3:34

The doctors are discouraged from really

3:37

thinking deeply about their patients because the guidelines

3:39

just railroad them down one path that is easy

3:41

to follow . You know it's quite mindless

3:44

to do at times , but it's not necessarily

3:46

in the best interest of patients .

3:54

Dr Deepa Mahananda and Dr Alex Petrushevsky

3:57

are general practitioners in Sydney , australia

4:00

, who are in the business of chronic disease

4:02

reversal . They offer holistic

4:04

care that emphasizes low carb , ketogenic

4:06

and other lifestyle interventions in their clinic

4:09

. Low carb specialists . In this

4:11

podcast , we discuss why so many GPs

4:13

are disillusioned and burned out under the current

4:16

prescription based paradigm , the one

4:18

diagnosis that vast majority of doctors aren't

4:20

making , and ketogenic diets

4:22

for cancer , as well as deep prescribing medications

4:25

. We also discuss the founding of

4:27

the Australian metabolic health society and

4:29

the work that Dr Deepa and Dr Alex are

4:31

doing to provide the educational training

4:33

for other doctors so they too can implement

4:36

these highly effective treatments and

4:38

help patients safely heal and come

4:40

off a lifetime of medications

4:42

and making inroads

4:44

into the epidemic of chronic disease

4:46

, obesity and medical dysfunction

4:49

. Hope you enjoy this episode . Okay

4:51

, dr Deepa , dr Alex , thank you for coming on

4:53

the show . Thanks .

4:55

Max , thanks for having us

4:57

on .

4:57

Thanks , max . So maybe

4:59

we can start about what you guys are offering as

5:01

general practitioners , because it's very

5:03

unique and , I think , very much

5:06

needed . But a lot of patients

5:08

basically don't know what you're

5:10

offering compared to what they're getting regularly

5:12

and why this is so important .

5:16

Yeah , so Alex and I we run

5:18

a clinic in Sydney which is called Sydney

5:20

Low Carb Specialists and you're

5:23

correct , it's a very different approach

5:25

to looking at somebody's

5:27

underlying health conditions and also

5:29

about optimising health as well . So

5:32

it really began as we

5:34

started to train in general

5:36

practice and discover that

5:38

much of what we had been taught in

5:41

medical school and in our registrar training

5:43

was more about reactive

5:45

medicines , so really just responding

5:48

with band-aids prescriptions and

5:51

not really ever being

5:53

able to affect great change

5:55

that basically reversed a medical

5:57

problem or completely treated

5:59

an underlying cause . And I think

6:01

we're just starting to become a bit disenchanted

6:04

with that approach and that's

6:06

actually probably not a great thing when you're only

6:08

a few years out as a general

6:10

practitioner . So that

6:12

was really where we started

6:15

to look at other ways

6:18

of treating disease and

6:20

that's about the time we also

6:22

started to see patients who were

6:24

applying different nutritional

6:26

approaches and optimising

6:29

other parts of their lifestyle and having some

6:31

phenomenal results , particularly

6:33

with things like diabetes and hypertension

6:36

reversal . And we

6:39

also started to look into the

6:41

work of Dr Gary Fechke , who's an orthopedic

6:43

surgeon from Tasmania , and

6:46

that's where we started to get interested in low

6:48

carbohydrate therapies , including

6:50

ketogenic therapies , and

6:52

learnt more about that through an organisation

6:55

called Low Carb Down Under in

6:57

Australia , and we attended several conferences

6:59

around 2016 and 2017

7:02

. So I think for us you know

7:05

that professional education

7:07

as well as personally doing

7:09

that for our own health as well , like for

7:11

myself , I was diagnosed with

7:13

stage 4 endometriosis and

7:16

I was at the very end of my medical school

7:18

at that time

7:20

. It was 2012 and I went

7:22

through all of the traditional treatment options

7:24

, including surgery and

7:27

marina use and just

7:29

to try and alleviate the symptoms of

7:31

my endometriosis , but I never really truly got

7:33

on top of it until I started to

7:35

change my nutrition and I really

7:37

reaped the benefits of that , and I

7:40

think many people are quite unaware

7:42

that it can have such a profound impact

7:45

. And whilst I'm just an

7:47

NNICALS one , I've seen so many patients now

7:49

who've had similar benefits

7:51

, so it's very hard to unsee once you've

7:53

seen this occur . So

7:56

our clinic really is about , rather

7:58

than using , you know , short 10-15

8:01

minute consultations , which is the traditional

8:04

way that general practice is , and

8:06

even sometimes , if you're lucky , it's not even five

8:08

minutes with a patient . So I think

8:10

for us it's about giving patients time

8:13

to really understand their complete history

8:15

and do a proper physical examination

8:18

and then start to look holistically

8:20

at what it is about

8:23

different parts of

8:25

their health so not just nutrition about

8:27

the environment , their movement , what's

8:30

their social connection like , and

8:33

also about their sleep as well . Importantly

8:36

so , we're a lot

8:38

more holistic and we get to apply

8:40

those principles in our clinic . And

8:42

yeah , so it's just been quite

8:45

a journey . We're now into our fifth year with

8:47

Cinelo Card Specialists .

8:49

I think just one thing to add is our

8:51

clinic is not just deep renown

8:53

, so it's a very integrated approach . So we've got

8:55

a dietitian we work very closely

8:57

with , we've got a health coach and we also

9:00

work with an exercise physiologist as well . So

9:02

really try to have that integrated

9:04

approach because a lot of patients don't

9:06

just need a doctor's advice or a doctor's

9:09

consult . They need that whole team approach

9:11

to get the results that they're looking for

9:13

. So in many ways

9:15

our clinic is somewhat unique in that regard and

9:18

that we offer that sort of integrated approach . And

9:21

, as Deepa said , you know we

9:23

came to this from our personal experiences as

9:26

well as our experiences as junior doctors . So

9:28

personally , I'd always had an

9:30

issue with weight management , ever since I was a child

9:32

. So we always struggled with that classical

9:34

inability to not eat for

9:36

extended periods of time , so we

9:38

didn't need to snack for energy and that sort of thing

9:41

. And then later on in life , since

9:43

parents , we also started suffering from quite

9:45

frequent and crippling migraines . So

9:47

therapeutic ketosis

9:49

or nutritional ketosis , I should say was

9:52

really effective for me in managing both of those

9:54

things . So again , it's a personal

9:56

story that a lot of clinicians have when they come

9:59

to this space . But , as Deepa said , we

10:01

just saw all of these mounting

10:03

use cases in our clinic and so on our

10:06

general practice days we're finding that our

10:09

schedules were just blowing out because

10:11

the standard 15 minute appointments

10:13

just don't cover it for a lot of the low carb

10:15

consults . You generally need to take a very

10:18

detailed holistic approach and that's why

10:20

at our clinic a standard new patient appointment

10:22

is an hour , which is pretty

10:25

unusual for general practice , for standard

10:27

general practice anyway .

10:28

So yeah

10:30

, fantastic , and what I think you're

10:32

doing is what I

10:34

think patients actually need , and I think that's actually

10:37

what general practice should be about

10:39

, which is holistically looking at

10:41

the patient and addressing

10:43

the reasons why they're falling ill and

10:45

not simply bandating the

10:47

problem with medications or

10:49

hand balls off to

10:51

specialists who will then hit the nail that

10:55

the hammer that they're holding without

10:58

really solving any problem

11:00

. It's funny , deepa , because your stories

11:02

sounds very similar to mine and

11:04

for my regular listeners , you'll know that I

11:07

had acne later in my life and

11:09

all through medical school and went

11:11

through standard dermatology

11:13

treatment protocols with antibiotics

11:16

and isotretinoin and absolutely

11:19

no analysis

11:21

or discussion of

11:23

the underlying causes

11:25

and , like you , low

11:27

carb down under was an absolute resource

11:29

for kind of self

11:31

education . I

11:34

want to explore this idea a bit

11:36

more about what is happening in

11:38

why

11:40

general practice is the way it is , because

11:43

so many colleagues

11:45

that you must have , and you had

11:47

and are in this

11:49

mode of five minute , 10

11:51

minute type of medicine . So can

11:54

you talk a little bit about this idea of disenchantment

11:56

, this idea of Dr Burnout , and

11:58

how this system is currently

12:01

geared ?

12:03

Yeah , so I completely agree with the premise

12:05

of your question . It's a real perfect storm

12:07

at the moment , unfortunately , not just

12:09

in general practice but in all medicine

12:12

really . But it's general practice is certainly

12:14

where the stresses are the highest

12:16

. So general practitioners , unfortunately

12:18

, are burdened with so many tasks and

12:20

so many responsibilities that it's incredibly hard

12:22

to keep up with all of them . Medicine

12:25

is often changing much

12:27

more rapidly these days , year and

12:29

year out , than it used to , so there's a lot of information

12:31

to keep abreast of . So it's certainly not an

12:33

easy job because you have to be across

12:35

a whole variety of different knowledge

12:39

areas . But I think the time

12:41

pressures do make it very difficult for general

12:43

practitioners to offer proper

12:46

deep , holistic care , and certainly

12:49

you can do it with one hour consult as

12:51

deep and I do . But the reality is that the health system doesn't

12:54

incentivise that . So if you look at what

12:56

the health system incentivises for doctors , it

12:58

incentivises quick consults and

13:01

incentivise procedures . They're the two

13:03

areas that get paid the most by Medicare

13:05

. So generally the

13:07

high grossing doctors

13:09

tend to be those procedural doctors or

13:11

doctors that can see a lot of patients per

13:13

hour , and unfortunately neither

13:15

of those two things is going to be helping lifestyle

13:18

diseases or metabolic disease particularly effectively

13:20

, and so on one hand

13:22

you've got this disincentive

13:25

to do the work properly and

13:28

on the other hand you've got other pressures

13:30

coming in . So a real reliance

13:32

on guidelines based medicine , which

13:35

has been useful in many ways . So

13:37

it's helped doctors , I guess

13:39

, move away from certain malpractice

13:42

habits that many of them might have had

13:44

. But at the same time it really

13:46

does oversimplify disease

13:48

states in many ways

13:50

and it also sort of railroads doctors

13:53

thinking this is the way it has to be . There's no deviation

13:55

from that and the medical

13:57

legal realities of the system are there . A lot of doctors

13:59

are highly conservative . They don't want to

14:01

risk medical legal concerns

14:05

or issues . So that again dissuades

14:07

them from really diving into lifestyle medicine

14:09

, because the reality is they're not well trained in

14:12

lifestyle medicine . So I think it's a cliché

14:14

. It gets repeated over and over again in the low carb

14:16

world . We all had couple of hours

14:18

at most of nutritional training in

14:21

medical school , so there's

14:23

no one out there that's really taken the time

14:25

to teach us these things appropriately

14:27

. So if you look at every low carb practitioner

14:30

doctor in Australia , they're all self taught

14:33

in many ways .

