Keto Salt Lake 2019 - 06 - Dr. Adam Nalley: Tuning the Thyroid with Ketosis

you don't want to get going too late so our next speaker is Adam nalli dr. Adam nalli and as an international known speaker dr. Adam alley puts a profoundly practical and charismatic effect on topics of importance he creates a bridge for the average person to see and clearly understand deeply complex concepts in the medical world with his knowledge humor and endless bacon analogies so I give you dr. Adam nalli thank you did you guys hear me okay is the mic all right all right I may move around so I apologize to the cameraman ahead of time I appreciate being here and I'm grateful of all the vendors and especially the keto Chow for inviting us to be here this is actually a lot of fun how many of you are healthcare providers of some sort just wanna give an idea and how many are just a lay person starting keto how many this is your first month in keto or your first week couple all right so it's gonna have an idea of what we're doing all right fantastic there's a little bit feedback there okay I'm the board certified family physician I'm a board certified obesity medicine specialist I'm also a health policy fellow through the American Osteopathic Association so I've dealt with a lot of areas I talk really fast and so if you haven't if you haven't buckled up your bootstraps and hold on your suspenders do so I would also say pull out your cameras and get ready to take some pictures because I'm gonna give you some slides that may be somewhat complex and there's a lot of information and it's easier to take a picture than it is to take notes for some people so I think you'll feel feel free to do that I hope this changes well that's okay perfect so thank you I have to tell you who I am a little bit my disclosures I'm the owner of muscles calm where I blog and post stuff and I'm also the author of what a lead author of the key to cure I'm the owner of a multivitamin company and also a distributor for a number of exogenous ketones so I have to tell you a little bit about the disclosures there I started this journey as a physician about 20 years ago and my fall this is my dad I grew up here in Orem in this part of the valley he's actually buried in American FARC you guys see that right and he weighed about 400 pounds when he died at age 58 he was a type 2 diabetic progressed to type 2 diabetes he's on 150 units of insulin and 32 pills a day when he passed away this is the last picture of him before he passed away I'm gonna bring some spit and his labs and my labs in our early 30s looked identical my concern was that as I entered medical school the challenge was that I weighed about when I came out of medical school I weighed about 65 pounds heavier than I do today and in the first 5 years of my practice could not get the weight to come off no matter how many calories are restricted and no money no matter how many triathlons I ran I could not get the weight to move and I figured something's wrong here so in the process I went back to school and said I want to learn about obesity and became a specialist of obesity and realized in that process that we've been doing it wrong for 50 years and so you're gonna see a component of that and I'm gonna start with dispelling some myths and then lead into how that affects the thyroid which is one of 16 disease processes that I commonly treat every day dr. Ron Ron who's just here a little earlier spoke last talked about insulin resistance that is a primary key factor we're gonna touch on that a little bit briefly and then move forward with that but I want you to understand that he showed you some great slides I just want you to know that we are getting heavier and heavier as the time goes on right now 38.5% obesity in the in the nation the East Coast is the heaviest and so that's the challenge that and we're catching up with it pretty quickly so that's the big concern I went to Disneyland my kids when I've got older kids now they're in their 20s 18s and 20s but in 2007 we took my kids to Disneyland and my wife's favorite ride is that it's a small world and it was closed and we were all upset especially my wife very upset they were replacing the boats in the flumes that was the challenge they needed larger but windy boats because they were bottoming out we as this as a nation as a people were bottoming out the most famous ride in the world because we were 30% heavier than we used to be and it's a small world couldn't handle the size so they replaced it over a two-year period of time and that one of the big challenges that we found the other concern is I'm former military and there's a huge number of costs that go into a number of different things that we do with this obesity that's there it's increased we've had to increase the braking systems on all of our equipment or airplanes and our buses our trains we've had to increase the size of stadium seating we've had we've had to relax when I entered the military in the Air Force we had to run a mile and a half you know a certain amount of time a year into the military they relaxed that requirement and said you have to walk them out on half in 45 minutes I don't want a soldier who who have who passes that requirement on my back I want someone else that can help me and that's that's a concern to me we now have the the Big John toilet seats if you have not seen them are there aren't in most stadiums and which was very loud and clear to me when my father passed away is you have to get the double-wide casket it costs twice as much but you have to buy the double-wide casket and that's a challenge and this is more and more common as we move forward through the through the years so in my office the c-word is a swear word because these are little tiny creatures that live in your closet and sew your clothes tighter every night now you saw this from dr. Rigby but you can see that amazingly all of a sudden in the early nineteen nineteen seventies boom there's this jump in obesity and overweight and it's fascinating that that same year is the year that lovastatin