Low Carb Breckenridge 2018 - Q&A Day 2 Morning Session

hi this question is for dr. Finney first I need to tell you a little bit about me my name is Brenda Zorn I've been ketogenic for years I am a former type-2 diabetic my a once they used to be 12 now it's five I do weight training and strength training twice a week and have been for several years I lift heavy I have practiced extended and intermittent fasting for over two years now I do a minimum four day water fast once a month and weekly intermittent fasting recently I had DEXA scans three months apart and I gained four pounds of lean mass so this is my question for you dr. Finney if sequential DEXA scans are not done how is it known from where the protein loss originated could it be a marker of etaf aggie and thus a positive rather than a negative excellent question the first is that whenever you study a group of humans you never see them all functioning together you see wide diversity we see cholesterol go up in some people on a wall for me to connect and down with some people and so you have found the right spot for you but when people say Steve what do you do tell me what you do so I can do that I tell them I only the only people I give that advice to is my identical twin to my clock so you know you have found the right thing for you and that works very well but as a physician and a scientist I found that one has to be very cautious about as a physician a scientist but I found that you have to be very careful about using an N equals one to to advise other people and so I again your your results are phenomenal and they work well for you but in terms of trying to find a x-ray exquisite ly sensitive diagnostic tool everybody can use to find out who is going to work for naught we don't have that available yet all right so it's a it's a it's a goal but stay tuned okay look thank you shift over to the right my question is for dr. Beckmann they're all in regards to carnitine so the first one is is there any efficacy in measuring blood levels and following them the second one is are there any sensitive screening questions that we can ask patients for deficiency and the third one is what are any recommendations for supplementing like how and when you would do that yes that is a great question and I was asked this by a couple other people to some varying degrees about carnitine that was clearly something I should have boned up on but I'm gonna I'm gonna take some educated guesses so I don't know of what I don't know of a quantified blood normal carnitine level that would be measured mind.you carnitine isn't something we care about when it's in the blood we want to get it into the into the tissues into the cells but nevertheless there there must be some level there but it's made in cells and it's used in cells so it may be problematic to try to look at it in the blood but but I bet there is a level and it's probably pretty well-established my um one of the reasons I wanted to mention it it was almost sort of a last addition not like Nina's to am addition they're a little longer than that but but it was something I added in partly because it was in the low carb community I fear that some people engage in kind of bizarre eating just for the sake of getting it staying in ketosis and I couldn't help but imagine a situation where the person is undergoing such a high degree of lipid oxidation because of the insulin glucagon ratio and yet insufficient and maybe even surpassing their own inherent carnitine production which we're all we're all making carnitine but we make it based on the amino acids as well and I couldn't help but imagine but perhaps this is imaginary but imagine a situation where the lipid oxidation is so high that it's surpassing their own inherent carnitine production and thus creating a bottleneck with the purpose of lipid oxidation and so this may be someone who is in fact issuing of avoiding meat for fear of the insula no genic properties and or not eating any meat at all it's sort of a keto vegan version of that nevertheless or someone who's engaging in very high intensity exercise where there is a greater degree of medical damage or just tissue damage which would involve mitochondria and nevertheless a greater need for lipid oxidation now whether there'd be some evidence my only get like could someone feel boy I'm in deficient in carnitine my only thought when you asked that was would a deficiency in carnitine kind of mimic a deficiency in ubiquinone like what you see when someone's on statins when someone obliterates their cholesterol production they can't make enough of all kinds of things one of those things is an electron transport carry in the carrier in the mitochondria and they have muscle pain and and muscle damage of this rhabdomyolysis I can't help but wonder insofar as the muscle has such a need for carnitine could the muscle be sensitive to a loss and that manifests as muscle aches this was a long answer that were involved a lot of speculation so take it for what it's worth okay does it help okay one practical thing on crying a teen especially if you're into athletics is the if you look at the food charts red meat is by far the most superior I'm enriched with carnitine so even two weeks if you have trouble recovering you're just feeling sluggish just try to sub out red meat for chicken or fish just for a couple weeks just see how you feel and I think dr. Finney was saying everyone's an N of one and I think your how your body responds to things tells you a lot um in our children on ketogenic diets we actually do check