14:36

Yeah , and nothing kind of sums

14:38

up what you've talked about more than the kind

14:40

of ever expanding indication and usage

14:43

of medications . You know it seems

14:45

like we blink and you know we're

14:47

supposed to be prescribing these SGLT

14:49

to inhibitors for a new indication

14:51

. Or you know someone younger and younger qualifies

14:54

for a Zempik injection

14:56

and it is , as you

14:58

said . It's complicated and difficult to keep up

15:01

with and it's much more simple if we simply

15:03

reverse that patient's disease or help them

15:05

resolve their condition , because

15:07

we don't need to worry about complex pharmaceutical

15:10

or pharmacological interactions or

15:13

all these other problems

15:15

that crop up . And in complexity

15:17

that crops up with polypharmacy

15:19

, we can simply help

15:22

the patient right at the beginning . The

15:25

other aspect to this and

15:27

you pointed to it is the incentive

15:29

system and this idea of you

15:31

know five minute tick and flick medicine or you

15:33

know , mcdonald's medicine . It's not

15:35

really helping anyone . It's not helping the

15:38

patient who , especially

15:40

elderly I don't know about you guys , but if an

15:42

elderly patient will come in and they obviously

15:45

have a list of things that need addressing and

15:47

they kind of get one issue , you know

15:49

, padded on the head and massaged

15:51

and they go out with all their other issues

15:54

on addressed and they've just wasted a whole bunch

15:56

of time , or you know , coming

15:58

to the doctor . So I

16:00

mean , it's a massive problem and I think

16:03

that most patients don't realize

16:05

that they have

16:07

an option to reverse , but they just haven't

16:09

been told about it .

16:12

Yeah , I completely agree . There's just a lack of

16:14

awareness in the community

16:17

about another way forward with

16:19

looking at their health entirely . And

16:22

sometimes the

16:24

way GPs react is

16:26

because of patient expectation and

16:28

I think the fast society

16:31

that we live in , with everything being quite

16:33

immediate , we often unfortunately

16:36

translate that over to healthcare as well

16:38

and expect that things are sorted

16:40

out within minutes , that there

16:42

is a medication that will just completely resolve

16:45

your issue , like , for example , reflux

16:47

. It's a very common example

16:49

of someone presenting with the classic symptoms

16:51

of what has happened and

16:54

a GP will react and say okay , look , you

16:56

know , these are your options . You could go down the route

16:58

of exploring . You know their food triggers

17:00

, you know there's a bunch of trees . It could be

17:02

, but probably it's simpler in

17:04

the interim to just go

17:06

onto a proton pump inhibitor

17:08

like somac and see how you

17:10

go , and most people who are

17:12

quite busy will probably

17:15

stay on the medication without

17:17

batting an eyelid and not even understand

17:19

that there are long term ramifications for

17:22

being on a medication like that and

17:24

not know that there was any other way forward apart

17:27

from that small snippet they got about

17:29

potentially changing around their

17:31

food intake and other things . So I

17:34

think it's just . It's such a perfect storm at

17:36

the moment . You know , patient expectations

17:38

being what they are GPs

17:40

not receiving appropriate support

17:42

and education and I think

17:44

the willingness is there and people truly

17:46

want to do something good

17:48

for their patients . I don't think there's ever any malevolence

17:51

to this . It's just about the

17:54

fact that people aren't trained and given

17:56

time to do it and appropriately

17:58

remunerated as well by the medical

18:01

system .

18:03

Yeah , and I

18:05

think that this is why I

18:07

do what I do . I think it's about giving people

18:09

options and letting them know what is

18:11

possible , because it

18:13

is long . I've no problem with with

18:15

prescribing medication for someone who doesn't

18:17

want to make life so change . I'm the first one to

18:20

say sure , I'm not , never going to push anything

18:22

on anyone . But the tragedy to me

18:24

and the injustice to me is when

18:26

people don't get advice when

18:28

they were someone who would have changed their

18:30

lifestyle , and I think that's

18:32

where this becomes more than just

18:35

, you know , an inconvenience

18:37

or a convenience for doctors . Oh yeah , you know this

18:39

, or you know , I don't know . It's something

18:41

that we need to know because we need

18:43

to give this option to our patients , otherwise

18:46

we're not doing the best by them , and

18:48

especially if it implies prescribing

18:51

some medication that they could

18:53

have side effects . Well , one of

18:55

the most and maybe we'll just quickly talk about this

18:57

, one of the most common , you

18:59

know , guideline medicine protocols

19:02

that you just mentioned , alex , was

19:05

that I kind of think about

19:07

is this the statin

19:09

prescription for primary

19:11

prevention . So maybe just talk a little bit about

19:13

about that and what you see is the conventional

19:16

approach .

19:18

Yeah , sure . So I mean the conventional approach

19:21

that's still taught and is

19:23

taught when we were training as GPs , is cholesterol

19:26

is very much a target or a numbers

19:28

based game . So we don't necessarily

19:30

look at someone's baseline risk . We

19:33

might pay some lip service to a bit . In

19:35

essence , we're looking for an LDL

19:37

target and that's the primary

19:39

teaching that you sort of look at when you're

19:41

studying for the RSVGP exams . Basically

19:43

, if your LDL is beyond a certain point , then

19:47

you will do some basic , rudimentary

19:49

dietary advice , which basically comes down to eat

19:51

less fat , and

19:53

if that doesn't work , you're going to tell that person look

19:55

, maybe you should go on a statin to prevent

19:57

heart disease . And that was

19:59

pretty much the limits of what you got taught to

20:01

pass your board exams . That's all you needed

20:04

to know really . So

20:06

really that was the sort of approach that we

20:08

used to have a CVD risk calculator or cardiovascular

20:11

disease risk calculator in Australia . That's quite

20:13

rudimentary , but the idea

20:15

is you would look at that and estimate

20:17

out someone's five year risk of having a

20:19

heart attack based on

20:21

their age , their blood pressure , certain demographic

20:23

factors , their family history and whether

20:26

they're a smoker I think that's

20:28

all of them and it would give you a five year

20:30

risk , so it would be five percent or ten percent

20:32

. So the guidelines suggest are if

20:34

a person's risk is above a certain point

20:36

so say fifteen percent then we

20:38

should put them on a statin . And in essence

20:40

, no one . Really it doesn't describe the fact that if

20:42

once you're on them , you're based on them for life

20:45

, there's no exit strategy . You're never considered

20:47

then okay to go off them . Really . Nor

20:50

do the guidelines really talk about

20:52

any other way to risk stratify people . So

20:54

one thing we get taught in general

20:57

practice and even in medical school

20:59

is if someone's got high blood pressure

21:01

, you should consider doing a 24 hour blood pressure

21:03

monitor to see whether it's truly high

21:05

outside of your office . And

21:07

the reason is not that you know blood

21:09

pressure measurement in office is horrendously inaccurate

21:11

. It's mostly accurate , but there'll be some people where

21:14

it's not a true reflection of things and

21:16

their true risk is actually quite low

21:18

and therefore you would say , okay , we're

21:20

not going to commit you to taking this lifelong

21:22

medication without a good reason . Unfortunately

21:25

, with statins we don't have that same attitude

21:27

, but in our clinic and our practice

21:30

and thankfully more and more doctors

21:32

are sort of looking at this is we would

21:34

try to risk , stratify patients for cardiovascular

21:36

disease with more information , because we know

21:38

that those standard demographic factors are not

21:40

particularly good at picking who's going to have a

21:42

heart attack . So the classic

21:45

test that you would consider here is something

21:47

called a coronary calcium score . So

21:51

to my mind , statin medication

21:53

the primary prevention for cardiovascular

21:55

disease , in other words , to prevent your first heart attack

21:57

or stroke it

22:00

should not be done without knowing what your current

22:02

, your coronary calcium score is , outside

22:05

of very specific , rare cases , because

22:07

that calcium score can really

22:09

help stratify someone into either a low

22:11

or medium or high risk group in a much more

22:13

accurate way . And it's

22:15

just not something that's on . And again , a lot of GPs

22:18

are reluctant to do it because it's not part of the guidelines

22:20

. So they think either

22:22

I'm going to be putting myself at risk

22:24

or I'm going to have to put my thinking hat

22:26

on , and that's a bit hard sometimes if you

22:28

get a result and you're not sure what to do with . So

22:31

I think again

22:33

, that's just a way that doctors are discouraged

22:35

from really thinking deeply about

22:37

their patients because the guidelines just

22:39

railroad and down one path that is easy to follow

22:42

. You know it's quite mindless

22:44

to do at times , but it's not necessarily

22:46

in the best interest of patients .

