Audience Q&A - 'Low Carb Sydney 2018' Third Session

Paul why don't you kick us off why do people get muscle cramps and what's the solution first of all it's multifactorial that's a doctor's way of saying there's lots of stuff and we don't really know but there's a few things that we do know there's associations with low sodium which is found in table salt and low levels of magnesium and one of the things we find that supplementing with adequate levels of both of these usually deals with probably about 90 95 percent of the cramps my patients get so with magnesium it comes in different forms so magnesium combines with something else and that's the form you buy it could be combined with magnesium oxide or citrate or aspartate so you have to be very aware that some of these magnesium formulations can cause diarrhea and because of that they're not well absorbed so the type of magnesium's that I like would be a magnesium chloride or a magnesium aspartate and they're two that we got experience with in the clinic that are beneficial and then as I said before with sodium we like people to have a minimum sodium intake and I would probably recommend at a minimum you need to be having 3 grams of sodium a day and preferably up to 6 not pork and I just asked the dose because I know some people who are on 60 milligrams of magnesium and I know other people who take a thousand milligrams and I know one guy who takes 5 grams of it to control his atrial fibrillation so what's a middling amount of magnesium so when you buy magnesium and you look at the size of the tablets they don't actually always account for the amount of magnesium in the tablet they'll give you the total so you've got a magnesium here and then you've got something like an aspartate or a chloride or you know some kind of amino acid that it's chelated with and depending on the size of the molecule that it's culated with if you've got a big molecule culated with a small magnesium then even you might be having five grams that be getting a very small amount of making so I don't like to say brands but the easiest thing that we do is to make it simply say there's a brand that we used to use in the hospitals when I was a resident in the hospital's running around we often supplement it with magnesium aspartate make min and two or three of those a night should be sufficient so I mean one of the other things that I found personally if I spent a long day operating and I'm dehydrated and I don't drink enough that day and it's got very little to do with salt or magnesium but just pure dehydration for me creates muscle cramps unrelated to either the salt or the magnesium so I think it is multifactorial Gary you're about to make a comment the with the salt be don't be it will just be throw it on your food so if every meal throw a little bit on we have is a sea salt sprinkle it on do not what be worried about the upper limit which is really what Paul was talking about why we why do we have a magnesium deficiency it's really interesting is that our agricultural practice is to put fertilizer on the soil and when you put all that potassium into the soil it actually binds the magnesium so the magnesium is actually not getting into our food so it's not getting into our plants though it's not getting into animals so it's just another side issue with the whole magnesium question and so supplementing it is one way the other thing is to you know be a little bit more mindful of where your food comes from just a quick word on salt the medical profession for some reason is obsessed with salt I think we should all be reducing them out of salt we have as most of you know if you're on a low-carb high-fat diet you have very little salt because most the salt that our society consumers in processed food and add it so if you're not if you're eating a real food diet you're actually pretty low salt intake and we actually need a supplement with with salt so as Kerry said sprinkle a lot on your on your on your foods I have two quirky little things I do with salt I I have a glass a cup of bone broth every morning and put a fair bit of salt in there in that and I've salted my green tea which you might think it's a bit weird but that's okay and the final word is you know I think the medical profession have chosen the wrong white crystal to get worried about just on that I just like to inquire of the other panelists what the supplements they take I take magnesium each day I've recently started taking a multivitamin just to see if it makes any difference Stephanie who I respect his opinion he says a multivitamin it's just like a bit of insurance might not make any difference but it just might but I'd just be curious of the other panel members and Doron what you know what do they do personally I like fish oil I've actually started taking cod liver oil the reason is that it's actually got some other nutrition as well as the omega-3s in it it's also got vitamin A and which is something again that we don't get very much of in the diet I also take magnesium I take magnesium aspartate I'll only talk specifically about supplements that are pertaining to metabolic healthier with my patients I often put them on chromium picolinate which has been shown to be an insulin sensitizer quite reliably in the research there's also a supplement called lecithin which contains choline which has got very good evidence as treating fatty liver so that's an individual one and there's a I've got a whole list if somebody's got a history of squamous cell carcinoma which is a pre cancerous skin cancer lesion there's evidence that taking vitamin b3 in the form of nicotinamide 500 milligrams a day will read the resolution of that so I mean there's a whole I've got a list of about 20 different supplements which have varying degrees of evidence for different conditions and I'll really personalize it so if somebody comes in on a statin for instance I'll give them coenzyme q10 and of interest when the statin medications were first being tested they actually predicted from the biochemistry that it was probably going to affect the muscles so the first studies on statins actually combined it with coenzyme q10 just out of interest and now that knowledge seems to have been lost zero I take no supplements I believe that we shouldn't need to take supplements you know we haven't taken supplements for the last 10,000 years why should we start taking supplements now it just shows that you're deficient of your diet and I think if you have a good real food diet you shouldn't need supplements I think to respect Paul if you're talking about patients who or people that have medical conditions and there are specific issues and they've gotten into those deficiency states then there may be a role for it the supplement I take is I live in a place called Tasmania and so I have this thing called fresh air some of you watch four corners sort of you at my window and we have weird fresh local seasonal food Jeff you know this is and if you will and you're not sick then I think you don't need no there's no role for supplements and then the the other thing to add is if you're eating fat fat is actually a higher vitamin source then most other foods that's where most of the vitamins are so if you're eating low fat foods you're not getting many of the vitamins that you're going to get from the fat so you need the fact you get the vitamins all right so garrier there's a couple of the double-barreled question I'll just start with you because you mentioned the cholesterol if cholesterol doesn't cause heart attacks what's the main factor that does Oh that's covered in my nutritional model of inflammation