the cholesterol drug was discovered and that same year is the year that the the food pyramid was designed now the food pyramid changed they kind of spread it around on the plate we now call the food plate but it's the same it really hasn't changed much but you could see that we've been gaining weight incessantly and diabetes follows that after that explosion that occurred in the early 70s all right so how does this affect our children well I recall growing up as a kid watching the black-and-white Godzilla and I loved it because that was the old that was a venture well now we introduced fishy crackers and this is our Godzilla for our kids so unicorns are real it's just that they started eating low fat in the seventies we now call them rhinoceroses so the challenge is we can only see a short distance ahead but what we can see lights the way greatly and what I hope to do is that you're gonna take away something from this that may be significant for you and I may be different for your neighbor but I there's a lot of information that I want you to pick up in your journey some of you may be early on in that journey a week into this journey some of you may be as far as I am at fifteen years into this journey I've been pita genic for 15 years or close their to my last meal for those of you that are interested was last night at 7 a.m. or 7:00 p.m. I got up this morning then spent an hour in the gym lifting weights and I've been here the entire time and so I'm going I'm going on probably 18 hours of no food or or will be by the time I have dinner but I just am not hungry but and that's the benefit of a ketogenic diet is it naturally causes these periods of not being hungry but let's look specifically at what causes the obesity and the challenges that are there and I'm a big fan of house and house says um you know what I'm gonna tell you goes against what you've been told for years it goes against some very strongly held dogmatic beliefs but truth is truth and right and wrong does exist so we're gonna look at that all right so what actually causes obesity my practice we see about thirteen thousand patient visits per year I have two pas in my office I've been in practice for twenty years that's a lot of people 85 to 90% of the people that walk through my doors have some degree of insulin resistance so what that means is that if you if I give you a piece of bread your body should produce a slice worth of insulin to help absorb the sugar in that bread however if you give me that same slice of bread I produce 10 times the insulin in response to that piece of bread so I store 10 times the fat I make 10 times the cholesterol I make 10 times the uric acid and risk for gout and kidney stones and I have ten times increased risk for a floor osis and ten times the increased risk for inflammation I have patients in my office that produce 30 times the normal amount of insulin all of us are somewhere along that spectrum if your insulin resistant you may be more you may be less if I walk by the I gained weight that's the challenge so you have to be aware of that so I say roughly 80 to 85 percent I think it's more closely than 90 now have insulin resistance and have this this regulation of over production of insulin we'll talk about that a bit sedentary lifestyle may play a role I live on a farm and the the farmer that's next door to me he gets on and off his tractor and does holes hay and does all the stuff with his cows he burns 2,600 calories a day just doing what he does that's the equivalent of running a marathon every day I burned 300 calories a day walking from room to room and jumping to conclusions so that's the difference between the two of us there is a difference in what we're doing there but that plays a role and we're gonna talk about thyroid as the tail into this and how this affects it and that's the metabolic deficiency or one of the main ones that I see and we'll delve into that fairly heavily so this is a patient of mine on the right-hand side she's seven years post gastric bypass regained 130 pounds after gastric bypass they told it would solve her problems it did not she came into my office in tears could not lose weight she was anemic had horrible asthma her blood pressure was through the ceiling fatty liver disease and a whole slew of things that were happening we put her on a ketogenic diet and in nine months she lost 75 pounds and she feels like a completely new woman the challenges I see this after five years after gastric bypass people start showing up in my office because this is what's happening we're not fixing the problem we're just putting a bandaid on it and surgery's not so the challenge in this life is not closing the gap between your actions and your belief the challenge is closing the gap between your belief and the actual truth so I hope I can present to you some science that gives you some valid truth that helps you make decisions on how you pick to use your meals and how you eat so two recent article questions and I'm not gonna just be going this briefly but why do popular self-help books scholarly articles media headlines still question the ability of the dietary calorie technically in predicting energy deficit accumulated access and the other question that's the same thing and if we have all this data why do we still use do I wipe do I do people still disagree with the calorie well as I said the calorie in my office is a swear word we don't count calories I don't want you to count calories because they don't it doesn't work doesn't work for most of my patients and the reason is this and I there's still Makita world and argue this but I say to them okay yes sure we have the law of thermodynamics the first law says you can't change energy energy oh you can't destroy or remove energy in a closed system you just change the form so you have to account for all that energy and we can't account for calories but what the human body doesn't follow is the second law of thermodynamics that's the equilibration of entropy and the problem is that if you're a closed system like an ice cube