Dr. Paul Mason - 'This Doctor Will Show You How To Be Healthy'

[Music] [Music] hey guys today our guest is dr paul mason dr paul mason obtained his medical degree with honors from the university of sydney and also holds degree in physiotherapy and occupation health he's a specialist sports medicine and expert exercise you don't have to go with all that bns i'm just a doctor from sydney yeah so i'm very happy to invite paul mason to the show thanks paul for coming to the show well it's great to be here bns thanks so much for inviting me on thank you paul paul uh before we go into the interview can you share where can people connect with you well i do a little bit on twitter so uh dr paul mason at twitter i've got a youtube channel again dr paul mason they're probably the two most common locations thank you paul paul my first question is why do some people who look fit are metabolically unhealthy well it's because what you see on the skin doesn't necessarily reflect what's happening under the viscera the interesting thing is though that most people who actually truly look healthy when you actually dig down into their blood work they often can be healthy so it's not a question of looking fit but it's a question of looking thin because it's easy to be skinny on the outside and fat on the inside that's what we call tofi um tofi and that's very common because you can have visceral fat um visceral fat is basically the fat that we refer to that's around your organs usually associated with fatty liver and if you've got fatty liver then it's very likely that you also have insulin resistance and as you well know insulin resistance is the root cause of metabolic disease so it's not about how fit you look but if you were skinny it is still possible to be very unhealthy thanks paul how do one know that they have metabolic syndrome well i mean that's just a diagnostic criteria so we have five different features that we use to diagnose it and they're all sort of medical criteria it'll depend on how high your blood pressure is what your hdl level is what your triglyceride level is what your blood glucose level is and what the measurement around your middle is what we call the abdominal circumference and generally speaking if you exceed the threshold on three of those or three or more of those then you'll be considered to have metabolic syndrome but the interesting thing is if you go back and look at each of those five diagnostic criterion for metabolic syndrome they all relate back to the action of insulin so if we have a look at blood glucose level the job of insulin is to take sugar out of your circulation one of the major jobs and if the insulin's not working properly your blood sugar level can increase first problem with insulin if we have a look at blood pressure what a lot of people don't realize is that insulin actually tells the kidney tells the body to hold on to sodium which is in table salt and when your body holds onto too much sodium it actually draws fluid with it and increases your blood pressure so again high blood pressure in most cases is caused by high levels of insulin if we have a look at the consequences of fatty liver disease so fatty liver is strongly associated with insulin resistance and high insulin levels and that leads to high triglyceride levels and lower hdl levels um and of course being overweight having what we call central adiposity where you've got this you know basically a rotund belly well being overweight that's an insulin driven condition in a lot of cases there is a very strong association of having high insulin levels and developing obesity or becoming obese and in actual fact it's very very difficult for the body to store fat if you don't have high insulin levels people with a type of diabetes where their body can't produce insulin they actually waste away their type 1 diabetics they their bodies literally waste away another type of diabetes type 2 diabetes of which there's a worldwide epidemic that's associated with high levels of insulin and obesity so metabolic syndrome while we say yes it's these five criteria that we use to diagnose it in reality it all comes back down to insulin and insulin resistance and i guess probably some of your listeners would be keen to know well what does insulin resistance actually mean and i'm i don't know if you've uh if you've heard any good explanations yourself but a lot of people get confused because insulin resistance basically just means your insulin does not work properly so your body will compensate by releasing more insulin so in actual fact insulin resistance can usually be equated to having high levels of insulin of course the organ in the body that secretes insulin is called the pancreas and if that for whatever reason becomes damaged and unable to function then it can't release as much insulin as it used to and then your insulin levels will actually fall and what a lot of people don't realize is that if you have persistently elevated blood sugar levels with diabetes that sugar will actually damage your pancreas it's through something called glycation we it forms advanced glycated end products that destroys what we call eyelet cells in the pancreas that release insulin and then even though your body needs needs more and more insulin because your insulin's not working the insulin levels paradoxically fall and that opens a real can of worms because then your your blood sugar levels go absolutely crazy and as you know high blood sugar levels in your circulation well that just damages the blood vessels and it damages whatever organs those blood vessels are going to you know it's the most common cause of eye disease it's the most common cause of going on renal dialysis because of kidney failure it's the most common cause of body part limb amputation i mean this is truly a terrible disease it will double your risk of having a stroke it will double your risk of heart disease um you know there's uh the consequences the follow-on of this insulin resistance if it's left unchecked can be absolutely catastrophic thank you paul paul can you talk about de novo lipogenesis yeah so this sounds like a bit of an ugly word denovo lipogenesis so i mean de novo sort of like creating something anew lipo is fat and genesis making fat so what a lot of people don't realize is that our body can turn something made of carbohydrate and turn it into fat and in actual fact our body can store carbohydrates as fat much more easily than it can store fat as fat and at the outset that seems really strange because it seems obvious that oh if i'm