and modern disease I'm setting you up here thank you sometimes walk through an open door two three minutes yes fructose the combination of fructose refined carbohydrate and polyunsaturated oils creates inflammation in every blood vessel wall and in every cell membrane in the body and so our modern diet is highly inflammatory and it's not just sugar it's not just carbs it's not just insulin and I think the polyunsaturated oils have a major and criminais ting role so you could have a very high sugar diet very high carbohydrate diet from an inflammatory point of view and have followed up just with all those byproducts and the all deals with saturated fats it wouldn't be a problem you can have a very low sugar low carbohydrate diet but if your diet is full very high in polyunsaturated or the Omega 6s then that's going to be inflammatory it's the combination of the three so for personally I have a low inflammatory diet it's very low in sugar a very low in carbohydrate very low in polyunsaturated seed oils vegetable laws whichever way you want to call it so inflammation sits underneath every single modern disease now diet is two major producer of that and therefore if you reduce those three things other major players I think everything I don't know everything on this but that's the model and that's the concept and if we reduce those and then the other things sort of sort of themselves out along the way so the role of that is if you have inflammation in a blood vessel wall over a long period of time it's more likely to be injured that's the cause of cardiac did you know it's not just heart attacks but it's cardiovascular disease was that long enough it's perfect so just to add to that about why cholesterol becomes harmful it actually comes back down to sugar again when if we're looking specifically at cholesterol most of you have probably heard about the small dense cholesterol particles well they become small dense because they become glycated we've heard about the advanced glycation end-products and you've got proteins on these lipoprotein particles and the b100 protein that identifies the LDL particles can become damaged by sugar and when that becomes damaged there's actually been studies that have been done in Japan that actually show the size of those part then become smaller and that then becomes what's defined as small debts and because this receptor has been damaged the cholesterol is not able to be taken out of circulation by the liver so that it ends up being taken out of circulation by these macrophages which then bury it inside the lining of the blood vessels so at the end of the day when you're worrying about cholesterol so it's true Marianne intimated before that high saturated fat diets make your cholesterol go up but it's sugar that makes your cholesterol go bad and and Paul actually did a beautiful lecture on this on that in November of last year which is actually up on YouTube both on the low carb downunder website and on our website so I'd recommend you if you're interested in that you go and have a look at that rod I'm going to bring the panel back to you over here this is a question we get asked all the time this certain lifestyle designers or exercise people that that suggest a weekly carb load you know for and with with the the the strength benefits etc and to better what's the other thing they say they to prevent metabolic down-regulation might just go work away across the panel what do you think of a weekly carb load or a weekly cheat if you want to call it something else carb cycling sometimes called and look I've got to say I'm not a fan I can't see a benefit to it it would boot you out of ketosis and we've been hearing the beneficial effects of those ketone molecules on our metabolism so to me it's a it's like a backwards step maybe the only people who might do it might be people in high intensity sport who might train low during the week and on match day have a modest amount of carbs on the day Peter Bruckner will probably address that group better than me but that would be my take on carb cycling I'm not for it I live the sports side of that too Peter in nature which is what I always come back to what would actually be happening in nature and in nature we never actually tested ketone levels and I actually every time I test I'm in ketosis but I think there's been some suggestion that maybe there's arguments particularly in cancer to actually cycle in and out of ketosis might actually be more beneficial might be more creating a mixed environment for a cancer might have some benefit so in nature if you're running around there you might have just happened to come across a crop of fruit and get hold of it and you're going to bounce in and out of it so I'm not a I'm not too fussed about the level of ketosis and I realized that's contentious I think it's a good spot to be most of the time I'm not too fussed if you cycle in and out of it because I think that probably happened in nature but do I do it no because I can't find the carbs in a house and you can find it in the in the theater suite but so I personally don't cycle in and out of it but from a theoretical aspect I don't think there's a huge fuss as long as you've got strong will but a lot of people don't have it and if you actually get back on their bandwagon it's easy you know get back into trouble again yeah from a sporting port of it well I did have one particular cricketer he'll remain nameless but he's currently suspended who who went on this low-carb high-fat diet and you know really benefited from it but he did love his carbs so we came to an agreement about carb Sunday and he would you know get into the carb Sunday and then it sort of got extended to it was Sunday somewhere in the world and so it became a very long and then when he sort of started trying to tell me that on Tuesdays I thought now hang on a minute you know there was no where in the world it is still Sunday so carb Sunday was was the go but I don't think it's necessary and I tend to agree with with rod just very quickly from a performance point of view obviously you know over the last 30 or 40 years it's been a carb generation that's been carbs carbs carbs you know pasture parties and out before though the marathon Gatorade and Powerade and all that sort of stuff more and more are particularly endurance athletes are switching over to a low-carb high-fat diet so that their fuel primarily by fat rather than by carbohydrate and that seems to work very well at low to moderate intensity zuv exercise so these you know crazy people who run hundred miles and all that sort of stuff they're they're on on low-carb high-fat diet the challenges is the sort of the middle group that still need to do high-intensity so it might be a cyclist who needs to sort of you know climb a hill or sprint Ora or a footballer or a basketball or who needs sort of bursts of intense energy and what a lot of football teams that others are doing at the moment is this concept of trying low compete high so they're their basic diet is low carb so that they get their fat oxidation going and they are their fat metabolism going and then on days of intense training so that they basically titrate their carbohydrate intake depending on how much training they're doing so on they're really hard training days or on match days they'll have moderate and not a huge amount of carbs not like this sort of a pasture party to the past but a moderate amount of cows maybe the night before or the morning of a game or a hard training session so you know for instance say a Chris Froome you know their Tour de France cyclist he's you know being photographed