and I put you out there entropy means that the overtime they're gonna be this increase random change the water will turn the ice cube will melt and turn into water that's true but our bodies were designed to prevent entropy from happening and that's what the second law of thermodynamics talks about and diet and the human bought mammalian body does not follow the second law of thermodynamics basically the problem is that we have hormones that block off these two boxes from working correctly to prevent us from working so the calorie is a calorie theory doesn't work in the mammalian body random disorder increases over time however the body's designed to resist that disorder by hormonal counterbalance it was briefly talked about but it doesn't take into the hormones and it doesn't take into the fact that ketones act like hormones which we may touch on briefly as well and then lastly this basically because you're maintaining weight in the system where you should be losing weight if you count calories this is negative entropy so so basically there are four laws of thermodynamics not one and if somebody says the calories of calorie they need to understand the other three laws of thermodynamics and how that applies to the body all right so how do I know this well over the 20 years of my lifetime I love hormones and these are the 38 hormones that allow you to gain or lose weight all you have to do is understand that and if you understand that you will know exactly how to lose weight but that is as far as we know the 38 hormones that resist entropy or change in the human body and so again it violates that second law of thermodynamics so this is my horse Bailey and the judgment comes from good judgment comes from experience and most of that comes from really bad judgment so let's start with something simple your brain is the main organ in the body and it wants glucose to be maintained for happiness between 70 and a hundred milligrams per deciliter or 3.9 to 5.3 millimoles per liter if you're from across the pond but your your brain wants that that's what it wants and it will do everything in its power to maintain that it will override every other organ in your body to make sure that happens and it's best friend is the liver and that liver let me back up for ego there so if that in your blood sugar drops below 80 milligrams your infant level begins to decrease and then as it drops below 70 your glucagon your epinephrine Rises and then if your if it drops low sixty-seven norepinephrine and growth hormone rise and then if it drops below 65 cortisol rises and then if it drops below 55 you get dizzy lightheaded and have low blood sugar because your autonomic nervous system kicks in your brain controls this and tells your body to maintain the sugar so this doesn't happen and that's what your body does that's why people's blood sugars are where they're at because of these hormones that are driving that process now under 50 brains aren't very happy they don't function very well unless you give them ketones then they do a little better but the liver is the brains best friend now we've often said well the pancreas produces insulin and insulin lowers the blood sugar that's actually not true that's a secondary function but that's what we were taught as a primary function medical school that's the challenge the mania the main job of the liver is to make sure that glucose stays somewhere between 70 and 95 that's what it does and insulin acts as a counterbalance to raise or lower the signal to the liver but we never took in to account the hundred and seventy hormones produced by the fat cells now fat cells I was told in medical school were there for cushion keep us warm and store energy but in the last 10 years we've realized that there's at least 170 hormones produced by fat cells and we now know that at least eight five to eight of them play a role in dramatically enhancing or affecting the way the liver produces glucose so what happens is these hormones either suppress or increase or dam the effect of insulin on the body so let's say I get bigger which I did sixty five pounds bigger I now produce more add less adiponectin less leptin essentially more resistant and I produce more of two men across this factor alpha interleukin 6 which happen to be the same hormones that caused cancer cells to grow faster those hormones actually suppress the effect of influence so when people wake up saying doctor any I don't know understand why my like glucose is 106 it's because their fat cells are still over producing these two hormones not letting influent effect itself so the pancreas says well I gotta produce more and it produces more insulin and now you've got insulin resistance because you've got six fat cells that aren't doing their job does that make sense whoa you now know more than most of the endocrinologist in Arizona I am so impressed all right I hope there's no endocrinologist here I just offended a bunch of them I'm sure all right so that's glucose 101 that's where insulin resistance comes from it comes from sick fat cells not a bad pancreas and until we fix that you're gonna have a problem now what happens if we take all your sugar you actually decrease your insulin loads and you produce something called ketones which is a byproduct of fatty metabolism and guess what ketones are really cool because they also act like hormones and they suppress these overproduction this is why I was so shocked when exogenously tones started being used and I had patients blood Sugar's totally normalized in two weeks no it what and because when a person got into ketosis or they were using products that allowed the ketone to be present we're suddenly changing the dynamics back and this is why I'm such a big fan of being in a ketogenic state you can do the low carb yes but you're not going to change disease until you're in ketosis and that's why I'm a big fan of being a kid you diet does that make sense all right seriously that's you you now know more physiology than I knew when I came out of medical school so that's why I wrote a book