eating the fat on the lamb chop then that must be easily stored as body fat it's actually not stored as body fat that easily but if you have a doughnut or a bowl of cereal or some sugars or something like that or mangoes or banana whatever carbohydrate that can be turned as fat so denivo lipogenesis is what happens when you deliver too much energy basically often resulting from carbohydrate consumption to the liver so the liver can has a is like a warehouse a vault and that can store a little bit of glucose is something called glycogen it can store about a hundred grams or thereabouts so not a great deal but and if you if your stores of glycogen in the liver are a little bit empty then if you're having excess carbohydrate then that extra sugar the glucose that you're having in the carbohydrate will be stored as glycogen but then what happens when your glycogen stores are full well the liver will then turn that carbohydrate into fat into a triglyceride fat and then that triglyceride fat what does it do well it often ends up being stored in your in your abdomen or your organs or wherever stored fat under the action of insulin so denivo lipogenesis is the process where the body will convert carbohydrate and turn it into fat and that fat very often is then subsequently stored in your stomach on your hips on your thighs in your liver thank you paul paul can we reverse type 2 diabetes so there's a lot of debate about whether you can or can't reverse type 2 diabetes and about the nomenclature that we use should we be saying it's in remission or should we truly say that it's reversed i believe you can reverse type 2 diabetes now the reason a lot of people believe that you cannot reverse it is they believe that a diet can keep it in check but then if you revert back to your old diet the diabetes would then rage on out of control so let's go back and look at exactly what diabetes is the definition of diabetes is having too much glucose circulating around in your blood so then the thought process goes well if carbohydrates are made of glucose and most of the glucose in your blood comes from what you eat if you simply stop eating the glucose that is stop eating the carbohydrates your blood glucose levels must be then well controlled and therefore um you don't have diabetes now that part is potentially true in terms of the diabetes will be under control while you're not eating the carbohydrate but then a thought process is well then if you just start to eat the carbohydrates again then your metabolism must be as sick as it used to be and your blood sugar levels would go straight up to you know terrible terrible levels you see people with diabetes they don't have the same ability to handle carbohydrates that an average person does because their insulin is not working properly whereas you or i we might be able to eat 100 grams of carbohydrates and our blood sugar levels wouldn't rise too much somebody with diabetes that would send it up into the stratosphere but the interesting thing is that it's possible to reverse insulin resistance and if you can reverse insulin resistance then you can restore a normal ability to deal with carbohydrates that people used to have in their younger years when they were more metabolically healthy and i do a test called a craft test on a lot of my patients and that's where we actually get a drink and it's of 75 grams of glucose in other countries it's 100 grams of glucose i'm not sure what you use in india and then what actually happens is you drink that and we follow your glucose levels over two hours and the craft test is we also measure the insulin levels over two hours and see if they're also going too high or too low and what we'll generally see is that people's ability to handle glucose over that two hour period after they've fixed their metabolism will often be back to normal their their blood sugar even when they consume the carbohydrates their glucose levels don't rise anymore and in those patients i think it's safe to say you reversed their diabetes now of course if you go back on a crap diet eating oxidized seed and vegetable oils and lots of sugar and stuff like that can you un-reverse the reversal of course you can you can reverse the reversal but it's fair to say that some people can truly reverse their diabetes with a healthy diet and that doesn't just mean that only why they're eating a low-carb diet it means you can also improve their tolerance for some carbohydrates thank you so much paul paul what happens if a poorly controlled diabetic consumes vegetable oils well vegeta well it's not just a poorly controlled diabetic it's anybody who consumes vegetable oils it just affects poorly controlled diabetics worse so vegetable oils by their chemical nature they have bonds that are prone to oxidation and prone to oxidation rapidly so that means it if it's been sitting on the shelf for a week or a month or three months it doesn't matter that oil in the bottle sitting on your shelf if it's vegetable or seed oil is oxidized and when you consume it your body absorbs these oxidation products the first thing is when we absorb fats they get absorbed into something called chylomicrons and they get transferred around our body through lymph channels and things like that and these oxidized fats end up becoming a part of fats that get released by the liver vldl particles and ldl cholesterol which you've probably heard about that circulates around the whole body and these oxidized fats they're called lipid peroxidation contained within these cholesterol molecules get delivered to every corner nook and cranny of the body and they deliver their oxidation products one of the the biggest recipients of these oxidized products is the liver and we've got very good evidence that drinking oxidized seed oils actually leads to fatty liver disease and contributes significantly to insulin resistance and this happens in everybody the problem is in people who are diabetic because they're insulin resistance their clearance of these oxidized fats is very much reduced and that ends up with a a much longer duration of oxidative stress to the body it can take three days to clear um oxidized products if a if a diabetic consumes oxidized seed oils but having said that even if you're not diabetic oxidized oils are still not healthy they've never been healthy all the research when we look at it with a critical eye that research that's been done with a good methodology actually indicates it tells the truth it tells us that seed oils are dangerous they just happen to be a little bit worse or actually