LowCarbUSA Podcast

Two years ago, Dr. Andrew Oswari, a family medicine doctor practicing integrative medicine, was experiencing what most doctors are currently experiencing, depression and disillusionment due to their lack of ability to help any of their patients with chronic illnesses get better. Ongoing progression of the conditions and escalating medications are the order of the day.

In the January of 2019 he was tested and the results came back with an HgA1c of 7.4 and he says we was devastated. He felt there was no way he could be diabetic since he practiced what he preached about diabetes to medical students coming through his practice. He had happened to notice previously that one of his patients who came in regularly for a certain treatment was losing weight and he would ask her how she was doing it. When she replied that it was by adopting the keto diet, he just blew it off but this time, in the February of 2019, when she talked about keto he paid attention. He said he joined a Facebook group to learn about it since there was no other way to find out how it worked, especially not in medical circles.

Within 2 weeks all sorts of things happened. He just felt great, his daily headaches which he used to attribute to the stress of the job had vanished. His irritable bowl syndrome which he thought he was stuck with for life disappeared. "I had gone low carb just to lose weight and hopefully cure my diabetes and all these things happened", he says. He learned about how this lifestyle could potentially address so many conditions and he immediately started contacting some of his patients with these chronic conditions, including one with cancer, and he says he has never looked back.

He started looking up where he could get some training and came across LowCarbUSA®. He found all the training we had in our partnership with the Nutrition Network and proceeded to do every module they had to offer. That has stood him in good stead when the new non-profit, The Society of Metabolic Health Practitioners (The SMHP) launched in mid-December they had a number of pathways defined to achieve accreditation and one of those includes a number of the Nutrition Network Modules. So Andrew became one of the first practitioners to get accredited with the SMHP and he now has the right to display the SMHP Accredited badge and use the credentials MHP after his name. So he is now Andrew Oswari, MD, MHP. He wrote an essay as part of his submission for SMHP Accreditation and it was so inspiring that I have provided a link to it here.

Andrés Rosales and Mauricio Moel are two youngsters from Mexico, studying at Harvard, who decided that there was a huge gap in the meal replacement market for a very strict, clean, keto version. They wanted medical practitioners who were using therapeutic carbohydrate deduction as an intervention in their practice to feel comfortable recommending it to their patients to use as a convenient replacement to take to work, or to somewhere where they did not think a keto option would be available, or even just if they didn't feel like cooking. They formed a board of advisors from many of the high profile doctors and personalities in the low carb space to help make sure that this product delivered everything it promised. Anyone embracing the ketogenic lifestyle can, and surely will, use one of these shakes as a convenient meal replacement but it was important to Andrés and Mauricio that the medical community saw it as a tool.

This product is now shipping for you to try today :) here.

Edit: an apology form Nick - "Apologies to everyone. At 34:30 I made a false statement when I said HMG-CoA reductase inhibition could inhibit ketone production directly. It is not the RLE in ketogenesis. There are indirect mechanisms potentially at play, but that enzyme is downstream of the divergence point in ketone and cholesterol metabolism. I was questioning the thought as it came to mind and regret the impulsive speculation. My sincerest apologies. That's embarrassing."

What a treat to spend some time with Nick Norwitz PhD. He just graduated from Oxford with a PhD in neuro-metabolism and now he is about to embark on his MD at Harvard. But this is not about his academic achievements, impressive as they are, rather it is about his immense battles with numerous chronic conditions that led him down the path to discovering keto. When he was younger he never put on weight and was as carefree as most kids are until the end of high school when he started to develop osteoporosis, which was super weird for a male of his age. By the end of college he developed ulcerative colitis. He went to Oxford to pursue his PhD and had a huge flare up soon after arriving ending up in a hospital in a strange country where no one knew what was wrong with him. So he started doing a bunch of research and he voraciously consumed scientific papers about carb reduction and the ketogenic diet and, although still skeptical, he decided to go for it. Within a week his colitis disappeared. So he titrated off his meds over time and feels confident that his colitis is gone. He is totally excited about this to the point that he is worried about getting expelled from Harvard for calling out his professors on this stuff.