with a sort of a very low carb high fat breakfast that photos done the rounds and so on but he's one of these people who cycles in and out of low carb depending on his training load for that day so if he's just doing a steady-state training day he'll go a go low carb high fat but if he's got a day where he's going to release of intense he'll sessions and so on he finds he just needs those extra carbs so there's a lot of individual variation some people are fine on low carb high fat it no matter what they do others need more carbs so I encourage my athletes to do a little bit of trial a tear I find out exactly how much how much they need but their general sort of day-to-day lifestyle is is low-carb for me personally I don't see any benefit to cycling with Cubs there's just a paper published recently looking at high-intensity efforts and the difference between that study and some of the previous studies was that it had a four week at updation period and when you have the four weeks adaptation period they actually found there was no decrement at all in high-intensity exercise there's been studies that have looked at glycogen levels in muscle which we assumed would be lower on a low carbohydrate diet but when we measured it they actually weren't on properly adapted athletes and even if athletes are depleting their glycogen I think you can actually intelligently supplement with carbohydrates I recommend something called you can which is a special starch matrix which has a very much lower insulin spike than other carbohydrates and so you can actually start to replenish your carbohydrate stores while still being in ketosis and the beauty about doing both is that then your body's got access to two types of energy that can use ketones and it can use the glucose or glycogen or carbohydrates as energy so I have to say I when I get asked this question I have a slightly different answer to that and I have to I go back to the person and say well what are your goals and how metabolically well or unwell are you because for example my mother who is you know type 2 diabetic if she did that it's gonna kick her out of ketosis for a week or more and no sugars are in there ah she's gonna be very unwell and very unhealthy so a cheap meal for her isn't possible she's medical medically I'm metabolically unwell somebody else they might be trying to lose weight well if you're trying to lose weight and you have a cheat meal it's gonna sabotage your weight loss somebody else they may just you know be somebody's birthday party they want to engage socially and they don't have any of the sugar drives afterwards so for them it's not a problem having that but to schedule it in your week once a week I think is a mistake number one and I don't I don't personally don't mind people doing it once a month once every two or three months but I I personally think you've got to look much more at what your goals are and whether you're metabolically well or not whether you can afford to do that any disagreement yeah I just wanted to add a point just drawn from evolutionary biology so gary talked about if you've stumbled on some fruit as a cave person there's a paleo person yes you would consume it if it was around for quite a while which it might be at the end of summer and into autumn you would then get a lot of it you would become insulin-resistant you would pack on fat and that would help you survive a long winter and the problem for us in our day and age is we do it 365 days a year so cycle for a cut for a cave person yes there was an evolutionary advantage to doing it for us we don't want to be doing it all the time Paul you've dealt with this quite a bit I might direct this question at you because there's a lot of them can you tell us a little bit about if somebody's had their gallbladder removed or if they've got gall stones and they want to eat this type of diet so the medical name for that is a cholecystectomy so we tend to blame high-fat diets on gall stones because what happens is it's a high-fat meal that leads to this severe pain up under the right ribs and you end up in hospital and the reason we blame high-fat diets is because the attack was triggered by high-fat diets and our doctor tells us it was because of the high-fat diets but that's wrong so when we think about it the gallbladder is filled with fluid like detergent that helps the body digest fat so it's a reservoir and every time you eat a high fat meal it squeezes empty and squeezed this is detergent like bile into the intestines where it can mix with fat and then it can subsequently be absorbed so if you don't eat fat because you follow the low-fat Dogma your gallbladder doesn't empty so you've got this fluid sitting there and then it turns to sludge it thickens and then an extension of that process is it can eventually form stones so then what happens is 99% of the time you're very very good on the low-fat diet then you can't have a meal of fish and chips your gallbladder tries to empty and you've got this stone and it's got a little tiny exit and that stone gets wedged up in the exit blocks it you get a severe attacker pain now what caused the stones to form the lack of regular empty it wasn't caused by the high-fat diet the high-fat diet just brought the attack on and what we've actually shown in my patients is that if we have a look at their gallbladder before and after they start a ketogenic diet we can actually see those stones dissolve and disappear over time and in actual fact we used to give one of these detergents in a tablet called Oso deoxycholic acid to dissolve it and the medical literature is got heaps of cases where we know we can dissolve gall stones and that's fallen out of favor the reason is because as soon as somebody dissolves the gall stones this fantastic but they're still put on a low-fat diet so they just reformed and standard medical theory as well if it's just going to come back why don't we just cut it out because you know I've got a second mortgage and I want to buy another car so that's not not for everybody but that's that that's a prevailing medical paradigm regarding gall stones and we know that people who have gall stones only about 15% of them will have an attack over if tenon or 15-year period so most of my patients even though they do have gall stones there is a small risk of having an attack and a couple of my patients have had an attack two or three out of you know hundreds and most of those it gets better they just deal with it they elect not to have it out surgically and when you're real try sound the gall butter the stones are gone I'm not going to try and defend my surgical colleagues at big boys and women patients after they've had a collie cystectomy can still run ill CHF and because the biliary tree which is it's not just the gall bladder that it's producing the detergent it's a great analogy the it's the that's all that biofluids come from the building from the liver and then it gets stored there for those meals so the the billary tree which is producing it can sort of up regulate over time so it's a matter of just over a period of time if you've got had a gallbladder out that it may be that you need to increase your fat intake a little bit more slowly than the average person but it will recover common question is fine totally agree and in fact there's a few questions here about people having a a diarrhea type response when they have a lot of fat Paul do you want to address that one as well no keep that debate oh he loves full of come on what what was that chemical Milner of sugars called so first of all if you have what we call steatorrhea which is diarrhea from