their carnitine levels every three months and there's there's actually no number that worries us per se but we actually look at free carnitine and if it's like less than ten and they're on valproate which is a seizure medication which we know effects carnitine and usually the symptoms are that they had good ketosis for a while and then unexplainably they drop and they usually they're fatigued there are some paediatric ketogenic centers that put everybody on carnitine but most kind of do it symptomatically what they're eating meat sometimes but they still drop their levels I mean there's interesting I just want to say that because one of the accusations against red meat is that it's the carnitine that causes heart disease the carnitine in red meat so there's been interesting and if somebody went and looked at all the sources of carnitine there's actually more get more carnitine from various kinds of fish and certain vegetables than you do red meat I don't know right yeah okay two questions first one is for dr. Bickman there's over here yes I'm I'm this way the first question there's an argument that later in life people should perhaps reduce mTOR signaling for longevity and and so under the conditions that you were showing with the IG ratios one under a high carb situation one under fasting or kita gen would you have any idea whether mTOR signaling would be different under those two circumstances I knew this was gonna come up em tor is such a hot-button issue I this is all I'll say it with em toward the general fear of mTOR is because of its role in cancer right that sort of weekend all up nod our heads that this this fear of em tours up and that's promoting cancer but I think that is just a massive oversimplification we know at its core cancer is a mutation something in fact usually dozens of some things have gone wrong with regards to mutations than that and that has caused the cancer may it could mTOR be part of that once a mutation has happened absolutely but I think it's for me a middle-aged guy who wants to maintain muscle I would I welcome mTOR and I'm glad for it frankly but nevertheless I don't want to have mTOR sufficiently high all the time that I'm inhibiting in Auto Fuji which mTOR would do but nevertheless it is this constant balance in the body and then we ought to be thankful the system is designed to have this molecule mTOR to control when a cell is going to grow or when it doesn't and to implicate that in cancer I just think is not fair because we know it is far more fundamental than just addressing mTOR there must be some series of mutations that have occurred to allow this cell to grow uncontrollably and it could mTOR be one of those mutations sure but that's not - that's not the same as saying I've activated a mentor because of insulin or whatever and now I'm afraid of cancer nevertheless I don't mean to be flippant about it but my point emptor has a role a let's respect it and I think it's overhyped when we are too concerned about emptor activation and it then suddenly promotes so you're saying that that cycling him to our activation breath is gonna happen whether we want it or not right and it's just the nature of all of our biochemical pathways mTOR is up when insulin is it's down when say when insulin isn't when it when it's when insulin is down I mean it's simplified but that really is the gist of it and so it will naturally coming up and down okay and I would argue that that's a good thing second question is for dr. finning this is a follow-on to the first lady's question I know that dr. Cahill's data everybody started from a basically a high carb situation and then they then they measured their their nitrogen losses and would you expect for example she appeared to be a very well key to adapted from what she was describing that somebody that's very well key to a Deborah that starts a fast that they would be farther to the right on those nitrogen loss curves that would be a good hypothesis but to my knowledge there's no published data that shows that my guess is that that would be true but again that's a hypothesis okay thank you Robert Sabo on a general practitioner in Melbourne and also run a clinic for metabolic repair call the local clinic in Melbourne my questions for physical comment for dr. Kushner which is thank you very much for an inspiring talk inspiring us all about what the future for type 1 might hold and just something that you quickly quickly mentioned maybe think of something I came across with a colleague recently which is that impact listen it can increase ketones you mentioned and a colleague recently mentioned that he had a type-2 diabetic who's on a low-carb diet on impact with listen who became very unwell very soon after commencing it and and was thought to go into ketoacidosis I don't know how how true that was but do you or does anybody else on the panel and have any experience with the glyph lessons having any impact on people who are on a low-carb diet so this is a this is a really good question this is a really good question and it is known that SDLT inhibition will increase glucagon and the and and and also increases ketones to some degree and if you imagine that ketones are the biomarker for nutritional ketosis or for or for a fat-burning state they're also a biomarker in somebody with type 1 diabetes of a life-threatening insulin deficiency right so we have a fundamental problem there in that if we're measuring or thinking about ketones in someone who is practicing nutritional ketosis or in or using an sglt2 inhibitors and I didn't really