We went on to talk about the new Society of Metabolic Practitioners (SMHP), a non-profit in which Nick is very active and even ended up in a pretty scientific discussion about cholesterol. We made mention of his new YouTube testimonial video he put out and he talked about his book and referred to a bunch of papers so I have put a few interesting links down below here.

I have wanted to sit down and chat with David and Jen Unwin for the longest time so this was a real treat. We start out by hearing briefly how he first came to learn about Low Carb, and that was through a patient who went off and reversed her diabetes on her own. When she saw him again she literally scolded him for not every telling her that starch was really just sugar in the body and she basically asked if he was even qualified! When I pointed out that he was never taught that stuff during his studies at university, I was amazed by his answer, "That is No Excuse!! As a doctor I should have know that. I was caught with my pants down". She apparently learned all everything from an online group of about 40,000 people who were all teaching each other about this and when he tried to join the group to learn more they would not let him in initially because they thought that if he was a doctor then he must be a troll. They literally investigated him in his practice before they allowed him in, but since then he and Jen have gone on to help them to develop an online program which has helped over 460,000 people so far.

What a brilliant discussion with two genuinely caring and humble doctors who are helping to change the world!

You can find that famous chart on the teaspoons of sugar under the Resources tab on this website. You can link to David's latest paper he was talking about here.

After bursting onto the scene with Good Calories Bad Calories in 2007, Gary Taubes has gone on to write many books that have managed to make it into the mainstream and not get pigeonholed in the Keto or Low Carb genre which, let's be honest, is still pretty small as communities go. It's because of this that I am particularly excited about this new book of his, 'The Case For Keto' (available on Amazon here). Our main focus at LowCarbUSA® has always been to not preach to the choir but rather to try to reach people who have not yet discovered the wonders of approaching metabolic health with lifestyle interventions instead of drugs.

What's also interesting to me is that for the first time, Gary has strayed a bit from pure science. Pretty much the second half of the book is practical insights and advice on how to be successful on this diet (we hate to call it that but let's leave it at that for now). His comment to me was that once we convince people that they need to consider this change, we need to make sure they do it right! Another deviation from the norm for him is that he has made it personal. He describes himself as one of those people who 'fatten easily' and so, for the first time, he is making himself vulnerable and putting it out there that he is not just preaching from his ivory tower but providing you with tools to come down and fight side by side with him in the trenches.

We discussed the purpose of his book at length and he says he is hoping to reach a bunch more physicians and hopefully persuade them to at least take a really hard look at this as an option. I really hope he achieves his dream!

What a fascinating discussion with Dr. Ben Bikman about what Insulin Resistance really means. He makes this statement towards the end but I would like to highlight it right here at the start, "We should be studiously avoiding dogmatic thinking and constantly be checking what we think we know, lest we become that which we have grown to despise in those who are very antagonistic towards a low carb diet."

There has been quite lot of chatter around recently about what it means and whether or not Insulin Sensitivity is something we should be striving for or not. I agree with his take on it that it is extremely desirable for most of our cells and organs to be Insulin Sensitive and it is that insulin sensitivity and the absence of chronic hyperinsulinemia that leads to all the amazing benefits in metabolic health that we see with carbohydrate reduction.

We discuss his thoughts on where insulin resistance starts and he is quick to point out that this is opinion of how it based based on his knowledge of the biochemistry and basic logic. It becomes really clear as the discussion continues about how important an enzyme insulin really is to our existence. It's only when we become chronically hyperinsulinemic that trouble starts to surface. At one point he talked about how in a type 1 diabetic where the beta cells in the pancreas are not producing insulin but the alpha cells are producing glucagon like crazy because there is no insulin to downregulate it. So the liver is making more and more glucose under the effect of the glucagon. He also explained that injecting insulin does not have the desired dampening effect since really high levels of insulin are required at the alpha cells to have the desired effect. Since the beta cells are right next to the alpha cells in the pancreas, the levels of insulin right there at the site of production are high enough, but injected insulin is never in high enough concentrations to be effective by the time it reaches the pancreas. So there is some research going into the idea that type 1 diabetes is just as much a disease of glucagon excess as it is of insulin deficiency. Dr. Roger Unger has shown that there are other therapies like somatostatin and even leptin which can be administered to turn off glucagon production and you can possibly solve the type 1 diabetes without insulin at all.