thirst it's a very particular kind you actually look in the bowl you'll have a slick on top of the water because it floats on top of the water so when people think that they have malabsorption when I actually ask them describe what you see it's usually not fat number one it's often so something else like the polyols remember the low carb bars with the artificial sweeteners it's usually something like that that's causing it true fat malabsorption following having the gallbladder out to be honest I'm having trouble recalling any cases at all that I've seen all right rod you've been doing this for a while what are you doing a social situation where someone comes and you know basically tries to force a piece of carbohydrate down your throat people can people can be very insistent and particularly if they know that you don't want to eat it they really try even harder to get you eat it to eat at all so what's your what's your method of dealing with that yeah I think I've toughened up and I just don't want to go back and the more years I've been doing it the less I want to have a cheat day or anything like that having said that occasionally special family occasion there's the a hazelnut meringue cake which it's a specialty in our family it's gone through the generations and that's continuing view made so I will have a narrow sliver of that when it is offered you can cheat on this by smelling the cake remember most of taste comes from the olfactory nerve from this smell you can do that till you know when you've got a cold you can food doesn't taste any good so you can actually do that test we actually put a lolli blocking I'll put a lolli in your mouth wait for the sweet sensation unblock your nose and you get this second wave so realistically if you want to have that cake and so we our daughter's wedding we had a wedding cake it was about this big right now I've got everyone to sniff it and the but literally you can actually smell it just to do it you know get that sweet smell it it will go up and hit your nucleus Akins you will get your chemical hit you will go oh I've gotten that then you get a second joy because you haven't gotten the calories in and you get a third joy in that you've actually cheated yourself and just one anecdote because of the temptation I came into the theatre tea room and there was all the staff there and there was that whole tray of colored carbohydrate and junk food there and I walk into a little only walking there and everyone turns around and what's he gonna say and there was a rep there who'd brought two cakes for us to eat and one was pavlova and the other one with fruit on top and the other one was something other and they said and I said I'll look thank you very much she brought all this cake in for the staff I'd like to eat the best bit of it and they thought I was gonna go for the fruit so what I did I went up and I got the cardboard box a night there hater did you have a comment with that one okay well I just like to say Gary probably didn't need the fiber Oh Peter this is relevant to the to the sugar by half as well I mean you know what what do you say when people you know give you the standard thing well you know sugar is not that bad well look I think we all have an amount of carbohydrates so we can tolerate and that varies from from person to person I mean I think if you're you know significantly insulin resistant you're type 2 diabetic you're metabolic syndrome you've got some one of those chronic diseases that I mentioned you know you've got to be really strict and you know you've got to restrict yourself to to you know 20 or 30 grams of carbohydrate today but on the other hand if you're relatively insensitive as many young people are you know I don't see a problem with them having a having a dessert every now and then abut it it should be a treat you know in the old days you know desserts were a treat now you know breakfast cereal as a dessert you know so you know having dessert all day so I don't have a problem with that for those who could tolerate it but it just there's a huge amount you know it said all sorry there's no one died for every person there's a huge amount of a variation on the amount of carbohydrate week and each tolerate and for a lot of people have you know I have the odd day I have a bit of a weakness for the odd creme brulee or a bit of a chocolate souffle or something like that but you know I might have that once a month rather than you know every night and you know so I think you know we can't we can't be too you know autocratic about this sort of a thing for a lot of people why not have a trait you know it's fun Paul there's a number of questions here about kidney disease you know proteins bad for kidneys salts bad for kidneys can I eat low carb high fat if I've got kidney disease you want to give us a little bit of a do on kidney disease and low carb when kidney disease gets bad enough we end up on dialysis do you know what the most common cause of people going on dialysis in Australia is diabetes there is no evidence there is zero evidence at all that protein damages the kidneys that was again a bit of extrapolation from a bit of bad science but if anything if you're losing protein through your kidneys you might actually want to have theoretically and I'm not suggesting you do but if you're losing protein maybe you want to have a little bit more with regards to salt being bad for your kidneys the reason we say salt is bad is because it can lead to higher blood pressure and the kidneys are actually what determines whether our blood pressure goes up or down but our kidneys handling of salt is determined by insulin so if you have low levels of insulin there's four different receptors in the kidneys including one that all the doctors here will know is called the enact channel that's activated by aldosterone that's also activated by insulin so if you lower your insulin levels it doesn't matter how much salt you have the kidneys will let it just pass out if you want to what I consider the smartest doctors their renal doctors because their kidneys a horribly complex and when I read their journals they describe what is termed essential hypertension which when I was in medical school we just said well that's just blood pressure we call it essential because we don't know what causes it the kidney doctors describe blood pressure as essential hypertension as an insulin dependent state they understand very clearly that if your insulin level is low you don't have high blood pressure so I would say that if you're worried about if kidney disease I mean as long as you don't have one of these weird and wonderful can conditions the most common causes diabetes keep your blood sugar down and if you're worried about salt keep your insulin level down and if you're worried about protein don't be I've got a couple of patients with end-stage diabetes just pre dialysis and their kidney function is improved over two to three years I'm not saying it's going to reverse on the whole but I have a three that I couldn't say that the other the other thing is the Northern Territory's answer to the indigenous diabetes epidemic and the increased problems of dialysis they require paper people requiring dialysis is not prevention it's let's buy more dialysis machines we've just it's completely unsustainable and if you that concept can be a little bit difficult to picture in your head so both in Paul's talk from November and in my talk which are both up there you can see diagrams of what Paul's talking about with those sodium channels in insulin and how the sodium gets excreted so not a bad idea to do some revision if you