52. Reversing Chronic Disease & Transforming General Practice with Dr. Deepa Mahananda & Dr. Alex Petrushevski

Dr Deepa Mahananda and Dr Alex Petrushevski are General Practitioners in Sydney, Australia who are in the business of chronic disease reversal. They offer holistic care that emphasises low carb, ketogenic and other lifestyle interventions in their clinic, Low Carb Specialists. 

In this episode discuss why so many GPs are disillusioned and burned out under the current prescription-based paradigm, the one diagnosis that vast majority of doctors aren’t making, ketogenic diets for cancer,  de-prescribing medications, and more.

We also discuss founding of the Australian Metabolic Health Society, and the work that Deepa & Alex are doing to provide educational training for other medical practitioners to adopt these approaches.

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Australian Metabolic Health Society - http://amhs.org.au/

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Transcript

Speaker 1: 4:12

The doctors are discouraged from really thinking deeply about their patients because the guidelines just railroad them down one path that is easy to follow. You know it's quite mindless to do at times, but it's not necessarily in the best interest of patients.

Speaker 2: 4:33

Dr Deepa Mahananda and Dr Alex Petrushevsky are general practitioners in Sydney, australia, who are in the business of chronic disease reversal. They offer holistic care that emphasizes low carb, ketogenic and other lifestyle interventions in their clinic. Low carb specialists. In this podcast, we discuss why so many GPs are disillusioned and burned out under the current prescription based paradigm, the one diagnosis that vast majority of doctors aren't making, and ketogenic diets for cancer, as well as deep prescribing medications. We also discuss the founding of the Australian metabolic health society and the work that Dr Deepa and Dr Alex are doing to provide the educational training for other doctors so they too can implement these highly effective treatments and help patients safely heal and come off a lifetime of medications and making inroads into the epidemic of chronic disease, obesity and medical dysfunction. Hope you enjoy this episode. Okay, dr Deepa, dr Alex, thank you for coming on the show. Thanks.

Speaker 3: 5:33

Max, thanks for having us on.

Speaker 2: 5:36

Thanks, max. So maybe we can start about what you guys are offering as general practitioners, because it's very unique and, I think, very much needed. But a lot of patients basically don't know what you're offering compared to what they're getting regularly and why this is so important.

Speaker 3: 5:54

Yeah, so Alex and I we run a clinic in Sydney which is called Sydney Low Carb Specialists and you're correct, it's a very different approach to looking at somebody's underlying health conditions and also about optimising health as well. So it really began as we started to train in general practice and discover that much of what we had been taught in medical school and in our registrar training was more about reactive medicines, so really just responding with band-aids prescriptions and not really ever being able to affect great change that basically reversed a medical problem or completely treated an underlying cause. And I think we're just starting to become a bit disenchanted with that approach and that's actually probably not a great thing when you're only a few years out as a general practitioner. So that was really where we started to look at other ways of treating disease and that's about the time we also started to see patients who were applying different nutritional approaches and optimising other parts of their lifestyle and having some phenomenal results, particularly with things like diabetes and hypertension reversal. And we also started to look into the work of Dr Gary Fechke, who's an orthopedic surgeon from Tasmania, and that's where we started to get interested in low carbohydrate therapies, including ketogenic therapies, and learnt more about that through an organisation called Low Carb Down Under in Australia, and we attended several conferences around 2016 and 2017.

Speaker 3: 7:41

So I think for us you know that professional education as well as personally doing that for our own health as well, like for myself, I was diagnosed with stage 4 endometriosis and I was at the very end of my medical school at that time. It was 2012 and I went through all of the traditional treatment options, including surgery and marina use and just to try and alleviate the symptoms of my endometriosis, but I never really truly got on top of it until I started to change my nutrition and I really reaped the benefits of that, and I think many people are quite unaware that it can have such a profound impact. And whilst I'm just an NNICALS one, I've seen so many patients now who've had similar benefits, so it's very hard to unsee once you've seen this occur. So our clinic really is about, rather than using, you know, short 10-15 minute consultations, which is the traditional way that general practice is, and even sometimes, if you're lucky, it's not even five minutes with a patient.