22:49

Yeah , and I'm going to launch

22:51

down a talk about a

22:54

podcast series about heart disease soon

22:56

, but I agree that they're

22:58

potentially , you know , one of the most over-prescribed

23:00

medications that the patients

23:02

are basically put on and not taken off and

23:05

it's problematic . What

23:08

have you guys seen in terms of the complication

23:10

or adverse effects on real , real

23:12

world of statin use in

23:14

your community ?

23:16

In our patient community . I think one of

23:18

the more more common complaints is

23:20

that they get muscle X

23:23

cramps . They don't feel quite

23:25

right in in

23:28

their limbs . So that's sort of something

23:30

that people do say

23:33

, and the problem is is it's quite

23:35

a , you know , relatively common

23:37

side effect . So people are looking

23:39

for it as well , and it's often hard

23:41

for patients to tease out what is the side effect

23:43

of the medication versus other

23:45

things that could be happening to

23:48

them from you know , different things like

23:50

electrolyte deficiencies . So

23:52

that's that's one of the ones

23:54

that comes to mind , and the other one is

23:56

that I do observe there is

23:58

an increase in insulin

24:00

resistance . So that certainly occurs . We

24:03

can often see it on cgms and you

24:05

know when , after someone has removed statin

24:07

therapy from their treatment , that

24:09

it does does lessen

24:11

their amount of insulin resistance . So

24:14

I think that's another , probably

24:17

less spoken about factor

24:20

as well .

24:21

Just on that insulin resistance note , it's not uncommon

24:24

in a clinic to see someone who's been put on a statin

24:26

by another doctor and they're

24:28

having their serial lipid panels done

24:30

and the other doctor is looking at the LDL and it does

24:32

come down , as a statin will do . But

24:34

they're ignoring the fact that the triglycerides are going up

24:36

, and up , and up and up and that's a clue to

24:38

us that you know that their insulin sensitivity

24:41

has been harmed . And , yes , it could always

24:43

be from some other factor , but when

24:45

the time course lines up with when they started

24:47

the statin , it's quite compelling to consider

24:49

that's a contributing factor .

24:53

It's amazingly ironic

24:55

that the medication that we're giving , or

24:57

supposed to be giving , patients to improve

24:59

their long-term cardiovascular fitness and

25:01

health is driving

25:04

up one of the key determinants

25:07

of actually what

25:09

is driving at the risk of cardiovascular disease

25:11

, which is endothelial dysfunction and

25:14

damage to that glyco-calix in the inside

25:16

of the blood vessel . So you

25:19

know these are things that aren't emphasized when

25:21

patients are put on these medications

25:23

, but it's really

25:26

quite distressing

25:28

and alarming because you're

25:30

simply creating more problems that you

25:33

know , we know if someone

25:35

becomes insulin resistant , then diabetic . You've

25:38

just opened up another whole event space of

25:40

different medications , different requirements

25:43

for ongoing specialist care kidney

25:46

specialists , eye specialists . It's

25:49

incredible how everything is linked

25:51

and not saying that this has happened

25:54

by design by any point , but it's

25:56

elegant in the fact

25:58

that we're just creating more business for

26:01

our colleagues and for ourselves .

26:03

Yep , and once they're a diabetic , they've got guidelines

26:06

definitely want them to stay

26:09

on the

26:12

stand .

26:12

Yeah , it's a battle . And let's

26:14

talk a little bit about insulin

26:18

resistance and talk about the

26:22

contributors from your mind , because for

26:25

the listeners of my podcast , I've talked a lot

26:27

recently about leptin and how

26:30

leptin resistance is even preceding

26:33

this idea of insulin

26:35

resistance . So maybe communicate

26:37

or package up this idea of metabolic dysfunction

26:39

and how you guys conceive of it .

26:43

So I think with metabolic dysfunction , you know

26:45

it's looking at a number of different markers

26:48

. I mean not just the physical

26:50

examination , which are things like your blood pressure

26:53

and waist circumference , but also

26:55

looking at pathology or blood test

26:57

markers as well . So in our clinic

26:59

we would routinely be looking at triglycerides

27:02

, at fasting , insulin and blood

27:04

sugar levels and also

27:07

looking at markers of liver

27:09

dysfunction , so particularly the

27:11

ALT and the AST

27:13

, and those are liver enzymes that

27:15

can be , you know , quite elevated and

27:18

, as you said , you know there are some preceding factors

27:20

before people are really presenting

27:22

with quite full-blown metabolic

27:25

syndrome . So you often do see also

27:27

that there is uric acid that

27:30

is elevated . So there's

27:32

a number of different markers which don't

27:34

all necessarily come under the

27:37

criteria , the specific sort

27:39

of five criteria that is looked at

27:41

for metabolic syndrome , because

27:44

it did list some of those in that list but

27:46

there are others that are just not included in general

27:48

guidelines . And I think that's where it's

27:50

pointing to the fact that with metabolic

27:52

health , when we talk about what is

27:54

metabolic health and how do you optimize

27:57

it , that's actually quite an evolving definition

27:59

at the moment and we

28:01

are learning a lot about things like visceral

28:03

fat and you know if people

28:06

who do appear quite thin on the outside

28:08

, they're not overweight , they're not obese , you know they

28:11

have normal BMIs , but they're actually

28:13

quite unwell and they

28:15

have , you know , liver dysfunction already

28:17

and they're even getting fibro

28:19

scans and seeing people to monitor

28:22

you know possible escalation

28:24

in their liver disease . It kind of makes

28:26

you think , okay , look what we know and what are the other factors

28:28

here that we've got to really look at . And so I think

28:31

that that really

28:33

shows you that it's quite

28:35

quite a lot

28:37

of factors that we have to consider

28:39

when we're assessing metabolic

28:41

disease . And

28:44

particularly what

28:46

we see in our clinic would be that there

28:48

are certain demographics as well

28:50

backgrounds where this is more prevalent

28:53

. So particularly I mean in

28:55

my background being Indian , the

28:57

Southeast Asian . So genotype

28:59

, that genotype

29:03

and that background seems to then present

29:05

more with the phenotype of metabolic dysfunction

29:08

when , particularly in

29:10

people who are exposed to a westernised diet

29:12

, so not their typical ancestral diet

29:14

. So I think it's

29:16

also you know how long people

29:18

have dealt with that level of insulin

29:21

resistance , and for

29:24

South Southeast Asians it

29:26

seems to be within just a

29:28

decade , maybe even less , five to ten

29:30

years , that's when they're already showing metabolic

29:32

dysfunction in their late 20s and early

29:34

30s , sometimes even earlier , and that's quite

29:37

alarming , whereas you

29:39

know , I suppose Caucasian counterparts

29:41

don't show this sort of disease till about

29:43

40 or 50 years of age . So

29:45

I think it's actually trying to look beyond

29:48

those general

29:51

, what we accept as these markers of metabolic

29:53

syndrome , because actually a lot of these people

29:55

just fall through the cracks . They would never

29:57

get the diagnosis of metabolic syndrome until

29:59

it's too late , and so I think

30:01

that's kind of how we approach it in

30:04

our clinic with our patients is trying to look at all

30:06

these sort of disease markers

30:08

that may not actually be right

30:11

right in the guideline at the moment , but I for

30:13

saying the future would get added .

30:16

Yeah , they're , and

30:19

what you're saying is that you know , in

30:21

terms of those five markers for people

30:23

, it's the their blood pressure , their waist circumference , their

30:25

triglyceride , their HDL and their

30:27

blood glucose and you're lucky if

30:29

you go to a standard GP and someone will

30:31

make you a diagnosis of metabolic syndrome

30:33

. That in

30:35

itself isn't being made and that

30:37

is the , the forewarner

30:40

of what will come

30:42

later , which is , which is forewarned , type

30:45

2 diabetes , and I really

30:47

I like that approach and I think it's

30:49

giving us this insight . And

30:51

this point which you mentioned is that every patient

30:54

is manifesting their metabolic

30:56

dysfunction in a different organ

30:58

at a different time . It's all

31:00

very there's no prescription or there's

31:02

no one size fits all and

31:04

, as you mentioned , you look in ALT

31:07

. So you're looking at like liver arrangement

31:09

, so that some people might be putting ectopic

31:12

fat in down in their liver first

31:14

before they do anything else . I

31:16

read a paper that suggested that gout

31:19

is a disease of fatty kidney

31:21

, so some people could be putting ectopic fat

31:23

on in their kidney , some people could be simply

31:26

storing it in in their viscera , viscera

31:28

and not having massive effect

31:30

on their metabolism , and I think that's the the Caucasian

31:32

type population that you

31:36

mentioned . So it's a really

31:38

useful thing to be looking at all these

31:40

different markers and having

31:42

an eye open for diagnosing

31:45

metabolic dysfunction

31:47

, even before we can make

31:49

a frank diagnosis of

31:51

metabolic syndrome and definitely before

31:53

we can make a frank diagnosis of

31:55

pre-diabetes or diabetes based on

31:58

on on HPA1c . So I

32:01

really like that . Do you have any specific ideas

32:03

and maybe this can kind of go into the next

32:06

point of why or why

32:08

this there's this variation in propensity

32:10

to develop um metabolic syndrome

32:12

, um metabolic dysfunction

32:14

? Why do you think it is , in

32:17

terms of the mechanisms and to

32:20

explain this variation ?