if you don't remember those talks go back and have a look and you'll see the pictures which will make what Paul explained now a little bit easier to understand all right so Peter you know you're the that's what exercise person there's a lot of talk about exogenous ketones so I'm just going to take the ketones and I'm not going to change my diet I'm going to get all the advantages of ketosis and it's going to make me perform better can you give us a little bit of a your thoughts on that it looks obviously a very controversial area and there are a lot of big commercial interests who want to make this work and want to make you want to convince us that exogenous ketones in other words ketone supplements you know the best thing since sliced bread now slice spare is no good since since anyway so you know it's a very hard to sort of a you know separate the the propaganda from from the science and unfortunately the science hasn't really been done on these these ketone supplements so really I think the jury is still out and I'm certainly not convinced at this stage that they're they're a great thing for for performance I think natural ketosis is is much better but if you're taking clearance supplements and you've still got a high you know carbohydrate intake in high insulin then it sort of seems to defeat the purpose to me so I think you were better off with with with natural ketosis than the computer and supplements but I accept that the jury is still out we need to do the proper research and find out in which situations in what levels of carbohydrate intake that you have with the supplements at etc etc we're a long way from knowing the answers to that question I know that's a bit of a cop-out but at the moment I'm not recommending it to my to my athletes Paul just on that note any idea of seen anything on the bioavailability of ketones after they've translated the stomach with all that acid I don't actually but I do know that when we have a look at other supplements which would increase your ketones such as your medium chain triglycerides especially the what we call c8 caprylic acid that you do get a significant boost in your ketones but my concern with the ketones is that people use them for weight loss and the reason that it's hard to get high levels of ketones and that they'll they'll never go you know super super high is it because the ketones themselves exert negative feedback on fat metabolism so if you're burning fat and creating your own ketones and that's exerting negative feedback on this process well that's very natural because we don't want the ketones to go necessarily too high but if you're having what we call exogenous ketones you're eating them or drinking them then that has a capacity to inhibit your fat metabolism you're still putting energy into your body and your body's got a choice let's say they're going to burn what you're putting in your mouth and if you don't put something in your mouth then it's got the capacity to burn your fat stores instead so it can actually be quite counterproductive in terms of weight loss and that's something which a lot of people overlook now what Peter was talking about with regards to athletic performance that's a totally different kettle of fish and I'm actually a firm believer that they can be what we call a good journey they can make athletes perform better but for somebody trying to lose weight I don't recommended so there's you know I don't I don't want to rubbish anybody say if you did write this a comment I'm actually not trying to make fun of you but he's a low carb diet appropriate for my sixteen-year-old daughter who is a high level gymnast she is healthy and not at risk so does anybody believe that eating lots of carbohydrates your whole life does not put you at risk see to me eating carbs put you puts you at risk regardless of your age activity level etc right any different I have real concerns about the fact that we've been athletes or athletic population have been so obsessed with carbs for the last 30 or 40 years we have a whole generation of athletes who have had massively high levels of carbohydrate intake that you know 10 20 30 years often in the form of very simple carbohydrates in their sports drinks their Powerade and Gatorade and so on and and they're having huge amounts over a long period of time and I have grave concerns of the long-term effects of that you know they will almost inevitably become insulin resistant and and develop all the complications associated with that we see quite a high incidence as just anecdotal but there's a lot of concern that there seem to be a lot of retired endurance athletes who are developing heart problems at a fairly young age and it's always sort of been explained I say well it's the strain they put on their heart while they were competing well I suspect it may have a lot to do with not what the strain in their heart but what they're putting in their gut and I think I have real concerns about that and so that's why I really like this idea of the the Train low idea of reducing having a low level of carbohydrates in the training phase or then if you need to top up just topping up occasionally much better than this constant high level of carbohydrates which with disastrous consequences so that's interesting and there's certainly a lot of case studies of the three or four hundred pounds linebacker in American football are having heart attacks at young age but just to answer the question more specifically on gymnastics low carbohydrate diets one of the very first studies that was actually done in elite level athletes it was done by an Italian team was looking at elite level gymnasts and it didn't necessarily assess their metabolic health but one can only assume that it improved they found that they lost body weight and importantly they did not lose power or strength during that so they maintained the same strength they lost body weight so their power to weight ratio actually increased so from an athletic point of view this Italian study would seem to indicate that even for these power athletes and which is one group of athletes which we tend not to recommend low-carb for while this study actually seemed to demonstrate some benefit again rod I'll just come back across this interview if we can work our way across the panel please if I cook a high-fat food and another member of my family adds carbohydrates or some other junk food to it is that worse for them then if they were just to eat the junk food on its own can someone start on that I'm not quite getting that one okay Paul well well okay so essentially what what you do is you're at home you bring out your beautiful high-fat food for dinner you put it on the table and instead of them just eating that they get out a piece of toast and they put the piece of Peters a beautiful fatty meat on the toast and eat the two together is that worse than them just eating the toast without the super fatty meat on it should they be having lean meat if they're going to eat the toast yeah this is this is a very interesting one and basically we're almost talking for that person they're having high fat and high carb all at once and I think the consensus is that doesn't work so this high fat that we're talking about is in the context of low carb if we're having lots of carbs as well I think studies over time have shown that's actually a bad mix and gives us bad outcomes and that's possibly one of the reasons why fat got a bad name over time because it was always more fat in the presence of lots of carbs and lots of carbs turning on the insulin so yeah I wouldn't be advising wouldn't be advising a high carb and