into the podcasting with Carl really as a way to keep him on track and help him and it became very clear to us very quickly that you love the science, and that’s what you love doing. And I believe it was two women who gave you the real kick up the backside to go back to school.

Donna said to me, sort of three years ago, she said to me, you really understand this stuff. And Donna’s been pre-med and has a Masters of Science and she’s a very smart cookie. Donna Lordi who was on our podcast with Daisy, actually. And she said to me early on, and I said, Donna, it’s just instinct. I look at something and I feel it’s just instinct that convinces me of what’s right and what’s wrong. And she said, you have really good instincts but you should formally train them. And I said, yeah, you’re right, I should one day. And then Louise, another friend of ours who was also in the same podcast, who has a PHD in…she’s a paramedic and she actually teaches. She’s a professor teaching paramedics at university.

And she basically said, here’s how you can apply to universities as a mature-age student. And I’d done pure math at uni, Queensland Uni in the 80s. I did that for two years until…see, here’s the thing, I wanted to be a computer programmer. My dad had always wanted me to be a doctor. All of the men in my family are doctors. I never wanted to be a doctor and I wanted to be a computer programmer, so I did pure math and I realized…this is before computer science ever existed as a subject. This is in 1984. And I realized about two years into the course that I wasn’t smart enough. If I was going to do math for a living, for a career, I had to be in the top 0.1% of my class.

Basically you had to be the top one or two people in a class of 200 people. That’s the top 1%. See how bad my math is. To realistically have a career doing math for a living, I would have to be an exceptional student. And I was merely a good student. And I realized that they were stitching me up to become a math teacher. I didn’t want to be a math teacher. So that’s why I dropped out of uni in the 80s and I basically studied programming and became a computer software developer. Did courses and stuff, and commercial courses to became a programmer. I regret not doing a different form of science. I’ve always loved astronomy. I’ve always loved physics. And math was something I was just good at. And when you’re 18 and you’re trying to work out what you’re going to do with the rest of your life, a lot of us just go to university just to not be poor, to have a slightly better career and we basically do something that we’re good at, at university. So we do, law or accounting or something.

Exactly, because you don’t know what you want to do. Some people are fortunate and they know exactly what they want to do, so they then plan their education accordingly. But otherwise what do you do? You just go on what you quite like and what you’re good at.

Yeah. I still really don’t know what I’m going to be when I grow up. I’m 53. I said to Professor Richard Feinman, I don’t know what I want to be when I grew up, but I think I want to be you. And he said, I don’t know what I want to be when I grow up and I’m in my seventies. Yeah, so both of those women Donna and Louise kicked me up the bum, and pointed me in the direction and said, why don’t you study biochemistry because one, you’re good at it and two, it would give you a formal education to underpin what you’re doing. And I said, yeah, and then I became really interested in why humans store energy; in what circumstance, what context do we store energy rather than using it. And that particular subject, I suspect will be able to sort of fuel my career for the next maybe 50 years. I don’t know, how long am I going to be here? How long am I going to be in science? Maybe 30 years. We’ll see.

It is very useful having even a very limited knowledge of the science behind what’s happening. And that’s what I found when I first started keto and I started looking at different articles and hearing these different terms being thrown around – the Krebs Cycle and all the rest of it – and it all sounded about right and sounded interesting. But it was only when I did my science course – and it takes you right back to that biology and chemistry foundations and knowing what happens at a molecular level – then you can picture in your mind a starch molecule. When you can do that, and then you completely understand why someone is saying, or when you’re eating starch, you’re basically eating sugar. You can understand it because you can see that image, and you can see how it works, and you can understand when you know what different molecules look like. You can understand that your body doesn’t care whether it’s a baguette, or a part of what sugar…it’s just going to take it in and metabolize it and use it in the same way. Once you get that, once you can see that, it actually makes it all a lot easier to understand.

Yeah. There’s no difference between a glucose molecule that you’ve plucked out of a starch polymer or that you’ve just plucked out of a disaccharide. There’s absolutely no difference as far as your body is concerned. It’s going to use it in exactly the same way. I had done some biochemistry subjects when I was doing my math degree, because one of the problems with math subjects is that they don’t have a lot of credit points and all of the biochem and psychology subjects have a lot more credit points. If you’re a math student, you tend to pad your degree with lots of other science that you’re interested in, and so I did some biochemistry back in the 80s, so I wasn’t a total idiot. I was able to read studies and understand them, or if I wasn’t able to understand them I was able to ask intelligent questions from people who did to be able to work my way through it.

It is a matter of, as you say, learning these basics and then putting them together into an integration in your head so that you understand how the whole thing works together. That’s fascinating. I’m actually now doing it in software. As I’m going through and revising my studies, I’m actually building software models for all of the things that I’m learning about biochemistry, which may end up being my PHD thesis. We shall see.

I heard you talking about that and I found it fascinating, and a really good way of using your existing skillset to help you revise and learn the current one.

Yeah, absolutely. I think one of the first things that I actually got it to do that was useful is that I created the structure of all of the proteins, the 20 proteins that are natural in the human body, and all of the base pairs that encode for those proteins. Basically I can give my software a stream of DNA now. I can give it 14,000 base pairs of DNA and it will build me a protein. It will build me an LDL. It’s basically an Apo B protein that wraps around an LDL particle. I thought a protein like that would be maybe 30 or 40 amino acids long. It’s 14,000 amino acids long that wraps around an LDL particle. So I’ve constructed the ability to be able to pass random pieces of DNA to my software model for it to create my proteins. But beyond that, I’ve got a long way to go yet.

That’s really cool. It sounds really cool. And I think anyone who’s listened like I have, and it’s something I love about the 2 Keto Dudes podcast, it’s a great place to send someone right back to that first episode when they’re starting out because that’s literally what Carl did. So you can literally follow along and learn as you go. But we got to hear the development, and the more and more knowledge you were gaining with what you were studying and the more sciency stuff that came out. That’s where the balance just became a bit too much, isn’t it? And why you’ve had to take a step back or your studies were really going to start suffering.

One of the things that happened this last year was that I had Ketofest Down Under in Australia, and the day after Ketofest Down Under, I had a chemistry exam that I got 50% on. And the chemistry exam at the end of the year, I got 86% on. That showed me that I need to focus on what I’m doing. And as much as I like doing Ketofests, I really can’t spend three weeks on a Ketofest when I’m supposed to be studying. So that was part of it. And part of it was also, there’s a political aspect at school that I don’t want to necessarily be known as the keto dude because…what we’re doing isn’t anti-science. In fact, we’re picking a backwater of science that actually supports what we’re doing, and we’re able to describe exactly why it works. And it does. It is effective. But it is not the mainstream.

I didn’t necessarily want to be running a podcast sort of pointing out that mainstream science was flawed, while getting a science degree. I decided instead what I’m going to do… I have a skill of being able to communicate complex topics fairly simply.

Mmm, you do.

This is something that one of our Patreons Graham pointed out to me and said, this is something you can do really well. You should make a career of it. And so I took that to heart and decided what to do… short, like five to 10 minute YouTube videos explaining basically, or debunking bad science journalism. So when you see an article that comes up in the paper that says, coffee will give you testicular cancer. And then the next day, you see an article that says coffee cures cancer. That’s bad journalism, bad science journalism. It’s people who don’t understand science just trying to get you to read their article. And so I’m going to do some short-form videos, that debunk that kind of thing and explain the science behind them, and basically drill in a little bit to do that. And I think that’s going to be better for my career than being a keto dude. What we did in 2 Keto Dudes I’m very grateful for and very happy with what we managed to accomplish, but I only ever said that I was going to do half a dozen with Carl and I ended up doing 149.

Exactly. And I’ve made the comment in a couple of places where people have said, understandably that they’re sad, you’re leaving and things aren’t going to be the same or whatever. And I say, well no they’re not. But that’s not a bad thing. And the way I see it as a listener, as an audience previously from the 2 Keto Dudes and going forward, we’re getting much more. Because 2 Keto Dudes is evolving. We’ve got fresh stuff coming in, they’re going to shake it up. We’ve got Carrie Brown coming on board. So Carl and Carrie are going to be forging ahead with something new and different. So we’ve got more to look forward to there. And then we’ve got all the exciting things you’re doing as well. So actually we’re winning overall because we’re getting a lot more than we were before. It’s just in slightly different formats. But I think it’s a fantastic thing for everyone. For Carl and Carrie, for you, but for us too.

I hope so. Carl and Carrie will do a really good job. Carl wants to make a career out of this and do it full time. He wants to dedicate the second half of his life helping diabetics fix their diabetes with ketogenic diets. And so he’s taking it pro, and Carrie is certainly going to help him with that because she has all these cookbooks and she has her own branding as well. And she’s a very good marketer. And so she’s going to be the second stage rocket booster. I got him 10,000 feet in the air and, and now I’m peeling off to do other things, but, Carrie is Carl’s second stage rocket booster and she’ll get him into orbi.t The 2 Keto Dudes…the content that we’ve created stands on its own, but I think that the future of 2 Keto Dudes is more interesting than the past. That’s certainly my opinion. And I’ll be around to drop in and do sciency things, but I’ll focus on the sciency stuff rather than recipes. To be honest, after 149 I was starting to run out of recipes and Carrie has an infinite number.

Obviously I like the fact that a woman’s getting on board, but also, and another thing that’s dear to my heart is bringing the psychological aspect, the mental health issues. So I think it’s fantastic to spread out from the Type 2 diabetes to encompass this whole new part of the population as well. So it’s only going to carry on increasing the reach. But I’m fascinated with these videos you’re going to be making. I love the fact that when we see these ridiculous headlines…the first stage of it is, is to send them to you.

Yes.

But then the second stage is that we’ll be able to take back the video that you’ve produced and post it in response. It sounds fantastic. I can’t wait.

I hope these things can go viral. It’s nothing about making money about it, I just want to get the word out that there is a way of looking at science that journalism is not helping us with. And I hate to use the term fake media because it’s not really, but it’s lazy media. It’s just picking apart a couple of words out of a conclusion, and then sort of assuming everything else. It does us a disservice because what happens is, if somebody says to you today, coffee is bad for you because it causes testicular cancer and then the next day they say coffee’s great because it reverses tumorigenesis, angiogenesis in tumors, and then somebody else says the next day, coffee’s now bad for you. You eventually just make up whatever you want it to be. And if you like coffee, you drink coffee and if you don’t like coffee, you don’t drink coffee. And now we’re all more ignorant.

Well of course then you just don’t believe anything that you read either. So, a typical something or someone who says, oh, did you read that article about how such and such is bad for you? And the response will be, yeah, but next week it’ll be good for you.

Yeah.

And the opposite of what they’re saying will be bad for you. And that’s exactly what happens. So people just end up being completely blasé about the whole thing. And like you say, either take what they want from it, or just not believe any of it.

Which leaves us all ignorant. I think it’s good to be able to take these two statements about coffee for example. I’m making those up. There are other examples, but take the two statements and compare the evidence bases of the two and see whether either of them is significant. In a lot of cases the problem with science is that science is inherently plagued with the fact that we cannot measure anything accurately. The more we try and measure something accurately, the more it moves about and doesn’t stay in the right spot. That’s the basis of the Heisenberg principle in quantum effects, but essentially because we can’t measure something accurately, any measurement that we make, sometimes the measurement that we make will be above the average and sometimes it’ll be below the average.

Inherent to any measurement is this inaccuracy and if we’re measuring something that doesn’t exist, we’re going to get…let’s make up something out of whole cloth. Let’s say, marathon running causes asthma and let’s say we go in and we test marathon runners and we find that marathon runners in the group that we tested, appear to have more asthma than the general population. Maybe the first time we did this study marathon runners had less asthma than the general population, but that wasn’t an answer we were looking for, so we forgot about the dataset and we went looking for a different set of marathon runners. Eventually we found some marathon runners that had a more likely chance of asthma than otherwise, we can actually say, well, you’ve got 1.1% chance of having asthma caused by marathon running. What happens in the press is, you get marathon running causes asthma. Don’t marathon run, otherwise you’ll get asthma.

The simple fact of it is that there were probably…every time somebody went to look at this particular question, there was probably a different answer because of this whole thing about measurement being inaccurate. And only the measurements that showed the result that people were looking for were actually published. This is why you really need to see a large signal. So for example, smoking causes lung cancer. People who smoke are seven times more likely to get lung cancer. That’s a big signal. Anything over two times is worth paying attention to – Tim Noakes talks about this, the Bradford Hill Standards of Causation – unless you’re seeing a 200% effect, it’s insignificant. Most of the epidemiology that comes out of Harvard these days is weak, and it’s weak from flawed data and observational in nature, and really isn’t good science. I could probably spend an entire career just criticizing Harvard TH Chan School of Epidemiology.

That’s the thing, isn’t it? It’s always following back, working back from any kind of headline. A great example of that is Nina Teicholz book where she just takes every statement and goes back and back and back, right to the studies it’s based on, and then, in the most case shows that they were such weak foundations. Yet all these guidelines that have shaped our health and the way we eat for so long.

Literally shaped us.

That’s what they’re based on. They’re based on these really shaky foundations that wouldn’t, shouldn’t have held up anything. It’s quite incredible. So yes, I can’t wait for that. And what’s it going to be called?

Well, I’ve got a blog already called “Some Study Says”, and I’m working on it right now. And I’m working on videos. I probably won’t publish that blog until I’ve got three or four of them coming out. So the first one that I’ve got coming out is, on the association between saturated fat and cardiovascular disease. And then I’m going to do one on nitrates and nitrites. I think that’s in the media right now….bacon.

Bacon’s going to kill you. That was definitely going to go viral within about 10 minutes.

Yes, I’m all prepped for that. Yeah.

And so when are these likely to come out?

Oh, probably the end of January, I think.

Oh, fantastic. I think the bacon one in particular, people are going to be queuing up at the door all ready to open that one.

Bacon’ll kill ya!! Well, let’s actually have a look and see what that study is.

Exactly. Well, fantastic. It’s been wonderful hearing all your news and seeing you on the computer screen. I’ve been pretending that you’re across the table from me again.

Well I was just a month ago.

Maybe you could leave us with a top tip.

Yeah. I think my top tip that I mentioned earlier in the episode is going to be on forgiving yourself. Really, if you’ve lost a good percentage of your body weight, if you’ve lost more than 10% of your body weight… Now in my case, I lost 33%. But let’s say you’ve lost 80 pounds or whatever, and you’re in a stall. Just realize that your body has reached a new homeostasis. Maybe it needs to sit here for a while and pause, but be grateful that you’re not putting on that 80 pounds back again, and yet you’re eating ad libitum. You’re eating excellent delicious food and you feel awesome. So don’t let some anorexic sort of midget on Facebook try and convince you that your abdominals should look like theirs because that’s actually not really healthy. Be gentle on yourselves and realize how far you’ve come. And take a victory lap. That’s really what I want to say. Take a victory lap.

Yes, absolutely. It does make me sad when people are so hard on themselves. And still striving to get that last little bit. Often it’s hardly anything much more than where they’ve gotten and dismissing the fantastic things they’ve already achieved. And like you say, for people who’ve had this plateau for a while, I like to just call it maintenance.

Right. It’s quite possible that that plateau is…you’re going to be 20 or 30 or maybe even 50 pounds heavier than what you wanted to be, but maybe your body knows something about what you need it to be that you don’t know. There was a study in Denmark, a longitudinal study that found that over the past couple of years that people who live the longest, have a BMI of 28. Now obesity starts at 30, and overweight starts at 25. So people who are right in the middle of between obesity and overweight live longer than anybody else. It may be that your body is surrounded with adequate calories. Maybe your body knows something about what you need.

Exactly. And also there’s something to do with just being able to easily maintain. I forget now the exact quote from Stephen Phinney, but it’s something when he’s asked about what your ideal weight should be, and it’s along the lines of, what you can comfortably and easily maintain.

Yes, exactly.

That’s what it comes down to. When you’re fit and healthy and that’s something you can comfortably and easily maintain. I know that’s something personally that I’m having to come to terms with a bit. I did get down to what I decided was my ideal body weight, but actually maintaining that is next to impossible, but I can maintain, six, seven, eight kilos above that, which is around about where I am now, I can maintain that pretty easily.

Yeah.

And at some point I’ve got to stop striving to get back to something I consider is what I should be and actually just embrace where I am because it’s a lot better than when I was twice the size I am now.

Yeah, the simple fact of it is that a lot of people who establish body ideals are doing so by starving and by caloric restriction, by limiting themselves. And that’s not a normal state for a human to be in, especially in a sea of calories. Not a normal state to be hypo-caloric in a sea of calories. When people tell you that it is, just tell them to get stuffed.

Exactly and it is something that you can achieve. It’s something that you can get to. I’m not going to deny that. I got to it. But to maintain it, now that’s something else. I think I got to, and was at, my goal for about two weeks. That’s the thing, that’s where it becomes almost impossible to maintain that, and that’s where you have to keep drilling down more and more, doing more and more extreme things to push your body past where it wants to be, basically.

When I got down to a hundred kilograms at my lowest – I think I got down to 98.9 or something, but within a hundred kilograms or so – that was when I was really hyper caloric and really trying to actively push my weight low. But what happened was my metabolic rate dropped and all of a sudden I started using protein for energy, and eating amino acids for energy, and all of these things that…cold in my feet and my extremities, and just not feeling quite right. I feel a lot better when my weight is between 103 and 106 kilograms. That seems to be my homeostasis – when I feel the best and my body feels the best. But if I eat carbohydrates, my homeostasis is 150 kilograms. So, there’s a big difference. Your body is a wonderful machine that has evolved to be able to right itself. And, if you give it a deranging diet, it will right itself at a higher weight. If you give it a non-deranging diet, it will right itself at a lower light. And that’s the magic of a ketogenic diet. It allows our body to find its new homeostasis.

Exactly. And I do think there are other things that can really muddy the waters and complicate things with things like, emotional eating and things like that. But that’s a whole different story. But I do think – I was thinking about this the other day – I think it is possible for everyone to achieve their perfect weight and size and shape. But a lot of that might be changing your perception as to what you think that is. And the way to get there is going to be different for everybody. And I think it’s just finding out what all the issues, and what the components are, that are stopping you getting there. And for someone it would just be a case of changing that eating, for somebody else it might be addressing some psychological issues at the same time. I do believe there is a formula to get everyone to that perfect place, but it’s like I say, it’s sometimes changing the image of what that perfect place is. It might actually be ALL that you need to do.

It might be, and it might just be that whatever your first plateau is that you hit on a ketogenic diet after six months and you stay there, maybe it’s just being there for a couple of years. You finally become comfortable with the fact that that is an easy point that you can maintain, and as Dr Finney says, that’s your ideal weight. He doesn’t like us calling it the Finney weight. Your ideal weight is probably where your homeostasis alights once you get all the derangements out of the way.

Exactly. And you’re happy and healthy. Well, I’m very excited to see these new videos and all the wonderful new things that you’re going to be doing, and look forward to seeing you at Denver.

Thanks Daisy.

And Ketofest.

Absolutely. I’ll see you at both.

Can’t wait.

This transcript is brought to you thanks to the hard work of Karen Jones.

Welcome back, Jessica to the Keto Woman podcast. It’s lovely to see you again. How are you doing?

Thanks for having me for a second time. I’ve been thinking about coming back on because there’s so many things I’d like to talk about. So, I’m so glad you’ve had me on

Exactly, it’s a pleasure to see you. And as you said you’re back. You were on, I looked it up, you were on episode 35 back in June and you told us all about you and your story and what you’re doing and you teased us a little bit with the Type 1 research that you’re doing and you promised to come back and talk about that and all the other things you’ve been getting up with. I’ve seen pictures you’ve been putting on social media. You’ve been really busy on the lecture circuit this year as well, I think.

Yeah. Yeah. Well there was that recent series in Australia where we had Steve Phinney come over and Jake Kushner and a lot of other amazing speakers and they spoke in Sydney and then they spoke in the Gold Coast as well, and I was able to go to both of those. And, I was so lucky to be able to take Steve Phinney and Jake Kushner out for lunch in Sydney.

Fabulous

I know! I was super star struck and then they’re just so down to earth and I just got that sort of out of the way. But it was just lovely. We went to the 360 Bar and Restaurant. Have you been to Sydney? It’s in the center point tower.

No, never been that far. The furthest around the world I’ve got to is Thailand and Hong Kong, that sort of area. So no, never got that far.

Well, when you come to Sydney, I’ll take you there because it is beautiful. You just look around all of the city, and it was a perfect place for them to go because they wanted to sightsee but it was raining. So I’m like, okay, well this will do. So yeah, it’s been fantastic and I’ve obviously been lucky enough to be able to speak at some of those events as well. 

Actually, when I was at the Gold Coast, I spoke about my personal story with distorted eating, which we spoke about on the podcast last time. So that was really good to actually get that out there into the conference space and get that out there to the doctors and other health professionals. A lot of individuals and the patients, they know all that happens because they’re the ones who live and experience that sort of disordered eating or negative relationship with food. 

But I think a lot of health professionals are blinded to that or they just don’t see it or they don’t think about it. So, I was really happy that they asked me to come along and speak about that at the Gold Coast. So, I’m sure that’ll be on YouTube eventually. And apart from that, I’ve been really busy stuck into the PHD this year, so I’m sure we’ll get into more about that. But it’s a busy time, but it’s all very fantastic.

Oh, great. It’s nice, isn’t it? When you’re busy doing something you love it, it doesn’t feel, doesn’t feel arduous in the same way.

Yeah. Well I mean there are parts of a PHD that are kind of like “what am I doing”, that are lonely and tedious. But I’m almost out the other end of that section now. And you’re right, If I wasn’t super passionate about this, I don’t think I could be doing it. So yeah, I feel lucky.

It’s pretty full on, isn’t it? I mean I know to a certain extent you can pace your own PHD, can’t you? You can decide how long it takes you to complete it

Potentially. So, the minimum amount of time is three years. And then I think you can do up to, I don’t know what the maximum amount of time is, but generally they don’t want you to go for longer than four years. Right. And it’s usually your supervisor who doesn’t want you to go longer than four years because they want to get on to the next thing. And if you’re going for longer than that, it either means you’ve been too slow and you haven’t been dedicating time to it, or something went wrong or you’re doing too much for your thesis. So any of those things could be applicable if you’re going for longer than three years or four years even. 

But my PhD is a continuation of my Master’s work, so it is on low carbohydrate diets for Type 1 Diabetes.  I can’t remember if we spoke about that at all last time, I would’ve said that. I know we touched on it. Okay, cool. So, yeah, in my master’s degree for dietetics, I did a systematic review looking at all the available literature on low carbohydrate diets for Type 1 Diabetes. And you know, we found what we expected, which is that there’s hardly anything out there. That’s the whole reason we did the review because we knew that the evidence was scarce, but we thought, “Well, you know these people out there living with Type 1, and it’s essentially a disease of carbohydrate intolerance, so we need to figure out which level of carbohydrate is appropriate for these people. We can’t just keep reverting back to the national dietary guidelines to give advice to people with Type 1 Diabetes”.

We have to make a change, and that’s going to take years, but we need to do that systematic review so other researchers go “Wow, this is an area we need to investigate”. And so we pulled together all the studies we could find. The studies we did find, though they weren’t large randomized control trials, they were decent studies and they all show that low carbohydrate diets had a positive effect on Type 1 Diabetes clinical outcomes in at least one of the outcomes – an HbA1c reduction or reduction in insulin or a reduction in severe hypoglycemic events, or just average glucose levels. So, if it was a reduction in any of those outcomes, then we classified it as effective and so the research was promising and that’s what we saw. But certainly the biggest conclusion of our systematic review was that more research needs to be done. And so that’s why my PhD is delving into this same exact topic and we planned to do a couple of primary clinical trials where we are investigating a specific low carbohydrate diet protocol for people with Type 1. So, I’m in the very early stages of my PHD, but those are the things that are to come over the next few years.