and basically what I did when I first came out of school I started doing to our glucose tolerance test but I was checking insulin as well and the labs hated my guts because I was sticking people all the time it was like all those who've been pregnant and had that two hour songs test if you've had that raise your hand yes okay you know I'm talking about that yummy 75 grams of glucose should drink and then you sit there forever and get lightheaded busy and they stick you for 12 times well a guy named Joseph Kraft did it thirteen thousand times but he did it for five hours and between what he saw and what I saw what we identified is that if you're a normal your insulin when you're fasting should really be less than five not twenty like the lab says and when you have two hours after a meal your insulin should drop to less than forty but most of my patients 90% of them are somewhere in here when they're fasting their insulin is up around fifteen thirty forty I had one guy that came in within 110 and he's up in that he's clear up past here now we arbitrarily called diabetes right here when you're fasting insulin is over 30 that's your type two diabetic and that this is actually 25 years into the process you've already had all this damage occurring because of high insulin loads for 20 to 25 years before you ever get that diagnosis of oh you're diabetic it's an arbitrary number the problem is not diabetes the problem is over production of insulin that's type 2 diabetes type 1 diabetes is they're not producing any insulin two different things all together but hopefully that makes it clearer for you alright and then like my father is after a while his pancreas burns out and then we have to start giving him a ton of insulin in order to compensate for his pancreas that then burned out so I don't want to demonize insulin because you need a little bit of it but when you have a lot of it this is these are all the really cool diseases that arise this is what keeps me in business this is actually job security by the way so excess insulin causes weight gain it increases the sodium retention and causes your blood pressure to go up not your salt sure it's your insulin it raises uric acid causes calcium alkoxide we call those kidney stones we also have a gout small dense LDL particle goes up every single time insulin directly stimulates oxidation of the cholesterol molecule and causes that to change in the small dense particle leading to a through Genesis that's that's the next step in the process increases triglycerides eight pieces free radicals these are not the terrorist type these are the ones that cause cancer we're going to talk about thyroid here two minute and then it it rate it lowers estrogen and women raises Esther than men and does the opposite with testosterone turn men women women men and I see that almost every day and then lastly it increases inflammation I'm amazed that I see 50% reduction in pain from arthritis within a few weeks of being in the kid jack diet with many of my patients for over 65 so pretty impressive alright so this is a gluten free salad doctors say that each piece of baked can you eat takes nine minutes off of your life and if that was the case I should have died in 1731 so let's define a low carbohydrate diets because nobody defines this and and if you're going to talk about a ketogenic diet you at least have to have something like this on your slides so number one paleo is low carbohydrate rich in - somewhere between 100 and 250 milligrams the reason the CrossFit guys love it is because they do so much exercise that puts them into ketosis periodically and they can get away with that many carbs but I can't an orc and many of my really insulin resistant patients second is a low carb diet which is what a lot of us started out with is a hundred grams or less a very low carbohydrate diet which is what I was trained with originally is less than 50 grams and then truly to be ketogenic for many of us who are very insulin resistant like I am you've got to lower those cart that carbon take to less than 20 grams per day or you ain't getting there and that's the challenge that I see so everybody get that so that's the world according to that's the ketosis world according to dr. nalli now you may see how Doc's defined that slightly different but that's really what I do all right correct rules under the dole team to pay your bills don't do math and eat naked every day now why do I say that because one of the biggest factors that affects your thyroid is autonomic dysfunction you may have a fairly normal thyroid but if you're under the fight-or-flight response which is what your autonomic dysfunction function does you see these changes that occur all the time and it actually suppresses thyroid function as well as many other hormones and raises insulin so just being under constant stress will actually affect insulin it will affect sex hormones and it will affect your insulin and now primary job number one in my office we fix the insulin first if you don't fix the insulin you can't fix anything else period the insulin has to be fixed first and if yours if you're saying doctor I'm still not doing okay and we treated my thyroid and we treated my testosterone but if you're still having a dingdong every third day you're not gonna see success you've got to bring the insulin down first before the other the other effects will happen alright so this is the thyroid level it would take a little time here so you're bought your body at the hypothalamus produces trh trh stimulates this little hanging down thing in the middle of your brain called the pituitary gland and that gland then produces thyroid stimulating hormone which most doctors are really good at measuring and telling you oh you're fine but that hormone then stimulates two hormones t4 and t3 now the thyroid produces a small amount of t3 only about 20% and the 80% is t4 we're gonna talk a little bit about that but this t3 is this T force converted into t3 and then acts like the gas pedal for your body for every cell in the body it increases