32:24

It's a tricky one . I think that's a very complex

32:26

question that probably has

32:28

a very multifaceted answer . I mean , certainly , as

32:30

Dieppe mentioned , genotype plays a big role

32:32

. So as she

32:34

mentioned , some of the people that we

32:36

have , we have a lot of patients from Southeast Asia

32:39

and India . In those sorts of places . Their personal

32:42

fat threshold is just set much lower , so

32:44

they're the sort of classical thing on the outside , fat

32:46

on the inside . So that topic that is building

32:49

up there's very likely a contribution

32:51

from the gut microbiome , whether that's

32:54

the microbiome they inherit from their parents

32:56

or from

32:58

their environment . And certainly clinically

33:01

in our practice we do see the

33:03

leaky gut phenotype

33:06

or leaky gut syndrome in a lot of our patients

33:08

and the inflammatory

33:11

cascade that that causes very likely

33:13

is a contributing factor

33:15

for some patient . So in that inflammatory

33:17

cascade can present in many different ways . It can

33:20

present in as autoimmune disease

33:22

, it can present as neurological conditions , it can present

33:24

as chronic pain , it

33:26

can present as gut issues itself

33:28

, so reflux ideas

33:31

, all those sorts of things . So

33:33

again , it's one of those truisms in low carb

33:36

that the gut is where all the disease starts and to

33:38

a degree it probably holds true that

33:40

that's a big lever that

33:42

you can pull and obviously if you change your

33:44

diet you're changing what's occurring at that gut

33:46

interface in a fairly significant way .

33:50

Yeah , yeah , definitely and

33:54

the other factor that we're

33:56

increasing visceral fat and

33:58

particularly people who are

34:00

becoming quite overweight

34:03

, and there is that you

34:05

know , obesity is something that's starting from a very

34:07

young age now . So we're seeing one in

34:09

four Australian children who are

34:11

overweight or obese , so it starts quite young

34:14

. So I think the time

34:16

to disease is also skewed

34:19

because of how early the disease is beginning

34:21

and we're often not even identifying

34:24

it . You know , purely out of you know

34:26

, not wanting to disrupt a

34:28

person's childhood , make comments

34:30

towards children , so it's a very sensitive

34:33

topic . It's often something that's kind

34:35

of not addressed actively and

34:38

I think a lot of consultations skirt the issue

34:40

often . But if you look

34:42

at the fact that you're accumulating this visceral

34:44

fat over quite a long period of time and

34:47

you're not really aware that there's got to be

34:49

some effort put into muscle

34:51

maintenance and growth

34:54

, you're actually going to end up in a state of muscle

34:56

atrophy and that weakens as well

34:58

over time . So I think lack

35:01

of muscle means there's also an increasing

35:03

risk of problems

35:05

with not being able to store

35:08

blood sugar in that particular

35:10

area , and so there's actually

35:12

no . You can improve a lot of insulin

35:14

resistance by by muscle

35:17

growth , and I think that's one of

35:19

the bigger issues too is that for some people

35:21

, if they're getting actual muscle atrophy

35:23

and that's it's becoming and getting into

35:25

the areas of psychopenia , they're

35:28

really starting to see an acceleration in metabolic

35:30

illness . So that's another aspect

35:34

, I think , and I think there

35:36

was this really amazing

35:38

image that Dr

35:40

Robert Lustig put together which

35:43

talks about metabolic dysfunction . I think

35:45

he came up with eight to maybe 10

35:47

different pathways into

35:49

the metabolic syndrome

35:52

as we know it , and it's

35:54

so complicated because it's everything

35:56

from inflammatory substances

35:59

and molecules in the bloodstream

36:01

all the way through to your environment

36:04

and what you're exposed to , things

36:07

like endocrine disruption and

36:09

how that can affect your metabolic health , and

36:11

then the leaky gut issue and autoimmune problems

36:13

. So I think it's such

36:16

a complex ecosystem

36:19

that that ends

36:21

up arriving at this point . But the

36:23

funny thing is , even though it's so complex

36:26

, if you can just get

36:28

at a few key components

36:30

, you will create a full and domino effect

36:34

. And I think nutrition is a huge

36:36

component of that , because sometimes

36:38

the sickest of our patients they can't

36:40

do things like move , like asking them to eat

36:43

less and move more , which is standard

36:45

advice , doesn't get at

36:47

the crux of anything and in fact just sets them up

36:49

for failure and disappointment , particularly

36:52

the move more part , because they actually can't move

36:54

more . They're very unwell people and

36:56

one of the two biggest things that are out

36:59

in your control , I think , are the food

37:02

and your sleep initially , and

37:04

I think that's where focusing on just that alone

37:07

can make such a big impact

37:09

on this metabolic problem .

37:13

Yeah , great answer . I talked

37:15

to Sean O'Mara and I think he's doing some

37:17

very pioneering work in kind of identifying

37:19

the earliest signs of metabolic

37:22

disease and basically using MRI

37:24

to basically

37:26

scan people and look and

37:28

see the deposition of ectopic fat

37:30

depots well

37:34

before they're manifesting in disease

37:36

. And I guess his five

37:38

kind of contributors to visceral fat is

37:41

processed foods , carbs , seed oils , those

37:43

kinds of things , stress

37:45

, poor sleep , alcohol and

37:48

chronic cardio exercise , so

37:50

like jogging , so they're

37:54

all very much contributing factors . I've

37:57

been delving down the circadian

37:59

rabbit hole and I think

38:01

I've more and more come to the opinion

38:05

that the allied environment

38:07

is impacting our metabolic health and

38:09

one of the most elegant

38:12

studies , albeit in

38:15

rats , was basically showed

38:17

that the two groups of

38:19

rats were fed the same diet but one , over

38:22

a six month period , had circadian

38:25

disruption , so they basically had a night shift mimicking

38:28

work and those

38:30

rats developed fibrosis

38:32

of the adipose tissue , they developed inflammatory

38:36

expression within their adipose

38:38

, they had a dipocyte , a hypertrophy

38:40

, so just dysfunctional adipocytes

38:42

and insulin

38:44

resistance . So I'm

38:46

really wondering about these specific

38:49

people , especially

38:52

South Asian and even

38:54

African American , in these high latitudes

38:57

, if we're disconnected from our

38:59

ancestral , the amount

39:01

of ultraviolet and solar information

39:04

that we are and we're circadian

39:06

disrupted . I really think that that is going

39:08

to be a critical part of depositing

39:11

or directing that fat into

39:13

the wrong area and then adding the processed

39:15

food on top of it is

39:17

just kind of hosing everything with

39:19

fuel and igniting

39:21

the fire . But

39:24

it's a lot too , as

39:27

you said , to contribute . But I'm more and

39:29

more thinking that the external factors

39:32

that influence the non-diatri

39:34

, external environmental factors , are

39:36

getting more important for metabolic dysfunction

39:39

rather than just what we're ingesting .

39:44

Yeah . I think , even just within that sphere

39:46

, it needs to be a holistic approach . You can't just be

39:49

diet for everyone

39:51

. Certain patients diet seem to be enough , but

39:53

for some it's not enough and

39:55

we need to be casting it wider . So

39:57

, as you say , looking at circadian

39:59

disruption , looking at mental health or emotional

40:02

health and chronic stress or the

40:04

raised chronic cortisol that comes with

40:06

chronic stress certainly plays a role

40:08

. So any of our patients have got

40:11

a continuous glucose monitor on . You can see

40:13

these factors coming in . So if they've had a

40:15

stressful day or

40:17

if they've had a really bad night's sleep , you

40:19

can see it . So , just thinking

40:21

, some of my patients got really stressful jobs . You can see

40:23

their blood sugar looks really good on Sunday and

40:25

then Sunday night starts creeping up when

40:28

they start thinking about the work the next day and then the

40:30

whole way through Monday . It's just that

40:32

half a point higher

40:34

and you can see it , and if you're not paying attention

40:36

you'll miss that , but it's certainly there

40:38

and it speaks to the costs that psychosocial

40:41

stress can have .

40:43

Yeah , that's an elegant . I

40:46

remember seeing my first continuous glucose monitor

40:48

trace of someone and they

40:50

had a spike and I said , oh

40:52

, what did you eat then ? And they said , oh , I didn't

40:55

eat . And they had had a stressful

40:57

phone call to someone I

40:59

think about business phone call but

41:01

there was a very marked spike in

41:03

their continuous glucose monitor

41:05

trace . And

41:08

it gets to exactly what you said , which is our

41:11

psychosocial environment . And if

41:13

we're in a job that we don't like and we're dealing

41:16

with people that we don't want to deal with and

41:18

we're under the artificial light , then this

41:20

is all going to , as you mentioned

41:22

, raise blood glucose and deposit visceral fat . So

41:24

lots of mechanisms

41:27

to provoke this , but

41:29

luckily , a couple

41:32

of distinct ways to solve it

41:34

. Can you talk about who

41:37

you are using

41:39

low carb specifically

41:41

with ? We talked a little bit

41:43

about it before , but what are the main patient

41:45

groups that you're

41:47

finding benefit and success with ?