Wow, fantastic. It seems to be something that I’ve often seen the arguments against using a low carb diet for Type 2/Type 1, and I’ve seen infographics and all sorts of things which basically say it’s a great way of eating for both, but quite often people who are familiar with Type 1s, maybe Type 1s themselves or have friends or relatives who are Type 1s, say “Oh but hold on, you know you can’t treat them in the same way” and “you have to have carbohydrates and you have to have this minimum amount”. And they quite often quote something that’s quite high. And it to me that logic doesn’t work. 

I would have thought having the carbohydrates lower is the best possible thing because it’s all about trying to keep that insulin as stable as possible. And I know you’re not producing any insulin at all when you’re a Type 1, you have to be putting in, but surely the least you need to be injecting the better. Can you just maybe address that a bit and get rid of or debunk some of the myths that are out there. Because I’m sure you know very well how to contradict some of those.

Well exactly what you’re saying is the rationale for why we want to do this type of research, why we even looked into it in the first place. You would think logically that if you reduce your carbohydrate, then you can reduce the requirements for insulin so you don’t have to have excessive insulin injections, and then you can expect more stable glucose levels

Because, of course, there are problems aren’t there. There are problems associated with injecting insulin and presumably the more and more you use it, there are side effects to that.

Yes. So that’s a big thing that we’re learning. Before the discovery of insulin, which was in the early 1900s, they were managing Diabetes with a low carbohydrate diet, and it had to be very, very low, basically it was almost no carbohydrates with periods of fasting. That’s how they extended the lives of people with Diabetes because otherwise they would have died in a few days, and they extended their lives from a few days to a few months or a few years. They obviously weren’t going to live full lives without insulin, but it was the best they could do at the time. And then when insulin was discovered, it was an amazing discovery, we can be so grateful for that discovery and the use of exogenous insulin when it came into the medical system.  

And so, the treatment for Type 1 Diabetes changed significantly. And then the sort of understanding that came from there was that “Well, you know, Type 1s or people with Type 1 already live with this difficult thing” or I guess their life is so tough that why would we then go and put them on a restrictive diet, like a low carbohydrate diet. You know they already have to go through so much, let them eat what everyone else eats. And so that started being the thought process. And particularly, I know that’s how dieticians are taught, we don’t want to put them on any restrictive diet because that’s unfair to them when they’ve already got this unfair condition. So that’s the way that they manage it basically, well we know they’re going to eat a diet just like everybody else because that’s what we want them to eat, so then we have to give them a set amount of insulin. That’s how it came into practice that we need to have carbohydrate regularly. We need to have the insulin regularly which can be an okay way of doing it. 

I know a lot of people out there can manage their Type 1 Diabetes with more moderate levels of carbs or even slightly higher levels of carbs, but it’s not easy. And it depends what sort of health outcome you as the individual want do you want those really, really stable blood glucose levels so you can really minimize any risk of disease?  If you do, then maybe you will need to have or find those other approaches, and find those other interventions like a low carb or a ketogenic diet. But the individual needs to be aware of the different interventions out there as opposed to just some random dietician coming to them in hospital when they’re diagnosed and saying “you must eat x amount of carbs this many times a day and if you don’t, you’re at risk of having a Hypo, you could die”, because that’s what they’re doing in the hospitals at the moment.  

I’ve seen it and you know, I wasn’t impressed at all. I was actually very frightened by the way that it was all going on so happy and bubbly, like there was no issue.  Just dosing all of these people, and very young people as well, up on all these carbohydrates when that could lead to really negative consequences and potentially a really low quality of life if they’re unable to manage their Type 1 Diabetes. I guess, the thing we should say as well, is that a low carbohydrate diet for Type 1 isn’t necessarily evidenced based practice yet but neither is a high carbohydrate diet. 

So there hasn’t been adequate evidence to support a high carbohydrate diet in the practice of Type 1, but people are doing it anyway and that’s the best practice guidelines at the moment. And you have to sit back and you have to go “Why, why, why are we just reverting to the guidelines for this population?” So that’s really the crux of my PHD. I’m asking why.

Yeah, amazing. It’s that fear factor. And that’s the thing I’ve seen cited often “You know, you don’t understand, we have to predict, protect against hypos because they can kill us”. And you can hear that the fear, and very understandably because it must be something probably most of them have experienced, and it must be terrifying. And, but, but again, with my logic, it seems that that you can predict much more what those peaks and troughs are going to be with the blood sugar when your carbohydrates are down. It seems to me that they get more wildly erratic when you throw the carbs in and it’s less predictable. Presumably the thing that would help most is predicting much more accurately how much insulin you’re going to need.

Yeah. Well, Dr. Richard Bernstein says that big inputs lead to big mistakes and small inputs lead to small mistakes, the input being the carbohydrate amounts and the mistake being the mistake in calculating insulin. So, you’re exactly right in what you’re saying there are, at least that’s what we would expect. And we have seen that in those few trials that are looking into low carbohydrate diets for Type 1. The other thing I want to highlight that people don’t talk about a lot in the “Type 1 Space” is that it’s really, really hard to estimate or calculate the amount of carbohydrates in food. So, even if you say, “Okay, well, I am eating two pieces of bread and I know exactly how many carbohydrates are in there.  All is well, I’ll give my insulin”. 

The nutrition label on that bread is not accurate, it’s an estimate. And then if you go to something like an apple for example, well how ripe is that apple, what’s the exact size, how many bites did you take? How much did you leave leftover in the end, did you eat the skin, did you not, what type of apple, what season was it grown? All of those things affect the carbohydrate content. So even though we go onto Google and we search the carbohydrate content in apples, that is just a big estimate. And as you can imagine, the more people are eating carbohydrates when they have Type 1 and the more they have to figure out how much insulin to take, the more risk there is for error.

Because that’s the variable isn’t it? That must be the biggest macro that you’re using to calculate how much insulin you need to compensate.

Yeah. Some people will also calculate insulin requirements based on fiber intake and protein intake, but then starch can also delay the release of glucose into the blood so it can change your insulin requirements. Again, that is more related to the timing of the insulin dosages and so on. So, I mean it’s so difficult.

I was going to say it just a nightmare thing to have to try and calculate all the time.

That’s the thing – even when we find strategies that are shown to be more effective, it’s never going to mean that managing Type 1 Diabetes is easy, it’s always going to be such a difficult condition to manage. And all those people out there that I see on social media that are absolutely killing it with Type 1 Diabetes and they’re sharing all their progress online, all their ups and downs?  I think that sort of social media support is incredible for Type 1 Diabetes because I know a lot of people can feel quite alone. And I think partly it’s because there is so little evidence on appropriate dietary management of Type 1 Diabetes that the health professionals actually don’t even want to see people with Type 1 Diabetes or they just want to send them to somebody else, or they just want to wrap up the conversation.  

I mean we do have the health professionals out there, but do we actually have those health professionals that really know what they’re doing when it comes to Type 1? I think there’s only a handful of them. So I really just hope that with the research that we’re doing, we can spark the interest of more researchers to investigate this as well. Because it’s just my study on its own, we need way more than that. Yes, we’ll be able to more securely and efficiently answer the question “Are low carbohydrate diets effective for Type 1 Diabetes?”. But we’re going to need more for the guidelines to change and for those standard practice recommendations to change.

Yes. And I think also that groundswell of what the public are doing, as you mentioned social media groups like the Facebook Group Type 1 Grit. they are doing amazing, amazing things in helping push and encourage that research, aren’t they? As well as just the day to day familiarity with talking to other people who are going through a similar experience to you. I mean that really helps when you’re making any kind of change or dealing with anything.  To talk to somebody who’s going through the exact same thing is so helpful isn’t it?

Yeah, definitely. And that kind of brings us to what I’m doing at the moment, which is trying to figure out the features of an effective low carbohydrate diet. I could do this for any dietary intervention. I imagine they’ve done it for plain old weight loss guides – what features of those diets are the most effective. But you bring up a specific feature there which is group support or group sessions. 

We could have two low carbohydrate diets that are exactly the same level of carbohydrate but one of the interventions will use something like group support and the other one doesn’t. And the one that doesn’t may not be effective whatsoever then people will be signing it going “Look, low carbohydrate diets suck. They don’t work”. But was it just because the intervention was no good?  Whereas the other intervention using more rich methods and methods that are really supporting the individuals is helping them stay compliant to their diet. 

I think a big part of staying compliant as you say, is that support, the peer support, whether it be other people going through the same thing or just regular sessions with the health professional. And then also education, I would expect that the more education someone gets behind why they’re making these changes in their diet, why is it carbohydrate they’re reducing, why is it fat or protein that they’re increasing and which types of fats and why are those types of fats healthy? 

All of these really deep questions are so important for the person that’s going to hopefully sustain that lifestyle long term.

Yes, absolutely. It’s certainly been something that’s helped me immensely making changes. The difference with the weight loss surgery I had the first time where there was just no support whatsoever and the second time finding the online groups and just getting that peer support, it made a vast difference and that’s actually how I got into low carb and Keto in the first place. It had a very important impact, it’s really, really important.

Yeah, I think it’s interesting you say that because the low carb Keto space has a very strong community behind it. I haven’t necessarily delved into or looked for Vegan communities or whatever, I’m sure they’re strong as well. But I know in the low carbohydrate community we put on these regular conferences, like what we were speaking about at the beginning, and we have so many podcasts like this one that is spreading the education and spreading the knowledge. I haven’t ever seen a low-fat conference going on with heaps of people that are attending for 10 hours on a Saturday out of choice.

I don’t think it would be as much fun.

No, I just, I wonder if they could even provide the rationale and the logic and the education for those other diets. Maybe that’s why they’re not holding full day events for them! But I think that is a huge reason people have found low carb or Keto or Paleo or whatever, because the rationale and the logic makes sense. Receiving that rationale and logic and knowledge is very crucial.

Yes. And I’m sure I’m biased, but it does just seem to be a really nice community. You know, all the people I’ve met, when I met people at Ketofest this year, they just seem to be a really lovely bunch of people

And I think they’re all empowered, aren’t they? Everyone has that sense of positivity about them. You know, even people that haven’t even, like you say, Ketofest -I went to the Ketofest in Canberra, in Australia in September – and I met quite a few people that hadn’t actually started a ketogenic diet. They didn’t know what it was before the conference, they had actually come with a friend or a family member, and even they were so empowered by the message and the community and the education and the cooking and the fun that was going on that day that they brought the same energy as everyone else was buzzing on. 

Everyone was just bringing each other up. I think in a world where we are absolutely plagued by these epidemics of obesity and Diabetes and heart disease and cancer, where for the last 20, 30 years, we haven’t really gotten better, we’ve just been getting worse, and we haven’t had the tools to deal with those diseases, and now finally having something which makes sense that we can apply and we can enjoy that is just huge. And it’s no wonder people are buzzing from ear to ear at these events and there’s hundreds of podcasts talking about these sort of dietary tools. So, yeah, I think it’s a fantastic movement to be a part of.

It’s actually, and I think you mentioned that buzzing I think, then the whole thing is, people feel good eating this way so they’re naturally predisposed to be being in a good mood. I mean, I can just imagine being at a low calorie, low fat conference so you know, I’m going to be grumpy walking in, so it’s going to be very difficult to feel upbeat.

Imagine how many tea breaks you would need! You would need a break every two hours so people could go and have something to eat because they’d be lagging and low energy. And I actually thought about this the other night, I thought at the next low carb conference I really want to do a behind the scenes thing, like a video series or something, because I think capturing that energy is the most amazing thing and it would be a really good way to get other people on board I think as well. Because something that I’m really interested in doing is spreading this dietary information that I am lucky enough to have with people who don’t have it or they just haven’t had the access to it. 

I always think back to my dad’s story, for example, where my dad ended up having a heart attack and was diagnosed with Type 2 Diabetes. But in the years leading up to that event, he was going to the doctor and he was trying to get some answers and he was trying to do something. He was always going on some sort of diet or doing more exercise or whatever it was, trying weight loss pills. He knew he had to lose weight and improve his health, but no one could help him do that, and I just feel that that’s an all too common problem. 

We have all these people out there who are wanting to do something and that are trying, but all the strategies they’ve been given are ineffective or they haven’t worked for them or they’ve done them in the past and it’s not working now. And a lot of these people, when you tell them about this new strategy, this alternative, well, it’s not a new strategy but it’s an alternative strategy to what they’ve been doing.  

So, let’s say for example, it is a reduced carbohydrate, high fat diet, and it works for them and they can sustain it, and they get the education behind it. Then they are just so grateful and they just think “Where have you been all my life?”! And that is just the critical thing, it’s not that low carb hasn’t been here, it’s all of a sudden new, it’s that people just aren’t being told that it’s there, they aren’t being offered it as a strategy. And whether or not people decide to use it forever or not, at least give them that dietary tool and at least offer it to them and let them know that it is there. 

And I think that’s how we tie it back to Type 1, I think that’s important for them as well. You know, we can say to them “Okay, well this is a high carbohydrate diet, this is a moderate carbohydrate diet, this is a low carbohydrate diet. This is what we know about them. This is what your management’s going to look like on each diet. What would you like to do?”. If that’s how they treated people with Type 1, then I feel like that would already be better.

Yes, absolutely. And I do love that sense of empowerment. That’s part of what is so uplifting isn’t it? And I can see, especially in the in the Type 1 community when you feel you’ve lost that, you feel disempowered because you’ve got this thing going on that is really difficult to control. If you can be offered a strategy that potentially can really help you with that and that sense of empowerment and feeling that it’s your managing it rather than the other way around, I can see that being a huge relief.

Yeah. You’re in the driver’s seat. And I think the other thing too is a lot of health is an investigation. So a lot of people, I mean I work as a dietician in private practice as well, and a lot of people want a yes or no answer. So, for example, they come in, they want to lose weight and then they’ll say “Okay, with these strategies we’ve spoken about today, am I going to lose two kilos a week for the next 10 weeks?”, or whatever it is. And I just think “Well, we don’t even know if you’re going to lose one kilo. We have to just try this, give it our all, and if it doesn’t work, that’s okay because at least we’ve tried it and then we’ll try something else or we’ll tweak it”. 

And we are constantly investigating, and we are constantly individualizing until we find something that does work, and I think that is lacking a little bit in the standard healthcare system. People always like a good one size fits all – if you want to lose weight, this is the diet use, if you’ve got Type 1 Diabetes, this is the diet you use, if you’ve got IBD (inflammatory bowel disease) this is the Diet you use. 

I think we need to kind of step back a little bit and we need to break diets down into strategies. So, if we broke the low carb, high fat diet down into strategies, one of the strategies might just be to reduce your intake of processed foods. And that’s one strategy and we haven’t even spoken about carbohydrate. The person or the individual will go off and they’ll do that, maybe they’ll do that for a couple of months and maybe that’s all they do, maybe they will see some positive health improvements, maybe they won’t. 

But then they’ve mastered that one strategy and it’s now become a habit, and we haven’t labeled it with anything, we haven’t called it Keto, we haven’t called it low carb, we haven’t called it Paleo, but we’ve made an improvement. And then the next one might be, okay, well let’s think about reducing your carbohydrate intake, let’s just cut it down by half, or let’s just get rid of the carbs at one meal of the day, or something like that. And maybe that’s what they then try on next, and they do that for a while. 

I think that layering of strategies is going to be far more effective than just saying, okay, well here’s the Keto Diet, or here’s the Paleo Diet, or here’s the Vegan Diet.  It’s a “Which one do you want to do?” kind of thing. I think we do need to get everyone involved really, particularly the person that’s actually going to go away and do the diet. They need to create their own diet using these different strategies that the health professional offers them, and we’re seeing a lot of that actually. What we’re seeing more of in the scientific literature is where studies will investigate more personalized approaches. 

So, for example, I’m doing a systematic review at the moment, I’m looking at all low carbohydrate diet interventions for Type 2 Diabetes and that’s going to help me build a protocol for my Type 1 Diabetes research. But basically there are some studies out there that will just say, okay, well our dietary intervention is just 75 grams of carbohydrate per day for every single participant no matter what. Full Stop. And there’s no individualization, there’s no flexibility, there’s no changing of that carbohydrate description after a few weeks or anything like that. Whereas there’s other studies that will base the carbohydrate prescription on the individual’s progress. 

So, for example, we can take the recent study by Steve Phinney and Sarah Halberg, the Virta Health study where they didn’t just say “Okay, well here’s a set carbohydrate prescription of 30 grams”. They actually sort of started between this range of 20 to 50 grams, but then individualized everybody’s carbohydrate prescription based on whether or not they could get those therapeutic levels of ketones, and then other studies have done the same thing based on glucose levels as opposed to ketones. 

I really like that because I think that that says “Okay, well, yeah, we may have to go really low carb at the beginning to help you sort of get to where you need to be”. But based on your progress towards your goals, whether it’s glycemic control, whether it’s weight reduction, whether it’s high levels of Ketones, whatever, we can actually be flexible in how much carbs you have, how much fat you have, how much protein you have. And again, as we were saying before, it puts the individual back in the driver’s seat and, if they want to reach those goals, it’s their health and if they want to reach those goals, they have the power and capacity to do that.

Oh, I can’t agree with that enough. I know it’s one of the things I just bang on about all the time about making this work for you, not the other way around. It’s not you who’s got to find a way to fit with some prescriptive version of the Keto Diet that you’ve been told. You know exactly what your macros should be for the day, exactly what you should and exactly what you shouldn’t be eating. And there is a lot of virtue in taking some kind of plan just to get started because you know there’s so much information out there and it’s very difficult to know what’s going to suit you until you try something. 

So, you’ve got to really take some kind of plan to get yourself going and get into the swing of it. But I really encourage people to find what works for them. I think it’s so important and that’s part of the whole empowering side of it is that there will be a version that is perfect for you. It might be super low carb, it might be that you’re on the higher and you found that works for you. Carb ups might work for you. Carb ups might be the worst possible thing you could do. More protein, less fat, more fat, less protein. There are so many variables that there is going to be a perfect set up just for you.

I agree with that too, and your own health goals are going to change throughout life as well and your metabolic health is going to change, which means your diet can change as well potentially. And I think of using myself as an example. When I first went from being overweight and having a problem with binge eating and the loss of control, then moving over to a low carbohydrate, high fat diet where I was able to eat a lot of fat and keep my glucose stable and not have any binges. 

When I first moved over to that space, if I were to have something that was carbohydrate dense, that would just be very, very negative for me, that would cause me to get those feelings that I was going to binge, I’d get anxious, I wouldn’t feel good, and I’d potentially be at risk of losing control and all of that.  And that was at the beginning of my journey with low carb, high fat eating. But now it’s been many years since then and I can have some more carbohydrate on occasion. 

It’s Christmas time at the moment, and the other night we had a Christmas party and I had a dessert. It was actually a really beautiful mango Mousse, you know? No, it wasn’t Keto. It was made with sugar. It had a lot of mangoes in it, and it’s not something I eat every day. It was something that I was doing because it was Christmas and I made that conscious decision I was going to have some and I felt really, really good after.  I didn’t get those feelings like I was going to lose control or I was getting anxious or anything like that. And that’s because now I’m at a different stage of my health journey where my whole metabolic system and my mental health is so different to what it was five years ago. So my diet can be different to reflect that as well. And I think that a lot of people would find that they also had their own similar experiences, but maybe with different examples.

Yes, exactly. And yes, it just depends, doesn’t it? I mean, I did, I did a similar thing on my birthday and I didn’t even eat the whole dessert. It was actually a bit too sweet, but, I had some of it, and I actually woke up feeling awful and it reminded me how eating that kind of food can make me feel. And I felt miserable that day, that depression, it’s sort of come in full force and I thought, oh, this is not nice feeling like this. So, I’ve made a real conscious decision. It’s going to be easier this year. I’m on my own at Christmas and really, I’ve just got too much to do to spend days feeling like that. So I’ve made a conscious decision not to have any of those foods.

And I went to a Christmas party. Oh. And I was very lucky, actually, the guy who’d done it, and he’d done all the cooking, and there were so many Keto things on that table of food. It was fantastic. Yes, there were crackers and carby type things, but there was a lovely plate of chopped vegetables that we could use for the dips and the things that the dips were – there was a lovely chicken pate, there were some fatty type dips- and it was actually perfectly easy to stay completely compliant.  I had a nice time, had a couple of glasses of wine and didn’t feel awful the next day.

That’s wonderful. And that sounds like an amazing little Christmas space there. That’s a good point as well what you say because a lot of people will say “Can I go out and have Chinese or can I have rice?”.  They’re always wanting to go and have something that they used to have and they used to enjoy. And sometimes the answer should just be, well, if you really want to do it, just think about what it’s going to mean for your metabolism and what it’s going to mean for the progress towards your goals. So, for example, if your goal is to lose weight and you want to go out and have some Chinese with fried chicken and fried rice or something like that, then maybe your progress towards losing weight is going to be slightly slower. But as long as you’re aware of that, that’s okay.

And so some people will then go “Oh yeah, well no, I don’t want to do that”. And when they relate it back to them and what they want, it’s not like I’m not sitting here going “Yes, you can. No, you can’t” for any benefit of my own, it’s all for the individual. And when they just reframe it like that and they say “Oh, it is actually my choice. The more I do things like that, like have something that’s carbohydrate dense or something that I know is going to spike my insulin levels, the slower it’s going to take me to lose weight and I don’t want that to happen”. 

Alternatively, people might be okay with slow progress and they want to make things a bit more flexible. And a lot of people, just like what you say happened to you, will go and have something that they’ve cut out of their diet for a while and when they put it back in, they’re just like “Whoa, I don’t feel good eating that food because all of a sudden that metabolism has stopped because the insulin has spiked and the body has to rely on glucose until we can get back into that fat burning state and inflammation levels are higher and there’s a lot of other things going on”. But of course, you’re going to feel different. 

Your whole body is using a different fuel source that it doesn’t like anymore. And so even that can actually be a positive thing for people because then they say “Well, I don’t want to do that again. You know, I tried the chocolate cake and I don’t want to go back”. So that’s a really important part in people’s journeys as well because then it comes again, back to what you said- I’m making the conscious decision this Christmas where it’s technically the hardest time of year for everybody to stay “healthy” and you’re doing it easy because you know that you don’t want to feel bad and you don’t want to feel sluggish and you want to feel good and you want to celebrate this season. And I think that’s what we should all be striving for.

Exactly. I think it can be a very useful learning experience. And I always say to people, if they’ve, slipped up and fallen face first into the chocolate cake spontaneously or people who are actually considering it for a particular event or something and asking advice what they should do. I know I say, “Really, please, whatever you do, don’t pile on the guilt and beat yourself up about it. Don’t go down that route because that is just going to waste your time. Just be mindful of it. Be mindful of the experience and approach it as something that you’re going to learn from.  And be very mindful in the moment.  I was mindful in the moment of eating that dessert and thinking, wow, this is actually really sweet.