the metabolism or decreases didn't know what t3 is hopefully that's simplistic enough to understand your thyroid function now these are the hormones that you may get measured most docs will measure these these first couple hormones here but we also want to see what your free t3 is we want to see occasionally what the what's bound your you're doing your these hormones float through your blood system only a percentage of them are loose and free available to be used the rest of them are bound to a hormone called thyroid binding globulin and they're not accessible they're just until the body pulls them off you can't access them then there's this really cool molecule called reverse t3 which is actually a conversion from t4 to t3 but it's an inactive form and we're going to talk about why insulin affects that and then there start with antibodies now the thyroid is very vast and and somewhat complex disease process if diseases arise and we'll briefly touch on that and I don't want to do a dissertation on it but I want you to understand some basics so we have two active forms of thyroid hormone there's a t4 that's made and there's a t3 and it's the free components of these two that drive your metabolism every cell in the body gets these and then turns up the metabolism turns down 2000 based on the level of those if the t4 is converted in the inactive form this does nothing but hang out and get dumped out in your bio so this this becomes inactive but it is it's present so we want to be aware of those three formal forms that are there so what happens if your thyroid is diseased well number one you can have inflammation of the thyroid and this is Hashimoto's or Graves disease this is an auto this is an antibody that attacks your thyroid is if it's sick you have your own immune system attacks your thyroid and causes the thyroid to either be over functioning or under functioning I'm gonna leave it at that it's that simple but that's really what autoimmune thyroiditis is second you can have iodine deficiency excessive iodine can actually cause both to happen and if you're deficient in iodine you can actually have hypothyroid symptoms so we need to make sure that's okay you can have under functioning or low functioning thyroid and you can have over functioning thyroid those are basically the four there is a fifth you're gonna fire it cancer I'm not gonna touch on that those are really the five things that essentially didn't happen with your thyroid and people ask me about thyroid all the time and doing ketosis and this is why I put these five things up here because these are the five things that happen most commonly so let's touch a little bit on thyroiditis I just want you to understand that this is multiple antibodies and there are three of them specifically that can affect the thyroid gland and can cause over or under functioning of the thyroid if you've heard of Graves disease this is an antibody to the TSH receptor if you've heard of Hashimoto's it's it's one of these two or both that are being affected by it and by your immune system and it causes either over or under function of that thyroid function of that re gland now many times it'll be over functioning for a while then it will suddenly become under function because the thyroid burns out and so that's what you'll see so if you have someone tell you I have a fiery die that's right Graves disease arrived Hashimoto's they have an autoimmunity attacking the thyroid and it'll eventually cause them to be under functioning in many cases some that are over functioning are so bad we have to actually remove the thyroid but we won't go into that all right so what factors cause thyroiditis well these are all really cool things that were exposed to on a daily basis that can cause you to form antibodies to your thyroid interesting enough we put this in our water we give this as drugs this used to be in fillings of our teeth we use this all the time to cook bacon I don't anymore but it's a lot of people do excessive iodine intake can do it all sorts of docks chemicals phthalates these these are actually what make your plastics soft so that soft plastic can actually affect that pregnancy interesting enough can do it one of my patients said doctor I have this parasite it's caused my thyroid that is genetics celiac disease and chronic urticaria all right you see that that was the wake up to make sure you're not sleeping too much all right so now how do you lower thyroid antibodies in my office we used to just wait total our thumbs and hopefully they would occur in one year usually 60% of people sorry antibodies will dissipate on their own the other 40% never go away at least that's what I saw statistically interesting enough though there's some literature now that talks about the fact that if you cut out the carbs you optimize your gut health and we give you selenium glutathione and rosmarinic acid it actually dramatically decreases the frequency with which those antibodies occur so in my office this is one of the protocols that we use to help tyroid itis all right now gut health is important because butyrate which is what comes from butter that's what butter was named actually feeds that gut and allows the gut to be less insulin resistant now as the gut microbiome which was talked about already wonderfully by Peter in helping us to understand how our gut processes a lot of these other foods that we eat and allows for good gut function I won't go into that but that plays a big role in thyroiditis and some people so we do focus on that so you know more far more than you know you know and deep down you really know you want another piece of bacon alright so under functioning low functioning thyroid these are all really cool signs and symptoms that may arise I didn't put them in order of a frequent occurrence but they do occur frequently the most common that I see are weight gain depression constipation alligator skin I will see brittle nails I see poor memory I'll see fatigue is a big one those are all things that can happen if your thyroids under functioning and