talk about what they are but what they do is they trick the kidney into dumping more glucose into the urine so it's essentially dragging sugar out of the body and in addition there's an effect on the alpha cell to make a more goofy gun so the fear is that people may be sort of insulated from their ongoing development of diabetic ketoacidosis if they happen to be on an SD LT inhibitor or for that matter on nutritional ketosis if you measure your ketone if you're not used to measure your ketones or thinking about it or if your glucose is nearly normal you may not have that elevation that you would normally expect in an ST ot inhibitor hyperglycemia is the biomarker for DKA right so there have been multiple episodes of DKA around the world and even some reported deaths with s guilty inhibition we're gonna need better protocols to understand this from from my from my perspective the most important thing is continuous glucose monitoring and if someone wanted to try an SG LT inhibitor with type 2 diabetes or nutritional ketosis with type 1 or SDLT inhibitor with type 1 you're going to need to be able to follow your glucose is very carefully did I answer your question yes yes and I guess I was wondering whether obviously with a type 1 you would never use a a look I have so um yeah so I I actually have a friend who has type-1 who's also a physician and and he tried in SDLT inhibitor and he found that his blood glucoses were much closer to normal all the time however what he eventually realised was that it was insulating him from the impact of dietary carbohydrates on glucose flux and he decided that he had a better chance of actually achieving you glycaemia going off the sdlt inhibitor because he really wanted to get his blood Sugar's down near perfect and he thought he figured out that he could get away with eating more carbs under steel tea inhibitor thank you first I want to thank you home for your presentation they were all great my name is Julie carrier I'm a community family physician in New Brunswick eastern Canada my question is more for dr. Finney and dr. Beckmann you both emphasize on the need for protein intake on a daily basis my question is more how can we distribute this protein to have an optimal feeding is it better to eat once a day twice a day three times a day or really doesn't matter and also related to that in case of intermittent fasting if we go above 24 hours how do we compensate for the lack of protein do we have to double the protein and taken the next day or we just forget about these protein for that specific day I can start by saying hey I wish we had studied that not in a prospective and careful way so to the first point NIDA made an excellent point that the Dietary Guidelines you know that the science behind it says eat three times a day and that's that's not been well studied so my guess is that if people and I know people who rarely eat breakfast and then distribute their protein at throughout today and it and have followed a ketogenic diet for years and don't seem to have wasted have been impaired so each of us finds a way that feels right to us and realize that we've all been assuming equipped by millions of years of evolution to figure out in trial and error what works right for us our software will eventually tell us what's good for us when we get it right and so try it out and see how it feels in terms of catch up again we haven't studied whether there's a benefit to eating more protein on the day after ending a period of fasting or you know if you're doing a 5-2 regimen should you be eating 2 grams per kilo of reference weight versus 1.5 we haven't been able to study that again I know people who've done intermittent fasting every other day where they only eat a moderate amount of protein at one meal in that day and you know one of the people I'm thinking of this a academic physician who knows you know if things would be going wrong and he's been doing this for a few years doing fine so again it's a great degree a matter of being aware that there may be problems that would go wrong and seeing how you feel and using your own personal instincts to find the right path until we have the now the elegant wearable device that's going to tell you precisely when you're doing right and wrong and I want to live that long long enough to see that doctor doctor again well I would just add that is a good cautious response from doctor Finney I mean internist of course I'm coach Stewart I definitely recommend look up the work of Stuart Phillips I think he's at McMaster anyone confirmed yeah he found in looking specifically a muscle protein synthesis as the outcome that it was better to distribute to whatever degree would work and I think dr. Finney's comment on that is is smart I think that's prudent that it's better it's more efficient the protein is better used for muscle protein synthesis when it is not one Bullis when it is spread out he actually also emphasizes the relevance of the evening protein bolus especially with aging and it's that over that 12-hour fasted period overnight where most of the protein loss happens even from the muscle and so to ensure that that last meal has in protein but nevertheless his studies are quite clear that it is better to have multiple bolus --is whatever that would be in in a normal diet for you or anyone else in the day that is superior to one and then I like to answer there with the ketchup being able to make up a day there's no evidence on that that I've seen okay thank you go over to this side yes hi my name is Nadia petiguana I am one