high fat that's one of the theories behind the rebound after diet that the weight bounces back on and bounces back past the point when they when they started you know as a group here I think we're all moving towards that simple concept of high car or low carb healthy fat rather than high fat once you mix it up in that is that the day you're falling off the bandwagon very simply don't invite that person bet I think my question was actually about a member of their family disinherit them that's what we've done with our son it's coming around because I've disinherited in forget what that question essentially described was a donut yeah no I agree you know that's the ultimate high fat high carb food and it's certainly not very good for you a fairly straightforward question how do you calculate lean body weight to be able to work out the amount of protein you should be eating anybody what why do you want to do that I mean I've been accused it these panels are being a laid-back low-carb ER and I openly admit it I mean I've got no idea how many calories I have in I have no idea how many grams of anything that I eat I've never photographed a meal if it appeared on Facebook someone's put it there I had very low carbohydrate I just don't know how much I have and I have vegetables so I'm getting some in there I haven't been selling this and glycogen in there I'm getting it's coming in how much fat right I ate to satiety and how much protein is my body now tells me how much protein I need it's really interesting once you get rid of the sugar out of the diet which is a major distractor on how you your feedback mechanisms your body will tell you I need a bit more protein so obviously if you're very young and growing or you're very old and debilitated and need a bit more protein those two states so if you're exercising a lot you need a bit more protein your body will tell you to try and actually get out and measure how much protein in eating lean body weight nothing personal but they're crackers you're making it too hard on yourself well although that's that's if you're metabolically well I I agree that that's the case but you know because protein does cause an insulin spike if you're metabolically unwell the amount of protein that you're eating may actually be important to you and I don't think you can intuitively know internally what that's doing for you so if you're someone that's really metabolically unwell with strong insulin resistance you know one of the ways that we do it and Paul can talk more about this is actually getting people to test their ketones and see what happens with the amount of protein they have so you keep ramping up your protein until it takes you out of ketosis and then you understand the deputy a moment in time that's how much protein you can handle and still stay within your fat-burning zone but you know that if you're well then absolutely just follow your body but if you're if you're really metabolically and I'm just concerned a tweak a little bit we're making it too hard and I think it's a journey and I think you actually work it out slowly over you know I you know I don't have it worked out but I'm still fiddling around I've been doing it for you know I use I think we're probably comparing two different things here so I agree with Gary's premise and especially from an athletic point of view that the whole science about how much protein you need isn't there yet if you go into the AIS website and have a look at their nutrition section there they'll tell you you need between if you resistant say athlete maybe between 1.2 and 1.4 grams per kilogram per day if you're a cardiac athlete up to this and an extreme endurance athlete might need up to 2.0 grams per kilogram of lean mass today and that's really bad science there's actually not clear data on these numbers so it sounds like the person who's asked this question maybe has had a specific recommendation to have a particular protein intake based on that now there is some very good evidence that if you have a leucine rich protein that's got a broad spectrum of amino acids and if you say whey protein and have a dose of that four times a day that's about optimal to stimulate muscle anabolism but the simple fact is on an appropriately formulated low carbohydrate we get plenty of protein in here and I'm approaching something of a carnival so and I know that I get a lot of protein in my diet and as Duran alluded to for some people that can be a problem so I think as the rough rule of thumb which I give people I think Gary will probably agree with you with his keep it simple approach is I say don't eat naked meat so what do I mean by that don't cut the fat off your steak by the treatments the stuff with the fat in it if you're eating chicken don't eat the chicken breast without the skin eat the chicken wings with the skin so when we have a look at nature and how it packages protein it's usually packaged with fat so if you're gonna consume protein consume it with the fat on the low carb diet almost certainly you're probably going to get enough protein anyway with measuring it just make sure it's well balanced with fat one of the components of that question that comes up for me is should we measure or do we not need to measure there's a wonderful woman in Melbourne called Dale who's now about 70 who has dropped 12 genes sizes she has been morbidly obese for much of her life and she has finally nailed it over the last couple of years and she does it by weighing and measuring very carefully and tracks every day and that hair has got her to a wonderful place after a lot of dark years and that works for her gary is fructose ever okay can I eat one Apple if you're a sperm the for a sperm production they're actually sperm motility actually require fructose and that's probably the only biochemical pathway that fructose is related and required for I actually asked looked happy that who was probably a person who described fructose metabolism pretty well in 2010 flew all the way to Sydney to actually ask him that not that just their question but one question I did ask him is is there a human physiological biochemical pathway that requires ingested sugar the answer was no and the same thing goes with fructose you don't you don't need it apart from if you're a sperm and the body will produce a little bit of that anyway do you again if you want to fruit I get asked this all the time so if you want to eat fruit yes have it it's fresh local and seasonal understand that it's in nature of design to turn into effect for winter hibernation if you want to eat your Apple eat it off your tree that's grown in your own backyard that you've fought with the possums too don't bite with the supermarket we're solving there's actually last year's apples everything comes into tasmania's fumigated including tourists and yeah we pulled the drawbridge up it's got too much good stuff happening there so what was the question can I have an apple you can have an apple but but there is no human biochemical requirement for it in the body carbohydrate is energy dense nutrient poor in virtually every form that it comes in whereas the healthy fats and the proteins we have essential requirements for essential proteins and essential fats and the fat soluble ones are the ones which we don't have any if you don't have them in your diet you don't absorb your vitamins if I could just make a comment on nutrient density so a lot of people are concerned that if they're not having vegetables they're missing out on the most nutritious foods that they can possibly have so when you see those tables you have to understand that it's a fraction