quite a lot worse if you're diabetic thank you paul paul what do you suggest to the doctors and nutritionists who are not open to keto or low carb diets well it's not what i would say it's what my patients would say so i see patients every day who have been suffering in life with chronic health conditions it can be joint pain it can be just being overweight and having poor self-esteem from that it can be having low energy it can be being diabetic and having the multiple consequences of being diabetic so you know kidney failure multiple infections you know heart disease having strokes these are real things that absolutely can destroy people's lives and my patients come to me and they're just incredibly frustrated where that the solution for their multiple health issues has been obvious in the research for a long time and they're outraged that nobody has ever thought to tell them that if they simply changed their diet they could stop most of the medications if not all the medications they're taking they could lose weight they could feel better they could reverse their sleep apnea because they you know they could reverse their kidney failure they could reduce their risk of having a heart attack and a stroke they could improve their memory i mean the benefits that people get when being healthy to being chronically ill is just amazing it has an incredible impact on people's lives and i think if doctors actually appreciated that there actually was a solution and i don't know that doctors do it well i know that doctors don't do it maliciously but i believe they do do it out of ignorance and it's not good for the doctors either because they get frustrated because they feel that they don't have treatment options for patients the only option they have what they've been taught is to pull out the prescription pad and increase the dose or add something else that's what medical training is all about medical training is not about giving sound nutrition advice and then de-prescribing and i think if doctors were actually open-minded the problem is we've all been let up the garden path we've been fed a lie we've had the food pyramid rammed down our throats for as long as we can remember and we believed it we've taken it on board and it's very hard to consider that that might be a house of cards it might be built on a foundation of sand it might be completely and utterly wrong and it absolutely is completely and utterly wrong there's multiple pieces of evidence that uh that the science has been completely and utterly misrepresented to the point where we now give dietary advice that is almost the antithesis of what it should be and i think if doctors knew that it would lead to much better outcomes for patients and it would also lead to much more satisfying medicine do you know how satisfying it is to actually stop medications to have patients come in and say you know what i don't need this medication anymore i don't have any reflux you know what i haven't taken any anti-inflammatory this month because i have no more knee pain this is incredibly satisfying medicine it's win-win i guess if you're a pharmaceutical company maybe not but you know for the people that matter this can only be good thank you paul paul how do lectins affect our health and what is the link between lectins and parkinson's disease well let's first of all talk about what lectins are so lectins are something we call a carbohydrate binding protein so that's a bit of a fancy name so what does that actually mean well it's a protein that literally will attach to a carbohydrate or a sugar and we have lectins contained in animal foods and we have lectins contained in a lot of plant foods and some lectins have actually been shown quite reliably to be associated with autoimmune disease now for the most part those lectins are plant-based lectins so generally when we talk about lectins we tend to think of plant lectins because they're the ones that are most deleterious and the most obvious lectin that everybody has heard about is something called gluten and and gluten is associated with a lot of autoimmune disease we know that so type 1 diabetes where your body's immune system will actually attack your own pancreas from the inside that's an autoimmune disease and we know that mothers who consume the most gluten while they're pregnant their children have double the risk of having conditions like type 1 diabetes than mothers who are consuming the lowest level of gluten so have no doubt this is absolutely real we know that gluten is associated with the most common autoimmune kidney disease called iga glomerulonephritis and there's actually done some studies where they actually take a biopsy they actually cut a bit of the kidney out and measure the autoimmune reaction looking at something called antibodies and they've shown that when people go on gluten-free diets the level of these autoimmune antibodies fall we've got really nice pilot study looking at the most common autoimmune disease against the thyroid called hashimoto's thyroiditis and shows that when you put ladies with high levels of these antibodies thyroid antibodies on a gluten-free diet over six months these antibody levels reliably fall so we certainly know that gluten is a problem and gluten is not the only lectin there's other lectins like concavaline and wheat germa gluten and some of these other lectins can actually stimulate the insulin receptor and this is really powerful you mentioned you asked me to comment on something called denovo lipogenesis before where the body basically turns carbohydrates into fat well this is done often under the action of insulin and the interesting thing is they've got studies that demonstrate that the ability to force the conversion of carbohydrate to fat is stimulated even more powerfully by these lectins some of these lectins acting on the insulin receptor than even it is done by insulin itself so they're certainly not benign now parkinson's disease is what we call a movement disorder in the brain it involves something called the substantia of the basal ganglia it's basically something just deep in deep within the brain and it's characterized by people having a tremor the movements are very rigid and they they have trouble moving initiating movement and they they're very stilted they're often very unsteady on their feet we see characteristic things there's a few odd things about it like when they handwrite they have what we call micrograffia their handwriting ends up carrying very small they sort of lose the ability to form letters normally but