So you were saying about something people often want to try again, something that they used to really enjoy, if they’re really mindful in the moment of having that thing again, 9 times out of 10 they’ll probably realize actually they don’t enjoy it as much now as they used to. They’ve had it up on the pedestal all this time for something they’ve been diligently avoiding. Now it’s in front of them and they’re eating it, it doesn’t taste as good as it used to, or perhaps it did and you enjoy and you see what happens as a result of that -you might find that you are metabolically much more flexible and you deal with it fine and you decide it’s something you’re going to do every now and then. Or you wake up like I did feeling awful and think “That’s a really good reminder of why I’ve been avoiding this kind of thing because I just, I just don’t want to feel bad. Thanks”. But either way, whichever way you look at it and whatever the outcome is, it’s really valuable to learn from it.

I love that. I think this is such an important conversation because it’s basically, 50% of my job as a private practice dietician is trying to help people understand this, that everything is a learning experience and as long as you are mindful about it and you take something away from it and learn from it, then it’s always going to be positive. It doesn’t matter what your decision is, it’s always going to be a positive one. And that’s why I think now, I would never be able to go back to the person that I was and make the food choices that I made when I was in the midst of my disordered eating because I’m too mindful now and I learn from every single experience that I have. And I’m still on my health journey. 

There are times where potentially I’ve over eaten and my stomach is bloated and my pants don’t fit me or whatever it is.  But I just go “You know what? I enjoyed that. I’m really full, maybe a bit too much, maybe next time I’ll think about not eating so much that my pants won’t fit, but it’s okay, it’s alright. The food’s going to digest, I’ll be fine.” You know, just whatever, I get over it. And before when I was in the midst of disordered eating, that sort of feeling where your belly is full and bloated is what gave me the worst panic attacks and the worst anxiety. And so now it’s just so different, and being mindful is one of the biggest things that has helped me overcome that I guess, in combination with better nutrition because there is a difference. And you may have had a similar experience, I don’t know, but there is a difference from how you feel when you’ve overeaten a ton of carbohydrate dense foods with how you feel when you’ve overeaten a ton of low carb, high fat.

Oh, for sure.

It’s very different. What, one of them is almost like you’re kind of high, when you’ve eaten a lot of carbohydrates, I guess you’ve got a lot of glucose in the system and you’ve got that feeling of being high, the high blood sugars and just unwell in the head and the body and feeling bloated and heavy and all of that. But then when you’ve eaten or you’ve overeaten too much high fat, lower carb foods, you do get that fullness. But that’s usually just it your mind is still the same and your mood doesn’t change necessarily.

That’s exactly it. You’ve literally just eaten too much and it’s like you were saying, you have to loosen the belt. Maybe undo your jeans. Yeah, but, but that’s it. You don’t have all the other things that go with it, like maybe feeling dizzy or sick or all the other things that, like you say, when you start messing around with, with your blood sugar that make you feel, yeah, really not good.

And it also usually means that in the four, five, six hours after you’re feeling that way you’re not going to eat anything. Whereas, I remember I used to have a binge on 5,000 or 10,000 calories worth of low fat, high carb foods and I’d feel horrendous. But then two hours later I’d be ready to do it all again because I’d be starving hungry. That’s another really important message as well. If you’re going to overeat, make it high fat, low carb. 

It could be a helpful strategy for Christmas coming up because we know there’s always too much food and it’s okay to have days where you’ve eaten too many calories or something like that. It’s okay, we are going to have those days where it’s higher calorie because the appetite’s high or, or something’s going on and then we’re hopefully going to be balancing those out naturally with days where we’re busier and don’t have as much time to eat and we’re eating lower calories. 

So, I don’t think we need to overcomplicate things, but really having that intuition to be able to say, I’m hungry, I’m going to eat now or I’m full, I’m not going to eat or I’m not hungry I’m not going to eat that, that’s really important as well. And that’s not something you can necessarily teach yourself either. I think that actually comes through getting your metabolism right, through good nutrition and healthy lifestyle principles as well.

Megan Ramos actually has it as a fantastic strategy for if you’re making that conscious decision, to have some of those high carbohydrate things – leave them to the end of the meal. And for me it is usually the dessert. It’s relatively easy here in France to make pretty good Keto decisions from the menu, and I can have something like, I had a set menu the other day and the first course was a goat’s cheese and ham tart with some pastry and it was very easy for me just to scrape off the ham and the cheese and eat that with the salad and just leave the pastry to one side. That was really easy to do. 

It gets a bit more difficult when it gets to the other end and it’s the dessert. But what she says is you fill yourself up on the Keto foods so you don’t have much room left. And the example she uses, which has always been something I love too, with a roast dinner, is roasted potatoes, and she could just eat so many of those if she had them at the start of the meal. But by putting them at the end, she can literally only manage one or two. And so you still get to have it if you want to. You might decide by the time you get there you don’t, but you can still have it. But you really minimize the impact it has purely by not being able to eat much of it. I love that. I think that’s a really a really good tip to, to fill up on the lovely Keto foods first. And so literally not leave much room.

I love that tip as well because again, it’s putting the individual back in the driver’s seat and letting them make that conscious decision. Yeah. So that’s not a bad tip for the festive season coming up. And I think that is partly how I was able to overcome a lot of my binge eating because the urge to want to binge and overeat wasn’t something I could just switch off. It took a while for that to settle and for me to have control over that. But, um, the way that I really helped myself get out of that was just by over fatting. So, I want all the time. No, it is like, it is a really important part in some of our journeys. And it was for me, I had to just really go crazy with the butter, the cheese, the cream, which so many people online would be like, oh my God, too many calories, blah, blah blah.

But my initial priority at that time, or my first priority was to stop the binge eating. It wasn’t necessarily to lose weight at that point. Um, and so I remember I was really diving into the sort of like fat bomb type recipes, like the Keto ice cream. Um, and they, uh, what are some other things I was doing just like real cheesy sauces and butter sauce on every single thing I was having and just drowning my plate with coconut oil. Um, I remembered that when I was eating dinner. It would just, the whole table would just be covered in oil after because I just have to put on so much. 

So, then I couldn’t possibly want to have, a binge on something after. And it really, really worked. I mean, yeah, I was overeating calories, but I was at least, I was doing it in a way that was able to keep my glucose and insulin stable, and then that allowed me to really just break free from the toxic dieting cycle. Um, and that over fatting term, I actually use it for people to help them to get into ketosis as well. If they’re trying to get into nutritional ketosis, even if they don’t have issues with binge eating, um, but they’re chronic calorie restrictors or people that have been avoiding fat for a long time. sometimes the body won’t get into that state of nutritional ketosis if it’s feeling stressed because you’re not giving it up enough calories from fat. 

That’s a very common thing for people that are just pro dieters and they’re just like, Yep, got this. I can lower the carbs super easy. Yup, I’ll have fun. I’ll have protein, but just not have enough food or enough energy from fat. They just may never get into ketosis. And then they’re sitting in that sort of state where they’re not quite burning fat for fuel, but they’re not quite burning carbs or giving themselves, enough carbs and they just feel absolutely terrible. 

So we go through our initial stage of over fatting, which a lot of people love and a lot of people are so afraid of as well. Um, but we go through that initial stage of over fatting and the goal isn’t in that time to lose a whole bunch of weight. Um, but the goal is to help the body burn fat for fuel and teach it to burn fat for fuel. And then once we’ve done that, we can go, all right, so now let’s tune into those hunger and satiety signals and pull back on the fat or the food if we need to.

It’s really difficult isn’t it? Because so many people approach it from a weight loss perspective and it’s really helpful to switch that perspective, especially initially to an improving your health perspective. Maybe there are no health issues at all and the only thing that you need to do is to lose a bit of weight. But it’s, it’s pretty rare. There are usually, there are other things that that come with it. And I loved what you were saying that your approach to start with was regaining control with the binge eating and nothing else mattered. Because once you could get a handle on that, then you could start getting everything else to fall into place. If you were overly panicked at that point that everything had gone completely wrong, if you gained a pound or two, there’s no way you would have stuck with it. So, I do think it’s really important to get your priorities straight.

Yeah. Prioritize your health goals and then prioritize your strategies as well. Especially with the new year approaching, people are wanting to just jump headfirst into these diets that they believe are the perfect diet for a perfect life and perfect health. Um, but it’s, it’s, you’re going to hit a position where you can’t execute that diet perfectly, whether it’s an event, um, or you go out for dinner or something happens at work and, and do you feel like you need to go get ice cream? Whatever it is, there is going to be something that comes along where you can’t execute that diet perfectly. 

And if you have your priorities, where maybe your very top priority is to be gluten free, let’s say it should be gluten free because you have an issue with metabolizing gluten for example, then if nothing less, you achieve that number one goal. You stay gluten free. Even if you end up eating sugar or more carbohydrates or damaged fats or whatever it is, as long as you stay gluten free, then it’s like, okay, cool. I’m still progressing. I’m in the driver’s seat, I’m still in control in control. Oh, you might have a different goal that you’ve prioritized or whatever it may be. But I think that’s important as well, that keeps it unique, that keeps people on path. Because going on and off the “diet” is a part of the Diet.

It’s about the process isn’t it?

Yeah. There may be some things that are just complete non negotiables for you. Like in that example it was gluten that was a non negotiable and then there’s other things that are slightly flexible. But at the end of the day, that’s how we create the perfect diet by having those points of flexibility within the diet as well.

Exactly. I think we spoke about being mindful of what you’re eating, mindful of how you feel, all those kinds of things. I think it’s also really important to be mindful of your personality and what your like in your approach. I find Gretchen Rubin’s Four Tendencies fascinating. And knowing yourself is really helpful in knowing what kind of approach is going to work. Some people love rigid guidelines, they find it very easy to adhere to that, and they like accountability, and so following a really strict plan is going to work really well for them. 

Someone like me who has a rebel tendency, strong overlap with questioning tendency, I just push against that the whole time, always pushing against it. So the kind of approach that I was talking about going into the meal and allowing yourself to have something if you want it, not putting down those rigid guidelines “you can’t do this” or “you can’t do that”. As soon as someone tells me what to do, and that includes me, my first instinctive reaction is, “hell no, I’m not going to do that, in fact, what I’m probably going to do is the complete opposite of what you just said”. That is my gut instinct reaction to anybody telling me, trying to impose what I should do. Whereas for somebody else, it’s going to work really well. So I think it’s really important to know yourself and how you react to change.

I love that you brought that up because it relates to my own practice, but also to the research as well in low carbohydrate diets. Just as you were saying, I love to find out when I first meet somebody in practice, are they a moderator or are they an abstainer, and actually get them to identify that for the different types foods that we’re talking about. So, alcohol is a big one where I like to say to people “Okay, are you a moderator or are you an abstainer?”. And some people will just know straight away “Oh, I’m an abstainer. It’s all or nothing. I’m either going to have a bottle of wine a night or I’m going to have nothing”. 

And then they’ve just created their own strategy for them, when they are ready to look at alcohol as a strategy, then they can go “Okay, Yep, I know it’s just all or nothing for me and I’m just going to completely get rid of it”. Alternatively, they may be someone who’s just doing four glasses of wine a night and that’s something that they want to prioritize as on improving. And so they say “You know what, I’m a moderator. I can bring it down to two glasses of wine a night and I can have an alcohol free night on the weekend”. And for them that’s okay. 

And by having that sort of approach, they’re more likely to go off and actually do that because if we didn’t find out if there are moderators are abstainers and we just said “Okay, now you’ve got to cut that wine back to, just having it three nights a week, two glasses of wine, whatever the guidelines are for alcohol intake. But if they’re an abstainer that makes no sense to them, they can’t, they’ll try and have one or two glasses and it will just lead to the whole bottle or more of the wine. 

But if they actually were able to recognize that they were abstainer and actually just say “You know what, if I’m going to be improving my alcohol intake, I’ve just got to get rid of it and that’s what’s going to work for me”. It might be hard at the beginning, but really it’s going to be better for them in the long run, and it’s a decision that they’ve made. And the way this ties into the low carb literature is that we have this massive issue in nutrition science, and it’s not just on low carbohydrate diets, it’s an issue of compliance and noncompliance. 

So, we could have this great big study and we have 150 people and we put them on a diet, let’s say it’s the Mediterranean Diet, and we might have 80% of those people that just don’t do what the prescribed diet was. So, it might be to eat x amount of fish per week, it might be to have 40% carbohydrate, it might be to have low fat, whatever. But if the Diet doesn’t work for that particular person or they don’t make sense of it or the way it’s delivered to them is wrong, then they may just not do it. They might not do what they were told, they may do a completely different diet or something. Then we are trying to make conclusions based on the prescription as opposed to “what did they actually end up eating?”. So a lot of nutrition research makes its conclusions based on the prescribed diet whereas some will factor in compliance and ask “Okay, well what did they actually eat?” and not go on to analyze the results according to what they actually ate. 

Everything’s always about the prescribed diet. And I mean, I don’t know if there’s one way that’s better than the other, but I think what we should be doing is going “well how can we improve compliance?”. I think that is the thing we should be looking at in the nutrition research and little things like what we’re talking about today like individualizing it to the person, bringing in the behavioral strategies, having flexible prescriptions as opposed to a one size fits all. Those things could be the things that help us improve compliance. 

And maybe this extends to other diets as well. So maybe it’s not just the low carb diet where we can improve compliance but others. So then it comes back to that question while if you want to do a different diet, if you want to do a vegetarian diet or a low fat diet or whatever, we can help you do it. So there are people out there that want to do those other forms of the diets and that’s okay. We’ve got to think of these strategies to actually help people stay compliant – finding out their personality type and finding out their social history. Can they cook? Who do they live with? What is their job like? Are they under pressure and under stress? Do they get sunlight? All of these things make a difference to people’s diets and which diet they should be recommended as well.

Exactly. It’s so variable and asking those questions of the participant, finding out why things didn’t work well for them can be so useful. I think this has been a fantastic conversation and I think very timely in the new year – like you mentioned before about people often set themselves up with all these goals that are quite often unachievable in the New Year. So, really getting to grips with understanding yourself and what might work for you might be the best goal you can have to start with. Maybe you could give us a top tip to kick off the New Year with.

I’m glad you asked that because I was just about to say my top tip before you asked and then I would’ve had to come up with another one! So my tip today is to really know your “Why” every time you make a decision.  Let’s say for example, it’s the New Year and you want to do this low carbohydrate, high fat diet thing. Cool. No worries. Just know why you’re doing it. 

Every strategy you implement, whether it be reducing processed foods, whether it be increasing your fish intake, whether it be choosing wild caught, whatever it is, always know your “Why”.  Come back to that reason why you as the individual are making that choice. Because all too often I see people just looking up what they should be doing online, seeing what other people are doing and going “Oh, I have to do that. That person is doing a 24 hour fast, now I have to do it”, and that’s not the case. 

Not everybody needs to fast, not everybody needs to do Keto, not everybody needs to do to all these things that we’re seeing online. So really saying, “Well, why am I doing those things?’, and if I have a valid reason as to why and I think that strategy is going to work for me, then I’ll do it and that’s fine. So that’s probably the most common word that comes out of my math in clinical practice is “Why”. Why do you want to do that? Because all the time people are printing things off the Internet and saying, “Well, my friend is doing this, should I be doing a five day fast?” and all of that. And everything’s got a potential benefit to it. And it’s that investigation, if you want to try something, okay, let’s try it, but we need to know why you’re trying it and not just because so and so online is doing it.

Perfect. Well thank you so much. It’s been wonderful catching up with you. I’ve really enjoyed it.

It’s been great. And we were having a few issues with this recording because the cicadas at my place were so loud, so I’m glad that they have been nice to us tonight and really shut up in Australia. There’s always these problems with the noisy wildlife, so we’ve been lucky tonight.

Well thank you and I, and I hope it’s a fantastic year, for you. 

Same to you.

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

Welcome back Annette to the Keto Woman podcast and another episode of ask Dr Boz. We got another long list of questions here. See how many we can get through today. How are you doing today?

I am doing great. Thanks again for having me. Again, I just love your audience. They have been, some of the most engaged and ask amazing questions. So thanks for letting me participate and use this as a remarkable teaching opportunity.

Well we’re not going to take up time with catching up with me this time. We’re just going to dive straight into the listener questions. You’ll be pleased to hear at home listeners. Okay, so let’s start with Louise. Yes, my mate, Louise Reynolds who surprised me recently. Some of you who, in my Facebook group, who see me on social media, will know recently how she… She was very scheming and she said she was planning to come down and surprise me with a visit. And when I opened my front door, it ended up to be none other than Richard Morris. One of the 2 Keto Dudes. It blew me away. I opened the door, my outside light wasn’t working, so I’m peering out into the darkness, and this voice comes back, hello Daisy. That’s not Louise.

 She really did do a good job because she was consistent throughout. She gave me all these updates about her journey, how she’d been held up here, and held up there, and how the flight was going. Incredible. She did a very good job. So maybe the top tip to take away from that is, don’t always trust Louise Reynolds.

Or trust her with a really good secret.

Exactly – no, a very good friend. And it’s very typical of her to spend a lot of time and a great deal of effort in doing something…planning something really nice for somebody else. That’s very typical of her. So it’s nice to start off with a question from her.

So Louise says, as an older woman, she says…she’s not so old…I’ve been working out lifting weights with the aim of further reducing body fat, trying to maintain 130 pound weight loss…we are actually weight loss twins, we both had weight loss surgery, we both had a very similar journey, we have lots in common…and she wants to improve muscle tone. While I’m lifting heavier weights, she uses the Stronglifts 5×5 app, so she’s been tracking it – which you’ll be pleased to hear – the scales now say I have gained 10 pounds since May, while my waist is still the same – my belt hasn’t changed. Is this weight gain muscle? This doesn’t make sense as I’m not looking Herculean and still have flabby jiggly bits. She doesn’t have so many flabby jiggly bits.

That’s beautiful because it is this process of when our bodies lose weight…I do a lot of education on igniting your autophagy and just that recycling of tissue, so 130 pound weight loss is amazing. Congratulations. That is a huge mark. I will tell you that in the course of internal medicine care for two decades, I can tell you there’re only a handful of people that I’ve ever helped lose that much weight. And prior to the keto journey over the last couple of years, it was incredibly intense exercise, and they mostly gained it all back. So I just want to say congratulations for losing it and really igniting your metabolism to be able to keep it off. So the question really centers around, doc what’s happening on the inside? So I’m just going to assume that these 130 pounds were off by May. So she was at that 130 mark, and really has been kind of plateaued, and looks like maybe even gained about 10 pounds since May.

Oh yes, she’s actually lost that weight and maintained it for, I don’t know exactly how many years, but at least several years before that.

If she was my patient, what I would first do is a little bit of studying. Because the weight gain on a ketogenic diet…people say I’m skinny, should I be on a ketogenic diet, I don’t want to lose weight. There’s an equation here that as much as we talk about calories aren’t the most important, they still do weigh in, especially once your body has stabilized. I don’t mean the amount of calories as much as I mean the timing of your calories. When you look at 130 pound weight loss, and then her body kind of just holds in this pattern, and really resets. You can make the argument that in many ways there’s a psychological component that says they got to this level, they kind of are able to say thanks…thankfulness, almost relaxed, like look at how much better my life is.

And now she’s been there for you say a better part of a year and is saying, I wonder if I can take it to a new level – a new level of health. And again, I commend her. When you’ve got that big of an accomplishment, and you just hold the zone of making sure all of your behavior changes are solid – that you do predictably get your good rest, and eat a ketogenic diet. Great. So now let’s bio hack where she is right now. The first thing I would do is actually I would tell her to go do a DEXA scan. Most insurances…she lives in the United States, right?

No, actually she’s Australian, but she’s in the United Kingdom working and living. Now I happen to know that she has had DEXA scans, and I’m not entirely sure what the results were with that, but I know she has had them. So if that tells her anything, she will know that already, so I’m assuming that’s not too much of a factor.

That’s perfect. Because again, what we’re looking for is, how do we take out the noise of weight and get to the…what is the body’s makeup of where the weight’s coming from? The first thing that I look at in older women that go to a ketogenic diet is, I’ve been impressed with how quickly their bone density increases. And that bone density is from these fat-based hormones that on a low fat diet, they really are difficult to push the hormones high enough to spark that bone growth. Again, they’re all based out of cholesterol and fat, and so on a low fat diet many times they are lower than they should be. They get onto a ketogenic diet. The weight loss happens. But what’s really happening that’s exciting for me to watch is the brain repair that’s happening, the coating of the neurons with a more dense fat around all their nerves. That’s a slow process. It does not happen overnight, but it is amazing how much better their system works electrically – meaning the brain, neuro conduction, and the nerves. And then finally to watch what happens with the bone density – that a ketogenic diet produces enough of the hormones, one of those being your growth hormone. And as you age that’s supposed to go down. But I will show you that the studies have seen that you can see a rise in that growth hormone if you ignite the process of a ketogenic diet.

What I mean by that is there are some rules. So Louise, I would want to know what time you wake up in the morning and then that wake up time will give me a pretty good guess that your circadian rhythm is hopefully matching the light hours. And I know I talked about this a lot in the last episode I did, but I just want to quickly remind you…if you wake up at six o’clock in the morning, and you put that cup of coffee in, And the coffee may be black, and I count that as fasting – I’m talking about me. But if you’re looking at the process of igniting a weight loss, or getting off of a plateau, or in Louise’s case, I would be wondering, have we been pushing her growth hormone, and spiking and valleying her growth hormone, to improve her bone density?

That weightlifting could be turning into some improved muscle mass – which you say, is that Herculean or not…but a DEXA scan would be able to tell us. So we want to say what time she get up in the morning, what time does a cup of coffee go in? And then how long does she eat for? Like, what is her time that she spends eating? And if she snacks all the way until bedtime, like oh I only ate twice today, but I had a handful of macadamia nuts at six o’clock, and then I had a little glass of kombucha at 8:30 last night…the calories that are going in are too spread out, and her history of being that overweight is going to lock down that reset. Like she’s going to stay stuck at this level until she’s resets her system.

Okay. I do have some answers for you because I happen to know Louise quite well. One thing I was going to ask you about though was the DEXA scan, because I have heard that that can be variable in how accurate it is, especially when it comes to differentiating between fat mass and muscle mass. Presumably it can be more accurate with bone density. And I think it’s interesting actually…I mean, people joke around, don’t they…saying, oh you know, I weigh x amount because I’m heavy boned. But it’s interesting that you could actually increase some of your weight with the bone density. That is one thing. And with the muscle mass as well. So I happen to know that she is not like me. She’s not really a snacker, and I think she quite often possibly just eats once a day.

She does tend to be very low-carb, verging on carnivore – she calls herself lazy carnivore. I know she sometimes does have a little bit of chocolate and some dairy, but very, very low-carb – often one meal a day. She’s not really a snacker. I do happen to know though that her sleep is bad because for a couple of different reasons – she is often having to be up late at night talking to a partner in Australia, and again early in the morning. She does some consults with students, quite often really early in the morning – it can be five, six o’clock in the morning. So I know that she very often doesn’t get enough sleep, so that potentially is a factor. But presumably all this weightlifting she’s been doing, that’s going to improve the bone density, and obviously the muscle mass as well.

Well, what I would contend is that she’s doing the right activity to increase her bone density and her muscle mass, as long as her hormones aren’t fighting her. That steadily elevated cortisol level, which is your stress hormone, it really resets during the sleep hours. So if her sleep is a little goofy, I would try to figure out a schedule that protects her sleep better. The other part that I would have her do would be…what is her morning fasting sugar and ketone levels when she first wakes up. What is that ratio? I would love to know what her insulin level is, but that’s going to be a blood test and a doctor’s visit, and then insulin’s goofy so you should do it a few times to know that you get it right because so many variables go into it. And it’s pretty darn expensive. The best next estimate of whether her insulin is low, would be to look at whether her blood sugar get into those 70s in the morning, maybe even 60s sometimes.