Speaker 3: 8:47

So I think for us it's about giving patients time to really understand their complete history and do a proper physical examination and then start to look holistically at what it is about different parts of their health so not just nutrition about the environment, their movement, what's their social connection like, and also about their sleep as well. Importantly so, we're a lot more holistic and we get to apply those principles in our clinic. And yeah, so it's just been quite a journey. We're now into our fifth year with Cinelo Card Specialists.

Speaker 1: 9:27

I think just one thing to add is our clinic is not just deep renown, so it's a very integrated approach. So we've got a dietitian we work very closely with, we've got a health coach and we also work with an exercise physiologist as well. So really try to have that integrated approach because a lot of patients don't just need a doctor's advice or a doctor's consult. They need that whole team approach to get the results that they're looking for. So in many ways our clinic is somewhat unique in that regard and that we offer that sort of integrated approach.

Speaker 1: 9:59

And, as Deepa said, you know we came to this from our personal experiences as well as our experiences as junior doctors.

Speaker 1: 10:06

So personally, I'd always had an issue with weight management, ever since I was a child. So we always struggled with that classical inability to not eat for extended periods of time, so we didn't need to snack for energy and that sort of thing. And then later on in life, since parents, we also started suffering from quite frequent and crippling migraines. So therapeutic ketosis or nutritional ketosis, I should say was really effective for me in managing both of those things. So again, it's a personal story that a lot of clinicians have when they come to this space. But, as Deepa said, we just saw all of these mounting use cases in our clinic and so on our general practice days we're finding that our schedules were just blowing out because the standard 15 minute appointments just don't cover it for a lot of the low carb consults. You generally need to take a very detailed holistic approach and that's why at our clinic a standard new patient appointment is an hour, which is pretty unusual for general practice, for standard general practice anyway.

Speaker 2: 11:06

So yeah, fantastic, and what I think you're doing is what I think patients actually need, and I think that's actually what general practice should be about, which is holistically looking at the patient and addressing the reasons why they're falling ill and not simply bandating the problem with medications or hand balls off to specialists who will then hit the nail that the hammer that they're holding without really solving any problem.

Speaker 2: 11:39

It's funny, deepa, because your stories sounds very similar to mine and for my regular listeners, you'll know that I had acne later in my life and all through medical school and went through standard dermatology treatment protocols with antibiotics and isotretinoin and absolutely no analysis or discussion of the underlying causes and, like you, low carb down under was an absolute resource for kind of self education. I want to explore this idea a bit more about what is happening in why general practice is the way it is, because so many colleagues that you must have, and you had and are in this mode of five minute, 10 minute type of medicine. So can you talk a little bit about this idea of disenchantment, this idea of Dr Burnout, and how this system is currently geared?

Speaker 1: 12:42

Yeah, so I completely agree with the premise of your question. It's a real perfect storm at the moment, unfortunately, not just in general practice but in all medicine really. But it's general practice is certainly where the stresses are the highest. So general practitioners, unfortunately, are burdened with so many tasks and so many responsibilities that it's incredibly hard to keep up with all of them. Medicine is often changing much more rapidly these days, year and year out, than it used to, so there's a lot of information to keep abreast of. So it's certainly not an easy job because you have to be across a whole variety of different knowledge areas. But I think the time pressures do make it very difficult for general practitioners to offer proper deep, holistic care, and certainly you can do it with one hour consult as deep and I do.

Speaker 1: 13:31

But the reality is that the health system doesn't incentivise that. So if you look at what the health system incentivises for doctors, it incentivises quick consults and incentivise procedures. They're the two areas that get paid the most by Medicare. So generally the high grossing doctors tend to be those procedural doctors or doctors that can see a lot of patients per hour, and unfortunately neither of those two things is going to be helping lifestyle diseases or metabolic disease particularly effectively, and so on one hand you've got this disincentive to do the work properly and on the other hand you've got other pressures coming in. So a real reliance on guidelines based medicine, which has been useful in many ways. So it's helped doctors, I guess, move away from certain malpractice habits that many of them might have had.