of the IDM fasting coaches so I have I first wanted to thank dr. Finney for pointing out that we also believe that you know 30 days of fasting or extended fasting can be quite dangerous most often is and with or without medical supervision but obviously without medical supervision my only question I'm asking this on behalf of some of my patients that are listening live is if dr. Finney believes that fasting water fasting is will have the same effect on the body that's low calorie diets or starvation diets or the Biggest Loser diets will have on the body the there's limited data I have to keep saying that sorry but no we have done studies with very low calorie ketogenic diets and I think one needs to differentiate between ketogenic and not because we now know ketones are potent deputy netic signal for a number of very important processes in the body that we can preserve lean body mass and better preserve resting metabolism when protein is provided in the context of a as a supplement it fast as opposed to a total fast but realize also we people vary one from another and you know there is no there is no perfect diet that that you know that's you know got whether it's a guideline or my plate or what I say works for me that we're sure everybody else send so I think people need to be open to the possibility that there may be some harmful effects with too much fasting but we will vary one for another and how we handle that so I think Bob Dylan said it best and I'm not being facetious here and I said don't follow leaders and watch for parking meters hey pootie don't don't follow me you know people say what do you do I want to do what you do and I say you're not my clone you're not my identical twin sorry but the reason why I'm asking is specifically is because I agree with you about the extent of fasting in the dangerous of it right but a lot of people here do some intermittent fasting or some two or three day fasts the reason why I'm asking this is because a lot of the examples they use today to show the dam the some of the damaging effects of extended fasting were based on low-calorie diets and not on fasting correct most of the data I showed was on total fasting complete fasting no no calories taken in and again I made it I tried to make it clear that I have no no problem with up to two days of fasting as long as there's good nutrient density in the diet following that it's when people get beyond two days and certainly when they could be on a week or more of compactive did fascinating that that I see major concerns on the other side sharp side of the sword showing up okay well then about the Biggest Loser contest not being the same as excited fasting right understood okay but that was a that was a a extreme of relative caloric restriction that weight loss was extremely rapid and it involved it's what I think are excessive amounts of exercise and don't get me into this but actually high volume exercising combined combined with caloric restriction has been shown in for impatient studies to reduce resting metabolism so again yeah that more science be done okay Ramon ISA here I'm a practicing physician from Loma Linda California coming to you based on my personal experience my morbid obesity metabolic syndrome is in remission currently since last year which I'm very happy to experience but being where I'm working in Loma Linda Southern California if you're not familiar we have a lot of vegetarians and vegans and I'm not one of them but I have a lot of good friends of Mines physicians and medical people as well as their family and friends and I want to get your so they've seen my transformation and they're like what happened to you you look this is amazing and then I don't know what to tell people that are vegetarian but and I'd this was news to me learning that there are a subgroup of a vegetarian healthy people that are very metabolically not healthy and when you take the time to talk with them and they show you their labs or lipids or it may be insulin resistant they may have pre-diabetes but they're the healthy weight there are some people out there that I think I would like to be able to you know you know benefit but this is all new to me so this question is directed to the clinical experience in nutritional ketosis low carb living anybody with experience making recommendations or healing patients using a vegetarian borderline vegan approach and if so what are your resources and what angle or approach do you use thank you this is excellent question then it is certainly possible as a lacto-ovo vegetarian to do a well formulated ketogenic diet with lots of food choices and when one gets to vegan vegetarians it's still possible but the food choices become more constrained and there are some potential pitfalls there and I think Nina might may comment on some of those in terms of anti nutrients within certain food classes but it's a secret I tried to hold that I'm a co-author of a book called the new Atkins for a new you along with Eric Westman they wouldn't let us use the term ketones when we wrote that book but in there there's a chapter on veget - how to do I cloak are behind rate diet - healthy low carbohydrate diet is a vegetarian okay you're a brave man I need to commend you for coming you know thank you that's a tough culture there that do they know you're here a little on the plane yeah so if vegan data is nutritionally not sufficient if you don't take supplements but I don't know if all of you know Loma Linda University is the University of seventh-day Adventist and it is part of their belief