Yes, I think so. I think she does tend to be, yes, have nice low numbers actually with her blood sugar. And I think her ketones…I know she measures, so she could certainly give you those numbers.

And do you think are ketones are pretty good in the morning? Her blood ketones?

Yes, I have a feeling that she complains that they’re not as high as she maybe thinks they should be, or would like them to be, but I know her blood sugar’s always down. They’re certainly well into that range that is quoted as being the range they need to be in. But I think sometimes she wonders why they aren’t perhaps a little bit higher. But as we know, it’s not always a numbers game. You don’t have to hit certain numbers. Different people have different levels, don’t they? That’s ideal for them depending, to a certain extent, how much you’re using them.

Right. So if she’s got this weightlifting process that she’s doing, what I would have her do is, I’d want her to hit a ratio of 40 or less. So let’s say she’s testing her blood sugars and her blood sugars are, 60 or 75 and if her ketones are less than one, so 0.9 0.8; that’s going to put her ratio above a hundred, or in the high nineties to 100 depending on what her sugar is. So to say, well how can we increase that ketone? And this is where I would put, if in fact she’s got nice low blood sugars but her ketone numbers are lower, then I would push her to fast longer. Like give me once a week – and this is what I do – I start on Sunday so she can watch me on social media, and then I fast until I hit a ratio of 40. Now in patients who are really sick, if I’m really fighting an autoimmune process, I want them to hit a 40 every morning in that ratio of taking their blood glucose and dividing it by the ketones.

That’s what I’ve seen – we could see the improvement when they did that. If you have a situation like this where she’s doing pretty good activity and saying, I wonder why the weight’s going up, I would at least hit 40 two mornings a week. It might be that you say, I’m going to fast for 36 hours. Or maybe don’t put a timer on the fast, as much as you put the bio-markers where you said, okay, your body hit our goal. And what you’ll see is if she does this week after week after week, even just hitting it once, you’re going to see about the second month that she realizes what hours it takes for her system to empty, meaning the glucose to go down, and the ketones to rise. And of course that’s where the cognitive function is better. They feel better. I would push her to check that ratio in conjunction with what her story is.

The other number that I would check is, I would love to know what is her blood sugar / ketone ratio after she works out. So again, the demand for energy is higher when they work out. I work out in the morning and when I check my blood sugars before the workout and after the workout, my blood sugars go up and my ketones go down while I work out. And I think it’s been very teachable understanding of my own body to say, yes, I’ve taught my system that we use ketones to…I’m talking about myself in the plural…I use ketones to fuel my body during that workout and my body is adapted in a way that it can do that. And I think especially as long as she’s been keto that I bet she’s doing the same thing, which is a good sign.

But that confidence that what you’re doing inside the muscle – inside the body – your sugar will probably go up, your ketones go down. But check it. See what happens while you work out. And I just think those kind of bio-markers help understand why is the weight going up. If you want that weight to go down, if you’re really looking for the next level, at least get the numbers below 80. But if you’re looking for any type of like remodeling, like getting autophagy to not have the flabby skin and all this stuff that there is pretty good evidence about. We can’t send you to the lab to check your autophagy, but we can have you look at these ratios, and those are in your home. And I would push her to at least hit 40 twice a week. So fast long enough to get to 40 twice a week, and then the rest of the time try to stay under 80.

Oh, she’ll take that on board, I think. She has a very acute scientific mind and so she’ll see it as a project and we’ll collect the data. Yes, I think that will appeal to her a lot. I can see her doing that and I’ll get some feedback and find out what happens.

Okay. The next question is from Siobhan. You’ve mentioned, she says, concerns over low ferritin. It’s one of your favorite topics, isn’t it? How low is too low? Mine tends to run low, eg around 45 to 80 regardless of whether I’m eating chicken or pork or entirely red meat – several pounds of red meat a day. Could this be related to other problems I’m not aware of, like folate deficiency or is it not something you’d worry about with yourself if you are asymptomatic?

Well, so let’s go back to why ferritin is such an important marker for me. I talk about brain performance and have quite a lot of patients that have had depression, or just slower mental processing because of trauma. It can be emotional trauma or physical trauma. So repairing brains is a very big part of how well their whole life does. Ferritin is one of those markers that you can’t make some of the nerve, the brain hormones like the neurochemistry without iron being around. And ferritin is a little bus that runs around and delivers the iron. If ferritin is too low, the lowest I’ve seen is not measurable – like less than four. They were like zombies. Their brains were just turned off. Their speech was quiet. They couldn’t articulate. The ferritin and iron goes back into their system, and bam! At least the brain is awake.

When somebody comes in and their ferritin is below 30, I do a really strong education to say, the fastest way to get this iron above…the minimum that I like to see patients at is 50. Between 50 and 150 is a good level If it’s below 30, I’m really going to talk to them about liver – braunschweiger, liverwurst – whatever way they want to do it, and just how powerful that iron replacement is compared to elemental iron. Iron supplements are another great option. They just take a lot longer and you don’t absorb as much. When they get below 20, I actually push them to go get iron put in their vein because it’s going to take us so long to get from a low iron, that’s that low – like in the teens. First of all, their brain’s not going to focus long enough to keep doing what I tell them to do. They just can’t. And it is 2018. This has been around for a while. You can go in and get iron put into your vein, and what would take you six months of iron tablets to replace, I can do with a two to three minute infusion. That’s not overly expensive unless you go to and infusion center and then I’ve seen it cost like $2,000. If you just get it as an IV push in a clinic, it’s pretty cheap. However, too low is anything below 30, I’m chirping at them. When they get above 40, I start to say you could have a little more, but it’s not nearly as critical as when it’s below 30, and specifically below 20.

I do a little bit more education on ferritin. Ferritin is something called an acute phase reactant, which means when your body has a response, ferritin is a protein. And so if I slug you on the arm enough to give you a bruise, you can see ferritin rise. So when people come out of like a car accident and they wonder how much blood loss they’ve had, but they have like 15 new bruises and a broken rib and an arm in a cast and you say, gee their ferritin’s nice and high. You can’t trust that. You’ve got to wait until the inflammation goes back down to see what is their true ferritin level. Ferritin is just a marker of how much iron your body has. I wouldn’t worry about a range between 45 and 80 – that looks pretty healthy. But then could it be related to folate deficiency? Folate is another one of those….I’m a big fan of eating the sprouts of vegetables. First of all, it’s very low carb with a really high density of nourishment. If you have brussel sprouts or broccoli sprouts, they are just really high in those leafy greens, and it doesn’t take a lot to get you the nourishment that you need.

They’re those things that taste irony, aren’t they? I’ve always been a bit of an odd child in that I liked those irony things. Really dark greens and spinach. I still do. They’re the things I love, but they’re the things that are naturally rich in folate.

Absolutely. You can take a supplement. Folate’s easy to take and absorb really well in the multivitamins, unlike iron. Those are a few rules with iron. Like don’t take it on…acid needs to be there…lots of rules. But folate’s pretty easy to absorb. And if you do any kind of greens, it’s pretty easy to get that in. I would just tell her not to be fully deficient. Don’t do that because it is a big part of how your body functions as well.

Yes. Interesting. I seem to remember that my ferritin levels were quite low so I looked them up because I thought, Dr Boz is not going to be very happy with me, and so I looked them up and mine is actually 11, and the reference range they give here in France is 13 to 150. I’m sure you’ve got something to say about reference ranges and although the lower limit might say one thing, that’s not the what you would consider to be the optimal lower limit because that includes everyone, doesn’t it? Including the extremes – which you don’t want to be. Perhaps you could just have a bit of a mention about that before you tell me off about my ferritin level.

I think we have an answer for your sleep problems, actually. Looking at reference ranges, let’s take glucose. If you go back into the textbooks from the fifties and sixties, the normal glucose range was from 60 to 80. When I tell patients that their glucose of 101 is not normal or 98 is not normal, they instantly say I googled it and I’m in the range. Where do you think we get these ranges? It’s where we take a standard deviation – I think it’s 1.5 standard deviations – in our population to tell us what is the range. And sadly the world is very low on magnesium. That range is interesting. The world is very low on iron. And the world is very high on blood sugar. So these ranges have evolved with our population and don’t necessarily reflect what I would want for my patients, my children, my husband…for the people I care about to say, no, no. no, no, you don’t want to be anywhere near that.

When you look at a ferritin level of 11, and so on that can you see the word that says saturation on that panel?

Yes, I might have that actually.

So while you look that up, I’ll keep going. If you look at a ferritin of 11, what that’s saying is when we drew the blood, we only found 11 buses that were scooting around your system delivering iron. And again, ferritins are proteins. If you don’t have a lot of iron being delivered to the system, then there’s nothing for it to do. If you increase the iron delivery, then the ferritin will compensate. Now that bus is so full I can’t fit any more iron in it, so let’s make some more buses. And that’s this protein that is carrying around iron. And without any reference point for where you’ve been, just knowing that your buses are down to 11, you haven’t been low on iron for a week or two. How long ago was your gastric surgery?

For me it’s a constant problem. I come in low on iron, low on ferritin. It’s been a consistent problem for a long, long time. In fact, when I had the last surgery – I had plastic surgery, and the surgeon actually insisted that I have a transfusion while I was in the hospital. It was ideal obviously because I was there hooked up anyway, so they put some iron in. And yes, my levels temporarily went up really high. I have tried to be much more consistent about supplementing. But I do supplement, but I’ve just really, really struggled to get my levels up no matter what I do. No matter what I supplement. I’m just looking at my panel here, and I don’t know exactly if they translate…I’ve got transferrin. I’ve got two saturation numbers here. I’ve got saturation, iron in transferrin and it’s listed as CTST here. I don’t know if that translates directly…and that gives it in two different values. I’ve got one value of 4.12…and that’s I think micrograms per liter, I’m not sure. The other one is 73.75.

Is there a percentage after the 73?

No, but the other one I have, which does have a percentage is called coefficient saturation of iron. That’s 13.36.

So, that’s awful.

Oh no.

Essentially what that saturation is doing is saying, let me just peek on this bus and see how many seats are filled with iron. When the saturation is 80, then you’ve got 80% of the seats filled with iron. So those buses are busy doing their job.

Ah, okay. So even though you’ve got fewer buses, they’re full. It’s not as bad as if you’ve got fewer buses and there aren’t many people on them.

What it tells me is that when you have the low ferritin, but you have pretty high seats filled – so the saturation in there is filled – it says, she’s increased her iron recently and she’s trying to get ahead – it’s working. The buses are filled. Because once the buses get – I think 60% or 70% – then there’s more stimulation of making more of those proteins. But if your buses, only 13% of the seats are filled, there’s no reason for you to make any more ferritin. There’s just not enough iron for them to do anything. So the process, you’ve got to break the cycle. If you were coming in to me to get a kidney transplant, I would have to prove to the transplant team that you are ready to receive this kidney. And one of the factors for being healthy enough to receive a kidney is what is your ferritin?

We would break the cycle like that, with an IV infusion of iron. You can go back in the history books about IV iron and it used to be this awful thing…we put people in the ICU. It was really dangerous. But when I was in medical school, there was a pretty big breakthrough that they put sugar – and don’t freak out for a ketogenic diet – but they put sugar around the iron and the delivery of the iron was so safe that we can now do it in a clinic. Now healthcare in our world has changed, so many times they just don’t bother with it. Doctors kind of get nervous about the history lesson of iron being difficult, but truly the data…we give these IV infusions of iron to neonates, to babies that were born too early. It’s very safe and it stops the cycle.

Because even if you start eating iron perfectly right now you say, I’m going to eat only braunschweiger for the next month, your gut has to absorb it and you’ve had a rewire, a re-routing of your system, or a gastric bypass. So it’s not uncommon for stories like this to say, the reason she’s tired, the reason she’s still struggling with that resetting of her sleep cycle, is because her brain doesn’t have any ferritin. It doesn’t have any iron. That is a powerful change in how well they think, how well they concentrate. Not only do you add in that you’re a menstruating woman who’s had, you know, leaking out the other end too many years. When you’re this low on iron, you shouldn’t have a menstrual period when it’s that low. Those are valuable little red blood cells, don’t waste them.

And obviously I’m being a little funny there, but the point I’m making is that you’re at a higher risk to not get ahead when you’re in this stuck situation. And it’d be the kind of situation where I’d say, go into your doctor, say, I’ve done this so many times, can’t I have an IV infusion of the iron? And I don’t know how it works in your world, but in our world it has to be low enough, or a certain level enough, for them to pay for it through your insurance. But I think the criteria, if it’s anything like in America, with that low of an iron and consistently feeling that heaviness in the morning or that fatigue, I think you could be covered by some insurance companies. And if not, two infusions of this is worth like seven months of iron pills. So two infusions and you are leaps ahead for resetting this cycle, this problem.

Oh, it’s very tricky and it’s certainly something I will look into. But yes, the system is so completely different here. Sadly my GP is very aware that I have this problem, but like I say, it’s been years that I’ve been borderline anemic, really. Yes to the extent that I mentioned that there was actually doubt as to whether I’d be able to have one of my operations because it was so low. So it’s certainly not something that they’re going to voluntarily let me do. I think the only option will be is to find out if there’s anywhere privately that I can go and have it done. Yes, like I say, a completely different system. But I will certainly look into that because I know it’s an issue. There’s one question that I have that I’ve remembered that came up with this question on the thread, and it is something that’s relevant to me and to a lot of other people. I forget who said it, so, forgive me for forgetting that, but someone mentioned that if you’re hypothyroid – and I have the Hashimoto’s form – that a lot of the groups that advise around that are saying that actually having too high ferritin is a problem, and that having a lower end of the scale ferritin, is potentially a good thing if you’re hypothyroid. Do you know what they might be referring to?

Yeah. You’re saying hyper or hypo.

Hypo. Hypothyroid. Yes.

Okay. Hyperthyroid is an over-functioning of a thyroid, right? Over-functioning of the production of those hormones. And especially if you had Hashimoto’s, those proteins are coming out of your thyroid because antibodies have been attacking it. So it’s an autoimmune problem. Your body is attacking the thyroid when it wasn’t supposed to do that. But here you are. And in that setting, this excessive production of proteins can happen in many layers. When somebody has one autoimmune problem, like they have Hashimoto’s, it increases your risk of getting other autoimmune problems.

Yes, I’ve heard that before. It tends to come in packs.

Right? So think of the excessive production of protein is another way – and I don’t mean the protein in your muscles, I mean these little proteins that travel around and send messages from one cell to the next. And that’s what’s happening in Hashimoto’s, is your body’s getting a message from a protein that you’re not supposed to make. Then you are an increased risk for having proteins that tell your joints to swell or to break down all your blood vessels and have lupus. So other autoimmune problems. But in general, the milieu of proteins is higher in people who have autoimmune disorders. So when they say, your ferritin might be high. Yeah, well, first of all, you don’t have to worry about that. You’re so darn low and your seats are empty on your bus, that we are so far from that problem, it’s like not worth mentioning.

But in the spirit of answering the question, if they have a ferritin of like 280 and you say, oh my goodness, are they iron overloaded? No, they’re autoimmune. Their body is attacking itself and is producing these extra proteins. One of them, it looks like it’s ferritin. And so the ferritin can be high as a product of this immune system that’s kind of gone awry. It’s stimulating itself to produce things. And when that happens, all kinds of things go wrong. Ferritins are not normal. When I said earlier, it’s an acute phase reactant, like you are producing a protein because you got all bruised up in a car accident, there are other things that are chronic inflammation that increase ferritin as well. So it is something that you have to look at all the numbers. Your history gives me the hint though, that you don’t absorb it right, and that’s from the surgery – of the weight loss reduction surgery – it’s really common. And so that’s why I would say skip trying to eat it. Put it in your vein. Your brain is depending on it.

Right? Yes. And that makes sense. I mean I didn’t have the bypass, but presumably it’s one of those things that I don’t absorb as much just because the stomach size shrunk down. And I know that different things are absorbed in different places, but it’s certainly been a problem for me for a long time. So yes, that’s something I’ve obviously got to look at. Because I have taken supplements and I still struggle to get those numbers up.

It’ll turn your stools dark and you’ll have very little absorption because of the chemistry of what supplements are. If it was me. If I was in your situation, no kidding, I would do a liver fast. Like you only eat braunschweiger for the better part of a month. And I know that sounds very restrictive, like is that possible? But liver’s high in vitamin C. Livers is a very fatty meat and if you had just bone broth and liver for a month, could you increase it on your own? The cells that are supposed to absorb it are clearly not working right. All meat has iron in it. Why isn’t your system absorbing it? Because it’s going to take you the better part of a month to navigate the system to find out could you even get IV iron, I’ll tell you I do it here in the States, but I’m one of the very few that does this. That’s a whole other story, but the point I’m making is in your case it’s going to take you a month to crack the code on how would you possibly get IV iron. If in that time you did an ultimate challenge of saying if the cells in your gut are still alive, and present, and in the right pathway that food passes by them, then I would be on a bone broth and braunschweiger fast for a month and just say that’s it. That’s all you’re going to eat for a month and watch what happens to your iron. Because that would tell both me and you whether you can absorb it. And once you get those cells out of hibernation and they’re back to actively working, then you can go back to do what I tell most patients, which is: if you’ve got that low of iron, I can give you an IV, but braunschweiger, a tablespoon three times a week. That’s powerful. That’s a lot of iron. And even if you don’t like the taste, eventually you’ll get past it.

Because that’s the other point. Like I said, I have had an infusion before. If you get your numbers up with that temporary fix, is it going to be the case that unless you make other changes, it’s just going to drop right back down again. You mentioned about this reset and restimulating, or is that just simply not going to work unless you do these other things as well?

Right. So somehow you’ve got to get iron sustainable in your system. You’re at the age where menopause is hitting your world, you’re not going to have menstruation as a loss anymore so it does get easier to get ahead. But I would contend that the fastest improvement for a lifetime, is see if you can wake up the cells that actually absorb iron. Sounds like they’re not absorbing much. The infusion you had, you had somebody else’s red blood cells put into your body and those are only going to last for about two weeks in your system before your body gets rid of them. Now you get the leftover iron that was in them. So that’s the good part. You got an infusion of iron by way of those red blood cells, but you don’t have to expose yourself to somebody else’s blood parts to get iron.

You can just get iron and that I think is safer and less risk. What it does is, all that iron…suddenly those little ferritin buses are going to have a hundred percent saturation. They’re going to be filled with iron, and that’s going to say, hey, we’re too full, we need to make more ferritin. And then you’ll have higher. So then you get a higher carrying capacity and that allows you to not be right on the edge here. You cut your finger and you’re going to have a lower… your red blood cells are already probably tiny little red blood cells instead of these big, plump, efficient, red blood cells that deliver oxygen. That’s probably, in part, why your fatigue is still lingering.

Right? Yes. Really interesting. So it is a case of doing the two things at once, stimulating your system interaction, but then doing the sustainability part to keep it going. Very interesting. Well we’ve started talking about me again, so let’s go back to somebody else.

Jojo has a question. She would like your thoughts on her recent overall cholesterol being so high at 357. What other tests should she get done? This is her first blood work since starting keto in July. She knows it’s common for this to happen, ie the cholesterol going up, but the more advice she can get, the better.

Right? So why has cholesterol become this marker of worry for the world? And it is because it was linked to heart disease, except they didn’t do such a great job when they first discovered this at linking the two in a correct manner. What I first and foremost remind patients is, cholesterol is the carrier. This is what carries fat from one section to the next. When I put you on a diet that’s 85% fat, guess what? The carrier is going to get higher. The cholesterol is going to get higher. It is not the predictor of heart attacks. You can better predict a heart attack with the size of your waistline. If you put weight on in your tummy, that’s a better predictor of a heart attack than your cholesterol was. So that’s easy. You can do that one at home. Your morning fasting blood sugars, those are a better marker of a heart attack than cholesterol.

Other tests from your doctor? I would encourage every single person who wants to know if they have a risk of a heart attack to look at a calcium score. This is a very high speed, MRI that takes pictures of the coronary arteries. If you have a zero on your calcium score, it is a protector for the next 15 years that you will not have a heart attack. Way better than I can do with that cholesterol, which is going to change depending on what your diet has been for the better part of the previous six weeks before I checked the blood. When I look at a calcium score and it’s zero, I can have a lot of confidence that the inflammation going on in their body is still very low and not depositing calcium into those coronary arteries.

Other markers that are somewhere in between are a Highly Sensitive C Reactive Protein. I say that very specifically a Highly Sensitive C Reactive Protein. This is a marker of inflammation that is designed to specifically predict what the inside skin layer of blood vessels is. In America there’s this cartoon that would happen after school called The Magic School Bus and this teacher would teach you about science and things with the magic school bus. Her magic school bus could get really tiny and she’d drive down the arteries of a human body and teach about anatomy. So if you were driving down the artery and you looked around the skin layer that lines the tunnel, the Highly Sensitive C Reactive Protein helps me know is that inflamed? And that is a predictor of a heart attack. You’re starting to put cholesterol deposits in that layer. Guess what? It’s very inflamed and it’s going to do that even before your blood sugar is high. Before you have a change in your Hemoglobin A1C, which is a predictor of diabetes.

If I needed to know if you are going to have a heart attack and I needed to be the most confident, if I got to grab which one I would look at first, it would be a calcium score in your coronary arteries and I’d vote for a zero. If I don’t get to do that. You don’t need a doctor’s prescription to do that. If you look at any – in America anyway – if you look at any place in America, you can just call up the cardiology team and I think it’s like $25. It’s really cheap. So it’s a quick MRI. It’s a screen for calcium. And if your score is zero, congratulations. If it’s like 250, we’re talking about some significant risks. I have a patient over the last six months who it was like 2,500. So you talk about the question we started this with where they have heart failure, and boy that calcium score is…that’s a delicate equation. We need them carefully monitored by a physician as they make some changes. But instead of focusing on the cholesterol, I would look at those markers instead.

I think another one that I’ve always thought as useful, and it’s funny that this question follows on from Siobhan’s question because she’s the lipid queen. She loves her lipid analysis. But I always think the triglycerides are a useful marker. People talk about the size of LDL particles, don’t they? But if you know your LDL, and you know your triglycerides…Triglycerides is literally a measure of how much fat is swimming around in the blood, isn’t it? And you want it low. That, to me, whenever somebody says, my cholesterol is high, the first thing I ask them, but what are your triglycerides doing?

That’s very true. I used to tease patients that if they wanted to outsmart their cholesterol screen for a life insurance – triglycerides were something the life insurance would look at more than the cholesterol, than the number, she was just reporting, and I said, if you want to outsmart them fast for three days before you go into that test. Triglycerides are really a reflection of what did your body intake recently, and is the storage tank full. Triglycerides are high when the liver is already jam packed full of stored carbs, that you’ve already got your fat cells and muscle cells overflowing with store carbs, and so the body’s turning them into fat lobules and trying to find a home for them. And those triglycerides, you’re right, it’s fat in the blood, but it has everything to do with the last few days.

So I tend to say, that’s another thing that I get to learn from if I see that on the panel. But if I get to pick I want to know in my dad like, are you going to die of a heart attack in the next year? If he hasn’t eaten for two days before he comes in for his triglyceride look, then I’m going to have a false sense of thinking he’s safe when he’s really not. But if I get a calcium score, it’s a marker of actual disease that’s happening now. It’s cheap, there’s no radiation. This is a magnetic MRI. It should be the gold standard. It is a better predictor of how well they’re moving in the right direction. And again, you do not need a doctor’s prescription to do it. It’s done in a cardiology office usually. Our hospitals do them for screening. It’s like a lead magnet or a funnel to get into the cardiologist. So be careful where you go but it is cheap. So I’d still push towards a calcium score over a triglyceride.