like I said there's multiple causes that can do that but and we won't go into that interesting enough I've seen this multiple times before we had TSH testing if you lost the outside third of your eyebrows like Queen Anne you probably had hypothyroidism I see this very commonly increased fat pads right over the collarbone is also a sign of hypothyroidism poor function thyroid hair loss turn down corners of the mouth common for hypothyroidism these are all things you might see and then hair loss from the lower legs that can also occur if you are cowboy boots just telling you that not hypothyroidism dry scaly ears and excess cerumen formation and then a delayed reflex so these are things that we used to look at we look for as physicians when we're looking for hypothyroidism all right what decreases the function of your t4 so you make this hormone it tells the thyroid to produce t4 what can cause decreased function of t4 well if you're deficient in zinc and guess what Zee comes from red meat so does copper that's where you find it so if you're a vegetarian I see a lot of hypothyroid vegetarians vitamin A comes from eggs and oysters they're really good on the half-shell your beat your B vitamins come from salmon fish and also red meat and especially if it's grass fed and then vitamin C I had to change my position on this if you if you eat grass fed steak you actually get adequate poops pardon me I gotta go back you actually get adequate vitamin C from grass-fed beef so that so that's a plus so you can actually get adequate vitamin C to support that if you're doing now if it's not grass-fed it's it's literally 1/4 of the vitamin C in that in that red meat so BIST be aware of that those those although will decrease though your production of t4 so let's look for a second all right there are actually three enzymes that affect this conversion of t4 to t3 number one this is these are called di o di odin aces and these these this enzyme is found mainly in the thyroid liver and kidney and it actually it's suppressed by higher insulin as your insulin goes up and your leptin goes up this enzyme works less now this enzyme is found in all of the cells of your body except for the pituitary and brown fat there's a different enzyme in the pituitary and brown fat and the challenge is that if you are insulin resistant you stop producing t4 to t3 in the body but you make plenty in the brain and when we measure it in the brain it says oh you're normal but in the body it's going well we're not and so the challenge is that increased insulin makes this work better it makes this work less so how do you know if your fat cells are overproducing leptin and you're really insulin resistant that you're not truly hypothyroid no you're fired TSH and and and your t4 are normal because if there's no feet this feedback neck mechanism right here if I can find my pointer from t4 tells the brain how well you're producing t4 but if this conversions broken your brain never knows that and you may not know that if you don't check the actual free t3 or you don't check the reverse t3 so if this shuts down then what ends up happening is this enzyme kicks in and produces a really cool hormone called I gotta wait for this all happen reverse t3 now remember reverse t3 is inactive this one doesn't work but you're making it but you're the bot the cells of your body aren't and so you'll see weight gain and you'll see dry skin you'll see hair loss and you'll see constipation you'll see all the signs of hypothyroidism yet your TSH and t4 are normal so the challenge is to really truly see if your thyroids working you to check all these hormones you gotta look at them all and if you're not you're missing part of the issue especially if your insulin resistant now the really cool thing is is that at least 50% of my patients that have abnormal thyroid function within about about three or four weeks they will actually see a normalization of their thyroid function where this will return to normal when we put them on a ketogenic lifestyle so it's actually pretty amazing to see that I never thought I'd say that but I just said it all right so what actually suppresses that's type 1 di Odin ace these are all really exciting things that depress that function poor selenium high carb intake that's the the cake you just ate this stress rate stress does it cadmium mercury lead toxicity prolonged fasting this is one of the reasons I'm not a big fan of fast longer than two weeks there's a couple studies that show that that reverse t3 starts to rise after two weeks of prolonged fasting and it's about it's a protective mechanism for the body and that's what it why does that if you're not eating enough protein the vegetarians and vegans in my office this is huge this is they're all that's why they all come in with hypothyroidism chronic illness will do it in inflammation does it libera dysfunction iodine deficiency in iron deficiency all play a role with that poor conversion and increased reverse t3 that's not active that your body can't use what medicines do this just about every patient of my office is on one of these beta blockers steroids do it birth control pills yes the artificial progesterone does it to you actually excess if you drink I have most of the women that come in my office our Gen dominant because of the exposures to plastics and the way we end their birth control pills and this estrogen extra SS lowers it lithium does it ventolin theophylline and and interesting that one little exciting hormone that's over produced by your fat cells when you're obese all right so diet suppressing conversion of t4 t3 if you eat too much broccoli or cauliflower it'll do it excessive amounts and this is why I think the carnivore movement has had success is because a lot of people are so convinced they have to have at least some leafy greens they eat a lot of them and it actually causes hypothyroidism and slows down the metabolism well when you back that off a little bit and you eat less you don't really need that much then you actually see an improvement in thyroid function