the interesting thing is the animal model of parkinson's disease is based on something called p lectin so this carbohydrate binding protein that comes from peas and if they want to uh study parkinson's disease in dogs they have to give the dog parkinson's disease first so they give them a chemical to increase the leakage leakiness of their gut and then they give them peas and what actually happens is that p-lectin is able to travel its way from nerves from the from the gut all the way to the brain it's called the vagus nerve and those lectins then end up in this part of the brain the substantia where they sit on neurons that secrete a neurotransmitter called dopamine we call them dopaminergic neurons and we've actually got some beautiful evidence um that this occurs so in the dog studies they were actually able to attach a fluorescing molecule to this p-lectin and so when you look at it under a microscope you could basically see it glowing and after they gave these dogs parkinson's disease they euthanized them and autopsied biopsy their brain and they were able to see that these fluorescing or glowing p-lectin molecules were actually all accumulated in the substantia of the dog brains and then they cut these nerves the vagus nerves that these lectins were traveling up from the gut to the brain on and they found that they couldn't give the dogs parkinson's disease and then there was this beautiful study that was done in denmark where they actually what we used to do we used to do an operation called a vagotomy where would cut the vagus nerves because we thought it was good for stress ulcers completely and utterly wrong but it used to be very common operation and in the denmark population they basically if you've had a medical procedure done they can accumulate the data from the whole population they've got a fantastic medical record system there and over a long period of time i think it was 25 years or something i haven't looked at the paper in a while they found that if you'd had this operation then your chances of developing parkinson's disease was reduced i think it was in the order of 47 or something like that which is i think a really good indication that yes these lectins are a problem and i think the fact that we use p lectin as the animal model of developing parkinson's disease is very illustrative and i've had several patients who have actually come in when i say i think about three or four who have all said they used to consume either a lot of peas or a lot of peanuts which is a legume and they they're called pea nuts because they're sort of like peas so i certainly think there's something there thank you so much paul paul can we use dietary approaches to treat and probably reverse dementia well we can absolutely use dietary approaches to treat cognitive decline in a lot of cases so you're probably aware bns that we now call dementia type 3 diabetes and there's insulin resistance in the brain so what does insulin resistance mean so we said earlier insulin resistance means insulin doesn't work properly so if there's some parts of your brain that need insulin to take up glucose then what happens if the insulin is not working properly it means there's some parts of the brain that aren't able to take up glucose or sugar normally in that situation those brain cells are starved they don't get the energy they need so they're not going to work properly that leads to cognitive dysfunction so how do you deal with that well is there a source of fuel to the brain what we call a substrate that doesn't require insulin it's called a ketone so if you go on to change your metabolism from burning carbohydrates to burning fat when you burn fat you can produce ketones and these ketones can cross into the brain and provide brain cells even if they're insulin resistant they can provide the brain cells with a source of energy so in that case we often see when we give people ketone drinks or something like that they'll have a an episode of lucidity i just had a patient today who was telling me about her father who in the nursing home she couldn't control his food at all but whenever she went she'd give him some medium chain triglycerides caprylic acid a medium chain triglyceride oil and she said while while she was there there would be a short period where he would come alive after she gave him that and it would only be a relatively short effect and then it would wear off after half an hour or thereabouts but it's really telling that we can actually improve cognitive function in an insulin resistant brain and remember type 3 diabetes is dementia and i guess if you're interested i've actually got a lecture provocatively titled are you smarter than a doctor and i do talk a little bit about some of the stuff on dementia there and i've got some longer lectures on dementia but the other thing is is that dementia is often caused by bad diet it is a metabolic disease the brain is only two percent of the body's weight but it uses 20 of the body's energy so what that means is it's incredibly active energetically metabolically active so if there was any organ in the body that was going to be susceptible to a metabolic disease it was going to be the brain and it is it absolutely is i'll give you an example we talk about uh this uh alzheimer's gene i'm not sure if you've heard of it apoe4 a lot of people saying oh i'm going to get my apple e4 checked because i want to see if i'm going to get dementia or not and it's often stated um a slight exaggeration that if you have two of these apoe4 genes one from mum one from dead then your chances of developing alzheimer's disease are increased by about 20 times now it's not quite that high that's probably actually lower than 10 but it still is a significant increase so then the question comes on well is that truly an increase of that much in everybody or is it only in those people who have metabolic ill health and there was this really elegant study where they took a population from nigeria they looked at a city in nigeria and they looked at a ethnically identical city in indianapolis in the united states and because these two cities were historically connected by the slave trade so they actually had the same dna and this population of ethnic nigerians actually had the highest carriage rate of apoe4 in any population in the world and then they said well if it's truly just a genetic thing then they should be the same level of increased risk of alzheimer's disease in the americans and in the nigerians now i don't need to tell you that the state of metabolic health in