system that people should not eat meat so and this is they've done scientific studies on this and their studies are infused by that bias so the only thing I was going to say is that you know you recognize that you're surrounded by people who may this may be part of their religious belief so very hard to change that and I think Steve's ideas is a good one which is to show them how they can get healthier on their chosen diet thank you very much well first thank you for your enlightened talks ie appreciated a lot all of you and my question refers to what happens after someone has follow a ketogenic diet and then phase out to a different diet especially I hear in the presentation from Eric and I'm very interested from the clinical point of view what we should take care of and watch in the patients as they go out so thank thanks for the question thanks for waiting so long to ask us we've done some limited studies in some of our pediatric patients who've purposely come off the diet because they don't need it any longer very limited studies mostly retrospective but starting to get some lab data on some of those patients that look quite good most of them go back to regular quote unquote foods they don't have food aversions that's something the parents worry about especially at a young age what impact of a very restrictive diet would have on their food intake but they eat sort of just like every other child can do but their labs have all looked fine their growth catches up that's we do see sometimes some growth issues and some of our ketogenic children and that catches up once it's over but it's a great topic we really just don't know much on the diet or off the diet what the long-term effects are in our children research and the net second question was about the the effects of the ketogenic diet in many in maybe and other mental functions maybe memory retention is there any research above that's it that's a great time it's almost electrum of itself people are extremely interested in neurologic benefits beyond epilepsy I mean if you look at sort of neurologists in the medical community those of us like myself that do epilepsy er this much compared to Alzheimer's autism migraines and one out of five people has migraines so people are very interested just like our anticonvulsant drugs work for things other than seizures maybe ketogenic diets would help other conditions early data looks very promising for brain tumors looks potentially promising for dementia but still very limited data it some of it is somewhat bias by companies looking at products that may be helpful for it so we need more studies that are unbiased and a little bit of data on migraine some mixed some say yes some say no it's depends who you're looking at but what's I think most exciting to me as a epilepsy doctor looking at all of these conditions is that for almost all of them cancer dementia autism it's probably different mechanisms so it for epilepsy maybe ketosis or as I mentioned maybe four different types of epilepsy different things but there's sort of an interesting theory that has been gone around for a while that for brain tumors the brain tumor itself can't just take the ketones of it has to be glucose and that's actually recently been proven not to be the case so that was a the original theory was the glucose you know being on a glucose diet was the tumors could survive but on a ketogenic diet they couldn't it seems to be much more complicated than that and so we're learning a lot more as we're going from some of these conditions that could help us in other fields it's probably multiple mechanisms for different conditions and I suspect 10 years from now we'll know for some very helpful for some not helpful at all let me just mention quickly that although mice are not really good analogs for humans there was a mouse longevity study and it's easy you do a five-year study in my son is to do a 120 year studying humans but a group at UC Davis that lead author is megan roberts published a paper in Cell Metabolism September and they put my song one of three diets one was a relevant high carbohydrate standard Mouse chow well most a low carbohydrate but not ketogenic diet with 20% of calories from carbohydrates and one was a ketogenic diet with essentially no carbohydrates and that was just protein and mostly fat and they maintain these animals under controlled conditions and allowed them to live out their lives without pathogens and and other premature causes of death that wild animals have like hawks and snakes and they looked at how long they lived and the two groups with the standard Mouse chow and the low carb at non ketogenic diets lived out to a certain point in time there was this trench of slightly longer lifetime in the low low carb but the ketogenic diet group group lived 13% longer and they did did not just functional physical strength testing but also mental acuity testing in these animals and at 900 days of life that difficult life lamb is a thousand days at nine hundred days the low-carb and standard carb mice showed decline in mental acuity and the ketogenic mice maintained their useful acuity and they lived 13% longer and at death when they did autopsies they had one half the number of visible cancers at autopsy primarily peritoneal sarcomas so it's a it's and by the way they had the bootleg the money to do the ketogenic arm in that study because the NIH really tried twice in the eyes you would not give them money to do this or third arm and so they found that elsewhere so obviously a biased study because they came into