too much too little protein in the diet will affect it very low fat diets or prolonged fasting again starvation issues alcohol does it to you yes I'm sorry all alcohol even if it's the key to approved alcohol it still does it walnuts soy fluoride phthalates and lead do it do it alright how many in time alright the elevated to necrosis factor-alpha interleukin 6 and interferon - these all go up with insulin resistance type-2 diabetes obesity Alzheimer's it's interesting enough parkinson's and aging does it to a small degree prolong fasting for longer than two weeks also changes that conversion of that increases the presence of that reverse ities we have said that twice now and then amazingly stress from anxiety and depression you stimulate that autonomic nervous system you know it used to be the only time that we the autonomic nervous system was stressed was when the bear reared up in front of you in the woods and either had to fight the bear run from the bear now that bear is someone cuts you off into the street bill collector calls you you you know your kid is at school something happens you watch the news with this 24-hour news cycle this is big this is a big deal that automatic stimulus plays a big role in suppression of thyroid function and then metal exposures or another one all right the molded what you may not be able to see very well the most common metal metals that are problem to this if your selenium is correct you you improve the conversion if you have enough potassium it does if your potassium deficient that's why your salt is so important because when you're when you start doing keto and you start producing you remember you when you burn fat you produce carbon dioxide which you breathe off and water and you gotta you gotta urinate that off well the only way to get the water to go out of your system is to put salt in the kidney and waters like the boyfriend for salt it follows it around so it goes into the kidney and then you pee it out well you're using potassium sodium magnesium and zinc you're also losing selenium and some manganese and you have to replace those and if you're not replacing those then you will see some change in thyroid function um iodine iron zinc 90s I talked about that there was one other on here well anyway all right so lastly just a reminder if you're t4t for itself has little activity it's not really active it has to be converted into t3 the conversion from t4 to t3 is mainly in the liver the kidneys and that's why the type one di ordination that that di Otis is inactivated because of high insulin and/or high leptin or both then you're gonna see hypothyroidism rise number two number two the t3 is literally five times stronger than t4 and so once you convert to that t3 that t3 is a really good gas pedal it's like stomping the gas and yet that's the cell metabolism work more effectively lastly the direct effects on the mitochondrial function effect this pretty significantly so if your mitochondria isn't working and we get to hear a really cool stuff from dr. Beekman about mitochondria that's what he specializes in this is essential for your thyroid function and if you don't have adequate mitochondrial function then you're not gonna have good conversion to that t3 and that's important to understand so well dr. now how do I lose fat alright so grab your bootstraps tying them on tighter cause I'm gonna tell you there are five back doors to the fat cell and there's one front door the front doors insulin when your insulin drops you stop pushing fat into the cell when insulin goes up you the only hormone that pushes triglyceride into the fat cell and it does it right here that insulin pushes that insulin when it's on pulls fat in the fat cell if your insulin drops it actually backs off the see I'm PD pathway and allows triglyceride to be able to act exit more effectively number two your thyroid hormone t3 is the second back door to the fat cell if your t threes adequate you will actually let try this right out of that fat cell to turn into a ketone really effectively it's not working you're not losing weight number four or number three I should say we're gonna go catecholamines epinephrine and norepinephrine these stimulate adenylate cyclase and actually allow that process to occur more normally interesting enough they also stimulate the heart to squeeze more effectively and release something called atrial naturally peptide which actually increases the metabolism as well number four testosterone most of the men in my office have very low testosterone when their insolence high and women with PCOS have high testosterone and low in estrogen and that actually has a reverse effect that also is door number four to let the fat out and then number five is sympathy mimetics ketones act as a sympathomimetic act as a signaling hormone to the fat cell to allow GP are 41 to change the way leptin is used decrease appetite and allow you to let more triglyceride out of a fat cell that's why it's important so the presence of ketone in short chain fatty acids which is butyrate butter allow this to happen now I'm not saying go slather your steak and butter I'm saying if you're using adequate amounts of fat include butyrate then you'll actually see this happen and then we use some drugs like phentermine to help stimulate that too in some patients so that's the five back towards the fat cell so you learn how to lose fat balance those five hormone pathways and you got it so change starts when someone sees the next step says my horse alright alright so let's so if you have a thyroid problem where you suspect you have a thyroid problem my suggestion is teach your reverse t3 checked if your reverse t3 is higher than 15 your your not your di oh today's enzyme is not working and you probably have high leptin or high insulin levels that's important for you to understand that so that that's a big key that it's we've learned in the last five years about siren itself number two get your mitochondria as healthy as you possibly can controlling insulin resistance eliminate stress as much as