america with the average american only 12 percent of americans not having you know at least one problem with one of the symptoms of metabolic syndrome is atrocious and that's what this study reflected the rate of dementia in the american population was two and a half times greater than the genetically identical nigerian population and there's reasons why the apo e4 genetics is much more susceptible to damage through metabolic health and i go through that in my lecture but needless to say good metabolic health protects against dementia the brain is incredibly metabolically active so if you have a metabolic disease the brain is a sitting duck thank you so much paul for explaining clearly paul what is your opinion on fish oil capsules i don't like them now i've done an about turn on this i used to recommend fish oil and i'm sorry if you're one of my patients listening to this who you know five or six years ago i recommended fish oil there was a study a couple of years ago in sydney and they went around to all the chemists uh in sydney and they purchased every brand of commercial fish oil that they could get and they took it back to the laboratory and they did independent analysis this was done through the university of new south wales and they found that there was not insignificant amounts of oxidation in every fish oil sample tested in actual fact the industry standard for oxidation which is shall we say lacks at best a lot of them actually even exceeded this very very lax industry standard and this is very understandable because omega-3 oils is a highly polyunsaturated fatty acid and we've already mentioned that polyunsaturated fats are prone to oxidation fish oil is no different and when it's sitting there it's oxidizing and there's only so much they can do by adding additives to it to um to deal with that so when you have vegetable and seed oils they often bleach it to take away the odor of the oxidation your only real protection if you want omega-3 fats and i truly believe omega-3 fats are healthy it's just that i believe oxidized fats are not healthy that they are deleterious to our health is get them from fresh food so the definition of rancidity or rotten food is oxidation of the fats within that food so if you're eating fresh food that's not rotten the fats in that food are going to be non-oxidized and they're going to be healthy and you can get omega-3 fats from grass-fed beef you can get it from fish there's lots of fresh food sources that actually do contain omega-3 in the amounts that you actually would need so i say if you want omega-3 then just eat food that contains it and eat fresh food but i recommend against any oil because to the best of our knowledge we have today there is not one fish oil out there that doesn't contain oxidation there's lots of people claiming it but i've seen no scientific proof that it's possible to have a non-oxidized seed oil thank you so much paul paul how to reverse arthritis i assume you're talking about osteoarthritis here which is generally what we call the wear and tear arthritis and you can't reverse it but you can make it feel a hell of a lot better so the reason for this is that let's go backwards step we've got lots of studies that show that when people lose weight their pain significantly improves the joint that we usually refer to when they talk about this in the research is knee osteo knee arthritis and it's been said that a 10 body weight reduction can reduce the pain of knee arthritis by about 50 percent so most of the data would actually suggest it's probably only about 30 but that's still pretty significant and if it was only due to the weight loss then would expect it to be proportional we'd expect a 10 reduction body weight to lead to a 10 reduction in pain not a 30 percent or a 50 percent so why is it so it's very well accepted now that it comes down to a cytokine effect that circulating molecules when it within our blood messenger molecules and i can tell you what those molecules are so if you actually think about you you get a soup bone like that when you're going to make a big soup out of or you're going to give to a dog or something like that and you know how you've got this shininess on the end of it it's shiny whereas the shaft of the bone is actually a little bit dull so that shininess on the end is actually called articular cartilage that's super smooth super hard wearing in actual fact two sheets of articular cartilage rubbing against each other have less friction than wet ice it's really smooth stuff and apparently i i don't know how true this is if you shoot a puck on ice if you could shoot that same puck on human articular cartilage it would go six times farther so i don't know if that's true or not but it's certainly a nice statistic to roll out from time to time but basically this is impressive stuff now if you were to slowly grind this articular cartilage down that's arthritis and when we talk about grade one two three or four we're really just talking about is that the first 25 percent are you in the next 50 percent 75 percent or how far through it are you that's how we grade it now you cannot once you've worn away some cartilage you can't replace it but you can make it more resilient what is left behind because it doesn't actually have any nerves so the fact that you've ground a bit away doesn't cause pain but if it loses its function and doesn't absorb shock and protect the bone that's underneath that bone has a lot of nerve and that can cause a lot of pain so if we actually were to look at this articular cartilage under a microscope you what you would see is you'd see a cell in the middle and that cell is called a chondrocyte and that would be surrounded by a protein scaffolding that we call the extracellular matrix and that extracellular matrix is what actually makes the cartilage resilient and strong and there's some things that can make the the chondrocyte in the middle is making this extracellular matrix or this scaffolding all the time and there's other forces in the body which are breaking it down and if the force is breaking it down uh much much you know quite high then that means you can only secrete a very little and not a very stable extracellular matrix so the resiliency of the cartilage and the ability to protect the underlying bone is going to be much reduced so then the question is what factors actually lead to breaking down of this scaffolding and the only protein in our body that can break down that type of collagen is called a matrix metalloproteinase matrix metalloproteinase it sounds awful