I sat down with Dr. Adele Hite to talk about the imminent launch of the nonprofit Society for Metabolic Health Practitioners (SMHP). She has been instrumental in helping us to get to this point. Back in 2018 she worked with the panel of advisors that we put together to oversee the development of the Clinical Guidelines for therapeutic carbohydrate restriction. We published them on our LowCarbUSA® site at our Seattle event in May, 2019 and they have been embraced by the community. However it was never really the ideal home for these guidelines and through numerous discussions with Dr. Tro Kalayjian, it became clear that what we really needed was a dedicated nonprofit entity for practitioners. So I went off and established a nonprofit called the SMHP and put a Board of Directors in place and built a website and by the time this podcast airs, we will be live at https://metabolicpractitioners.org/.

You can help is to get this going by engaging on the website and an social media: Website: https://metabolicpractitioners.org/ Facebook: https://www.facebook.com/TheSMHP Twitter: @TheSMHP YouTube: The SMHP Instagram: @TheSMHP

Pam talks to Dorian Greenow, Founder of Keto-Mojo which produces a meter to measure blood glucose and blood ketone levels. When they first launched, at our LowCarbUSA® San Diego Event in 2017, they had already managed to bring the cost of the test strips down to 25% of the cost of the other available strips at the time. But he has never been satisfied with that and is constantly striving to bring the cost down further and also to try to get it certified for use in many other countries around the world. In order to achieve this he has needed to change manufacturers which has bought with it many challenges.

With this change he has managed to reduce the cost of the meter by about 30% and the cost of the strips down by 20%. More than that, the old strips came in batches of 50 which came in a vial. Once that vial was opened, the clock starts ticking and after 6 months those strips expire and you have to open a new vial. Now the strips are individually wrapped so there is no 6 month expiry problem. However it means that they will eventually run out of stock of the old strips for the old meters and so he has been offering people the chance to upgrade to the new meter just for the cost of the new strips.

You can learn more about, and view all those videos Dorian was talking about on the Keto-Mojo Site.

I first came across André Obradovic while I was working my way through the Advisor Training Course from the Nutrition Network. What stood out immediately that it wasn't a doctor or scientist trying to teach me something about the benefits of carbohydrate restriction or the LCHF lifestyle but rather about coaching and teaching people and how to effectively help them to understand why they might need to make a change. André calls himself a performance coach so I guess performance, in this case, is about how effective a doctor might be in communicating with the patient. What I also found fascinating was that even though the talk was pitched at a practitioner with respect his or her patient or client, it applied equally well to anyone trying to get through to a friend or family member. For those of us struggling to get the message through to friends or family, there is so much here to help us.

During the talk he mentions the Wheel of Life Tool.

He also talks about his free app. You can find it in your app store under Andre Obradovic.

Adam Pike was one of the lawyers involved in the successful defence of the charge against Prof. Tim Noakes for replying to a lady on Twitter about the best way to wean a baby. Since then Adam has presented a talk on ethical behaviour of medical professionals on social media for the Nutrition Network, which is a spin-off from the Noakes Foundation. I had a fascinating chat with him about what constitutes ethical behaviour on social media and we discover how the behaviour of Prof. Noakes did not constitute unethical behaviour (which is why he was exonerated) whereas the behaviour of Claire Julsing-Strydom, who was instrumental in bringing the charge against him, and the ADSA did in fact behave unethically in a number of ways in the aftermath of that fateful tweet and yet no charge was ever brought against them.

We then went on to talk about how protected a practitioner might be if they are to disseminate advice on therapeutic carbohydrate restriction and the LCHF lifestyle. We are working really hard to establish an alternative Standard of Care (SoC) for this. Part of that effort is to establish a non-profit called the Society of Metabolic Health Practitioners (The SMHP) which is due to launch shortly. You can learn more here. But until that happens, how protected is a doctor who advises their patient in this way. What Adam said was really interesting. If a doctor provides care that goes against the accepted SoC but they can show that they based their decision on solid evidence then they would still be able defend themselves in court if it ever came to it. Patient autonomy (or informed consent) is also critical here. As long as the patient is fully informed of all the options available with all the supporting evidence and they then make a decision on their course of treatment, no harm can be done and the doctor is protected. That is just critical knowledge that all doctors should have.