41:49

I think the main patient

41:52

groups are people with pre-diabetes

41:54

and diabetes , of course

41:56

, particularly type 2 , but

41:58

we also are increasingly seeing more

42:00

type 1 patients as well , and

42:02

I think that's great because

42:05

a lot of type 1 patients are unfortunately

42:07

trapped within the hospital system

42:09

where it's not necessarily

42:11

offered as an option or

42:13

a way forward for their ongoing treatment

42:16

and management , and that's quite a tragedy . When

42:18

a diagnosis quite young as well , a

42:21

lot of people just will want to

42:23

follow their endocrinologist

42:25

advice and unfortunately

42:27

, if the endocrinologist doesn't mention that this is

42:29

an option , then it

42:31

becomes very tricky . And beyond

42:34

that , there are people who

42:36

are trying to manage

42:38

their blood pressure better , come off medications

42:41

that they've been put on Again

42:44

, people who are looking at management of

42:46

their cholesterol and how to improve

42:48

that . Also in

42:50

the field of fertility , so

42:53

those people who've been experiencing

42:55

sub fertility or

42:57

just looking at optimizing preconception

42:59

. These are some areas where using

43:02

variations of low carb therapies

43:05

is really useful . And

43:08

again , in things like which is a bit

43:10

of a , I suppose , a relationship

43:12

to that is polycystic ovarian syndrome

43:14

, where you see more than 50% of the women

43:16

with this condition are affected by

43:18

insulin resistance . And

43:21

I think , beyond that , things like kidney

43:23

disease and in heart failure

43:25

. These are two other areas

43:28

that are emerging and there's a

43:30

lot more evidence that's escalating

43:32

at the moment for the use of ketogenic

43:34

therapies specifically , so therapies

43:37

that are actually inducing ketosis

43:39

, and in cancer care particularly

43:42

Alex can talk to that in a moment

43:45

but I

43:47

think just such a wide variety

43:49

of disease conditions where

43:51

this works and the other

43:53

areas in autoimmune

43:55

disease , such as in Hashimoto's

43:59

, which causes underactive thyroid

44:02

disease , and in

44:04

inflammatory bowel diseases

44:06

. So those are some of the biggest

44:09

, I suppose , issues that

44:11

that our patients present with

44:13

and I

44:15

think for me . I see a lot of the women

44:18

who are experiencing perimenopause

44:20

and often it's

44:22

about weight , but once

44:26

we sit down and have a chat we realise

44:28

it's about a whole lot more than that and

44:30

that's one of the biggest

44:32

takeaways I want to be able to give my

44:34

patients who are going through that part of

44:36

their life . I know

44:38

that maybe the reason they're presenting is weight

44:41

, but there's actually a lot more to it than that

44:43

and I think it becomes quite an insightful

44:45

and rewarding journey

44:48

for those women to go on , because they start

44:50

to understand where

44:52

their health is or

44:55

how their health became the way it was , and

44:57

then how they can actually get out of it without having

45:00

to go on a whole bunch of

45:02

cascade of medications , which is really nice

45:04

, nice to help them avoid that

45:06

pathway . So

45:08

I think Alex is going to

45:10

have a bit of a chat about the cancer side of things

45:12

, because that's something Alex tends to see a bit more

45:14

.

45:15

Yeah , yeah . So before I jumped

45:17

into general practice , I actually worked in Sydney

45:19

Cancer Services for several years as

45:21

radiation oncologist . So again

45:24

, similar to the whole hospital job

45:27

environment , you're really dealing with acute medicine

45:30

A lot of the time . You're dealing with sick patients

45:32

. You're not really doing a lot of prevention . And

45:35

even within that sort of treatment paradigm , 50%

45:37

of our patients were not curative treatments , so

45:39

they weren't patients we were trying to cure

45:41

. So in many ways we're already getting to them too

45:43

late . And what struck

45:45

me from my time there was there was really

45:47

little training on sort of how to prevent cancer

45:50

or any other sort of approaches

45:53

. So I was really blind to the idea

45:55

of the metabolic theory of cancer back

45:57

then , as most people were . But

45:59

these days , more and more , there's there's

46:02

growing evidence that cancer is a metabolic disease . So if

46:04

you've got a metabolic treatment

46:06

for a metabolic disease , it may well be helpful

46:09

. So unfortunately we don't have

46:11

all the data yet , but it would appear that

46:13

a ketogenic diet and this would be quite

46:15

a strict ketogenic diet

46:18

is is well tolerated

46:20

and could be potentially effective for a variety

46:23

of tumor types . So that's something

46:26

we're seeing more as patients looking to

46:28

adopt a ketogenic diet , to use metabolic therapies

46:32

to help their cancer treatment and , and you know

46:34

, in most cases there's need not be an

46:37

either or situation

46:39

. You know , so often we use this in addition with the standard therapies , and

46:43

I tell basically all my patients I do

46:45

the treatment that the oncologist suggested , so

46:49

it's more of an adjuvant . Or in cases where

46:51

there are other patients have exhausted their treatment

46:54

options , that's something that they can try . And as

46:57

far as anti cancer treatments go , it's quite

46:59

useful in many regards because

47:01

it's not a toxic treatment . Going on a ketogenic diet has

47:05

many other health benefits anyway . So

47:07

it's , you know , in that regard it's cheap , it's non toxic and

47:10

it's something that potentially

47:12

offers a lot of utility . And to combine with

47:14

that , often we 'll use

47:17

some other medications which we commonly

47:19

use for metabolic disease . So if you're listening

47:21

, as you're interested , care

47:23

oncology C-A-R-E

47:25

is an organization that puts

47:27

together various protocols for different

47:29

tumor types and their real

47:31

thrust is to use certain medications

47:34

or repurposed drugs , so in other words drugs

47:36

that have been used for other things , and then

47:38

sort of reusing them for an anti cancer

47:40

effect . So commonly used

47:42

medication will be something like metformin , which

47:44

is a really commonly used anti diabetic drug

47:47

. So it's been well

47:49

studied in many different cancer

47:51

types as potentially useful . Now

47:53

, in and of itself it's not going to cure a cancer , but

47:56

when combined with this sort of holistic

47:58

metabolic approach , it would appear that it's potentially

48:00

helpful for cancers

48:06

.

48:06

This idea of oncology , amongst

48:08

all these specialties , I think we've

48:10

got a centralized treatment paradigm in all our

48:13

subspecialty medicine and

48:15

some of the most , I'm

48:18

going to say , harmful in

48:20

terms of their focus

48:22

or myopia , is

48:24

something like psychiatry , I think , because

48:27

there's such a default to prescribing

48:30

psychotropic , antidepressant , mood

48:32

stabilizing medications without looking at

48:35

the metabolic

48:37

milieu and

48:40

circadian milieu . But

48:42

also endocrinology , which you mentioned , dpa , this

48:46

idea that if you have a type 1 and adolescent

48:48

type 1 diabetic , they're advised

48:50

to eat carbs and chase that carbs

48:53

, those carbs , with a shot of insulin and

48:55

a shot chaser a shot chaser for your

48:57

whole life . Then they wonder why their

48:59

HB1 sees it at 9 when

49:01

they're supposed to be doing everything right

49:04

following their advice . It's like a gas sliding

49:06

operation . I really

49:08

think that there's so much benefit to low-carb

49:13

and in type 1s it really

49:15

makes me sad and

49:17

angry that a lot of

49:19

mainstream or a lot of centralized

49:21

endocrinologists aren't adopting

49:24

this , because it's really possibly one of the

49:26

diseases that could be helped the

49:28

most by adopting a low-carb

49:31

approach . This idea of

49:33

the endocrinology , of oncology

49:36

I think it's the most profitable of

49:38

the specialties . The

49:40

amount of money that gets washed around in

49:42

using various

49:44

oncological treatments for the

49:47

return on dailies or disability-adjusted

49:50

life years . I think you're probably

49:52

getting your worst return on investment the

49:55

fact that you're able to use something

49:57

like a ketogenic dialyx as

50:00

an adjuvant and no one's advising people

50:02

not to use whatever

50:04

their oncologist has prescribed , but to

50:06

use ketogenic therapy as an adjuvant and

50:09

have an effect which , as

50:11

we both know through the work of Dr

50:14

Thomas Seafreed , provides

50:16

very , very strong evidence that this is a mitochondrial

50:18

problem . To improve a mitochondrial problem

50:21

, you use these mitochondrial

50:23

solutions , of which fasting

50:25

and a ketogenic

50:27

diet is one of them . It's really great

50:29

to see that . I

50:32

interviewed a gent who

50:34

had a friend who had

50:38

basically reversed his lymphoma with two

50:40

weeks of extremely cold water

50:42

swimming this

50:44

idea that he'd obviously built up

50:46

a massive amount of brown fat and it was just sucking out

50:48

all the energy substrate out of his

50:50

body and reversing his insulin

50:53

resistance . There's

50:56

so many things to ways to

50:59

discuss it , but I really

51:01

like that you're using these

51:03

approaches . Can you talk a

51:05

little bit about do you have any specific

51:08

treatment guidelines in terms of goals

51:10

for cancer ? Do you try

51:13

and aim for a certain glucose ketone index

51:15

or what's your general approach

51:17

? If you have any comments on what I've said as well , feel

51:20

free .

51:22

I think you're on the mark with some of the limitations

51:25

of the centralized oncology models

51:27

. Again , as DC alluded to

51:29

before , everyone's a caring doctor . No one's

51:31

malicious with this . Everyone's trying to

51:33

do their best in cancer . It's a really difficult

51:36

treat , horrible disease , but

51:38

I guess with the tools that they have to

51:41

use , they're by nature not going

51:43

to be perfect . If

51:46

you treat cancer as a genetic disease , you're

51:48

going to run into some significant

51:50

limitations . The

51:52

other thing I consider a lot of oncologists have , unfortunately

51:54

, is a lot of their patients do get scammed . They get taken

51:57

in by charlatans . They're going to tell them everything's

51:59

going to work , from apricot kernels to all

52:01

the different fad things . They

52:04

end up blowing a lot of money on all these things . By

52:06

nature , a lot of oncologists are conservative

52:08

and suspicious about adjuvant therapy

52:10

. I can get that . In

52:14

terms of GKI , the glucose ketone

52:16

index , which is basically just a measurement of your glucose

52:18

divided by your blood ketones . You're

52:21

typically aiming for a GKI of under two , ideally

52:23

, just assuming this

52:25

is someone who's not been in ketosis for a long

52:27

period of time . Anyone who is fat

52:30

adapted , this becomes somewhat unreliable because

52:32

their blood ketones tend to drip down over time

52:34

by design

52:36

. That's going to mean that if your blood glucose is four

52:38

, which is fairly low , your ketones need to be at least two

52:41

. A lot of

52:43

the time these sorts of KJN protocols

52:45

they are actually very high fat , they're

52:47

incredibly low carbohydrate and they're actually fairly

52:49

low protein . This is not the same

52:51

as a KJN diet for someone who wants

52:54

to be doing longevity stuff or someone who's going

52:56

to be trying to fix their diabetes or lose some

52:59

weight . This is quite a specific approach

53:01

. It's more akin to , I guess , the epilepsy

53:04

type therapeutic KJN diet . Patients

53:07

need to understand they're going to be eating a lot of fat

53:09

. It's not the easiest diet to stick

53:11

to , but I guess the

53:13

counterpoint there is when you

53:15

have cancer that's incurable or that you've

53:17

gone other options , you tend to be highly motivated

53:19

. A lot of patients are very

53:21

much willing

53:23

to push through to get that GKI

53:26

where they need to be .