it wanting to do that are excellent questions Darla romp I'm a nurse and a clinical social worker but for my sake I'm also a diet controlled type two diabetic my question is on optimal carb levels and may be optimal fasting windows or durations with the impact on hypothyroid and I know dr. penny you've said some stuff before on t3 and that kind of thing on low carb or ketogenic diets so I was just wondering if you could address how that might impact when people are trying to do ketogenic and deal with hypothyroidism yeah there's a lot of discussion done on that blogs about does your thyroid need carbs so Jeff folic and I wrote a piece and published it on our virtus I ins blog on on that topic it's not begin there to you know there can be much much better research than what's been done but it is a common observation that whether one's dealing with a hypo chlorogenic diet or a you caloric weight maintaining ketogenic diet that t3 levels drop dramatically when one starts a ketogenic diet t4 levels stay constant and in a few recent studies TSH levels stay constant and what that appears to show and then Jeff had done a study but didn't include this data in the paper but he done resting metabolism in a crossover study for people who were on one month on a high carb diet and and one month on a low-carb diet and the t3 went down dramatically on the low-carb diet but resting energy expenditure stayed the same so if TSH levels stay the same in resting energy expenditure stays the same what that says is the body is becoming much more t3 efficient much more t3 sensitive so we now know insulin sensitivity improves we never discussed this much but leptin sensitive sensitivity improves people's leptin Goes Down but their satiety stays up and then t3 so the body is much more efficient in its use of hormones when is keto adapted and that seems to be a pattern I hope that answers the question my name is dr. cat Kanaskie I'm an internal medicine hospitalist I work with the cardiology team so I get to see a lot of patients who come in with an acute MI and get to newly diagnosed them and be the first person to first clinician to really address diet nutrition and lifestyle changes so I'm really good at getting people off of insulin type 2 diabetics off of insulin getting them on two different kinds of lifestyle changes that our low carbohydrate and our cardiologists are really awesome and supporting us on this however I don't know how to do that as as efficiently with a type one diabetic and dr. Christian I was hoping you'd help me well the a person with type 1 diabetes is not gonna come off insulin right and ultimately the journey for a person with type 1 diabetes is lifelong and I I tend to talk about learning around novel forms of nutrition as a sort of multi-step process and it's silly to imagine that you can just take somebody and immerse them in a body of knowledge and have them say yeah I'm all over it I first and foremost you gotta have continuous glucose monitoring and it's been expensive and complicated and hard to get up till now however that said there are some cheaper more effective solutions that are coming on the market including the Abbott free style Libre which though it doesn't provide continuous readout with alarms it gives you continuous glucose readings and you can scan it and knowledge is power with for people with type 1 diabetes once you can see your glucose flux and you have somebody encouraging you to understand and put the relationship in between for instance the the apple juice that you drink and the huge glucose flux that happen afterwards that allows you to think more holistically about the relationship between dietary carbohydrate and sugars and then over time you take people through lessons right and they can go from avoiding and rich carbohydrates in their meals they could try a paleo meal I often ask families to plan out a low-carb weekend and I say think of the foods that you love plan it way beforehand by it cook it eat it look at your sugars and then sit down as a family on Monday morning and figure out if you learned something from the experience more like when people are are wanting to do low carbohydrate wanting to cut their carbohydrate how do you cut down on their insulin so that they don't have a hypoglycemic cells it's really important that people not be on fixed doses of insulin and unfortunately the standard of Education in the United States is such that a huge percentage of people live with type 1 diabetes use the same amount of insulin for every meal so you're asking a very good question you I'm I had falsely assumed that the patient's you're talking about we're on insulin the carb ratios and correction factors and that kind of teaching is essential to then go into these more sophisticated lessons if you remove carbohydrate without dropping your insulin you're gonna go low you're gonna get mad it's gonna be really frustrating and by the way once people go on low carb diets they very quickly lose weight and then they need less basal insulin so we have to be cognizant of that and be able to adapt quickly we have time for a couple more it's a little afternoon honey now this is for you you know when I first came to this country I was amazed at the creativity of the foot industry to create a gazillion food items from four or five ingredients and I'm talking about the cereal aisle and the chip aisle later on I came to understand that there was a direct result of the way agriculture is practiced here and then I understood that it had to do with a farm bill and now I want to