you possibly can make sure that you have adequate selenium get that mitochondria tuned up and then in some cases we have to replace the t3 if I in patients that aren't producing enough of it and so that's usually how we approach it in that regard and then lastly I have a lot of patients that I'll put on thyroid hormone it and also they call me been up three days later and go oh my gosh I'm having population's this drug is horrible well they're often low in magnesium so if I give you fire red hormone and your magnesium is too low cuz you've been doing kita Jake diet you have been taking your salt guess what happens you get heart palpitations and so as a side effect it's usually a low magnesium level in a patient who's not adequately replaced in salt gut health plays a big role there if you had a heart attack your thyroid is going to be out of whack so don't check thyroid hormone for at least two months and then if you're having increased fatigue make sure that you're you're changing up that mitochondria and you're not overdosing the t4 sometimes we we give people T 4 which is synthroid or levothyroxine and then we'll give them t3 separately and sometimes you can if you overdose one and you're under dose and the other you can actually get similar symptoms as well so just be aware of that and that is not me by the way I think he had have his collarbone fixed after that all right so might under the function if your mitochondria is not working this is what I commonly see in my office chronic my getting headaches that never go away and no one can find an answer to chronic fatigue syndrome I see a ton of this and it's broken Matic Andriana sues we fix the mitochondria all of a sudden they feel wonderful again fibromyalgia I really think that's a mitochondrial disorder personally they have real pain and if there's real issues but I think that's significant related with mitochondria and then other chronic pain syndromes this is how I refuel of mitochondria in my office today I help tune it up and make sure people have adequate nutrients for it especially on a ketogenic diet we give them coke coops didn't mean to do that sorry guys we'll go back we've got two minutes so coq10 deoxyribose magnesium NADH if we need to replace it l-carnitine which only comes from red meat by the way and alpha lipoic acid all right hopefully picture that from you that everything should be as simple as possible no simpler and throw in the next minute and 30 seconds I'm gonna give you the the wisdom you need this is actually a patient sample that he brought to me he said doctor I have the stool sample for you he pulled it out that's actually if my patient gave you that it really is important to understand that so here we go all right in my office this is what we do we have a we have an eight step program another twelve step program so number one control the insulin resistance number two moderate your protein and if you need those calculations they're on my website or they're in the book or whatever you want to do we want to balance out protein I usually start with a protein to fat ratio of one to one that's grams that's not calories and percentage that that's not macros macros are the second swear word my office we do not use macros in my office we use a one-to-one ratio of protein of fat red meat is one to one just the way the good Lord made it eggs are one to one the way the good Lord made them bacon is one to one the way the good Lord made it and if you have a ratio of 1 to 1 in calories that's 70 percent fat your egg is 70 percent fat your ribeye is 30% fat your pork and 70 percent fat and your bacon is 30% fat the way meal good Lord made them you don't have to add any extra butter to it it's already pre-made that way all right keep hydrated only when you're hungry that's a very important thing and it takes 3 months for people to learn their hunger signals again I found it took me six months supplements if we need to fix the gut bacteria balance that thyroid function but if you don't do this first this won't work seriously been doing this for 20 years try it at multiple times till you fix this this won't get fixed and until you fix to this giving you testosterone or other sex hormones is worthless you just create a really expensive school all right I think I'm last I won't go into this clearly make sure your doctor watches you I'll because I'm out of time here how are you doing all right the ketosis killers everyone asked me doctor now your diet failed it doesn't work so this is the next question I ask all right are you eating carbohydrates no I'm having bacon well tell me what you ate for breakfast this morning I don't meal okay your bowl of oatmeal is 200 grams of carbohydrate you realize that right no it's good for me that's overly simple carbohydrates sweeteners now in 20 years of practice I have found that many of the these sweeteners actually spike insulin and for someone like me xylitol kicks me out of ketosis every time as does monk fruit and as does agave and aspartame which I which actually is a great appetite suppressant makes the gut bacteria more insulin resistant so these if you're Ani these you'll probably not see successfully you may see poor poor function and then I have some people that are just wick taken way too much protein and remember that protein does have an insulin response and as someone who's still really insulin resistant is taking too much protein because they're bodybuilders trader told them were supposed to then they'll have trouble losing weight once you get to where you're much more lean there's the body's much more forgiving with protein but if you're obese and your insulin resistance you can eat too much protein and it will make you worse and I've seen that for 20 years alright that is really the weapon of mass destruction and that's the end [Applause]

Channel: Keto Chow

Views: 164,587

Keywords: keto, ketogenic, keto diet, hflc

Id: S3n6gEia_iM

Length: 45min 30sec (2730 seconds)

Published: Wed May 01 2019

Reddit Comments

[u/Seventh_Letter]

This talk wasn't very informative IMHO