Yes, and it’s definitely something that Ivor Cummins has been talking about and campaigning for a long time, hasn’t he? He would like it to be a standard test that’s performed, and yes, I can see why.

I think we’ve got time for one more question, and this comes from Kate. If night sweats interrupt your sleep – and it sounds like for her this is happening about every two hours – is there anything that can be done? She meditates. She started taking plant-based estrogen cream, and she does all the typical food and bedtime habits. Is there anything she can do to improve that? Maybe you’ve got an idea why it’s happening and how she get around that. That sounds very uncomfortable to have to put up with that all night. We talk about how important sleep is, that’s going to interrupt to isn’t it?

Here are some assumptions I’m going to make about Kate. She’s got night sweats and it’s happening every couple of hours. She’s got an estrogen cream, so that makes me think she’s been to a doctor. The first thing whenever I hear about somebody who has night sweats, is that can be a danger sign. Unexplained night sweats are one of those medical mysteries that you should definitely…tuberculosis does this, a growing cancer does this. They are a warning signal that can be dangerous, so I’m going to assume because she’s got a prescription medication there on her list that she’s already been to a doctor and actually had her own medical advice on this. When I look at two hour cycle of night sweats, I get nervous about how long has she been practicing that? And I don’t mean it in an accusatory way, I just mean that brains get wired and they keep using the same wires.

If she’s in a transition in her health where she was on a low-fat diet and now is on a ketogenic diet, after they’ve gotten keto adapted….so let’s say they’re six weeks into a ketosis diet, we start to see that these hormones like growth hormone, and cortisol, and estrogen – fat-based – they all begin with a fat. And so those hormones start to rise. And so if you’ve had a low-fat diet and you’ve had the hormones that weren’t great. And you can tell by, is there a hair nice and thick? Are their fingernails nice and strong? Is their skin nice and resilient? Those things are just kind of by-products of a healthy fat supplied diet. Those hormones have to be stable. But if the hormones have not been supplied…I talk about the supply chain, but in a ketogenic diet, what’s really happening is the supply chain for testosterone, and estrogen, and cortisol, and growth hormone, those have been intermittent and they’re not predictable when you’re on a low-fat diet. But when you become ketogenic, you now have this constant steady supply of fat. The supply chain becomes predictable, but then it hits the body – especially for somebody who’s not used to what estrogen is supposed to be – and the production of estrogen. Estrogen and progesterone can cause night sweats. If she’s having ovaries that are sputtering, like they produce some estrogen and then they don’t – that’s because she’s going through menopause. Or maybe it’s the reverse – which I’ve seen happen – is they go on a ketogenic diet and the ovaries have kind of shutdown saying, we can’t produce any extra energy to the ovaries. We have all these other things that aren’t supplied. Ovaries are an extra, so they kind of go into early menopause. But then they get a ketogenic diet and bam, they start producing estrogen again.

And as those ovaries wake up, you’ll see about almost a two month pattern of sweats that happen that I wouldn’t be adding extra estrogen cream. I would say journey through this and just be checking your numbers in the morning that that glucose to ketone ratio that you’re really hitting a good supply every day. I’d want her numbers to be 80 – like glucose divided by ketones at least 80 every morning for two months. And that would give me the confidence that she’s supplying her hormones with a steady level, that whatever is blipping up and down to cause the night sweats, has stabilized. When women go through menopause, if they’re estrogen would just stay high, they wouldn’t have a night sweat. If it would stay low, they don’t have night sweat. It’s when it bumps up and down that it causes the body to just break out in a heat wave. If that’s what this cause of her night sweats are, I would study herself a little better. First thing in the morning, check those numbers, and if you’re hitting 80 every day and stay there for two months, and this will pass. Easy to say when I’m not the one staying up every two nights,so…

Yes, and it’s interesting and it shows again how important the context is. And like you say, it does sound because she started doing a particular kind of treatment that she has consulted with a doctor. It’s obviously important to reiterate what you said at the beginning that if you’re getting unexplained night sweats, that it could be indicative of a serious problem. So that’s definitely the first thing that you’ve got to do is go and see your doctor about that. But yes, certainly the first thing that came to my mind was menopause because it’s just supposed to be at a typical thing that’s associated with menopause, isn’t it? That you just get hot flushes and sweats because of that. But like you were saying, it’s not necessarily as simple and straightforward as that. It can be to do with a shift, a hormonal change for a number of different reasons, one that can just literally be starting to eat ketogenically.

The other key there is your first instinct was to think of menopause. My first instinct was to think of fever of unknown origin, which is this danger signal of somebody better be looking. And I think that’s why it’s important that…why don’t you see a lot of doctors out there saying generalized advice? And it’s for stories just like this saying, well I heard this doctor on the podcast say x, y, and z. And I just want to remind everybody, I love teaching about the ketogenic diet and answering questions, but I do not replace your doctor’s relationship. I’ve had a lot of folks reach out to me saying, how do I find a doctor like you in my area? And I would say take them my book. And I’ve had so many stories come back where they’ve said, I just wanted my doctor to open up their mind and see this. And I’ll be honest, I’ve been that doctor where people bring me a bunch of things to read and I do try to read them, but sometimes it’s like if I take a bath in activated charcoal, my fingernails grow better. And I’m like what? You know, some silly things that you’re just like, I don’t have the space for that. So when you first start saying to a doctor who’s a traditionalist saying, I’m going to eat a bunch of fat and get skinny….

So instead of doing that, just take them my book and say, read the first 10 pages. And what it does is it shows the sceptic of me saying; this can’t be real, could it? I would know this if this was real. And then I unpack where I found the first nuggets; where I had to stop my practice and look into this. And then as if a sign from God said, let me practice on the person I care about the most, which was my mother. And that’s what the story does is tells you her story while I teach about this ketogenic process. And boy, I’ve had some amazing messages back saying, that’s what I did. I took him the book, and by golly he’s doing ketosis himself. So I would encourage you go to Google type in Any Way You Can, and take the book to the doctor if you want that. But do not take medical advice from me over a podcast.

No, exactly. Nothing beats that relationship with your own GP. But potentially you can influence them to change their opinion. I’ve certainly worked with my GP over things. I haven’t managed to…there’s certain guidelines obviously that they all fall within. And obviously as you’ve heard, I bump up against those with having the low iron, but he was very receptive when I went in and spoke to him about retesting my thyroid and treating with T3 and not just T4. So it’s always worth having that discussion with them, isn’t it? Because they are there ultimately to help you get as well as you possibly can.

Yeah. And I contend that relationship is not replaceable. That it is an incredible privilege to sit in front of someone as they tell me about their healthcare, and that I get to be on this journey with them. And with that responsibility is a host of education and commitment to saying, okay, this is my job to help you, and that cannot be substituted through a podcast. So just don’t surrender that they’re going to know you better than me. And if they don’t quite think like you want them to, help them.

Exactly. The point we’re getting at through this discussion of different topics – and it’s something that I really love about what I see happening with women in particular who embrace keto – is that sense of empowerment, and the self-confidence to be able to help drive their own health treatment even if it means arguing a bit with their doctors. And putting across things that they’ve discovered because they get to know their body better with these little tricks that you shared with us, like about pressing your thumb down on your shin. But these seemingly silly little things, but all add together…getting your numbers, getting your blood glucose, your ketones, all the rest of it…really getting to know yourself well gives you that empowerment and that confidence to say, no, I know when I’m well, I know when I’m not well. Here’s an idea of what my treatment could look like. I think when they really – doctors I’m talking about when I’m saying they here – when they really see that you’re really invested in your own health, and you’re prepared to put the work in and really work with them, I think they’re more likely to help you rather than if you’re just coming in with a list of problems all the time without potentially seemingly to want to help solve them.

It’s very powerful. I like to write and I think the stories that you get privileged with as the patient…in my book you’ll hear how I heard about a ketogenic diet? A patient told me. I know medicine can have this kind of closed down mindset, that they’re in it for the drug companies, and they charge too much, and I’ll tell you the system is broken, but the people that I attended medical school, that I know are my colleagues, in their hearts, they didn’t do all that because they hate people. They want to help you. And if you can just kind of nurture that side of them, what you’ll find is very caring industry of people who’ve done a lot to help another essential stranger, so give him a chance.

Of course. Yes. I completely agree with that. Well, we have more questions, but we’re out of time. So we’re going to come back with another episode very soon. But in the meantime, if you do have comments you’d like to make, if you’ve got a question of your own for Dr Boz, let me know and maybe see it featured here in the next episode.

Absolutely. I will include in the show notes, the glucometer thing that I talked about, and I wrote out those ratios that I was talking about – where this is what I recommend, and you can find them on my website as well. But I just want to again say thank you. Your audience is amazing. And when the podcast was posted the first time, it was just such an overwhelming response of wanting to learn, and being hungry for information. So I just say, you guys are the best, thank you.

They are. I have to second that. They’re fantastic. We love you.

So I will be signing off and hopefully there’s a positive response, and we can do this again.

Absolutely. I’m sure there will be. Well, thank you once again. It’s been a pleasure talking to you again today.

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

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

I am doing great. Thanks for having me back, Daisy. This is a true privilege. I love your audience.

Well it’s really nice to see you again and yes, they love you too. And we had such great feedback that we thought we might do a…what’s going to turn out, I think, to be a regular episode where listeners can ask Dr Boz their questions, and we can go through them and have a bit of a chat about different things that come up.

I also got quite a bit of feedback when we were on and just had such positive response for explaining what we did with just listening to your story and your headaches, and how important sleep was in the equation of really repairing and resetting a metabolism. So I just want to say thank you for being willing to share your story and how many people it helped by just sharing where you’ve been, and being a little vulnerable to say life for you isn’t perfect, when it isn’t for anybody. But when you share it publicly, sometimes it can make people nervous and they shy away. But you were able to just talk through your history and what those headaches had done and how they had evolved, and where the sleep a story came from. And just a lot of great feedback saying I learned so much by listening to that.

It’s funny because I did mention in the intro, or the…it was probably the outro actually…I mentioned that I do have a tendency to stay online too late. One of the reasons is, because in the main I’m talking to people in America who are at least six hours behind me. So obviously that’s a problem. But I asked people to tell me off if they saw me up past midnight. And people have been very good at telling me off. Unfortunately, I don’t always listen, so I feel like we have a bit of a follow-up coming on, so I will have to own up to some of my sliding tendencies.

The beauty of 20 years of practicing is, when people talk about the changes that are made, boy, there’s so much that’s involved in a behavioral change. It is more than just a doctor saying, the science says, if you don’t want dementia, you should get eight hours of sleep and it should match the light versus dark hours. Okay. So there’s the science. Now add the humans. And man, we messed that up so many ways for so many good reasons. And I think if you’re looking for two mantras that I use and how do you change behavior? The two tested-over-time things I continue to tell myself or encourage a wife who’s trying to help a husband, or a son who’s trying to help a bro…someone who’s trying to help anyone…the two things that have stuck throughout time when you’re trying to change behavior is…focus on improving you. And stay connected to the person you’re trying to change. So that whole scolding, shaming, belittling people for not making the best choices, that doesn’t improve behavior over the long run. You’ll get a short term improvement, but nothing that is sustainable. Sustainable acts come from seeing a model behavior, like somebody who is trying to work on something themselves. And then if you want to change somebody and you never speak to them, you’re never in their life, it’s pretty hard. Stay connected, and keep working on you. So in that aspect, how have you been?

Well I have to say overall that I improved. It had got to a point where it was so bad as I think I said…talking about my sleep, this is…that I was often not starting to sleep until the sun was coming up. So, I’d really set myself up for the worst possible case scenario there. And so I did start pulling it back and I did get very good about getting to sleep. Or at least going to bed – because it can take me a while to get to sleep – but at least being in bed before midnight every day which is a massive improvement for me. And that has slipped, but it certainly hasn’t slipped back to where it was, but it’s still often…I’ll start thinking about it. I’ll look at the clock, and it’s 11 o’clock and I think, right, I really must start winding down now. I’m not going to start watching another television program or I’m not going to start doing something else. I’m going to start winding down whatever I’m doing with the intention of being in bed by, or before, midnight. And then before I know it, I’ve got involved on questions or comments in my Facebook group or something like that. And before I know it, I look again at the clock and it’s like half past one, two o’clock! And I’m like, oh no. And so then I shut down and I do, right, I’m going to bed now. On average I would say it is more like a half past one, two o’clock, which is a slip, but it’s not back as far as it was. I have been aware of that and I have been thinking, yes, I must get good again about bringing it forwards.

I tell you my biggest problem, and that is getting up in the morning. I can remember you saying when we spoke in the first place, I can’t do anything about telling your brain when to go to sleep, but I can tell it when to wake up. I tell you the problem. I will have great motivation and resolve when I’m going to sleep. I think, yep, tomorrow’s going to be the day that I start getting up on the dot of whatever it is, seven o’clock…it’s never going to be seven o’clock…eight o’clock in the morning; at least set myself a time that I might achieve. That’s it. Eight o’clock I’m going to be up. I’m going to be out of bed. But when that comes around and the alarm clock goes off, it’s like no, it’s just not happening and unless I’ve got somewhere I have to be for a certain time, my resolve and my motivation just completely goes out the window.

And then of course by getting up later…although I am better about pulling myself up and getting up before a certain time, so I don’t let it go as long as it used to…then I’ve slept too long, which of course then makes it more difficult to get to sleep at a decent time the next night when I should be asleep. So it just keeps having that knock-on effect because I am one of these people who ideally does like a nice solid eight hours sleep. And so just do the maths. It’s not difficult. If you haven’t got to sleep until two, three o’clock in the morning and you still want that eight hours, that’s why it’s so easy for it to keep getting later and later. I do know that that is probably the answer but I just have to make myself get up. I can be 100% resolved to do that, but when it comes around to it, it’s really, really hard.

Let me give you some encouragement. The human brain really only can perform its best for 16 hours. So as you look at what we’re trying to do is we know that that circadian rhythm, which is set by sunlight and as much as our electronics and our lights have messed with that, there still is signal in people who do the night shift, that they have a circadian rhythm that is still present in the morning. Now they end up with other rhythms that show up years later with a night-shift worker. But when you study their brain performance, when they took people who are sleep deprived. The study starts with medical students. So they want to get a good grade. They’re very motivated to follow the rules. They get put in a sleep lab if you would, and without any distractions over the next three or four nights, got a really nice, good reset of sleep, so their sleep debt was kind of caught up. And they wake them up and they do these tests of intelligence. Kind of like how do you solve a puzzle, and how quick can you put this pattern together? And so it’s kind of like an IQ test and it’s timed. And you know they’re smarty pants and so they did really well. And then they keep the students up for 24 hours and they did the test again. And then they kept them up another 24 hours and tested them at 48 hours. And then they let them get some sleep, and then they go back to their life, or not the life, but they go back to these places where we can monitor their sleep. Instead of giving them eight hours of sleep like they had before the tests, they deprive them of one hour. And they did that for a week.

At the end of the first week…now its seven hours instead of eight…I am a mom, I’m a doctor, I have a full life, and this is naughty that they did this and told us because it’s seven hours instead of eight. At the end of a week, they were functioning as if they’d been awake for 24 hours. If you extended that seven hours versus eight hours for two weeks, they were functioning as if they’d been awake for 48 hours. So the brain’s cognitive efficiency, its ability to perform has such a profound performance level of making good decisions, making reproducible, efficient, and calculated decisions based on rest. Based on eight hours of solid sleep…how are you doing? And if you’re waking up, there’re points against that. And if you’re not in bed for that long, you’re certainly not getting the right hours.

They then let the students sleep again, retested them at the eight hour level. They went back to their performance that they had before and then they let them sleep six hours instead of eight hours. And at the end of one week they tested as if they’d been awake for 48 hours – two days. So the people who say, I can live on six hours of sleep, we have really good evidence. It shows what you’re sacrificing is the mental acuity, very efficient performance that can only be found in the human brain associated with good rest. I get a lot of questions about why are my sugar’s high or Doc this keto diet isn’t working for me, and the first thing I’ll talk about is their sleep. If you want your weight loss to continue, if you want your body’s metabolism to go back to what it was designed to be – which, we aren’t designed to be obese – we are designed to be a body weight that’s pretty close to that BMI chart as much as that gets negative reviews from the masses. But that body weight, it matters and your body will gravitate back towards that if you give it the right tools and the right settings. And one of those settings is the reset that happens in your mind, in your brain, in those eight hours of sleep. So now that’s the science. Now how do we help a behavior change? So let me give you some good ideas. It’s not that you’re maliciously staying up. You’re staying up because it’s been a pattern. You set a pattern and there’s something comforting about listening to a story, whether that’s on television or podcasts or books or reading. So escaping your life into a story has been a tradition for thousands of years in our human race that we use stories to kind of cope with life or learn life.

And you’ve got one of those habits. That’s not a bad habit. That’s better than drinking. Better than using other forms of escape where the habits can really hurt people too. So we say, how can we transfer the comfort that you give yourself with those stories to something else? And I would encourage that to be a desensitization skill or reset. And what I mean by that is, if you say, okay Doc, I’m not going to watch a movie, but I’m going to play scrabble or I’m going to play online a bubble-popping game or something. Again, that’s an isolated activity with an electronic instead of a human relationship. Those lights are very stimulating to the pineal gland, which is what our circadian rhythm is set from. So if instead you said, okay midnight’s the goal, I would actually push you back to about 9:30 that you turn off electronics, and even if I know…

Yeah, I’m making a face!

So you find something comforting that you can do to help reset yourself. I’ll give you some suggestions. These are things I’ve had patients do over the last couple of months, maybe six months, that I’ve just really found helpful. I don’t know if you have them in in your country, but in America there’s been a kind of a swelling of something called a float. It’s a really dense, highly saturated water filled with Epsom salt, which is again, a magnesium base. It kind of mimics the dead sea salt that you can’t sink. So these little spas have essentially a pod. It’s like a bathtub that has filters that clean the water when somebody’s done, but the pods or the tank has such a high viscosity of like 1100 pounds of salt in the water.

So you can’t sink and you’re in this pod, and they turn off all the lights, and you have ear plugs in your ears, so there’s no sound; there’s no lights. And then there’s this infusion of magnesium. Magnesium is one of the things we know can be absorbed through the skin; especially when we’re trying to shut down our minds. If they’re low on magnesium, this really helps. Now if your magnesium’s normal, you’re going to pee it out. It’s not going to be any big deal. But one of the key signals that your brain will receive is a timeout. Jason Fung does a really good job of talking about removing a signal and that is the best way to reset it. Not decreasing it, but removing it. And same thing goes for the sounds and the lights.

You really feel like you’re floating in space because you can’t sink. Most people fall asleep by the time the hour is up because their brain just really finally shuts down. And I will contend that if you signed up for like three floats, by the third float…I’ve had such positive response from patients trying to reset their sleep habits saying, I’m trying to find something that can comfort you. Most of the spas here are open until 10 o’clock at night. So if you took the nine to 10 o’clock spa, on Monday, Thursday and Monday, over a course of 10 days, you would be amazed at how well you feel by just removing all sensation. Now you can do this in your own bathtub too. An Epsom salt bath in your own bathtub would be fine too.

What you want you might not do such a good job of – because you’re all by yourself – is you’ve got electronics in your house and you’ve got distractions, and you got on the telephone and you’re texting, and you’re listening to a book. So it’s not the sensory deprivation that happens when they do these little spas. Just try to remove all of that input. And boy, what a great antidote. Other things that I know are out of tradition, but are very helpful for the human brain to shut down when you’re reprogramming sleep, is to get a pencil and paper and just journal.

Some people don’t like the journal part of it and I do a workshop on brains of addiction and how do we break cycles? And one of the little activities I do is a three minute timeout. Nobody in the whole workshop – and I’ve had as many as 200 people in the room – nobody can make us sound. No burping, farting, laughing, nothing. Three minutes of complete silence. And then they take the utensil, should be a pencil in the wrong hand. So if you’re right handed, it goes in the left.

Ah, yes. You mentioned this before. Yes, doing the cursive L’s.

And that little rhythmic…just give yourself a three minute saying, I don’t want to do this. I want to keep doing my electronics at night or whatever keeps you awake. That habit is powerful. It sounds silly. Like what could this possibly do? But I do a lot of work in jails and of course they just sit in the dark and if they’re anxious, they have no tools to start.

And I can’t tell you the number of letters I’ve received over the years saying, you came to the jail, you might not remember me, I did your silly little loop thing. I still do it to this day because it calms my brain so quickly. And there is something about the cursive language, the cursive writing – even if it’s just an L loop, it doesn’t have to be words – that’s rhythmical and almost like hypnotic, a form of meditation for your brain. So I’m going to encourage you to detox starting around that 9;30/10 o’clock hour, giving two hours of anything to comfort you that doesn’t have to do with electronics.

Yes. That’s certainly going to be a tall order? I can certainly see the logic in what you’re saying and yeah, I’ve got a very logical brain, so that always appeals to me. But yes I live in the middle of nowhere in rural France, so going to one of these isolated…that’s not going to happen. But as you were talking about it and then you did say towards the end, it’s something that you can do at home. I do actually have a tub of Epsom salts, so that is something I can do. And yes, as soon as you mentioned journaling, it’s something that I encourage people to do, especially if they’re trying to find a problem. If they’re saying they’ve got a problem of some kind, whatever that is…their weight loss has slowed down or whatever it is, I always encourage people to journal. So it’s something that I should start doing myself again because I have seen the benefits of it. I think it is a good way of just downloading those worries and concerns that you’ve had during the day instead of…and I’m very much the kind of person…I call it brain whirring, and I go to bed and certainly if there are things I’m still worrying about, they just go around and around and around in my head, and I can’t get to sleep. I just lie there and I potentially lie there all night not being able to sleep. So yes, I can see the benefits of calming yourself down with the magnesium bath, downloading all those concerns onto a piece of paper and then going to bed. That sounds like a very good night-time routine.

Yeah. What you’re trying to do is bio hack it a little bit, which is keeping in mind the brain only performs for 16 hours a day. You are human. That’s the limit. After that, you’re really hurting yourself. So shut off. To shut off at 16 hours can be like trying to flip a switch when you’re a human. So adding magnesium definitely calms down the body. And one of the best, most relaxing ways to do that, I contend is still the skin. A nice warm bath – 40 minutes of pretty tepid water has got some good evidence behind the replacement of magnesium, and now you’re adding tricks to your shutdown process that help protect you. Like remember that 16 hours is all you get. After that, you’re going to have to undo this somewhere in the future. Maybe it’s not tomorrow, but somewhere you’re going to pay the price for the poor performance you’re doing because you’ve been up too long. And then the next step is find things that comfort you. Find things that just help offload that stress.

Yes, and getting a bit more strict about the mornings. I’m one of these people who is really just not a morning person and feel so groggy if I get up early. But you just have to get through that and establish these new habits. I can see myself and I remember you saying before that whatever you feel like, you’ve just got to stumble through that grogginess until it becomes a habit and your body is used to getting up at that time of day, and starts to get alert that bit faster.

You had the advantage last time that you’d just been on the other side of the pond and so the light was matching your schedule better and then you said, I couldn’t believe how much better. I felt. I’m like, yep, that’s how that works.