know from you how does the farm bill influence the creation of this foot pyramid the farm bill is well first of all it has influenced subsidizes all of those grains and crops that they make them cheap cheap corn cheap soy cheap wheat and so that is that makes those ingredients more appealing to to put into all the the packaged foods that we have in our supermarkets so there are huge subsidies for those industries we are we're not we're not trying to take that on in our work but the other way that that the farm bill you know the farm bill oversees all the activities of the US Department of Agriculture the USDA is the agency that puts out together with Health and Human Services they jointly put out the Dietary Guidelines so if we want reform of the dietary guidelines for instance if we wanted to say if we wanted Congress to amend the dietary guideline authorizing language to say you need when you review the science you needed to do it in a rigorous way and according to international standards for systematic reviews that is something that the farm bill could potentially do to put that language in there the farm bill could Congress could say we want our dietary guidelines to be nutritionally sufficient you know whenever I go around talking I always say did you know the dietary guidelines are nutritionally insufficient that should be illegal so I think you know Congress could make that illegal so those are the two main ways that it that come to mind for me Eric a couple comments and a question dr. Kushner thank you for your talk as a creative way to get research done one of our Duke endocrine fellows Annabeth Barton did a survey of the type one Grit members and got 200 people to reply and then a Harvard researcher in our area our space David Ludwig said let's do it again and verified some of the doctors reports and that papers accepted for publication should be out in the next few months at a prominent journal you can pubmed that thank you for your talk nina i seem to remember that there was a I look to McMaster and people like gourd guy at evidence-based medicine then he write a blog about meat as well did you mention that yes and Gordon Guyot he wrote a piece that was published in the Financial Times but it's behind a paywall we if you get our newsletter we I recently posted that up so everybody could could read that paper and it's really about the points that I made that this decision was based on purely on epidemiology the IARC decision was based purely on epidemiology while ignoring the relevant randomized control clinical trials so if you want to look up all that data that is posted it's on our newsletter so I'll put it on our website my question dr. Finney in your talk it seemed like you were giving the connotation that a lowered metabolic rate was a bad thing can you comment on that do we know that having a lower metabolic rate is truly a bad thing awesome question dr. Westman if I were rain Wohlford and part of the caloric restriction longevity movement I would say lower resting metabolic rates associated with greater longevity but if you're trying to manage your weight it's a two-edged sword so you know nothing is purer in medicine nothing's a hundred percent in medicine and that's why my talk was not you know while one sided blade it's a two-sided blade and we need to keep those perspectives in balance but if people are feeling cold all the time and they don't have energy to get up and out of their chair and do stuff and I've dealt with people who've been on prolonged supplemented fasting and I did it too I converted encourage them to do it and these are the people who had to wear a sweater to a theater in July because it was the air conditioning made it too cold for them to sit in the theater and watch a movie and they felt you know fatigued and cold all the time and in part that's it's not hypothyroidism we tested for that it's probably to a great extent reduced lean body mass and again people differential responses just be aware that we some people will have responses that look feel more negative than they them to be there with if we want to finish with two quick questions and okay I've got a quick one I'm Richard Morris I'm a podcaster and also an ex diabetic reduce my hba1c from some large number eleven point two to five point two thank you for everybody on this audience thank you but I have a question for dr. finian it's regarding regarding fasting and the differentiation between the lean person fasting and an obese person fasting so a lean person with say 10 pounds of body fat who can produce 300 calories of energy for their daily use and somebody with say 100 pounds who can produce 3,000 calories of energy for use my question really is is that a nuance it's worth mentioning when it comes to fasting because the person who is producing adequate energy shouldn't need to recruit amino acids to supplement their caloric use and plus they're also able to produce more substrate for gluconeogenesis that doesn't require protein so would that be a useful nuance in talking about fasting as I showed in one of my slides from the study by Forbes and Renick published in 1979 I memorized that they showed that when they fasted lean people the rate of weight loss was greater than the rate of lean tissue else is greater so the obese patients had some degree of protection but it was like 20% less lean body mass lost per week of fasting if you will did they say how how Abby's they were with the ISA Beast one these are very severely obese functions and these are people they kept on fast for up to 60 days