Speaker 1: 14:23

But at the same time it really does oversimplify disease states in many ways and it also sort of railroads doctors thinking this is the way it has to be. There's no deviation from that and the medical legal realities of the system are there. A lot of doctors are highly conservative. They don't want to risk medical legal concerns or issues. So that again dissuades them from really diving into lifestyle medicine, because the reality is they're not well trained in lifestyle medicine. So I think it's a cliché. It gets repeated over and over again in the low carb world. We all had couple of hours at most of nutritional training in medical school, so there's no one out there that's really taken the time to teach us these things appropriately. So if you look at every low carb practitioner doctor in Australia, they're all self taught in many ways.

Speaker 2: 15:14

Yeah, and nothing kind of sums up what you've talked about more than the kind of ever expanding indication and usage of medications. You know it seems like we blink and you know we're supposed to be prescribing these SGLT to inhibitors for a new indication. Or you know someone younger and younger qualifies for a Zempik injection and it is, as you said. It's complicated and difficult to keep up with and it's much more simple if we simply reverse that patient's disease or help them resolve their condition, because we don't need to worry about complex pharmaceutical or pharmacological interactions or all these other problems that crop up. And in complexity that crops up with polypharmacy, we can simply help the patient right at the beginning.

Speaker 2: 16:03

The other aspect to this and you pointed to it is the incentive system and this idea of you know five minute tick and flick medicine or you know, mcdonald's medicine. It's not really helping anyone. It's not helping the patient who, especially elderly I don't know about you guys, but if an elderly patient will come in and they obviously have a list of things that need addressing and they kind of get one issue, you know, padded on the head and massaged and they go out with all their other issues on addressed and they've just wasted a whole bunch of time, or you know, coming to the doctor. So I mean, it's a massive problem and I think that most patients don't realize that they have an option to reverse, but they just haven't been told about it.

Speaker 3: 16:50

Yeah, I completely agree. There's just a lack of awareness in the community about another way forward with looking at their health entirely. And sometimes the way GPs react is because of patient expectation and I think the fast society that we live in, with everything being quite immediate, we often unfortunately translate that over to healthcare as well and expect that things are sorted out within minutes, that there is a medication that will just completely resolve your issue, like, for example, reflux. It's a very common example of someone presenting with the classic symptoms of what has happened and a GP will react and say okay, look, you know, these are your options. You could go down the route of exploring. You know their food triggers, you know there's a bunch of trees.

Speaker 3: 17:40

It could be, but probably it's simpler in the interim to just go onto a proton pump inhibitor like somac and see how you go, and most people who are quite busy will probably stay on the medication without batting an eyelid and not even understand that there are long term ramifications for being on a medication like that and not know that there was any other way forward apart from that small snippet they got about potentially changing around their food intake and other things. So I think it's just. It's such a perfect storm at the moment. You know, patient expectations being what they are GPs not receiving appropriate support and education and I think the willingness is there and people truly want to do something good for their patients. I don't think there's ever any malevolence to this. It's just about the fact that people aren't trained and given time to do it and appropriately remunerated as well by the medical system.

Speaker 2: 18:41

Yeah, and I think that this is why I do what I do. I think it's about giving people options and letting them know what is possible, because it is long. I've no problem with with prescribing medication for someone who doesn't want to make life so change. I'm the first one to say sure, I'm not, never going to push anything on anyone. But the tragedy to me and the injustice to me is when people don't get advice when they were someone who would have changed their lifestyle, and I think that's where this becomes more than just, you know, an inconvenience or a convenience for doctors.

Speaker 2: 19:17

Oh yeah, you know this, or you know, I don't know. It's something that we need to know because we need to give this option to our patients, otherwise we're not doing the best by them, and especially if it implies prescribing some medication that they could have side effects. Well, one of the most and maybe we'll just quickly talk about this, one of the most common, you know, guideline medicine protocols that you just mentioned, alex, was that I kind of think about is this the statin prescription for primary prevention. So maybe just talk a little bit about about that and what you see is the conventional approach.