Exactly. So I know I can. Yes. That’s a very good point to remind me of that actually because yes, I’m sitting here saying that I get really groggy if I wake up early in the morning, yet when I was in America for just over a week, I was awake and alert at half past six in the morning, and I didn’t have what I tend to get here…if an alarm goes off, or even if I wake up early my tendency is to just feel groggy and go back to sleep. I didn’t feel like that at all there. I was quite happy to well, I’m awake, I’ll get up now. So, you’re right, it’s obviously possible for me to do it. Just need to establish a habit.

Right? So the good news is, is that you and many people trying to change behavior, the most powerful part is to not scold yourself. Just have forgiveness. This is a habit. This is how you change it. Set up some things that make it easier. Like don’t have a super dark room that allows you to sleep when the light is up. And I know that, we want darkness when you sleep, so don’t have the neighbors light shining in there.

Well actually, yes, that’s a precise advantage that I have, and I only have very light curtains actually if I draw them, but I never draw them. Yes, there’s no light coming in from anywhere unless it’s daylight. So yes, it’s perfect for me to just leave the blinds open. So yes, that morning light comes in, although obviously in the winter it comes in later, but still…

Yeah. Well you can have a couple more hours of sleep in the winter and still stay on your circadian rhythm. How have your migraines doing?

Yes. Good. I still get them, but not too often. And I think that they were tied quite a lot to hormones. I’m definitely in that peri menopausal period, and hadn’t had a period for ages – since May. I didn’t have one for about nine months and, no, I wasn’t pregnant. And then they came back just for a little while and then they went away again in May, and all of a sudden earlier this month, I got one again and I got more migraines associated with that. So I think there was a tie in. So I think that has kind of helped them diminish. But not bad. I would say on average I still get probably one a week. I’d like it to be one a month, but certainly better. Better than they were.

So that’s progress. We’ll keep going on the sleep and I would contend that when the sleep is stable, the migraines will be even less.

Yes. I can believe that. I completely can believe that. So enough about me.

I know you’re always a little hesitant to share, but I just think it’s such a great teaching opportunity. So thank you for sharing. The good news is, is you’re the leader of a tribe. So when you sent the casting call out to say, does anybody have questions? Wow. Look at all the questions you can get.

Yes, we got pages and pages. So I did mention in the post that, don’t worry, there’s going to be more than one episode. So yes, we’ve got lots. So let’s get stuck in, shall we? Okay. So the first question is from Terrilee: Heart failure patients like myself are informed to limit salt. How do I keto on low sodium?

That’s a great question. I’m going to use a couple of patient examples to do some teaching. So my dad is 75 and he has an injection fraction, which means the percentage of blood that’s pumped out of his heart every time it beats is under 50%, somewhere in the forties. And this is officially what they call heart failures. When you’re squeezing that blood out of the heart every time, if it’s more than 70%, 80% of the blood that goes out of the chamber every squeeze, that’s considered normal. As that muscle either gets too thick or becomes damaged because it got low on oxygen, that transition has a failing rate and it cannot squeeze as much. When somebody has heart failure that term is a representation that the blood going out of the heart, doesn’t have the power behind it that it used to.

So people say, well, do I have heart failure? And one of the best ways that I start to look at heart failure is to go to your shin bone – the part of the front of your leg that’s between your ankle and your knee. And I don’t want you to touch on the muscle. I want you to actually go to the shin bone. And this is a place where you don’t store fat. It should be bone. It should be skin. If you’re dissecting a human being, it should be skin and then bone. So I have the patient usually put their foot up on my knee and then I take my thumb and I push on their shin bone. Usually they say, ow! What I’m trying to do is push on the thumb enough to make the blood not come into my thumb.

And again, I’m pushing on their shin right against the bone. And I push there for 30 seconds. If you think you have heart failure, this is one of the places where I would have you do this. And I’ll tell you, even I’ve had times where this thumb print, after 30 seconds I lift the thumb up and I run my finger over the shin and I can feel the indentation. Fat does not leave an indent. Fat does not leave an indent. Fluid that’s in the wrong spots – called oedema, the fluid outside the blood vessels – you’ll leave an indent. And this is one of the markers – there’s several, but this is one of the physical exam markers that you can do at home that my patients, I ask them how deep is the thumb print today. And this helps them measure how they’re doing in their heart failure.

I can always do the fancy tests like the echocardiogram where we can measure your heart, but when there’s an indent in your shin, it’s one signal for me to say that your heart and your kidneys aren’t getting that fluid out. So if you want to make the fluid worse, add a bunch of salt, which is where Terry Lee’s question comes from. If you’re on a keto diet, we talk about that fluid, that volume of fluid inside the blood vessels, it drops so quickly and your kidneys flush out the sodium and potassium and magnesium, to kind of keep up with the fluid coming through the kidneys, that you can get dehydrated. And so we say add salt, add water. Okay, now you have heart failure. So in the setting of heart failure, I tell my heart failure patients to look at their indentation on the shin of their leg.

And even if you don’t have heart failure, I do this sometimes too to see how much fluid am I retaining. And when I’m feeling kind of punk, if I have swelling in my legs, it’s another signal that things aren’t working as efficiently as they should. Your lymph system, your blood pressure, your kidneys are all part of how that fluid stays out of that space. And when it sneaks into it, it says you might be falling behind. So when I have a patient who’s on a ketogenic diet and they’ve had a history of heart failure…say my dad, he checks his weight every morning so he can tell you what his weight level is. The first few days that you do this, it’s kind of noisy. But if you get about 15 data points of weight, you’re going to see what’s your typical weight. But the other thing I like them to add is how much fluid is in that space, in that shin bone.

And so if they have a big dent, a medium dent or a little dent – that tells me is it okay for them to add more salt? So if their weights are doing okay and they have a pretty strong thumb dent in there, I’m going to tell him not to add any salt until that that fluid is out of the shin bone. Because it says the body’s got all this extra fluid. The other part that I have been very encouraged by with people with heart failure is that, sodium is one of the many electrolytes that hold on to the fluid inside your blood vessels. And you’ll know when you’re low on sodium because you get intensely thirsty. So listening to that signal is way more important than my blood tests, than my thumb pressure.

When people are intensely thirsty, it’s a sign of dehydration and sodium being low. And I don’t just mean I feel like I need a drink of water. When you look at heart failure patients that are constantly thirsty, their sodium is often low. But my heart failure patients have to follow up with me pretty closely on this ketogenic diet, and once they get the rules of where their body’s at, once they get through the transition, then I use these things like, we look at blood pressure because blood pressure also tells you what’s the volume of fluid and how well is your heart pumping through those hoses. And then we look at that little indent on their shin as a way to say, how are you doing? And if there’s a big indent on their shin, I tell them to lay low on the salt, please don’t add salt right now. Your body needs to get rid of that fluid and the salt is messing up the equation. So it’s a long answer and it’s complicated. So if patients have heart failure, the degree is also very important. That’s one doctors should be walking with you on. And I do encourage patients to know about their own, like check your shin, see how much fluid you’re storing.

Yes, that’s absolutely fascinating. And I’m totally biting at the bit to do it myself now but I’m going to have to wait until afterwards. But yes, it is a standard thing isn’t it? I hear it all the time. And I say it to people all the time when their saying…especially when they’re starting keto and going through that carb withdrawal stage, if the having headaches…it’s one of the things that I do if I’ve got a headache, is to take some more salt. It gets thrown about a lot, take more salt. Are you getting enough salt? And recently I’ve been regularly measuring out a teaspoon and a half of salt every day and making sure I take it through the day to see if it has a beneficial effect because I hear it so much and I say it myself so much. It’s just interesting that it’s just another one of those things that is potentially a general rule, but you have to be self-aware of what’s going on in your own body.

And I like these simple tests you can do on yourself that just increase that self-awareness of your own health. So when you hear one of these people throwing out this generalization, eat more salt. Well, yes, okay. That’s okay if you say it, but it’s not necessarily going to be right for me.

Right? The other part is that if you have healthy kidneys and a healthy heart, salt is easy to get rid of. Your kidneys are really efficient at wasting it into your urine. So healthy people, if they have too much salt, their body gets rid of it. They don’t say, oh, salt makes you swell. Well not if you’ve got good kidneys and you’re hydrated. I can have a bunch of extra salt and it doesn’t do that if you’re healthy. I would contend that most people starting on a ketogenic diet, or coming from a place that their health hasn’t been great, which might be what attracted them to this. If you’re a seasoned keto producer the salt has a lot more forgiveness. On that first journey when the water’s coming out and the shin thumb print is heavy, you might need a little help guessing what’s the right replacement? And the scale gives you a pretty big hint too.

Hmm..interesting…very, very interesting. Yes, I will definitely hold off on throwing out that general advice. Just take more salt because it’s not necessarily going to be appropriate. It’s more a question of maybe more salt. Perfect. Okay.

Question from Sandy. She has a question about avoiding healing diverticulitis. Since a recent visit to hospital, she was just discharged a few hours ago when she wrote this question. Does a keto diet encourage…or I guess what she means by that is to potentially bring on an attack…because it’s diverticular disease. I know it a little bit about this because my stepfather was diagnosed with it. Diverticular disease, when it has a flare up is diverticulitis, isn’t it? And so obviously that’s what she wants to avoid. Does she need more fiber to avoid recurrences? You get the point, what can she do? She wants to avoid this happening because it’s obviously very painful. And I know there are all sorts of things that are said about what you need to avoid eating to avoid an attack. Like people talk about avoiding seeds or things that can get caught in those diverticular…because they’re little pockets, aren’t they? So perhaps you could just explain…better than I have…exactly what the problem is. And I know it’s something that’s very common as well, because I looked up the statistics and apparently it’s something that’s very typically you have, once you get to a certain age, but perhaps just explain a bit more about what it is and f keto can help. What maybe you need to avoid to having an onset of this problem?

I love this question. It is near and dear to my heart. The book that I wrote, which is about my mom at 71 who had had cancer for over 10 years; and her cancer was in the white blood cells. The way we first found out that she had cancer was she was put into the hospital for a diverticulitis attack. And 10 years go by with chemo, and not chemo, and life, but all along this diverticular disease continued. And when the book starts she had had a few flares of a diverticular problem, and that’s when I started the ketogenic diet. At 71, knowing she has hundreds of pockets of these diverticular outpouchings in her lower colon. So let’s just describe what diverticulosis is. As you look at the stools passing through the large colon, when it gets to the last section – I would say like two feet before the rectum, two feet before you go to the bathroom – there is an increasing water removal from the stool. So the stools become more bulky. During that phase the pressure inside the colon over years of life can be so much that it causes a weakening in part of the last section of that colon. And there is an outpouching.

So everybody’s heard the word colonoscopy. If you’re doing a colonoscopy and you feel that lower colon full of air, you can see that you’re taking these little outpouchings and you’re blowing up a balloon, essentially. So the inside of the lumen, the central part of the colon, is filled with air and it puffs out these little diverticula. But they’re not reinforced with a nice muscle layer. They’re very thin casings around this balloon. If you have one or two of them, no problem, but if you have hundreds – you don’t usually end up in the hospital without quite a few of them – what happens is that as the stool traverses from that last two feet, if you get some stool stuck in these pockets, it doesn’t have a muscle to squeeze it back out of there. You just have to hope for the movement of the stool, and the kind of forward motion to empty them out. And if the stool gets stuck in there, it’s an abscess and that’s going to require surgery. We try to reverse it with fasting, and with nothing by mouth, and some antibiotics in the veins. We do all kinds of things to reverse when you get close to the danger point. But if indeed you do get an abscess in that part of the colon because of diverticula, it’s a surgical emergency. You are going to need a surgeon.

She’s right to have a fear that the surgeon seems to think that she’s going to have her colon cut out. And I just want you to see with my own mother at 71 in the last section of her colon with hundreds…I mean you can probably say thousands…she had so many diverticula, it was too many to count. I put her on a ketogenic diet. So that gives you the answer to say, is it safe? But in that same aspect, there were several things that were helpful for her to process and live life without upsetting her diverticular disease. They talk about not having seeds and not having popcorn, isn’t it? But that turns out not to be that significant of a finding. What we think is a better progression of helping this disease state settle down…because having a little pockets isn’t going to hurt you at all. You won’t even know they’re there…it’s when they become inflamed, which is when we take the word diverticulosis, and we turn it into diverticulitis. That’s what will end you up in the hospital.

Those hurt, they have lower pain, sometimes their bowels stop moving, and that really does require a surgical emergency. My patients who have diverticular disease and have been flipping in and out of diverticulitis, I will really be strict about the times that they eat. Bowels rest when you’re not eating. So if you read the book, what happens with my mom is she does really well on the ketogenic diet, and then she gets a dose of IV sugar. She gets an IV in her arm and sugar goes into her veins, and everything swells up including those thousands of diverticula.

So again, it comes back to this how we talk about inflammation, and how keto reduces inflammation. And I was just thinking earlier, when you were saying that about it getting infected, but inflammation is presumably what starts causing all the pain that you get.

Yes, that’s exactly where I was headed with that. She had such an infusion of sugar and then it inflamed anything that was delicate. And in her body, that section of her bowel was delicate. And it swelled up so much, it swelled the colon shut.

Wow.

Yeah. At which point we did the most powerful thing to help her diverticula, and she fasted for over a month. And if you read the book, you’ll see what happened during that month and how many things changed. But thank goodness she’d been on a ketogenic diet before that, so her body and her mitochondria were totally ready to use ketones as a fuel. And she lasted over a month before she actually did end up with surgery, but she should’ve died. She should’ve died. She should’ve died. Because no, there was no stool coming out her bum – it was all blocked.

And that was…you’re supposed to die, so… The point I’m making is that when I look at what things do I encourage my patients to do when they have diverticulosis who’ve had flares, is time restricted eating becomes really powerful. What time restricted eating means is you start the clock with your circadian rhythm in the morning. So the sun comes up and your clock starts. Now I want you to limit that you only get the next 12 hours to eat. Now I have people play games and say, but I want to eat at night. And I’m saying, nope, you don’t get to move your circadian rhythm, especially in the world of improving your immune system and that inflammatory response. So keeping the time restricted eating from…my mom has her first cup of coffee in the morning around 5:30 or 6:00, so I tell her she can’t put food in after five 5:15 because I wanted it out of the stomach by the time those 12 hours are done.

That doesn’t mean that you’re gobbling it down right at the top of that 12th hour. That doesn’t work. I need you to be finishing the eating at the 11th hour so it’s out of your stomach by the 12th hour, giving you 12 hours of time restriction where your bowel gets to reset and rest. And if you want to look at the best protection against a diverticular disease, it is time restricted eating. The colon gets to rest when you stop eating. And so if they snack all day long, and what many people don’t realize is that your metabolism begins the first drink you have in the morning, especially if there’s anything in it. If it’s water, you can make the argument that you’re continuing a fast, especially if the volume of water is, I don’t want, people tend to have low volumes of water, but if you’re looking at a trial, how does the GI start its secretions, and the liver start its metabolism? Circadian rhythm matters, the sunlight matters. And then that first gulp of a significant amount of liquid will start your metabolism going. My mom drinks coffee. That coffee is her first thing in the morning, and from 12 hours after that I want her not eating anymore. And that’s what I do with my diverticular patients. That’s difficult to do. We talked about changing habits with your sleep patterns, but it is just as difficult when I ask a patient to say, I want nothing in your mouth after, essentially 5:30.

Yeah, that’s another thing I’m a shocker for. So that time restricted window, but also you did mention there, so there’s this benefit as well in not eating too often, even within that window.

Right. The first place I limit is to get them to only eat during the 12 hours. The second thing is I want you eating your food in a bolus. And what that means is eat, feel full and then stop. And that kind of bolusing of food, meaning not trickle it in over time, it gives the bowel times to rest, which is really important with the diverticular process. So when it comes to fiber and other things, a ketogenic diet does not tend to be high in fiber. I’ve told patients forever how important their fiber intake is. As I’ve transitioned into a ketogenic way of living and really looked at some of the evidence that says, if you time restrict, if you eating with a bolus, that gut lining is actually pretty healthy.

It’s not a mandatory. There are lots of times where our bodies went without significant amounts of fiber. Fiber has been the mantra in the medical literature though, saying, keep the bolus really full of fiber in those last two feet of colon if they have diverticula. And again, the science behind that is to say, don’t let the stools slip into those diverticular pockets. And the way you can kind of hold the osmotic pressure is to keep the fiber in the stool. And that’s one option. But I would contend you got to eat a lot to do that, and on a ketogenic diet it’s going to be really difficult to reach the threshold of how much fiber is necessary. I would push you to time restricted eating, and eating a real meal when you eat.

And it feels logically to me that if you can improve how everything’s behaving in the first place – so your colon and those diverticular are less sensitive, less inflamed in the first place – exactly what you’re eating becomes less important anyway.

Yes, I’ve seen the process of inflammation reverse at such a profound level on the ketogenic diet, better than anything I’ve done in 20 years as far as prednisones, or really strong chemotherapy drugs to kind of shut off arthritis, and shut off Crohn’s disease. You have these powerful drugs that will shut things down, and they are amazing. I’m thankful to live in this generation of healthcare. But when you added a ketogenic diet – which kind of got to the root of where this inflammation was coming from – not only did those medications work better, but some of them got off of all that. And that’s been another place where you look at what’s going wrong with the diverticula? You look at all the people who have diverticular outpoachings, and it’s a big percentage of all of us.

Inflaming those is an immune system that’s kind of teetering on the edge of not protecting our bodies as well. And I contend that the longer you are on a high fat diet, the better you supply the body with the nourishment to have a stronger immune system, to have those lower inflammatory responses, or at least not overproduce the inflammation when you have your inflammation response.

So if you have this vulnerability, if you like, if you have diverticular disease, you’re on keto, great, because it’s going to put you in the best possible position for these episodes not to happen. But I have read in my Facebook group, people who’ve had the odd attack. So the chances are that the reason that’s happened is that maybe they’ve gone a bit high carb for some reason? But presumably, other things can impact that inflammation. So maybe, again coming back to lack of sleep, or maybe they get stressed. All those things I guess, can potentially inflame things and make them really hyper vulnerable to an attack.

The other part about what you just said is that there’s this guessing, like oh, I’ve got diverticular disease…I don’t want to have diverticulitis…how can I protect myself? And I give this generalized answer, like this is what I do generally, but I don’t skip the part where I tell this patient, you should help me. Help me see what’s going on inside your body. And that really comes with checking these biomarkers that you can do at your home. That is your blood sugars and your blood ketones. It is one of the things I do on Instagram. I start a fast every Sunday and I fast until I hit a biomarker. I call it a ratio of 40. This is again trying to hit that autophagy; how to keep my body’s inflammation low; how to keep my body burning on a ketogenic journey.

Not because I have some super goal for myself… I’d like to lose a little more weight, but I like the way my brain functions. It’s almost a way to keep you accountable. I have patients who are looking for examples like, nobody fasts. Okay, I’ll fast and I’ll post my numbers on Instagram. This is possible. Then I have other patients that do it and they kind of send me the numbers and stuff. The point I’m making is that if this gal really wants to know what’s wrong – am I at risk for having a flare? Check your numbers. In my mom’s case, I would have her check her blood sugar first thing in the morning. For the ladies, put it next to the toilet. I don’t want you going letting the dog out, going and making them a cup of coffee, I want you checking it right when you empty your bladder in the morning. Put it in that place where you go to the bathroom and check your blood sugar, and then check your blood ketones. I can tell you that not only does that help me when the patient tells me, but it’s such powerful feedback for the patient to say you’re waking up in the morning and I know you think you’re on a ketogenic diet, but your ketones are less than 0.3 and your blood sugar is still 95 in the morning. And I think that helps them see why I want you to time-restrict that eating is because you didn’t empty your liver last night, you still have leftover carbs that your body is still producing and fueling off of, and now you don’t get to push your circadian rhythm back.

Your body already started when you woke up this morning and the light hits your eyeballs, and the first cup of coffee hits your stomach. Those break the fast in the sense of this medically-restricted diet. You can talk about fasting in another realm, but if you’re looking for how can I help this diverticulitis not to happen, I want the blood glucose divided by the blood ketones – I want that ratio to be less than 40. The more days she can hit that, the better I know she’s going to be protected from a flare. If she really wants to stay away from the surgeon, that ratio is what I would encourage her to reach for. With my mom, who had this problem and then she had cancer, we wanted her ratio to be less than 20. And I know that when you’re using the metrics for the European glucose versus the American glucose, you guys use a GKI, Glucose Keto Index, because you’ve got to divide your glucose by 18.

It’s a one-to-one ratio in your market. But in America you’d have to divide the glucose by 18, and then you have to compare it to your ketones. And then you want a one-to-one ratio. And I’ll tell you that was too much math for my mom. She’s a smart woman, but she was sick and I needed something simpler. So I took the glucose divided by the ketones, and if we could get the number under 20, we hit our goal. And we were super strict. When you read that book and see what we did during the time where her diverticula had blown up to the point where she couldn’t have a bowel movement, we only reached the ratio of 20 a couple of times.

But she fasted and you can read what that’s like in the book. She did that for all 34 days or something like that. In my case, I tell patients if you want weight loss, if you’re trying to get off a plateau – and I know several of the other questions were about what happens with a plateau – I tell them, look at your glucose first thing in the morning, divide it by your ketones, and if your ratio is 80 or less, you’ve got a pretty good chance you’re going to be in a weight loss zone. You don’t hit that once a week. You need to be hitting that every day if you want to lose weight. If you want to take it to the next level, which I encourage my patients to do…is a form of autophagy. And I talk a lot about how you recycle that body.

This woman has diverticular, which means things have gone wrong. That’s not normal. As much as it’s a population in 2018 – where most of us have this, if you go back and look at mummies, they didn’t have this problem. They had a different lifestyle, a different diet, a different body mass. Their insulin levels were nowhere near as high as ours have been as a population. So just because it’s common, it doesn’t mean it’s normal. So here she is, later in her years trying to say, uh-oh, this has happened. Can I undo this? And I don’t make any claims about undoing diverticulus, but I know that autophagy helps to recycle those broken cells; those broken parts of inside the cell; the debris that’s in your brain; for dementia; for cancer prevention; is linked to how well you hit autophagy at a regular routine basis. So these fasts that I start on Sundays and I post my numbers for, once I hit 40, I then go back to eating a ketogenic diet.

If I was being perfect…if I had Crohn’s disease, or I had ulcerative colitis, or I had psoriasis where I was really trying to get my immune system to reset, I would set a goal of hitting that 40 every day for at least 90 days and maybe a lifetime, because it would reverse and repair and we could have a pretty strong level of confidence that your system really does have some undo buttons in it…and that’s in this autophagy state. We can’t send you to the lab and say, are you in autophagy? But we can have you looking at some of the biomarkers at your own disposal. I’ve tested a whole bunch of glucose monitors to say which ones work the best. I can send you a link to the one that I’ve found. My patients have said this for years, but now I really have pricked my finger enough times to say, all right, at least when I use this test strip, it’s giving me the right numbers.

Don’t be duped by saying we have the cheapest strips. Sometimes those are taking four or five tests from my patients to get a number. The other side of that coin is you can test, you don’t need my prescription to do this. You can be at your house in your world, in your life, and you don’t need a doctor’s visit to do this. Just order the test strips and test yourself a few times saying, well, why am I stuck? Is this possible? How hard would it be from my body to reach that? And that’s the empowerment that I think 2018 medicine really has is that as long as you have somebody gifting you the knowledge, you can really bio hack your system into a lot better health.