you've got a numerator number on top and a denominator and what they do they calculate the absolute amount of nutrients in the food and then because that is so bad they divide it by the amount of fat so if you divide a number by a bigger number you end up with a littler number so what this does is that biases against animal products so that's why you can have something like a carrot possibly being considered to be more nutritious than a piece of cheese or a piece of meat which is absolutely ludicrous so the other feature about nutrition is that we divide it by that because we think fat is bad but fat is also an essential nutrient so as gary said several times you can survive without ingesting carbohydrates your body will make what little glucose it needs but you cannot survive without fat fat is actually a nutrient in itself in the same way that protein is so this the way these equations work to give us these rankings of nutrient density of foods it's absolutely ludicrous so don't be deceived in thinking that vegetable sources of food more nutritious than animal sources of food and just to the adding to the fruit comments something that I struggled with when I was learning the science I knew that fructose really didn't create an insulin spike so I couldn't understand why eating fruit would kick me out of ketosis if ketosis was my goal and it actually took me a long time to understand that fruit doesn't just have fructose in it it's also got glucose in it and so when you eat it you're not just getting fructose as you're getting fructose and glucose and that's where often you can get kicked out of ketosis if ketosis is your goal it's not just fructose in the fruit all right anybody yeah you can anybody can comment on this what are your thoughts on metformin you know some people use it for weight loss there's a certain appetite suppressant for it it pushes glucose into muscle tissue you know can we can we recommend metformin to the best of my knowledge metformin is the only diabetic drug that has been proven to increase lifespan so in America now there's a lot of people in this field some of the luminaries who actually advocate for metformin as a longevity medication and a lot of that is on the basis of animal studies we know when you give metformin to mice they tend to live longer I certainly think if you're diabetic or have a degree of insulin resistance then I recommend it for a lot of my patients it seems to help people get into ketosis easily it definitely helps with their weight loss you know a proportion of them maybe 15% have troubles with a bit of nausea and a little bit of loose stool but that tends to be very transient and it often passes within two or three days so for me it's certainly while I think that insulin is a terrible drug and in actual fact with a only review insulin has never been compared to no insulin I was just looking for the data the other day in a randomized control trial based on mortality and the data we do have is not statistically significant but the midpoint of that data and while not being statistically significant suggests that all cause mortality may increase by almost three times about 2.8 times when diabetics are commenced on metformin now I didn't present that formally today because it lacks statistical significance but I mean it really makes sense because if the problem is your body's not responding to insulin you don't fix that problem by giving more insulin so you get a short-term gain and then in the long term that insulin will escalate the same way you don't give an alcoholic who you're trying to help recover you don't give them more alcohol if you want to reduce their alkyl ISM you give them less alcohol so if we compare insolence in that form and then that form in his world's ahead and I personally don't have a problem with it at all I'm in 2d prescribing has a whole concept and coming off medication that former was the start of my journey with my cancer someone brought it to my attention pharmacist she said look there's all this stuff coming out of South America saying that people are on metformin as an therapy with their end-stage cancer we're living longer than those who weren't and I thought Holmes is interesting because I had cancer I've never taken metformin but I thought this is interesting so here we've got a drug that lowers blood glucose or blood sugar and therefore it's got a better outcome and it's certainly the longevity studies are coming out about why don't I just reduced sugar and that began the start of my journey but I've looked at the metformin stuff and I agree it's being and it's being advocated as a longevity drug it's interesting we actually don't know the mechanism that metformin really works as it's multifactorial and yes so it's definitely associated with better outcomes but what I put someone on when I know that I can actually reduce their insulin resistance State by reducing their carbohydrate like ward that's my first and foremost but I don't think we know the answer of it there's a lot of it definitely accelerates weight loss from what I see clinically but it's correct I mean it's got multifactorial mechanisms when people ask me about it I normally say oh it's a Class A drug called a big one I'd and that sounds quite complex and then people think I'm smart enough and I just hope that they won't ask me about how it works and a certain number of patients get nausea from it and don't tolerate it the slow-release formulation is better and they start off taking it at nighttime so they don't get the nausea overnight they get tolerate tolerant to that to some extent but some people just really feel sick on it so it's it's not a complete panacea either you've got to be careful not to use it as a substitute for a free low-carb diet I mean there's you know the medical paradigm that we work under you know is that we with the medications pharmaceuticals are the answers to everything and so that's very attractive to two doctors to give them a drug rather than rather a diet I mean it metformin should be used if despite in spite of a low carb diet you still have don't have adequate control of your diabetes that's the time you use metformin not as the first line of treatment sort of second line of treatment just another thing with metformin I've done a fair bit of reading about how metformin depletes people of vitamin b12 when they can get nausea and numbness and tingling sensations and it's often it goes undiagnosed so we were talking about vitamin supplementation if you're healthy and you're not taking medications you can get your nutrients from food but medications like statins deplete you of kokyu enzyme 10 and KO QA whatever it's called and metformin is widely known to deplete people of vitamin b12 so you might need supplementation or injections to keep an eye on it so if I could just then we're gonna finish up fairly soon if I could just go through the panel with a sort of more simple question actually you if you're giving people advice really about the the psychological issue of giving up sugar and I think all of us have talked to a lot of people about this over the years do you and I know I'm putting you guys on the spot because we haven't prepped this question at all have you got like one or two points that you think are important to help people get over let's say the psychological as well as the physical addiction to the sugar practice breakfast when I psychologically I mean just even from a journalistic point of view I read this information for about three years before I was ever confident enough to think that I could put together a program the the heart of the matter programs