Speaker 1: 19:57

Yeah, sure. So I mean the conventional approach that's still taught and is taught when we were training as GPs, is cholesterol is very much a target or a numbers based game. So we don't necessarily look at someone's baseline risk. We might pay some lip service to a bit. In essence, we're looking for an LDL target and that's the primary teaching that you sort of look at when you're studying for the RSVGP exams. Basically, if your LDL is beyond a certain point, then you will do some basic, rudimentary dietary advice, which basically comes down to eat less fat, and if that doesn't work, you're going to tell that person look, maybe you should go on a statin to prevent heart disease. And that was pretty much the limits of what you got taught to pass your board exams. That's all you needed to know really. So really that was the sort of approach that we used to have a CVD risk calculator or cardiovascular disease risk calculator in Australia. That's quite rudimentary, but the idea is you would look at that and estimate out someone's five year risk of having a heart attack based on their age, their blood pressure, certain demographic factors, their family history and whether they're a smoker I think that's all of them and it would give you a five year risk, so it would be five percent or ten percent. So the guidelines suggest are if a person's risk is above a certain point so say fifteen percent then we should put them on a statin. And in essence, no one. Really it doesn't describe the fact that if once you're on them, you're based on them for life, there's no exit strategy. You're never considered then okay to go off them. Really. Nor do the guidelines really talk about any other way to risk stratify people.

Speaker 1: 21:33

So one thing we get taught in general practice and even in medical school is if someone's got high blood pressure, you should consider doing a 24 hour blood pressure monitor to see whether it's truly high outside of your office. And the reason is not that you know blood pressure measurement in office is horrendously inaccurate. It's mostly accurate, but there'll be some people where it's not a true reflection of things and their true risk is actually quite low and therefore you would say, okay, we're not going to commit you to taking this lifelong medication without a good reason. Unfortunately, with statins we don't have that same attitude, but in our clinic and our practice and thankfully more and more doctors are sort of looking at this is we would try to risk, stratify patients for cardiovascular disease with more information, because we know that those standard demographic factors are not particularly good at picking who's going to have a heart attack. So the classic test that you would consider here is something called a coronary calcium score.

Speaker 1: 22:29

So to my mind, statin medication the primary prevention for cardiovascular disease, in other words, to prevent your first heart attack or stroke it should not be done without knowing what your current, your coronary calcium score is, outside of very specific, rare cases, because that calcium score can really help stratify someone into either a low or medium or high risk group in a much more accurate way. And it's just not something that's on. And again, a lot of GPs are reluctant to do it because it's not part of the guidelines. So they think either I'm going to be putting myself at risk or I'm going to have to put my thinking hat on, and that's a bit hard sometimes if you get a result and you're not sure what to do with. So I think again, that's just a way that doctors are discouraged from really thinking deeply about their patients because the guidelines just railroad and down one path that is easy to follow. You know it's quite mindless to do at times, but it's not necessarily in the best interest of patients.

Speaker 2: 23:27

Yeah, and I'm going to launch down a talk about a podcast series about heart disease soon, but I agree that they're potentially, you know, one of the most over-prescribed medications that the patients are basically put on and not taken off and it's problematic. What have you guys seen in terms of the complication or adverse effects on real, real world of statin use in your community?

Speaker 3: 23:55

In our patient community. I think one of the more more common complaints is that they get muscle X cramps. They don't feel quite right in in their limbs. So that's sort of something that people do say, and the problem is is it's quite a, you know, relatively common side effect. So people are looking for it as well, and it's often hard for patients to tease out what is the side effect of the medication versus other things that could be happening to them from you know, different things like electrolyte deficiencies. So that's that's one of the ones that comes to mind, and the other one is that I do observe there is an increase in insulin resistance. So that certainly occurs. We can often see it on cgms and you know when, after someone has removed statin therapy from their treatment, that it does does lessen their amount of insulin resistance. So I think that's another, probably less spoken about factor as well.