That’s right. There are a couple of things I wanted to say there. I love it when I’m listening to something you’re saying and it’s ticking over in my brain. Hmm, I need to change a little bit what I do. When you said about how it’s really important to make it the first thing you do, and not the thing you do after you’ve pottered around, and you’ve let the dogs out, and you’ve made yourself a cup of tea, and then you’ve…you can guess this is what I quite often end up doing. So that’s something that’s going to change tomorrow and be stricter about making it the first thing I do. But yes. So what I tend to do, I have a little diary and I put my numbers in every day.

I tend to weigh myself every day. It’s just something I do. I don’t freak out when the numbers go up and down. In fact, I find it interesting with the fact that I can see that they do go up and down for no reason at all, actually reassures me not to take it too seriously, but I write that down, and then I write down my glucose and my ketones. So yes, it’s an interesting point that it’s important when you do it. But the other thing I was going to say…you talk about the test strips and how you can do it at home, but they do add up. They can be costly. But it’s the kind of thing I think that if you can do it rigidly for a while, and then you get a good sense of how you feel at different levels…for me, I can tell if my ketones have dipped because my mood goes down and I get more headaches.

If you test for a while and you’ve invested a bit of money in doing that, as long as you carry on doing what you were doing in that period of time when you’ve been testing and you know regularly that you’ve hit that less than 40 or whatever marker; as long as you keep reproducing that, you don’t actually need to be testing anymore. It’s only really getting yourself into the routine, isn’t it? Once you’re in that routine, you know what you’re doing, you know what works, you don’t have to keep testing ad infinitum. It might be useful to come in and retest every now and then, but you don’t have to be doing it for the next 10 years.

I think of it as the cost of discovery. That you’re going to pay $200 to come see the doctor – your insurance is going to cover a bunch of that. But if you spent that $200 on just you learning about you…I mean I think the kit that I…I’ll send you a link on the one that has both ketones and glucose in the same monitor. And again, the reason I’ve kind of gravitated towards this monitor is because I have spent six strips to get a ketone level on some of these other monitors. And nothing makes me more angry than having to poke my finger again. And just that cost. So, those strips are really reliable but then more importantly, the knowledge of what’s going on in you.

This person sends in a question and I instantly have a profile in my mind from the thousands of patients I’ve seen over 20 years, but it’s a guess of what she’s like, and what the problems are, and where she’s been, and where she’s going. She could best understand herself if she did one week, just every day, get up in the morning first thing glucose and ketone numbers. And if you’re using the American numbers, you take that and divide it. And what you’re looking for is a ratio of 40 or less. And if you don’t hit that, I’m telling you, you need to restrict the time that you’re not eating, and you cannot move the morning number. You have to move the evening number. I tend to start patients at 10 hours. At the 10 hour mark, you should have no food. That gives you 14 hours of eating and then I remind them that when the 10th hour gets there, you’re not eating. You ate probably half an hour to an hour ago, because it should be out of your stomach. So I really want you truly done with food at the 10th hour so that you get the 10 hours break. And if you’re waking up every morning with 10 hours of fasting and your ratio isn’t below 40 – and that’s your profile with the diverticular story – I would contend you’re in trouble. You’re going to end up with a flare.

If you’re saying, doc, I’ll do anything; I want to do anything to not end up in surgery. Like, okay, here’s the rules: first thing in the morning, test yourself for a week. Get that ratio below 40. And if it means that your body is so insulin resistant, and you’ve been overweight for so long that you had to fast for 12 hours every day, or you had to time restrict for 14 hours every day, I’m telling you, it gets better, okay. This is a skill that you learn to say no in the evening to food. Salt and water is the only thing you get after that time. And I can’t tell you the number of patients that have walked away from some serious medical interventions because they got the numbers, they checked them. Now they usually come to my keto group because you kind of need a little support…it’s a lonesome journey if you’re doing this all by yourself. There’s plenty of ways of support: from listening to podcasts, to checking out YouTube videos to having a support group of your own. But those all have been the links to say how do you change the trajectory that your health is going…measure yourself!

Yes. It’s very true. I meant to say earlier, when I write those numbers down and I can guarantee that if I’ve had a snack late at night and because I always write it underneath, if the blood sugars up a bit higher than it should be – than it normally is – maybe the ketones are down, maybe not. It kind of depends, but the blood sugar is the definite marker. If it’s higher than it normally is, and I put underneath with big exclamation marks, that’ll be the late night snack.

It’s real. You are human. There is something powerful about changing behavior with that instant feedback for how you see yourself.

Yes, it’s very good to have it there in black and white, isn’t it? Because it’s something you can’t argue away. Well as usual Annette, you’ve gone into such amazing depth and given us so much information and knowledge to take away. We’re up to our time on this episode, so we’re going to round it out now. I knew when I put up this topic in the group that I was going to get lots of questions, and that we were going to have to go onto multiple episodes, so that’s what we’re going to do. Thank you very much for making a start on this big long list and we’ll be back soon with some more questions and answers.

Excellent. All right. Well, tune in next week.

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

Welcome Carrie Brown, to a special pre- Christmas holidays podcast on Keto woman podcast. How are you doing today? 

Hello Daisy. I’m doing great, I always have a great day when I talk to you. 

Oh, that’s nice. Me Too.

It’s like talking to an old mate

Exactly, exactly. It’s, it’s very comforting isn’t it? 

Well I suppose for both of us, ’cause you are in France surrounded by French people speaking French and I’m surrounded by Americans, which I love, but still they’re Americans and so it’s like, yeah, it’s kind of a bit like coming home talking to you even though we’re like across the other side of the pond from each other. 

I know and I saw you post in your kitchen group the other day that, that you’d been talking to a friend in the UK for a while. So, you were talking particularly British after that. It does affect your accent doesn’t it, depending who you’ve been talking to. 

Yes. Yes. I was, I was talking to England, and I can’t remember who I was talking to now, which is really weird because it doesn’t happen very often. But anyway, yeah, I talked to England for a really long time and it was awesome. I’m pretty sure that I sounded a lot more British at the end of it than I did when we started. 

Yes, it does work like that. I tend to be a little bit of a chameleon with that and pick up bits and pieces depending, depending on the people you’re talking to at the time.

After a couple of days I was calling the trash bin rubbish and you know, things like that. 

Hahaha

Put it in the bin! 

Yes. I, I notice a lot of your, a lot, a lot of your Americanisms now there are a lot of things in your general speak that are much more American than, than British. But that’s, that’s what happens I guess when it’s, when you’re living there and those are the words around you all the time, you just naturally start picking them up. 

Well, I, I just think it’s, it’s how you get on because it’s… so British people, we all grew up watching American TV, but Americans don’t grow up watching British TV. So British people are much better at knowing how to do American than Americans are at knowing how to do British. And so, I, I found when I moved here, so if I want it to be understood and didn’t have to explain myself every five minutes, I just used their phrases, their expressions, their words with my British accent, but with all of the American phrases and words, and that’s kinda how it goes. So now I just use, yeah, I just use just so that I don’t have to explain myself all the time. I got out and have to explain a hundred times over what rubbish is or what a bin is, or I know a lot of Americans know some of the core things, like they know that a hood is a bonnet and a trunk is the boot, but there’s a lot, lot, lot more different words that the British use that they don’t know. And I just found it easier to use their words and phrases and call it good. 

It’s very funny I say that. So that’s one of those that little light bulb moments that I hadn’t thought about what the reason was for why as Brits, we seem much better at those translations and of course that’s what it is. Of course, it’s TV as you’re, as you’re growing up, it’s obvious. I’d never thought of it before, but that’s why it is completely dependent on the television you watch. You know, I mean I can remember, yeah, growing up and watching obviously the American films and programs, but also picking up all the Australian lingo as well because of watching things like neighbours, you know, and that that is absolutely isn’t it? How you, how you pick up those things and learn the translations and if you’re not watching them, you don’t know. 

And there’s a lot less. In Australia there’s a lot more Australians who grow up on British TV, but not, not so much in America. So that’s why we are better at being American than the Americans are at being British. 

Absolutely. Now, yes. Now it all makes a lot more sense to me. Anyway. We are talking about the holidays. 

Yay Holidays or whatever it is. We’re supposed to call them now. 

Exactly. It gets, I mean, you know, it’s always going to be Christmas for me. Even though I’m, you know, I’m not religious and don’t actually believe in the whole Christ behind Christmas thing personally, but it’s just for me it’s just a name for that time of year in the UK. I know particularly in America, it’s a different holiday season. It really seems to start at Thanksgiving and, and sort of carry on from there. But there are, I mean there are so many different festivals that come into play this, time of year aren’t there, and I think that’s why just calling it holidays is probably a good way just to encompass everyone and everything

Yes, I think you’re right that in America there’s so many more different cultures here than in England, but also there’s thanksgiving and that’s the big holiday here, whereas in England everything revolves around Christmas, like we really only have one big I mean we have Easter but even that isn’t anything like the scale that we do Christmas.

Christmas is the biggie isn’t it, yeah.

And that’s when we get, you know, everyone takes like 10 days off and you know the public holidays everywhere. And so, for me, like you, everything was about Christmas. Even though I didn’t grow up in a religious family either, you know I grew up in a household where we went to church for weddings and funerals, for me it was all about Christmas because that’s the big holiday. So, for me, I’ve just, you know, I spent my entire childhood saying Merry Christmas and now it’s like, well now people, some people choose to be offended about that. And I’m like, it doesn’t actually, it’s just a nice greeting like really just like it’s just a pleasantry, like I, you don’t have to get bent out of shape about the fact that I said Merry Christmas and not happy holidays. However, having moved here I can see how it’s more because there are so many more holidays here and you don’t know what the person you’re talking to celebrates or doesn’t or whatever, that it is just easier to.. it feels more inclusive to say happy holidays rather than Merry Christmas but I do still trip up.

Like I had a blood draw yesterday and as I left I said to the lovely Gal who took my blood as I walked out the door, I said I mean this the nicest way possible but I hope I don’t see you again, because you know, who wants to go for a blood draw, so I said in the nicest way possible I hope I don’t have to see you again, but merry Christmas and I was just like Oh, I was supposed to say Happy holidays, oh whatever. The other thing is that in America the Americans get incredibly excited about every holiday. Like they decorate for every holiday Halloween’s a huge thing. They redecorate the houses for every holiday. I mean everything and it’s very, I have found it very, very difficult not to get sucked into that and I don’t mean that in any bad way at all. In fact, I’ve started to actually look forward to the change, the, you know, every holiday they decorate their houses and they wear green on St Patrick’s day and I’ve actually come to appreciate that and enjoy that. It’s not really something I participate in, I don’t wear green on St Patrick’s day, but I love the enthusiasm and the excitement with which Americans embrace every holiday they possibly can. So happy holidays does seem more appropriate here.

And it’s nice to spread it, have some different festivities around the year as well rather than having it all at one time of year. But I think, I think it’s just when you grow up with something and it’s a habit, it’s so enshrined in like you say it, the words tumble out of your mouth without really thinking about them and I think, you know, a lot of things have changed in the last couple of years where we’re actually having to address some of those things and some of those phrases and words that tumble out of our mouths automatically and we’re having to start to think about how other people might react to those, and I don’t think that’s necessarily a bad thing but I also don’t think it’s a problem that it just takes us a while to have a transition from one to the other and have to keep reminding ourselves, like you were saying, Oh I meant to say happy holidays but merry Christmas tumbled out. I don’t think that’s a bad thing. I think it’s nice to be aware that we’re trying to change it to make sure that it’s more inclusive and that we’re not maybe offending someone by, by saying the wrong thing. I think that’s a good thing to be aware of that I think probably people are forgiving of us if it takes a little while to get used to it. 

Yeah and I think there’s a lot of people, there’s this furore.. furorey… I don’t know if it’s reached France yet but there’s some people who have gotten their panties in a wad about the song Baby It’s cold outside, which was written in like whatever, 1940 something and like there’s a bunch of people that are just getting really upset saying we shouldn’t listen to it and he’s talking about date rape and blah blah blah, blah., and the rest of America is going wait what? Like, have you heard the music that’s being written today, and you’re okay with that, but you’re not okay with this.. like what? But I think, and sometimes I’m like we got on with, like this stuff was never a problem, why is it a problem now. I think one of the things is that the world has got so much smaller because we do travel. It’s like we’re not like just in our little culture bubbles any more. We do have to start embracing other cultures and being more inclusive because we travel and the Internet has made the world so much smaller in that we can touch all these things now, whereas before we couldn’t you know, we were in England and what was good for England was, was good. And we didn’t think about the rest of the world because the rest of the world didn’t touch us and we didn’t touch them but then with the Internet and then travel, now all of a sudden it’s like, well actually we can’t be insular. We can’t just sit here and think, well, you know, it’s all about us. It’s right and proper in my opinion, that we should start embracing the other people and the other cultures that we touch now by virtue of the Internet and travel. So, but I think that’s why for you know, 60 years things like baby, it’s cold outside weren’t a problem. But now, you know, maybe we do have to look at things in different ways. Of course, no I don’t think we should stop listening to it, but.


Well my perspective is on it. And there was, there was a post in my group about that and they were listing all the other things that should be banned because of that. And, and, and my first reaction was, was to laugh it off. And that post actually got flagged by somebody and I had a discussion with them about it and it opened my eyes as to how, okay, we’re not, we’re not necessarily saying this song has to be banned, but we’re just having a conversation about actually this song that has been part of our culture. Think about the culture it was written in the people maybe who wrote it. And some of the words and some of the phrases that are in it are actually potentially triggering people and hurting people. And we are in a different environment now. And I, but I think it’s just, it’s not necessarily about saying what songs we should listen to, shouldn’t listen to what should be banned, what shouldn’t be banned. It’s having those conversations, it’s like having the ‘me too’ conversations. It’s like having the, the, the different gender, uh, conversations, the race conversations, all those things. It’s about having the conversations. And actually for me, that what I always benefit from is just opening my eyes to different points of view and actually having those little light bulb moments. Gosh, yes. I’d not thought about that. My first instinct was to laugh, but here I am hearing from somebody who has actually felt really unpleasant when they read that post and it actually impacted them in a really negative way. So immediately that’s going to, that’s just going to alter my perception. I don’t, you know, I think that’s a good thing. It’s just about learning and appreciating other people, isn’t it? 

Yes, I just think that’s hard.

Yes, it is hard, very uncomfortable. 

Some people would rather just carry on laughing and ridiculing because if they don’t, they have to stop and think about, wait.. maybe that is impactful, and that takes work and we’re humans and for the most part we don’t like work so it’s easier to you know, keep on keeping on with what you’ve done for your whole life or what you grew up with. But I do think and I think maybe because this is the fourth country I’ve lived in, I think I’ve had an advantage in I’ve been forced, right? I say that in air quotes because I chose to move those full time. So, but when I say, you know, having made the decision to move, then if you want to get on well and be successful, you have to integrate into the society you’re in. And so, I’ve been exposed to a lot of different cultures and a lot of different views and now I can see why we should try not to be lazy and we should try to see it from the other person’s point of view and maybe make a new decision, maybe not.. maybe stick with where we were, but at least be open to learning why different cultures do things a different way or how people that have had horrible experiences might come across some things. So, but you know, as humans we are lazy and it’s easier not to do that because it’s work I have just been exposed to having to do the work because if I wanted to survive in wherever I happened to be living, then that’s what I had to do, so I’m kind of grateful for that. I’ve been forced into not being lazy, dammit. 

Yes, exactly. And I think you’re absolutely right and that was in a way that was, that was my first reaction when I had to start thinking about that post and what went with it. It was, you know, I don’t have time for this or I don’t want to go down into this quagmire.

Just get over it, why are you making a drama? 

Yes, but the rest of me, the biggest part of me was, well, no, this is important and yeah, suck it up. You’re going to have to feel uncomfortable for a while. But ultimately what comes out of it is that it’s interesting learning about other people and, and how they feel and the benefit you get from going through that brief period of feeling uncomfortable, I think has so much value. And people who refuse to do that in my opinion are missing out, 


I’m endlessly fascinated with why people do what they do. Why people think it doesn’t mean that all necessary change my mind, but I love to see how someone sees something in a completely different way to me. I’m just endlessly fascinated with psychology and why people do and say what they do 

For sure, and I love to have things that I think, or I thought that I believed quite strongly and challenged because sometimes it does get changed. That’s how I started low carb and Keto actually from somebody challenging me and saying that I was talking a load of rubbish about carbs, which, which I was and it was somebody really challenging me but doing it in the kind of way that pulled me in and said, you know, go and look at the science and this is interesting and because I had respect for her as well. It was just really a fascinating journey finding out about what she was saying and probably trying to prove her wrong and prove myself right. Not being able to do so in the process and look what a different path, you know, that sent me off on, so I think sometimes people can radically change what you think. 

This is not at all what we were supposed to be talking about.

No we’ve gone off on a bit of a ramble. 

That’s a brilliant segway into one part of what we’re going to talk about I’m going to talk about which was understanding and embracing the fact that not everybody, feels merry and bright at Christmas or during the holidays, whatever we’re going to land on calling it. 

Yes because there is that expectation isn’t there? 

There absolutely is. 


You know, happy holidays, bonnes fetes is here. Everyone’s supposed to be happy and having fun and, and feeling festive and it’s all, yeah, I hate it. Hate is a strong word. That’s not true, but I don’t enjoy the festive season that much, I find it very difficult 

And there is a lot there’s a lot of people who do not feel merry and bright and actually there’s a lot more people who do not feel merry and bright around the holidays. Rates of suicide are up at the holidays, rates of reported depression or clinical depression are up during the holidays. So actually, there are less people being merry and bright than more and our little discussion that we hadn’t planned on perfectly points out that it will be really useful. I mean, I hesitate to say that we have to, I do think we have to, we all have to make the choice to do it, but I think it will be incredibly helpful to mankind if people who do not suffer from depression or suicidal thoughts, it will be incredibly helpful if those folks could at least try and understand or, or embrace the fact that there’s a lot of people that do struggle and how they can help it to not be such a difficult time for so many people. So, having the conversation about mental health at the holidays I think is incredibly important. Although anyone that knows me knows that mental health is my thing I think it’s incredibly important and I think it’s particularly important around this time of year. 

So, I suppose, I think a good way maybe to approach this would be both sides would be how best to get through it as the person who’s in the position of not feeling great at whatever level that is. And from the other side with friends and family and people who know that person or suspect that someone they know a loved one feels that way. How best to help them through that time. Like I say, I find it difficult and my way of dealing with that is generally just to sort of hide away and make particularly the day, Christmas Day, but the time around it just as sort of cosy and as nice as I can and, you know, cuddle my dogs and my cats and just try and do things that will make me feel relatively nice. I don’t know. I don’t really have a perfect strategy of getting through it. I’m not sure that there is one um, but you know a lot more about this and maybe thought more about it, I don’t know what are your feelings from both those angles about how best to get through this in one piece 

So, as a sufferer or an ex sufferer, Christmas, as we said at the beginning, Christmas has always been a huge thing for me and when I was a kid growing up, it was the best time of the year. I mean, it really was those two weeks over Christmas and New Year. 

The excitement, right? 

Oh, the excitement was incredible. It was the only time of year that my brother and I had chocolate biscuits, cookies. It was the only time of the year we had candy, sweets, chocolates, crisps you know, all of that like soda, like fizzy drinks. We never had that stuff during the year, we only ever had it . So, so, and not that food is everything but it was that two weeks was so different that it was this hugely exciting thing. And you know, in England, the build up to Christmas is huge and it’s like, you know, we actually decorate our houses and you know, do fun different things. 


Oh, exactly. And it starts, yeah, it starts at the beginning of December and my, my birthday’s in the first week of December, so that’s when the weekend there’s my birthday, we’d get the tree and that would be decorated. And that for me that was, yeah, that’s, that’s the beginning of Christmas. That’s when it all starts kicking off what it did and the excitement. Yeah. 

So, it’s a huge, huge thing and it’s terribly exciting. And so that’s what I grew up with. So historically Christmas was always good for me and then, you know, I got older and recreated that for myself, but then ( I lose track) 12/13 years ago I don’t talk about this a lot, but I was married and I became unmarried 12 or 13 years ago and it wasn’t so much, the loss of, cos’ I’m an introvert, so being alone is not an issue for me. So, it wasn’t loss of that, I think it was the loss of having someone to focus on or buying gifts for or I don’t know what it was but when, and I have no family either, so I’m kind of in this bubble of just me. And so, 12 years ago what I decided that I was going to do was I decided that I sat down and thought about, you know, what are the things that I really, really love to do and my, favourite things are driving. I know I should have been a truck driver, I missed my calling.

Yes I know your epic road trips

So driving, going to see new places, exploring new places and landscape photography, and so I decided that every year I was going to like open up the map and put a pin in it and say, I’ve never been there, you know like I’ve never been to Yellowstone or I’ve never been to Yosemite or as I used to call it, I don’t know, I’ve never been to death valley or I’ve never been wherever, I’ve never been to Taos, New Mexico and I would leave around the 18th or 19th. I’d pack up my forerunner and I would just go on this epic road trip. And um, and so I would literally leave before Christmas kind of started and, and I’d get back typically New Year’s Eve because like want to be home so that I was with my kitties for the fireworks ‘cause they were always terrified, so I always used to try and get home on New Year’s Eve so I was there for that. So that’s kind of 10 to 12/14 days. 


I would be out like discovering new places, driving, shooting new landscapes, you know, I’d eat, what I wanted when I wanted, there was just like, and I would find the, I wouldn’t even realize which day was Christmas Day. I, you know, I would, I kind of literally just miss it and, and for me that works really, really well. So, and there’s no, it also takes away, ’cause I don’t know about you, but for me, and I think for a lot of people, single people or people who have families but they’re not really very connected with their families or their families are toxic and they don’t really like to hang out with them, which is perfectly fine by the way. Um, I think it can be that being invited to someone else’s holiday celebration or someone else’s Christmas particularly is awesome. It’s wonderful that people, you know, open their arms and their houses to have you come and join them for what a lot of people is a very special time of year, but for me, I often feel worse when I’m in a group of people than when I’m actually on my own, I actually feel lonelier kind of being a gooseberry. And I don’t know if Americans know that term or not, but, but I feel whilst being a gooseberry on the kind of fringes of someone else’s Christmas Day or Thanksgiving than I do if I was on my own. So, while I always get a load of invitations, I would, I’d like, you know, I’m road tripping. I’m going, you know, so what are you doing at Christmas? I’m not, I’m going to be in Taos New Mexico. And so it actually made it okay to turn down all these lovely invitations, which came from the best intentions and the best hearts of, you know, people that I love, but spending Christmas with another family I find harder than being on my own, so road tripping was my, was the way that I handled it, and so that meant that the holiday period between Christmas and New Year, once again became my favourite time of year because I was focused on going off and doing the things I love.