back in the days when we're allowed to do that and you know they're the side effects of that are ever such that I Arby's human subject approvals and is withheld from people wanting to do that kind of extreme fasting short stays is there any evidence of the metabolic rate drop for people who have adequate energy from storage so for example I mean the people in the father bills Gill study I call it the Kevin all Biggest Loser study because Kevin Hall himself can't explain the the metabolic slow Dion if you ask him he'll say all my model doesn't really explain it very well and again I've been the first set of slides I showed that reduction in resting metabolism in both lean and obese people okay that so adiposity doesn't protect one from so access to energy so protect you from correct okay and it's unfortunate reality of the data is currently is published okay thank you for questions okay last question hi my name is Bill aerco I'm a family medicine physician I'm in a rural area in Washington so I get kind of the luxury of seeing all ages a little bit more and so I have a lot of population of geriatrics or over 65 year olds that have cardiovascular disease post a my posts tempt patients and they're interested in ketogenic diet and but there's always sort of a conflict with their cardiologists and you've probably heard this before my question is how do you approach these patients in the setting of sort of already taking a statin the current guidelines on medical management of cardiovascular disease once it's established how do you implement Dietary Guidelines to this mixed you still promote statin use in conjunction with nitric Islands or do you try to sway them away from statin use just wanted to see if anybody had any clinical experience with that of that panel dr. Sarah Hall Berg is a a certified lipid ologist and is running our study in Indiana on 260 people with type 2 diabetes she's presenting this afternoon and I would defer that question to her that when people came into the study on statins we typically left them on statins our goal is to have the fewest conflicts with the primary care physicians and if we take people off of statins they're gonna say well you're changing my we're only taking away the diabetes meds rapidly and so you know we tried to make as few changes as possible and only do the ones that were necessary but we'll let her answer that for you if you like to dive down into this one too this is what I do every day at West Virginia University I'm a hospitalist family medicine doc and you always want to embrace their other providers and make sure you communicate but rarely do you get into any conflict just by getting rid of sugar and junk food that's a pretty common area and that makes so many powerful changes and then it goes physicians you know our job traditionally and how we've been trained is you know people look at us for advice and the right answer like we're supposed to have the right answer but I think as we all know that that's not true so I think we just need to just acknowledge and we just be upfront with patients is I can give you some information but you know I you're gonna figure it out I'm not here to tell you what's right or wrong and advice but always I mean I'm always calling their primaries and their cardiologists when they discharge you say oh by the way we've you know dropped the insulin and drop this ofany area I mean those are the meds that there'll be no controversy of removing because they check their sugars you know so it's dangerous to keep them on those meds and you see in the hospital it's crazy you'll see a hundred units of insulin go away in 24 hours in the hospital just by controlling what they eat and and it's a good experiment you know one day you know they come in for a chest pain rule out tomorrow talk about we have a low carbohydrate pathway in my hospital that involves all the different services so I can give a 10 gram carb per meal you know the kitchen knows what to do the nutritionist isn't going to come in and tell something different and the residents aren't gonna order sliding-scale you know so you just basically if they choose to do that pathway we don't implement that without informed consent you say here's an option do you want to try it and the majority say yeah that sounds I'll do that for a day I can eat extra meat extra eggs extra salad you know sure you know I'm in and then you see where it goes but communications keep every other nursing home patients because you can really kind of more continuously monitor their blood Sugar's and data over time and I've seen the best results and kind of sometimes the kitchen staff really feels empowered at that point making the changes kitchen staff yeah you beat you go down in the kitchen and get to know them by name and if they do a good job they're the lowest paid employees in the hospital that you treat them as if they're part of the healthcare team and when those patients transition from bedridden to the ambulatory doctor mark does deserve to be called out for this because I think this is the first Hospital in the country that offers a low carb meal option and he fought really hard for that I think that's it time for a midday protein bolus [Music]

Channel: Low Carb Down Under

Views: 27,199

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Breckenridge 2018, #LowCarbBreck, #LCB18, Ben Bikman, Eric Kossoff, Jake Kushner, Nina Teicholz, Steve Phinney, Mark Cucuzzella, The Big Fat Surprise, Virta Health

Id: vJspPCZGADQ

Length: 48min 52sec (2932 seconds)

Published: Sat Nov 24 2018