but basically metallo just means it's got a metal line in there protonaze means it can break down protein and matrix just refers to it breaks down the extracellular matrix so it's actually you know an almost logical name and they're made by the liver now the liver normally makes a a small amount in the background it's what we call a constitutive secretion it's always making a little bit but if you have fatty liver disease you make a whole lot more and some of that extra stuff that gets made circulates around the rest of the body and it gets exposed to your cartilages to this extracellular matrix so it weakens it so it weakens all the proteins and all the collagen proteins in the body and so that means that you're more likely to develop tendon injuries which are also made of collagen you're more likely to have arthritis pain because you the lining of your joints is less resilient so when you lose a little bit of weight the beautiful thing is the weight that you lose first actually comes away from your liver so even before you lose the pot belly you're reversing fatty liver disease you reverse fatty liver disease reduce the amount of fat in the liver the body makes less of these matrix metalloproteinases we abbreviate them as mmps if you have less mmps then that means there's less of this breakdown stress on your articular cartilage and even though you've got the same amount of cells the same amount of chondrocytes that hasn't changed it means that the area around them that scaffolding is much bigger and much stronger and much more resilient and that protects the underlying bones and what we actually find so i work with an orthopedic surgeon called dr duran sher he's excellent surgeon but what we find is that when he gets his patients to lose weight and go on a healthy ketogenic low diet low in seed oils low in carbohydrates about 30 to 50 percent of the patients who would have been booked in for surgery cancel they no longer need the surgery is there arthritis reversed well technically it's not reversed but their pain's gone away and that's pretty much the same thing thank you so much paul paul many people are afraid that uh feed too much protein then it will raise uric acid levels what do you say about that so it's very important to not be confused between the difference between urea and uric acid so eating a lot of protein absolutely will increase your urea but that can absolutely be a good thing let me tell you about one of the major benefits of this in no way do i consider an elevated urea to be problematic you'll urinate a lot of it out there's a study done i think i was in 1963 that actually showed that the most important factor in urine in terms of antibacterial activity was how much urea you had and there's been several studies that have then looked at some different diets a few of them were in dogs where they were trying to actually induce urinary tract infections and they found that they could give dogs who weren't eating much meat urine tract infections but when they fed the meat they couldn't because the urea in their urine was basically killing the bacteria before it could proliferate so i would actually suggest that especially for females this is a particular female issue if you're worried about utis and have a problem with urinary tract infections in a high protein diet increasing your urea could certainly be a good thing and for a little bit of extra bonus on top of that i would supplement with a good mix of electrolytes including sodium potassium and magnesium because we also know that the combination of salts or electrolytes in the urine also exerts extra antibacterial activity and i've had several patients who previously suffered from chronic utis some patients even have so many utis that they're on a daily antibiotic long term permanently to try and reduce the risk of developing utis and i've had patients who have been able to come off this you know antibiotics every day is not a good long-term solution much better to have a healthy diet high protein diet with good electrolytes very natural way to do it and much more effective and no side effects um uric acid is actually also often going up on a ketogenic diet but that's something different so uric acid um is a breakdown product of purines in some people it can cause attacks of gout because it can crystallize and form these needles when we look at it under a microscope it's what we call negatively birefringent crystals when we do something called polarized light microscopy that's just a fancy way of saying sharp needles that we can diagnose and they cause terrible terrible pain in a lot of people so a lot of doctors get very concerned when they see a high uric acid level a lot of doctors make the mistake where they assume that if you have higher uric acid levels you must have gout and that's absolutely incorrect and a lot of i wish people would stop making that mistake it just increases the possibility having said that most most of the purines and most of the uric acid we get doesn't actually come from meat in the diet it's a big myth that meat is actually what causes an increase in uric acid and increasing gout you will get a transient increase in uric acid when you start a ketogenic diet because your body will start producing ketones but the cellular machinery for your body to actually burn those ketones hasn't been upregulated yet so the body says oh i've got too many ketones what do i do well we're going to urinate them out they pass out through the kidneys and they share the same transporter that uric acid does so if the ketones are leaving the body they're actually making it harder for uric acid to leave the body so you'll often get an increase in uric acid level for about a month or so after starting a ketogenic diet the thing is this doesn't lead to a surplus of attacks of gout i think i've only seen one patient who's had an attack of gout while they've been on this kind of diet and i would say that the chances are that that probably would have happened anyway that was almost certainly coincidental i see a lot of people who have histories of gauss and even though the uric acid level may go up during that transient period of a ketogenic diet their chances of having an attacker gout are actually down and it's actually my job to usually reduce the medications that people take to try and suppress their uric acid levels they usually take a drug called allopurinol which is what we call a xanthine oxidase inhibitor which as xanthine oxidase is the enzyme that processes purines into uric acid and i'm very successful