The other thing that I’ve done in the past is over Thanksgiving when I was working in corporate America, there was that 10 days over that Thanksgiving week, where Microsoft who would kind of shut down, no one was there. So, it was like, well I might as well just have 10 days because nobody is going to be there anyway and but what I used to do was that was my, that was a cookbook writing 10 days. I wouldn’t write the whole book obviously, but that was when I would like do, I’d be creating recipes like crazy. Like I do five to seven recipes every day. So, I was, I had this massive project for that period of time and everything will be focused on that project. And so again, it took away the, you know the invites from people that you don’t want to turn down because you love them and you don’t want to make them feel bad. But I’m like you know, wow, I’m going to be, I’m working on a cookbook and I’m scheduled that day and thank you very much and I’m afraid I won’t be able to, so it took that away. But it also kept the focus on something creative, which is I’ve always found incredibly good for stopping the emotional roller coaster. It keeps you focused on something, it keeps you busy. It’s just there’s so much good things. So those are two strategies that I have used over and over and over again that’ve been really successful either having a really big creative project over, for me it was Thanksgiving and it was writing cookbooks and um, over the, the Christmas slash New Year’s time, it would be road tripping, opening up the map, I’ve never been there, I’m going to drive there and I’m going to shoot it with a camera and, and discover new places. And so those are two things I’ve done to completely eradicate the, the word terror came to mind, but I’m not sure that’s the right word, but for people who struggle with depression or people that are alone, either because they are single and have no family or because the family, you know that situation is not good. That’s the way I’ve dealt with those two ideas for how I dealt with the times very successfully and I kind of breeze through them without even realizing like, oh, oh, it’s those, y’all supposed to eat Turkey today, you know, or whatever. 


Oh, that’s, that’s fascinating. And it’s brought a few things into place in my mind when we, we went from that earlier on, both sharing that and remembering that immense excitement that we used to feel as children at Christmas, and you know, I can remember knowing that I wasn’t allowed to go into open stockings until whatever time my mother had set because it’s seven o’clock in the morning or something, you know? And, and those were the days where there was, there was nothing you could do. Um, I think I had a tiny little radio that I turned on that I think the BBC might’ve come on at five o’clock in the morning, but before that there was nothing. So, it was, you know, maybe a book or something, but that, oh, having to wait because you were so excited and you wanted that day to start. And that overwhelming feeling of excitement and joy and anticipation and I think part of the problem, it’s just sort of come home to me really, and it’s obvious really is that we’re trying to recreate that. That’s our standard, that’s our benchmark for what we think Christmas should be. And of course, attaining that level is nigh on impossible and I think to a certain extent it does get recreated by people who go on to be parents and have those young children themselves and then enjoy Christmas or that period of the year, the celebrations in that time. They enjoy it vicariously through those children and get that level of excitement again and experience it in a slightly different way and I’ve seen that participating last year I was, I was back in the United Kingdom with we thought and it, and it did turn out to be my stepfather’s last Christmas, so it was, it was really important to be there, but I got to see the excitement of those young children and get some of that excitement of the day again and I, and I think, but I think the trouble is if, if you don’t have that and like you were saying, it’s very difficult. Some people can involve themselves in other people’s Christmas and get enjoyment for that, but I feel the same as you do. I felt a bit like a gooseberry it and it just makes me think of what I don’t have rather than I have in that moment, which is, which is not really helpful for anybody, but I tend to sit at home focusing on what I don’t have and you know, waiting for that phone call to hear from my niece and nephews or those kinds of things. And so, it, but that’s what it just dawned on me with you were saying about focus, it’s changing your focus to something else and having that project or something else to do. Yes, putting something in place, this is what I’m going to do. 

It’s also planning and I think planning one, you can build the excitement if you know this thing is going to happen, but also it means that you don’t inadvertently wake up and you’re sitting there waiting for your niece and nephew to call or whatever your scenario is. If you have a plan when Christmas morning rolls around, you just, you’ve already got a plan. You’ve pre- decided what you’re going to do. It could be as simple as you’re going to get up and take yourself off to the wildly expensive buffet at the fancy pants hotel or the, you know, wherever it is, which is something you might never do, but you have a plan that you’re going to go do that. So, you get up and get excited and you get dressed and you put your mascara on or whatever and you go and have the fancy pants, keto of course, breakfast buffet for $45 or whatever it is. So, I think planning is super, super important for folks who are either in a situation where they’re alone at the holidays for whatever reason or people that struggle with being sad or depressed or even suicidal at the holidays. I think planning is really, really, really key. And as I say for me, having these big plans, having some creative projects to work on, having a schedule, it may sound dull, but trust me when I tell you that it’s always worked out to be the absolute opposite of that because I’ve, you know, my Thanksgiving’s up, got to the end of the week and I’ve produced this amazing thing or you know, I’ve got something to show for it. And, and I’d been so busy that I haven’t really had time to think about what I don’t have. And, and I’ve also been able to gracefully decline any invitations because I already had a commitment. The commitment was to myself, was, was still a commitment, you know a commitment to ourselves is as important as a commitment to someone else, um, so or going away and so those for me have been hugely successful. And I think planning is, is important. So, you know, start thinking now about what you’re going to do.

And the other thing I’d really like to have people think about is don’t be afraid to start your own traditions or develop your own family culture for how you deal with holidays. Because it might be that a lot of people in the family are secretly thinking the same thing because tradition and culture, and a family cultures can be so strong like nobody wants to do it, but everybody keeps doing it because they’ve always done it. And everybody’s afraid to say, why do we not do this this year? Or why don’t we do something else? Or you know, one part of an extended family is, is too nervous to say, you know what, we’re not coming this year. And so, I would just encourage you all to think about or if you’re in a family to sit with your family and go, you know, does this tradition actually work for us? Are we doing this because it’s the best thing for us and are we doing this because we enjoy it, are we doing this because it’s a positive thing. Or are we doing it purely out of traditional habit or culture? And don’t be afraid to, to start a new culture or new tradition for your family, even if that’s a family of one. You know, my tradition now, my culture is that over Christmas I road trip. And so actually last year I didn’t road trip, but that was the first time I hadn’t road tripped, Um, but that was because I randomly decided to move from Seattle to Connecticut, so I was busy getting the house ready for selling, the house ready to sell and packing and purging, and so I had this massive project all over Christmas, I don’t even remember which day Christmas was, but I had this massive project. It wasn’t road tripping for the first time, but I still had this massive project and that just kept me occupied and busy. And of course, I was excited about the move and I always find purging incredibly beneficial. I feel like my brain clears out when I clear out my environment. 

Oh, and the weight lifted. Yeah. When I deal with, I’m dreadful for writing things on scraps of paper and I and I just collect them and then it just becomes this over flowing mass and it just stresses me out looking at it and when I do deal with it, it’s like a weight lifted. And I love what you were saying about having a project and what you were saying two-fold in my mind it came in thinking about when you were saying is that you get that real sense of achievement and fulfillment for having completed that project that you set yourself. But also, I can see it being a great reminder because when we, when we start doing these new things and trying to form these new habits, it doesn’t always work perfectly the first time. And it’s something that takes a bit of practice, but I can really see how that’s going to help for the following year, seeing those, so with you, the lovely landscape pictures from your road trip or all the new recipes that you created, that’s going to be a really good motivation for helping you plan the following year, so I think that’s, that’s a, that’s a great idea and I’m going to try that. 

One of the reasons that I suggested you might want to look at whatever habits or traditions or cultures you and your family have because I remember when I was still in Corporate America and way back, way back when, before keto and low carb and all of that, on Thanksgiving what I used to do was I would go to rent box and get six movies, and I’d roast a Turkey on the Wednesday night, Thursday morning I’d make an enormous pile of Turkey and cranberry sauce sandwiches, which is like my favourite food ever, and I’d make this enormous pile of sandwiches and I’d get my six movies and I’d get my six cats and we would literally spend all day on Thanksgiving, on the couch, eating Turkey sandwiches and watching movies, which for anyone who knows me knows that like I barely even know where my television is. Like I’m just not a TV watcher or a movie watcher. So, this was like an extraordinary day for me. But it was something that was really, that I did really look forward to and it wasn’t traditional at all. It was Turkey sandwiches and movies. But for me that was really different. And to spend an entire day relaxing, just hanging out or watching movies on the couch was like such a delicious thing because I never, never did it. And so, and this was years back, before I started road trips and keto an all of that. But that was like that became my thanksgiving tradition was that was how I did Thanksgiving.

And the following week when we’d all go back to work and we’d all share, you know, hey, how was Thanksgiving and I would tell people what I did. Almost everybody as long as we were just one on one in my office or whatever, every single person would say, wow, that sounds great, I wish I’d done that and I’m like so what did you do? And they’d say, well you know we and I have this stream of people who would like secretly wishing that they had just hung out, you know, with their pets or their spouse and kids and a pile of sandwiches and a bunch of movies and just chill there all day. And so that’s when I started thinking. So why don’t you like, why like be brave be if it’s not working for you. Hey, if you just doing it to keep other people happy or you’re just doing it because it’s tradition or like sit down with your family or with yourself and go, does this actually work for me because if it doesn’t then I’m going to create something that does. So that’s why I, I just would like to encourage you all to examine like why you do what you do and if it’s actually working for you. And if it’s not, don’t be afraid of, like just making your own tradition up and as something that serves every member of your family. Like maybe you have some introverts and some extroverts and some, maybe you can, if you’re in a family unit, maybe you can split yourselves in half and dad and you know, x number of kids like to go hiking. Just don’t be afraid to figure out what works for you now and do that. And I think, I think you’ll find that a lot more people will struggle a lot less if they do that. 

Yes, it’s a, it’s a good point. And I can see even maybe taking turns, you know, if you have a family unit where you all want something completely different is maybe doing, doing it differently each year that and you might actually, well you will learn something about each other and might find, you know that you end up forging a tradition that the ends up, does end up suiting everyone. It’s a fascinating idea to just potentially shake it up. Not if you don’t, you know perhaps you, you absolutely all love the way it is and you love the traditional day and that’s, and that’s great but I think it’s, yes, I think it’s a really interesting idea just to, just to have that conversation because like you say, everyone might just be thinking we’d like to do something different. What about, I think we’ve kind of probably covered it really by just showing how people might be feeling this time of year, but is there anything, any tips you would give to people who do really enjoy this time of year are either come across someone they feel isn’t and they might want to help them out or they have a friend or a relative that they know doesn’t enjoy this time of year? What, what strategies would you offer them with how to help their loved one get through it? 

So, I think people that don’t struggle with depression or suicidal thoughts, I think that a lot of them find it really difficult because they don’t know what to do with this, and I think part of that is that they’re scared of doing the wrong thing or saying the wrong thing or being in over their heads and it’s all so difficult in that if you don’t understand the difference between a clinical depression and situational depression or someone that’s just sad, then it can be very frustrating to have this miserable person kind of hanging around. So, I think the first thing I would like to encourage people that don’t suffer is to just try and get an understanding that a clinical depression or suicidal thoughts. It’s like having a broken leg. It’s not something that we can, we can’t just go, oh, I’m going to toss my, crutches away and walk because you know, I’m just going to get over my broken leg. You can’t think this way out of a clinical depression any more that you can think yourself out of a broken leg. So, you know, or if you’re diabetic, oh, I’m just not going to have, I’m just not going to have that diabetic coma. I’m just not going to do it or I’m just going to wake up, just wake up out of that coma. You know what I mean? It’s just a lot of people ask us to do the impossible by snapping out of it or it’s not something that we have control over, so I think it’s super important if people would try and understand what it’s like for people that struggle with clinical depression or suicidal thoughts, if they could just understand that it’s not something that we have control over and then give us space.

And so, for me, when I wasn’t you, I think everybody knows that my, my bipolar has now, I haven’t had any symptoms of bipolar for over three years. So this is kind of in the past for me, but when I was there, it was, the thing that helped me most I think was having two or three close people who understood and who realized that when I was having a difficult time, I didn’t actually necessarily need anything just to go and hang at their house, just like don’t sit in the corner of their house, just to not be alone was incredibly helpful. But I think the mistake that a lot of people who don’t suffer make is that they think they have to entertain you or, or try and cheer you up or try and do something and we actually don’t need you to do anything. We just need someone to be there and not judge us. That’s so, there were times where I would call my girlfriend or I would text her and I’d say I’m having a really difficult day. And obviously there were times she weren’t able, but when she was able she would just like, okay, I’ll be over. And she would show up like with, with Thai, coconut soup from the take out and a redbox movie in her pyjamas with a quilt and she’d just show up and we wouldn’t talk about it. She was just there and we would just eat soup and then we’d go hang out on the couch and watch a movie. There was no, it was just her being there that was important. It wasn’t that she had to, we didn’t have to talk about it. She didn’t have to try and get me and bring me out myself. She didn’t have try and cheer me up, there was no pressure on her. She just had to be there and know that I was having a hard time and not put any pressure on me to change do anything, be anything, you know what I mean? She was just there. So, I think being there is just possibly the most useful, powerful thing that you could do for someone who’s struggling and take off of yourself any need to try and fix us. 

Yes, don’t take responsibility for anything.

Don’t take responsibility. And so, there were other times where I would like, I would text her and say, uh, can I just come and be at your house? And she’d go of course. And I’d show up and we wouldn’t necessarily talk to each other. I would just clamber on the couch. Her kids would be watching whatever. I would just clamber on the couch in the corner and quietly and just be there. And that most of the time was all I needed. So, I think, you know, our friends and family can, because they love us and because they’re trying to help, because they want to help us, but they, they think that they have to do these big enormous things to try and do that. And you really, in my experience don’t, just being there for someone or just the other thing that I thought of the other day you was, I don’t think, and this may sound a bit woo woo, it doesn’t matter what you call it, whether you call it the universe or God or whatever you call that higher power. In my experience, if I get a thought about something, anything, if a person pops in my head, I don’t think that’s ever random. So, if I suddenly start thinking about someone I have trained myself, though I will, I might text to a heart emoticon or I might say, hey, I was just thinking about you or I might call them, or I might, but I’ve learned not to ignore random prompts about things. And I think that can be really, really helpful for people who are suicidal or depressed. But just knowing that someone is there, it doesn’t have to be a big thing just, and I think so often we, we have these thoughts about people and we go, oh, she’s busy, I won’t call her now. And then we forget. Or oh, Um, I you know, we just brush it off. But I think that those prompts from wherever you think they come from, it doesn’t really matter. I think they’re really important, so I’d like to encourage people, everybody actually is if you get a thought like that about someone, just act on it and it doesn’t have to be huge or big or take a lot of time. It takes literally three seconds to text an emoticon or to say, hey, I was just thinking about you, hope you’re okay,  love you Bye. That can be literally life changing, literally life changing.

I really, yes, I really agree with that. I’ve had such a big smile on my face when people have done that to me and yeah. Hey, I was just thinking about you or yeah something. Just to know that people do think about you sometimes and people care and, and just like you say just that, just that one Emoji or that one sentence or those few words it does, it really does make a big, big difference. 

For someone who is swimming in a sea of depression or despair that they have no control over. So let me be clear about, I’m not talking about as terrible as is my puppy died or, or you know, whatever situational depression where there’s a reason for being sad, I’m talking about clinical depression where there’s actually, it makes no sense that you’re depressed, you just are and as I say it’s like having diabetes or a broken leg, there’s nothing you can do about it. It can literally be that little insertion of someone in your life like a phone call or a text or just a thing saying hey, I was just thinking about you, can almost like pop us back to reality even if it’s for a moment that might be all it takes to get us back from the ledge. And, and so I’d really like to encourage everyone to, if you, if you have a thought about someone, act on it. And the other thing, and I know there’s memes all over the Internet about this and there’s that old adage that, you know, be kind because you don’t know what someone else is going through it really ,really ,really is true. There have been, I mean I, when I was before I figured out my bipolar and keto and all of that, I would show up at work and I would be suicidal but it’s kind of, you can’t let people at work know that because one, it’s not fair and two that will, that’s not a career enhancing move, and, and so, you know, nobody would know. And the emotional pressure of having to hide that all the time is absolutely staggering. I mean, the effort involved in having to put on a game face is absolutely huge. And so, I just, nobody knew, nobody at work had any idea how I was struggling inside. And so, it really is, I mean, I think particularly during the holidays when we’re supposed to be merry and bright and, and so we do because we don’t want to let side down and we don’t want to be the Grinch and we don’t want to be all that and so the pressure on us to be merry and bright is even greater, than normal. And at the same time there’s a lot more people that are suffering silently. So that adage right now is that, you know, be kind because you don’t know what someone’s going through. It really, really, really is important. We are surrounded by people who are battling and I mean really battling for their lives and we have no idea, so be kind, always, always be kind because you really, really don’t know what might be going on for that person. And, and just a little bit of kindness can make the hugest difference. It doesn’t have to be this big magnanimous thing, it can be just a small little gesture can make the hugest difference to someone who’s struggling with mental health issues. 

It really, it really can. And we, we haven’t spoken much about it well at all about it and we are coming to the end of the show now. But I do think it’s important just to touch on how important if you possibly can and it, and I know it’s can be difficult to stay on track, but staying keto really does help keep you afloat during times that there’s a lot of pressure coming in and, and it, that in itself I certainly find can be what makes the difference. And I, I went out for dinner on my birthday and it was predominantly keto, but not completely. And the next night I also had some chocolates and because it wasn’t that much, I didn’t go completely out of Ketosis, but I dropped down the levels that out of the levels where I do best at and I woke up feeling awful. I woke up feeling like somebody had died and, and you know, there was no reason for it. But that just shows how quickly that change in the way I ate, affected my mood. And of course I just went back to eating the way I should and actually within a day so that that picked back up, but it just goes to show that if you throw that massive spanner in the works and you go off plan and you’re already feeling a bit vulnerable at that time of year, that can be something that is going to plummet you right, right down and I know it isn’t always possible and I’m not, I don’t want people to get too stressed about it and I certainly don’t want people to punish themselves if they do go off plan, but just to be careful because it’s just that extra thing isn’t it? That’s really going to impact your mood. 

It really can. Sugar and things that turn into sugar after you’ve eaten them can absolutely play havoc with your brain and if you’re one of those people that struggle more at this time of the year really, I would encourage you to do the very best you can to limit your sugars and things that turn into sugar once you’ve eaten them to zero. You, I think it’s a very, very slippery slope and I think it’s a lot more difficult for, for people with mental health issues to get back on track once we’ve gone off and, in my experience, it will make you feel worse and you’re already at risk, you’re already suffering. It will again, in my experience, because I know everyone is different, but in my experience, you will feel better if you stay away from the carbs, but I, but it’s probably when you’re feeling down is probably when you get the cravings more. 

Exactly. That’s, that’s the problem, isn’t it? That’s one of the reasons actually why I’m glad I’m not in that, in that environment. So that you were saying earlier about feeling a little bit of an outsider in somebody else’s event or just not necessarily wanting to go to those sorts of days, for whatever reason. But one of the benefits of that is that you’re not putting all that temptation in front of you because I know absolutely. So, if I’m feeling at a little bit of a low ebb, I go to an event like that and all that food’s out in front of me, it’s going to take some Herculean effort for me not to have some of that. Even though I know how I’m going to feel the next day, it’s going to be really difficult. So, the easiest way to deal with that is not to, not to put the temptation in front of me in the first place. I know that’s not always possible, but ah it’s tricky 

But again, the key to success here is planning. Plan. Either plan not to go to things like that because you’re busy doing your creative project or you’ve left, you’ve gone off and you’ve gone somewhere else. But if you are at home, plan. Make sure you have no carbage in the house. Make sure that you have all your favourite keto things in the house, you know if you have to splurge, and spend a bit of extra money to get the things that really, really float your tastebuds from a Keto perspective, do that because you’re worth it. You know you’re worth the money to get you through, you know, whatever it takes to get you through, do that, you know. And if you do need to, you know, I mean for me, I’m probably going to be home this year, which is going to be weird, but there it is. I may well go and get myself some foie gras because I love it. It’s my favourite thing to eat on earth. I would never normally spend that kind of money, but It will, one it’s liver, it’s incredibly nutrient dense. But it will, it will make it, it will stop me feeling like there is nothing or you know, do you know what I mean? And that can be my little celebration and I can get myself super excited about ooh today’s the day I get to cook the foie gras or whatever it is. Don’t be afraid to get all your favourite Keto things in. Don’t be afraid to splurge a little bit extra maybe on something you wouldn’t do normally or go out for a meal that someone else is cooking, keto obviously you know, whatever it takes to get you through, do that because you’re worth it and you’re important and you have value in this world and we don’t want to lose that value. So, I can’t stress highly enough how important it is to avoid all the carbs. If you are struggling with mental health issues, it will make a huge difference. But I also know how hard that is. So as Daisy said earlier, if you, if you do slip, don’t beat yourself up about it. Just get back to keto and keep on going. 

Absolutely. And you know, we talk about staying at home and doing things special for yourself at home. But of course, you can take those goodies and treats with you if you are going to event or a family gathering or whatever it is and you don’t want to make a fuss, ask people to cook special things for you. You just slot into their take, take those treats with you and, and, and enjoy those. And when you’ve got something lovely in front of you, you’re going to be less tempted by those other things that are around. And that, that is certainly, I would have thought, at least likely to help. 

Indeed, planning. Planning is key. 

Planning is key And I think, well we’ve, we’ve had lots of, we’ve had lots of tips. I don’t know if you’ve got any particular one special tip to, to round off today?

Be kind.

Be kind and plan 

Be kind and plan, yeah be kind and plan and know that you have value, even when you think you don’t. You do, don’t lose sight of that.

yes. Yes I agree. 

And if you do lose sight of it ask somebody to remind you. 

Yes, because there are there and that ‘cause there are people who care. There are people who care in real life that you can reach out and touch. But there are people online as well and there are groups and there are all sorts of things. So there really are places where you can get that love and support when you’re feeling like there isn’t enough. 

Well I hope, I hope that’s helped. I hope it’s helped people who don’t suffer to be able to be better equipped to help those of us who do, and I hope the people who do suffer, feel like maybe they have permission to do something different. Do what helps them rather than them always having to think about putting on a game face and doing whatever to make sure everyone else is happy. Because yes, making other people happy is a good thing, but not at the expense of your health and all your life. 

Absolutely. 


And, and you know, if it comes down to keeping yourself alive, I don’t give a frig what, if anyone thinks I’m being selfish when I’m busy trying to keep myself alive, I couldn’t care less and the same for anyone else that is in a clinical, depression or suicidal, it’s all about them and it should be because you know, we need to keep them alive. So yeah. If you’re in crisis, be selfish. you have our permission.

For sure. I hope it’s had some uplifting moments and given people some optimism for having happy holidays. It’s, you know, don’t feel the pressure to feel like you have to, but hopefully we’ve offered a bit of advice for how you can make the most of it and still have a good time. 


Oh, and I just think you just pinpointed something right there was like just the act of feeling like you have to, can make it harder to just let it naturally happen. So hopefully if we relieve the pressure of having to be merry and bright will actually help you to be more merry and bright, because the pressure of having to perform has now gone. I hope that even that is helpful you know, it’s okay if you’re not merry and bright. And it’s ok to find a way to make yourself happier and brighter in whatever way works for you. And I hope that just, you know, giving you permission to do those things is helpful in you being able to enjoy this time of year more. 


Yes, and as a little aside to that. I’d love to hear about it. So, if anyone does come up with some new and exciting projects, show us the results with, we’d love to see your equivalent to road trips or new cook books? It’s a, I think it’d be very interesting to see what people come up with 

I would love to see people’s merry and bright holiday projects that have actually nothing to do with the traditional way you spend the holiday. I would love to see what you all come up with for, or I would love to hear about the result of your family council, where you sit down and go, hey, you know, this is going to be our tradition or you know, we’re going to change the culture of holidays in our house and this is what we’re going to do. And you know, I would love to hear about the new traditions that you and your families create for the holidays. I would love that. 

Yeah, me too. Well, we’ll look forward to that. Thank you. Thank you very much for chatting to me again. It’s been, it’s been a pleasure as always, and I’m sure I’ll be, I’ll be speaking to you, uh, over the Christmas holidays, probably on Christmas Day itself. I imagine. 


And maybe even tomorrow. 

Yes, most likely. Well thank you very much Carrie.

All right, love. I’ll talk to you soon. 

Bye Bye.