because just psychologically it had been drummed into my mind that you know fat makes you fat and cholesterol causes heart disease and I would read something it would be counter to that idea and then I'd be all excited about it and read a bit more and then after a while it'd be like oh no it's it's fringe it's it's just too unbelievable so it was really practice I just kept reading about it and eventually I got convinced of it and I think the same thing can happen with smoking and sugar and other kinds of addictive habits you might have to give it a few goes before you're successful at kicking the habit and rod I know you've just started up a program do you want to mention anything about the program with us yeah I look at the whole psychological things interesting I mean knowing that sugar is addictive might be helpful for people to know that and as I did mention earlier I've started up or low-carb down under has started up an online course and you're very welcome to flick an email to low carb Down Under at gmail.com and we've got about 40 people enrolled at this point it'll run for a couple of months and it's got a number of components like short answer questions it's got multiple choice questions it's got some videos to watch and answer questions from it it's got some interactive segments on just something I've been keen on for quite a while finally getting it off the ground and invite you to to partake so thanks for giving me the opportunity to give that a little plug other conferences or we'll come back to those later we'll come back to that at the end Garriott questions about helping people get over sugar the I've got a hundred different ways of entering the topic with my patients doctor in Latin means to teach doesn't mean to medicate or to operate it means to educate and the very first thing I've got to try and find is the wedge into that person's head because it's all psychology and one very useful thing as I say that my patients will have all of them but from time to time is that most of us are really interested in our financial retirement we understand the concept of saving money dollar cost averaging putting away money for that that long-term future compounds over time how many of you are actually interested in your health retirement because everything you invest today and tomorrow and you keep doing it over time will only compound over time and a lot of people get it they go ah I planned my financial retirement but I haven't planned my health retirement it's a really good concept that guessing get the ball rolling and when you come to a surgeon we know that when you come to a surgeon that's a very stressful time for patients and it's a point of time when you can actually intervene in their life the people most likely to succeed in convincing the patient to stop smoking is a surgeon it's not a family member it's not a general practitioner it's not a physician is actually a surgeon there's a crunch moment and I mean coming along and seen Doron and myself and taking us seriously is a stressful moment for anyone to take you seriously to be honest the things that I the things that I mentioned about to my patients is first of all it's going to be hard and I think you have to realize that you know they can't just sort of switch off just like that secondly that it's quite likely they'll feel like crap for two or three weeks you know the infamous keto flu and so on so you've got a warned about that because otherwise you know they'll feel like rubbish after a week and give up so again you've got a so always sort of get them back you know we or to to sort of talk to them again and make sure that they're they're they're reassured and they're and they're aware of it and then the other thing is I think the hardest thing for that I found and that I think a lot of people find is just getting your head around the fact that fat is okay I mean we've been told for forty years that fat is bad and all of a sudden you know a bunch of jerks up the front here saying you know I know if that's okay and they say well hang on a minute whoa you know and that's really hard and you know I think that's that's what I struggle with and I think that's what a lot of people struggle with so again they're the sort of little pointers I would have I guess for for someone giving up well you know moving on to a low carb top diet so you probably took away from Vicky's little talk before when she alleges that I told her to suck it up I haven't always been the most empathic person when it comes to getting people to stop sugar now I used to have five sugars in my coffee so I and I only say five because the truth is it was probably more but I'd be embarrassed to say that so I used to like my sugar and it's definitely an addiction so there's a couple of things practical things that you can actually do to break the habit so first of all sleep is important sleep has three big effects so it leads to dysregulation of two other hormones leptin and ghrelin leptin helps you feel full and sleep deprivation makes that law and ghrelin makes you feel hungry and sleep deprivation makes that higher and then when you're sleep-deprived you know your willpower is reduced you know when you sort of lash out or do you know you do something you probably shouldn't it's when you're tired when you loo when you don't quite have that degree of control so if you're trying to resist sugar cravings sleep deprivation is the single worst thing that you can do you know if you think about it I often give people a sheet if they fall off the diet we say why did you do it one of the things that comes up frequently is sleep deprivation the second point I'd like to make is that you need to distinguish between hunger and cravings and the difference is if you're hungry you give into it that's natural that's allowed you eat if you're craving then that's worth resisting because with time those cravings weaken so for me personally I call it the cheese test now I used to get home I used to go and sit on the couch watch TV and then I'd start to think oh I'm hungry so I'd get up and go to the fridge and I'd see the cream and I don't feel like cream I'd see the salami not so much I'd see the nuts not really I'd find where the wife had hit in the ice cream bonds up sit down and eat the tub so the question is was i hungry or was i craving if I was hungry cream and berries would have been a delicious snack bit of cheese would have been good some dried meat would have been fantastic I wasn't hungry I was craving so I now for a period of time when I was breaking that I would ask myself when I'd say I'm hungry I said would I eat cheese and if I'd eat cheese then I'd be well okay it's not very cobby I must be hungry I'd go on it and if I'd say no I don't even want cheese doesn't matter blue then come in there the best the Swiss Gouda no I don't want that then I'd say actually you need to fight this this is a craving this isn't hunger I think that's a great way to finish off we're not quite done just yet I'm just going to ask you to thank the panel and then rods going to give us some messages so thank you [Applause]

Channel: Low Carb Down Under

Views: 99,900

Rating: 4.862361 out of 5

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Sydney 2018, #LowCarbSyd, Weight Loss, Diabetes, Insulin Resistance, Metabolic Syndrome, Paul Mason, Peter Brukner, SugarByHalf, Gary Fettke, FructoseNo, Rod Tayler, Maryanne Demasi, Doron Sher

Id: 5nC-F5_cx64

Length: 66min 2sec (3962 seconds)

Published: Sun Sep 30 2018

Reddit Comments

[u/unibball]

Excellent explanation about nutrient density at about 50:00 by Dr. Paul Mason, my new hero.