53:29

Yeah , it is surprising the amount of fat

53:31

and a surprisingly low amount of protein

53:34

to really maintain that level of therapeutic ketosis

53:36

. Definitely not a

53:38

lifestyle protocol . That's

53:41

a really big point . I'm

53:43

glad you brought it up . And that I

53:45

really want to emphasize is that people

53:48

and patients , especially when

53:50

they're doing their own research and maybe they've

53:53

followed someone like Dr Paul Saladino for a long

53:55

time and he was a long time kind of

53:57

advocate who's now advocating for

53:59

fruit consumption the

54:02

nuance that gets lost , especially with

54:04

his message , is that there is a very distinct

54:07

difference between someone who has stage

54:09

4 cancer , inoperable

54:12

, and then someone who is simply

54:14

wanting to perform better

54:16

in their job . What

54:19

you've discussed , what you just talked about , is a therapeutic

54:21

protocol . I make that really clear myself If

54:24

you're sick , you need a therapeutic protocol

54:26

, and that is completely different to someone

54:28

who is surfing four

54:31

hours a day and living

54:33

in Costa Rica . I

54:37

really want to emphasize that point . Ketosis

54:41

is one of the most powerful tools that

54:43

we have in helping

54:46

people who

54:48

are sick , this sick .

54:49

Absolutely . I

54:52

think that's really key is

54:54

that people know there

54:56

are different forms of

54:58

achieving nutritional

55:00

ketosis , and even the height of the ketones

55:03

doesn't necessarily other

55:05

than these few specific conditions

55:08

where we're really needing to achieve a particular

55:11

GKI . It doesn't

55:13

necessarily need to be the driver for

55:15

what you're doing and why

55:17

you're doing it . Actually , first

55:20

and foremost is about how you're feeling

55:22

when you're eating this way . That's

55:26

one of the first questions we ask people when they

55:28

come back to see us is

55:31

how do you feel ? Is this

55:33

working out as a sustainable approach

55:35

for you ? If it's not

55:37

sustainable , it's going to

55:39

be tricky for someone to continue

55:41

. Often , the

55:44

reasons that we need to start

55:46

looking at are making

55:48

sure that people are aware of what is the

55:50

why or the motivation for doing it . As

55:53

you said , if you're on the internet , you might

55:55

be reading something else

55:57

about someone who's doing it for a particular

55:59

disorder and think that everything they're

56:01

saying , including the supplementation regime

56:04

etc . Must apply to you . We've

56:07

seen people walk through our doors who are on

56:09

20-plus supplements because they're following

56:11

someone's online supplement protocol

56:13

. Of course , when

56:16

you explore that a bit further , that person's

56:18

got some conditions that

56:20

are reasons for why they're on those

56:22

things and they're just taking it because they

56:24

thought it was the right thing to do to support their

56:26

dietary framework . I

56:28

think it's really important that people

56:31

are guided by what is needed

56:33

for their health , rather than their

56:36

friend or their family member or someone they read about

56:38

online and just look at online

56:40

information as a general information only , because

56:42

that's really what it is .

56:45

Especially if they've got a significant medical condition

56:47

that they're trying to reverse . It really should

56:49

be ideally guided by someone

56:51

who knows what they're doing . For instance

56:53

, diabetes if you're on insulin , insulin's

56:55

the most dangerous drug a diabetic can take . If

56:58

you're going to go on a low-carb diet , you ideally want someone

57:00

who knows how to wean

57:02

that or deep ascribe that Same

57:04

thing with certain diabetic tablets

57:07

. Ideally you want someone to manage

57:09

that safely so you know you're doing it safely . Heart

57:13

failure is similar . A lot of electrolyte issues

57:15

can happen with patients with heart failure . Acid

57:18

inhibitors and spruinal lactone and beta blockers

57:20

they tend to raise your potassium , whereas

57:22

thiozone frizomide diuretics tend

57:25

to lower it . So it's often a balancing act between

57:27

those Deep ascribing

57:29

. Something we do quite a lot in our clinic and it's one

57:31

of the best parts

57:33

of being a metabolic practitioner is to get people

57:35

off medication , which the average GP doesn't

57:38

do that often Getting patients off

57:40

blood pressure medications , getting

57:42

them off PPI's and making

57:45

sure you wean them , because often patients will get

57:47

rebound reflux if you stop them , if they've been on for

57:49

a long time . As you

57:51

mentioned , max is psychotropic . So the SSRI's

57:53

a lot of people don't realize . The withdrawals from

57:55

those can be significant and protracted . Often

57:59

you need to wean them slowly to limit those withdrawal

58:01

symptoms .

58:03

Yeah , the point I want to make is that people

58:05

are going to do this , whether or not they

58:08

we're there . This

58:10

is another call and

58:12

maybe a message for any other doctors listening

58:14

is that your patients are going to put

58:17

themselves on a ketogenic carnivore

58:19

diet . They're going to take a laundry

58:21

list of supplements , whether or

58:23

not you're there . I

58:25

sometimes think about this as like harm minimization

58:28

If you've got a heroin addict

58:30

in your city , you provide clean needles

58:32

and you don't ignore the

58:34

problem and pretend that it doesn't exist . What

58:38

we're doing and I completely echo your

58:40

call , alex is if

58:42

you're sick , if the patient is sick , they need to see

58:45

someone who knows and has experience in this

58:47

area . That is why

58:49

, as doctors , we need to have this knowledge

58:51

so that we can guide and help our patients who

58:53

are going to be doing this regardless . Maybe

59:00

, on that note , we should probably make a quick note of

59:02

the medications , particularly that people

59:05

should be aware of . Typically

59:07

, insulin is . If you're injecting insulin , then

59:10

that definitely , typically

59:12

almost needs to be halved and

59:14

obviously don't do this yourself , but typically it needs

59:17

to be halved with someone who goes low carb . Talk

59:20

to us about the other medications . That

59:23

as a warning sign for people . If

59:25

they're taking them , what

59:27

are the ones ?

59:28

Another really common diabetic medication

59:31

is the SGLT-2

59:33

, and he was such as things like

59:35

Giants and sometimes combined

59:37

with Metformin , giantomet . It's really

59:39

important for us to

59:41

recognise that it can actually be

59:43

continued for people who

59:45

have diabetes , and with

59:48

some close supervision , because where

59:50

it can go wrong is a very rare but

59:52

still possible side effect of

59:54

euglycemic ketoacidosis

59:56

, where the blood glucose doesn't necessarily

59:59

look dangerous but the ketones

1:00:01

will be rising quite significantly in

1:00:03

the background , and that's because SGLT-2

1:00:05

inhibitors can actually increase

1:00:07

the ketones present in bloodstream

1:00:09

. So that is one of the ones

1:00:12

that we'd probably carefully look at

1:00:14

and we used to

1:00:16

try and bring that off quite early , and

1:00:19

now , with some more new

1:00:21

research that's come to light , we're happier

1:00:23

to leave people on it , with certain caveats

1:00:26

about sick day treatment

1:00:28

and regimes that they can engage in

1:00:30

if they actually become unwell . And

1:00:33

then another is Frisomide

1:00:35

in the setting of

1:00:38

disorders like heart failure . Again

1:00:41

, alex spoke about how it

1:00:43

can actually cause electrolyte deficiencies

1:00:46

for people who are going on a strictly low

1:00:48

carb or ketogenic approach , but

1:00:50

also we know that Frisomide is

1:00:53

known to cause

1:00:55

insulin resistance as well . So it's actually one

1:00:57

of the ones you want to try and bring

1:00:59

off earlier in the piece rather than leave

1:01:02

on for too long . So again

1:01:04

, that needs to be closely monitored . Blood

1:01:07

pressure medication is a big one , so often

1:01:09

we are halving that within a few

1:01:11

weeks of someone commencing

1:01:13

a strict ketogenic protocol

1:01:15

. And also things

1:01:18

like SSRIs need very slow

1:01:20

weaning and

1:01:22

we really want to limit withdrawal symptoms

1:01:25

. So they need close supervision and sometimes

1:01:27

that has to happen over a few

1:01:29

months . So that's the first six to

1:01:31

eight weeks we watch quite closely and then we can

1:01:33

make reductions in medication , but

1:01:36

also keeping in mind what someone's

1:01:39

sort of social environment is at

1:01:41

the time as well , because we know a lot of disorders

1:01:44

actually don't just have that effect

1:01:47

with what's going on biochemically

1:01:49

, but it's also what's happening externally to the

1:01:51

individual . So making sure they're not

1:01:53

stressed , they're in a good position , their mental

1:01:55

state is quite stable . So there's a whole

1:01:58

number of whole host of factors that go

1:02:00

into deciding when to start to deprescribe

1:02:02

medication , and one of the biggest ones and

1:02:04

the ones I enjoy doing the most , is taking

1:02:07

someone off Panadol osteo . It's

1:02:09

like one of my favourite things

1:02:11

to deprescribe because often it's

1:02:13

the thing you mentioned earlier in

1:02:15

our discussion about patients who

1:02:18

are more elderly and they may have

1:02:20

osteoarthritis , and

1:02:22

it's a very common condition in general practice

1:02:24

that almost everybody with

1:02:26

that condition is on two tablets

1:02:29

three times a day of Panadol osteo and

1:02:31

they're just taking it blindly , thinking that that's

1:02:33

helping limit the

1:02:35

pain . And often within

1:02:38

a few weeks people mention to us they're feeling less

1:02:40

pain and they're still taking the medication . But

1:02:42

we often say to them look , actually you can start to come

1:02:44

off , that you know you really don't need to be taking

1:02:47

these extra medications and

1:02:49

it's really lovely

1:02:51

for them to see them come off a medication

1:02:53

that they thought they really needed and

1:02:56

had to take long term . So

1:02:58

that's a wonderful thing to deprescribe pain

1:03:00

medications , particularly opioid medications

1:03:02

too , so the reliance

1:03:05

on that sort of medication becomes less and less

1:03:07

over time . So , yeah

1:03:10

, there are a number of medications there that can

1:03:12

be deep prescribed

1:03:14

quite safely . And

1:03:16

I think we didn't mention anything about the

1:03:21

medications for autoimmune disease , because of

1:03:23

course that needs close supervision and

1:03:25

we try to work with people's specialists

1:03:28

as well , because often they are seeing rheumatologists

1:03:31

or immunologists . So I think that's

1:03:34

actually an area where , yeah , they also

1:03:36

will require less overtime

1:03:38

, so just less frequency and dosing , particularly

1:03:41

of the biological type agents

1:03:43

. So , yeah

1:03:45

, that's hopefully a bit of a roundup of

1:03:48

some of the medications people need to watch

1:03:50

closely if they're gonna put themselves

1:03:52

through a lower carb eating

1:03:54

approach .