in in a lot of patients who have had a chronic history of gout once they're stable on a diet they've lost a lot of weight and they're metabolically healthy we say well let's stop the allopurinol and see what happens 99 of the time almost i can't even actually recall a case where i've stopped oligarinol and they've had to go back on it um so uric acid related to protein is really not a valid concern urea related to protein might actually be beneficial thank you so much paul so now we have questions from subscribers paul first question is will high protein diets damage my bones that isn't no that's the easy answer but let's go back into it so how did this myth arise that protein is bad for the bones well it came over 100 years ago when we actually discovered that when people had high protein diets there was higher levels of calcium in the urine and people assumed that that calcium must have been leached from the bones in actual fact that is not true because when you have a higher protein diet you absorb more calcium from the diet so and if you absorb more calcium then that means there's potential for more to then leave the body in urine but it's not being lost from your bones it's just being lost because you've just absorbed more in actual fact we have randomized controlled trial level of evidence that a high protein diet can assist in reversing osteoporosis so there was a study done back in 2002 and they looked at supplementing with calcium and vitamin d and they looked to see whether or not they could actually reverse osteoporosis they followed people over three years and they did a bone density a dexa scan dual energy x-ray every six months over that three years and this was menopausal females and males over the age of 65 i think it was and what they found that on average they could slow bone the bone degrading by giving vitamin d and calcium but they couldn't restore it and then they did something smart they said what happens if we stratify the results based on how much protein people are consuming and they found that the group that was consuming the most protein actually reversed osteoporosis in their hip bones reversed osteoporosis and this is really logical because bone is mineralized protein it's protein strands that's got minerals embedded within it so if you're trying to build more bone you can't just give calcium because that's not the complete ingredients you need all the ingredients bone has protein in it forty percent of the dry weight of bone is protein so a high protein diet has been shown to be conditionally essential to actually reverse osteoporosis protein is good for the bone full stop that's awesome uh paul thank you second question is how to deal with pcos so polycystic ovarian syndrome is a condition a genetic condition we believe it's genetically associated that's got three main diagnostic features under what we call the rotterdam criteria the rotterdam criteria is atrocious it's a it is very unreliable but it's still what we use so we look at whether there's cysts on the ovaries we have a look at whether there's high levels of testosterone or what we call evidence of hercysm hair on the face or male pattern baldness or acne or basically anything to do with testosterone excess and we have a look at menstrual irregularity so uh whether the periods are just really not coming very often or their their cycle is very variable and we generally say that if you've got two of the three then you have polycystic ovarian syndrome and that that's i think doesn't reflect the complexity of the disorder i believe it's on a continuum and i believe people have degrees of it and they might only have one of those symptoms but definitely have it the problem is polycystic ovarian syndrome is strongly associated with insulin resistance so a lot of females who have pcos they're trying to lose weight with one arm tied behind their back for them they will generally be heavier on a particular diet than somebody without pcos would be and that's important to understand because it means that yes it's not fair but it does explain why these people might have troubles and they know that they just need to be more diligent and it sort of gives them an understanding of why they might be having troubles with their weight and the best thing you can do for polycystic ovarian syndrome is actually improve your metabolic health we often see so levels of testosterone dramatically fall when people go on ketogenic style diets after with a diagnosis of pcos there's another supplement which is quite useful and called myo-inacetol and there's several studies that show that that can be beneficial and that can just overcome one of the particular deficits within pcos and a dose of 2000 milligrams twice a day is what's usually studied and i believe they also throw in 400 micrograms of folate as well so that's certainly worth for people with polycystic ovarian syndrome have a chat to your doctor and see whether it might be worth supplementing with my inacetal combined with a little bit of folate thank you paul one next question is should we limit our salt intake i don't believe so i don't believe there's any i don't there's not sufficient evidence at this stage to limit sodium intake so when we say salt we normally talk about sodium chloride and the sodium is what people get concerned about just for an example in i think of september of 2017 the australian dietary guidelines removed any upper limit for sodium intake for individuals that means that i can now tell you to have as much salt as you would like and not be in contravention of the australian dietary guidelines and i believe that this upper limit was removed purely because there was no evidence to support it in actual fact the in the document where they discussed this they stated that by reducing the average intake to the guide of the two grams a day that would lead to an average reduction in blood pressure of two millimeters of mercury an absolutely tiny amount and if that's the whole premise of recommending a low salt diet then that's ludicrous and poll like it also raises the heart rate right so if it reduces the blood pressure it raises the heart rate so it's um but often that's often a compensatory mechanism um if you are the trouble is the the fluid volume of your blood is governed by how much sodium you have and if you don't have enough sodium in your blood vessels then number one you'll often feel thirsty because your body's saying we need more fluid we don't have enough fluid so you'll drink a lot but then because you don't have the sodium remember