1:03:56

Yeah , and I wanna emphasize how abnormal

1:03:58

it is to be actually deep

1:04:00

prescribing medications . I mean , for

1:04:03

us who do it , it becomes

1:04:05

routine and part of the

1:04:08

job . But for most

1:04:10

other doctors the fact that you're actually

1:04:12

removing rather than adding new

1:04:14

medications to a patient's list is almost

1:04:17

unheard of . So

1:04:19

just to , I know

1:04:21

that you made it sound almost very

1:04:23

, you know , ho-hum , but I wanna

1:04:25

really make the point that this is a very special event

1:04:28

. It's a very , it's a joyful event

1:04:30

. It's someone it's like

1:04:32

, you know , unshackling

1:04:34

a chain from someone's leg , metaphorically

1:04:38

speaking . So I don't think we

1:04:41

can't , we shouldn't , minimize that

1:04:43

. It's a very great

1:04:45

event . That speaks to the effort and dedication

1:04:47

of the patient to

1:04:49

improve the health . It speaks to the

1:04:53

dedication of the doctor to be

1:04:56

aligned with that patient's best interests and

1:04:58

go through a process of a

1:05:02

long process it's not necessarily , it's not happening overnight

1:05:04

to work with that patient to

1:05:07

help them . This is what

1:05:09

I think we went into the job for . So

1:05:12

, yeah , I really wanna make that point and

1:05:15

I guess , the mirror of that

1:05:17

point , which is how sad it is that

1:05:20

basically

1:05:22

, patients getting entrapped in this

1:05:24

list of medications , they're getting entrapped

1:05:27

in interactions , they're getting entrapped in dosing

1:05:29

. It's not easy to come off

1:05:31

, as you've just given us an

1:05:33

idea . It's not easy to get out of this trap and

1:05:36

you , ironically , need more medical care

1:05:38

and more close supervision . Not

1:05:42

ironically , you do , but the sick you are

1:05:44

. So , yeah , thanks for

1:05:47

that summary , and I

1:05:49

really hope that more doctors will

1:05:52

consider learning about this so that they too

1:05:54

can help their

1:05:56

patients , because , I mean , at the end

1:05:58

of the day , no

1:06:01

one wants to be to use a semmel a vice analogy

1:06:03

no one wants to be the

1:06:05

doctor that's still kind of doing the

1:06:07

cadaverous dissection and then delivering a baby

1:06:09

. I mean , you

1:06:11

guys are the equivalent of the one saying

1:06:13

that we need to wash our hands before we

1:06:16

do a dissection . And I'm

1:06:18

there with you and

1:06:20

we're trying to tell people that you should wash your hands before

1:06:23

you do an

1:06:25

obstetric delivery . But it's

1:06:27

an ongoing process . So talk to us about

1:06:29

the society that you've just started

1:06:31

and kind of making this movement

1:06:33

become more widespread .

1:06:36

Yeah , so the society that

1:06:38

was incorporated last year

1:06:41

, mid-last year , was the Australian Metabolic

1:06:43

Health Society , and that's

1:06:45

really to address the

1:06:48

need , the absolute need in Australia

1:06:50

to have professional education

1:06:53

for all health professionals that

1:06:56

revolves around improving metabolic

1:06:58

health , particularly with reference

1:07:00

to the use of low carbohydrate therapies

1:07:03

, including ketogenic therapies , and

1:07:05

, unfortunately , with all other societies

1:07:07

, they have not been open

1:07:10

enough or evolving enough to

1:07:12

include an open discussion

1:07:14

about ketosis , nutritional

1:07:16

ketosis , and its benefits across the

1:07:19

plethora of diseases and conditions

1:07:21

, as we spoke about . So

1:07:23

the aims of our organization

1:07:26

, which at the moment has

1:07:28

three directors , two of which are Alex and

1:07:30

myself , but the director is Dr Lorraine

1:07:33

Lawless-Smith from South Australia

1:07:35

, who's a fellow GP as well , and

1:07:38

we've got a nine-member scientific

1:07:41

committee as well , made up of primarily

1:07:43

GPs , but we also have Professor

1:07:46

Karen Dwyer , who's a nephrologist

1:07:48

from Victoria , who's joined our

1:07:50

scientific committee , and

1:07:53

so together we have established an

1:07:56

upcoming course that's to take place

1:07:58

in Melbourne on

1:08:01

Saturday 16th of March this year and

1:08:05

that's specifically

1:08:08

for doctors who would love to learn

1:08:10

more about the foundations

1:08:13

of low carb medicine and how

1:08:15

to apply that within their

1:08:17

consultations , even

1:08:19

in short consultations , as we spoke

1:08:21

about , in general practice , because planting

1:08:24

the seed and giving small snippets of education

1:08:27

and actually providing it as an option is

1:08:29

the first step , and then the

1:08:31

second step after that is understanding all

1:08:33

of these intricacies about deprescribing

1:08:36

and how to apply it to

1:08:39

particular disease conditions . So

1:08:41

that's really what that course is about

1:08:43

, and that's a one-day course . So we encourage

1:08:45

anyone who's listening to your podcast

1:08:48

to join up for that , because

1:08:50

that will be a great way

1:08:53

to enhance

1:08:55

your professional development in the area . And

1:08:58

the other aspect to our

1:09:01

society is in advocacy . So

1:09:04

we're really privileged to have

1:09:06

the support of the Society

1:09:08

of Metabolic Health Practitioners , which is

1:09:10

our sister organization

1:09:13

, and that's sort of how we established

1:09:15

with their support in Australia . They're

1:09:18

actually based in America , but they've been

1:09:20

incredibly supportive of our endeavors

1:09:22

here and they

1:09:24

share the same vision for increasing

1:09:27

health professional education but also

1:09:29

advocacy amongst

1:09:31

the community , but also at the

1:09:34

government level too , because we recognize

1:09:36

needs to be done at a grassroots level

1:09:38

. The community awareness is incredibly

1:09:40

important , but at the same time , for us

1:09:42

to make big change , we need advocacy

1:09:45

at government levels as well , and

1:09:47

I think , with some of the changing guidelines

1:09:50

that we can see just recently , there's been some tireless

1:09:53

people within our community

1:09:55

who've managed to recently

1:09:57

get the Australian Diabetes Society

1:09:59

to endorse low carbohydrate

1:10:01

therapies for diabetes as a guideline

1:10:03

, and the

1:10:05

diabetes Australia has

1:10:07

actually changed the wording around

1:10:10

diabetes no longer

1:10:12

being a chronic progressive

1:10:14

condition but now being something that can

1:10:16

be put into reverse and can

1:10:18

achieve remission . So it's just

1:10:20

terminology that's changed in some

1:10:23

ways . But that is huge for

1:10:25

the acceptance amongst

1:10:27

health professionals in Australia

1:10:29

and gives people confidence to

1:10:31

prescribe things and

1:10:33

to provide it as a way or

1:10:36

an option . And , as you said , you know not every

1:10:38

patient needs to take it up , but just to even have

1:10:40

it as an option is huge . So

1:10:42

that's something that I think giving

1:10:45

professionals the confidence to mention

1:10:47

it and to have some knowledge

1:10:49

around it , so they're not thrown when

1:10:52

someone mentions they're on a carnival diet

1:10:54

or they're on , you know , some form of a low

1:10:56

carb , you know protocol

1:10:59

, that they can actually support

1:11:01

them really well and even point

1:11:03

them in the right direction of where they can find

1:11:05

more assistance , which is important . So

1:11:08

, yeah , so I think you know

1:11:10

one of the aims or divisions we

1:11:12

have as time moves on this

1:11:14

year is that very shortly

1:11:16

we're going to be able to offer

1:11:18

a membership to the Australasian Metabolic

1:11:21

Health Society and

1:11:24

that will be about

1:11:26

having access to

1:11:28

monthly grand rounds where

1:11:30

we're going to have presenters that people can

1:11:32

listen to within the Australian

1:11:34

or Australasian setting , which

1:11:37

is quite useful because our local

1:11:39

practice of low carb

1:11:41

has certain elements

1:11:44

to it that don't mirror what happens internationally

1:11:46

. Sometimes our units are different . Just

1:11:49

the way we go about navigating our healthcare

1:11:51

system is different , so it's nice

1:11:53

to be able to have that as

1:11:56

something people can tune into

1:11:58

and get real community support amongst

1:12:00

health professionals , and

1:12:02

when I say this it's not just the doctors . This

1:12:04

membership it's for anyone who has

1:12:07

a health professional background

1:12:09

or training , so that includes allied health

1:12:11

professionals , psychologists , dentists

1:12:14

, nurses so

1:12:16

we really want this to be an all

1:12:18

encompassing umbrella for people who are

1:12:20

interested , because we recognize metabolic

1:12:22

health transcends any

1:12:25

one specialty area . It's

1:12:27

about a fundamental shift

1:12:30

in the way we look at health . So

1:12:32

that's and then

1:12:34

I guess you know what people gain as

1:12:36

a part of being a member is that they can

1:12:38

use it for their continuing professional development

1:12:41

, which is important , and also

1:12:43

for networking and access to

1:12:45

a lot of our courses and workshops that we

1:12:47

plan to provide . And

1:12:50

I think , importantly , we really

1:12:52

want to reach medical students and

1:12:55

or help professional

1:12:57

students of any kind , because

1:13:00

we know the next generation is

1:13:02

where we're gonna get the biggest shift

1:13:04

forward in using

1:13:06

this metabolic therapy , and we're

1:13:09

trying to keep the membership

1:13:11

rate very low for our trainees

1:13:14

any trainees out there or students

1:13:16

, to be able to join and support

1:13:18

this foundation , because the more support we

1:13:20

receive from the community , the more we can do

1:13:22

as well . We are

1:13:24

not taking pharmaceutical sponsorship

1:13:27

, and that's something that we wanna

1:13:29

try to be very transparent about

1:13:31

because , unfortunately , previous societies

1:13:33

haven't done that . Has

1:13:36

it been offered ? No

1:13:38

, no , I probably won't expect

1:13:40

any forthcoming pharmaceutical sponsorship

1:13:43

.

1:13:43

I think that's been a real point

1:13:45

. That's let down . Some of the other society

1:13:47

health societies in Australia who might have

1:13:49

been taken on this mantle , you know , five or 10

1:13:52

years ago , Is that connection

1:13:54

to either pharmaceutical companies or

1:13:56

supplement companies and that sort of thing . So we're gonna

1:13:58

try , we are going

1:14:01

to be separate from all of that because

1:14:03

we wanna maintain that independence . I think that's a critical

1:14:05

point because that sort

1:14:07

of pharmaceutical industrial

1:14:10

complex has really interfere

1:14:12

with the practice of good medicine in many

1:14:14

ways .

1:14:16

It has , and that's a great

1:14:18

way of putting it . I think most doctors

1:14:21

, as you mentioned , you know all our colleagues are

1:14:23

all well-meaning , everyone's gone into this for the right reason

1:14:25

, but they're trapped within the

1:14:28

greater system and those profit

1:14:30

motives of the pharmaceutical industry , unfortunately

1:14:34

, I think , are the main driver behind the

1:14:37

guidelines-based approaches

1:14:39

that you mentioned

1:14:41

earlier . So what this

1:14:43

Australian Metabolic Health Society

1:14:45

represents in my mind is really the opposite

1:14:48

. It's a grassroots , decentralized

1:14:50

response to the

1:14:53

lack of options or

1:14:55

the lack of formal top-down training

1:14:57

for doctors to administer

1:14:59

effective , evidence-based lifestyle

1:15:02

treatment to our patients . It's

1:15:04

emerging . It emerges a need you

1:15:07

guys are addressing a fundamental need that

1:15:11

we need to offer and that

1:15:13

our patients need . So very , very excited

1:15:16

for this , very excited to be

1:15:19

attending . I'll be there in

1:15:21

Melbourne next year sorry , this

1:15:23

year and I'll definitely

1:15:25

be there . I think what

1:15:28

you said about the medical students being

1:15:30

the next stage , I

1:15:32

completely echo that and for any medical

1:15:34

students listening or if you know any medical students

1:15:37

, please send them this podcast you

1:15:40

can be part of a changing

1:15:42

paradigm . You don't have to perpetuate

1:15:45

a scientific and intellectual

1:15:48

paradigm that is , it's a

1:15:50

legacy paradigm and anyone

1:15:52

who's a student of history will

1:15:54

realize how , as

1:15:57

a humanity , we get trapped in

1:15:59

different intellectual and thought paradigms . Whether

1:16:02

the earth , whether the sun planets

1:16:04

revolve around the earth . You

1:16:07

wanna be the one talking

1:16:09

about the heliocentrism early

1:16:12

on . You don't wanna be a late adopter of

1:16:14

heliocentrism and , just

1:16:16

like that , you don't wanna be the last person

1:16:18

to offer your type one diabetic

1:16:20

low carb diet that

1:16:23

can get them into a normal HPA1C range

1:16:25

. So I really

1:16:27

love what you guys are doing . I think it's fantastic

1:16:29

. It's very sorely needed and

1:16:31

I'm very optimistic that this

1:16:33

is gonna be a major catalyst

1:16:36

for giving our patients options

1:16:38

, giving them better medical care , which is again

1:16:41

why we went in this in the first place

1:16:44

. So I will include a lot of information in the

1:16:46

show notes and maybe

1:16:48

anyone who has a medical

1:16:50

background can also , or affiliate

1:16:53

allied health can also

1:16:55

attend . Maybe someone will

1:16:57

send a link to their doctor . They

1:17:00

might help them to

1:17:03

open their mind to these ideas . Any

1:17:05

final thoughts or anything

1:17:07

else that I haven't asked you guys that you wanna make

1:17:10

mention ?

1:17:13

I really think that

1:17:15

we've covered quite a bit in

1:17:17

the podcast , but you

1:17:19

know , I think , moving forward , I

1:17:22

think the practice of this type

1:17:24

of medicine is going . It will be mainstream

1:17:27

, it's going to be part of just

1:17:30

all of the options we offer people and

1:17:34

but we do it really is going to take

1:17:36

a whole environment

1:17:38

shifting , so it's

1:17:40

not just going to be doctors all of

1:17:42

a sudden offering this . It's got to be patients

1:17:45

wanting it and understanding that

1:17:47

this has a role and other

1:17:49

health professionals understanding it and then a

1:17:52

broader community understanding as well

1:17:54

. The government actually backs the

1:17:56

kind of services

1:17:59

that will help people eat in a way that

1:18:01

is going to be conducive to their health

1:18:03

, and things like regenerative

1:18:05

agriculture is incredibly

1:18:07

important and critical to this becoming

1:18:10

sustainable long term

1:18:12

and available to

1:18:14

more populations , rather than us having

1:18:16

to rely on a lot of processed

1:18:19

food to meet the shortfall

1:18:21

for nutrition , because that , unfortunately

1:18:24

, is where a lot of populations , marginalized

1:18:26

populations , even within Australia , will

1:18:28

find and but the cost of

1:18:30

living increasing , people will start

1:18:33

to turn to the cheapest foods and

1:18:35

, unfortunately , a lot of the time , that

1:18:37

is the processed foods . So we

1:18:39

need to make it affordable and

1:18:41

that's a huge like it's going to . It's a big

1:18:44

task , but I think just nearly

1:18:46

having this conversation and having more

1:18:48

people hear this message increases

1:18:51

, and my biggest message is that

1:18:53

people put their money into

1:18:55

, invest their money into these

1:18:58

people , the people who are

1:19:00

growing and providing us with

1:19:02

food , actual whole food

1:19:04

, not the processed stuff because that's market

1:19:06

demand and that's where

1:19:09

where more of the supply is going to

1:19:11

come from is if we put the money towards

1:19:13

that area .

1:19:14

So that's what I hope to see

1:19:16

shift and shift quickly

1:19:18

, because we need that to happen as

1:19:20

soon as we can yeah , quickly

1:19:22

on that point and you think , get

1:19:24

fully grass fed , chemical free , antibiotic

1:19:27

free , regeneratively raised beef for $20

1:19:29

per kilo if you buy in bulk . So that

1:19:31

is the kind of shutdown on anyone who

1:19:33

says that this is unsustainable or unaffordable

1:19:36

. It takes a little bit of budgeting , it takes you

1:19:38

a little bit of initiative and forethought

1:19:41

and planning to have an off freezer space

1:19:43

. But low carb carnivore

1:19:45

, it's all possible , it's all affordable and

1:19:47

if you are intentional in your lifestyle

1:19:50

and that's something I've talked about extensively

1:19:52

on previous podcasts . So I urge

1:19:55

everyone to check out my previous

1:19:57

interviews with regenerative farmers and for

1:20:00

more information on that . But yeah , thanks , deepa

1:20:02

, for bringing that up , because that is a critical piece

1:20:04

of the puzzle . And if we want people

1:20:06

to eat healthy , healthy

1:20:08

meat in large amounts

1:20:11

to reverse their disease , then we want them to be

1:20:13

eating it in with the highest quality

1:20:15

. So

1:20:17

, alex , anything else that you want to add ?

1:20:19

No , I just echo both your points that I think I'm

1:20:23

optimistic about how this is heading , but

1:20:25

it does need that fundamental change . I

1:20:27

think the fundamental change of perception

1:20:30

of health is really important . So our birthright is

1:20:32

not to be chronically diseased . This is a relatively

1:20:34

new phenomenon . It's

1:20:36

not how it's been for the vast majority of

1:20:38

our species history . So

1:20:41

getting back to our birthright of being in

1:20:44

full health , full

1:20:47

connection with our

1:20:49

planet , really in all aspects

1:20:51

, that's part

1:20:54

of our goal , I think , going forward .

1:20:56

Yeah , I love it . And yes

1:20:58

, a final call to people and patients . I

1:21:00

mean , you've got the power . You've got the power to

1:21:02

demand this from your doctor . You've

1:21:04

got the power to implement

1:21:06

any lifestyle change . You don't have

1:21:09

to be sick . So , thanks very

1:21:11

much . I really appreciate the conversation for

1:21:14

you both and , yeah , I really encourage

1:21:16

everyone again to attend the event

1:21:18

. So thanks again and we'll

1:21:20

keep in touch .

1:21:22

Thanks a lot , max . Thanks Max .

1:21:32

Thank you .