the sodium is necessary to hold the fluid inside your blood vessels so you'll end up urinating it out so people on ketogenic diets um because you often need more salt on ketogenic diets if if they're finding that they're constantly thirsty and they're urinating a lot so when they drink it just passes out it's often a sodium deficiency and one of the other major symptoms people will feel is that if they stand up quickly they'll feel dizzy because their blood pressure isn't enough to maintain the blood pressure going up to the brain you're basically starving the brain of oxygen if it's blood supply so they're two common symptoms of sodium deficiency um easily fixed just by having more sodium in the diet thank you paul one next question is can you talk about meat and tmao sure if tma if tmao is so bad from red mate why do we not care about it from fish or from chicken it's rubbish these people who say you shouldn't eat meat because of that they're also saying you shouldn't eat fish or you shouldn't eat other white meats rubbish thank you paul well next question is how to boost testosterone well look i'm not going to talk in too much about this but just a couple of key points what's testosterone made of cholesterol if you're if you want to provide your body with the capacity the ingredients to make testosterone you better make sure you've got enough cholesterol one supplement which does come up from time to time that has been suggested to support sex hormone capacity including testosterone is boron and that's a nutrient which is often deficient in our diets and people will often be taking a dose of about six milligrams a day to supplement with boron but there's a lot of other things that interact with sex hormone status but that's probably two of the most obvious ones thank you paul last questions from subscribers how fructose causes hypertension in addition to fatty liver well fructose directly contributes to insulin resistance so we've got some beautiful studies where they've actually had groups of children who have been consuming a lot of sugar which is 50 fructose 50 glucose and they've taken out the fructose but they've basically replaced it with same amounts of glucose so the total carbohydrates have stayed the same but the fructose has reduced and in those studies even very short periods in the space of you know just over a week they've been able to demonstrate significant reductions in liver fat and have no doubt that liver fat is fatty liver is a direct con cause of insulin resistance now if you have insulin resistance we said before that means the insulin is not working properly so then your body will increase the level of insulin now the thing about insulin not working properly is it's very tissue specific so while it might not work as as it normally does in your muscle tissue helping your muscles to take sugar out of circulation it can still work relatively well at the fat level so help your fat stores take sugar out and it can still work quite well at the kidney level and one of the jobs of insulin at the kidney level is to actually hold on to sodium so that's actually a much more important factor for increasing the sodium in your body and causing high blood pressure then is the amount of sodium that you consume if you consume a modicum of sodium but have very high insulin levels your body is going to try very hard to hold on to all of that sodium you can on the other hand consume a whole lot of sodium but have very good low insulin levels and any excess sodium that can you consume will just come out in your urine high insulin levels prevent that from happening effectively so fructose causes high blood pressure predominantly through the mechanism of insulin resistance now it can also interact with nitric oxide levels via uric acid and some of your viewers may have seen lectures by professor tom robert lustig he did a famous lecture that's about 11 years old now and he's got quite complicated diagrams in there that demonstrate how fructose metabolism leads to changes in uric acid levels which then lead to changes in nitric oxide and nitric oxide is actually something that relaxes blood vessels and actually helps lower blood pressure and if you interfere with that pathway then that's another potential mechanism to increase blood pressure but i believe the predominant one is the sodium retaining effects of insulin at the kidneys thank you so much paul last question would you like to issue a seven day challenge to our subscribers yes well i mean absolutely well here's the thing the changes and the benefits of healthy eating can be incredibly rapid so we can we've seen evidence i've done mri scans on people's fatty liver and in the space of a week we've been able to see that you can remove 30 of the fat from people's liver so you don't have to do this for a long time to start seeing the benefits and once you start seeing the benefits you might not want to stop so it actually makes a hell of a lot of sense to do a seven day trial you really don't have anything to lose so all you have to do it's really simple so cut out sugar so we're not even going to go low carb necessarily we'll just say the two most toxic things in the modern diet are sugar and seed and vegetable oils so cut out sugar and cut out seed and vegetable oils for a week make sure that you you may want to increase the salt and speak to your doctor before you do obviously this is uh i'm not your personal doctor so mate get it cleared by your doctor first but then you may want to increase the amount of salt in your diet otherwise you'll get what we call the keto flu used to be called the atkins flu and see how you feel after a week and i promise you uh you're very very likely if you're overweight to lose a bunch of weight in that week it's not unusual for people to lose a kilogram or more of fat in the first week it's an absolute myth that the rapid weight loss at the start of ketogenic diets is only due to fluid loss that is absolutely not true and we've actually we can do uh with body composition scans to prove that but you do rapidly lose fat so give it a go thank you so much paul for coming to the show and helping us to become healthy my absolute pleasure thanks so much for having me bns it's been great to chat [Music] you

Channel: Low Carb Down Under

Views: 62,623

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, BNSGOKUGREAT, metabolic health, dementia, seed oils, LCHF, Carbohydrate Restriction, Vegetarian, Carnivore, Keto Diet

Id: f45P4EtgWtI

Length: 60min 47sec (3647 seconds)

Published: Sat May 08 2021