Speaker 1: 24:59

Just on that insulin resistance note, it's not uncommon in a clinic to see someone who's been put on a statin by another doctor and they're having their serial lipid panels done and the other doctor is looking at the LDL and it does come down, as a statin will do. But they're ignoring the fact that the triglycerides are going up, and up, and up and up and that's a clue to us that you know that their insulin sensitivity has been harmed. And, yes, it could always be from some other factor, but when the time course lines up with when they started the statin, it's quite compelling to consider that's a contributing factor.

Speaker 2: 25:31

It's amazingly ironic that the medication that we're giving, or supposed to be giving, patients to improve their long-term cardiovascular fitness and health is driving up one of the key determinants of actually what is driving at the risk of cardiovascular disease, which is endothelial dysfunction and damage to that glyco-calix in the inside of the blood vessel. So you know these are things that aren't emphasized when patients are put on these medications, but it's really quite distressing and alarming because you're simply creating more problems that you know, we know if someone becomes insulin resistant, then diabetic. You've just opened up another whole event space of different medications, different requirements for ongoing specialist care kidney specialists, eye specialists. It's incredible how everything is linked and not saying that this has happened by design by any point, but it's elegant in the fact that we're just creating more business for our colleagues and for ourselves.

Speaker 1: 26:42

Yep, and once they're a diabetic, they've got guidelines definitely want them to stay on the stand.

Speaker 2: 26:51

Yeah, it's a battle. And let's talk a little bit about insulin resistance and talk about the contributors from your mind, because for the listeners of my podcast, I've talked a lot recently about leptin and how leptin resistance is even preceding this idea of insulin resistance. So maybe communicate or package up this idea of metabolic dysfunction and how you guys conceive of it.

Speaker 3: 27:21

So I think with metabolic dysfunction, you know it's looking at a number of different markers. I mean not just the physical examination, which are things like your blood pressure and waist circumference, but also looking at pathology or blood test markers as well. So in our clinic we would routinely be looking at triglycerides, at fasting, insulin and blood sugar levels and also looking at markers of liver dysfunction, so particularly the ALT and the AST, and those are liver enzymes that can be, you know, quite elevated and, as you said, you know there are some preceding factors before people are really presenting with quite full-blown metabolic syndrome. So you often do see also that there is uric acid that is elevated. So there's a number of different markers which don't all necessarily come under the criteria, the specific sort of five criteria that is looked at for metabolic syndrome, because it did list some of those in that list but there are others that are just not included in general guidelines. And I think that's where it's pointing to the fact that with metabolic health, when we talk about what is metabolic health and how do you optimize it, that's actually quite an evolving definition at the moment and we are learning a lot about things like visceral fat and you know if people who do appear quite thin on the outside, they're not overweight, they're not obese, you know they have normal BMIs, but they're actually quite unwell and they have, you know, liver dysfunction already and they're even getting fibro scans and seeing people to monitor you know possible escalation in their liver disease. It kind of makes you think, okay, look what we know and what are the other factors here that we've got to really look at. And so I think that that really shows you that it's quite quite a lot of factors that we have to consider when we're assessing metabolic disease.

Speaker 3: 29:22

And particularly what we see in our clinic would be that there are certain demographics as well backgrounds where this is more prevalent.

Speaker 3: 29:31

So particularly I mean in my background being Indian, the Southeast Asian.

Speaker 3: 29:37

So genotype, that genotype and that background seems to then present more with the phenotype of metabolic dysfunction when, particularly in people who are exposed to a westernised diet, so not their typical ancestral diet.

Speaker 3: 29:53

So I think it's also you know how long people have dealt with that level of insulin resistance, and for South Southeast Asians it seems to be within just a decade, maybe even less, five to ten years, that's when they're already showing metabolic dysfunction in their late 20s and early 30s, sometimes even earlier, and that's quite alarming, whereas you know, I suppose Caucasian counterparts don't show this sort of disease till about 40 or 50 years of age. So I think it's actually trying to look beyond those general, what we accept as these markers of metabolic syndrome, because actually a lot of these people just fall through the cracks. They would never get the diagnosis of metabolic syndrome until it's too late, and so I think that's kind of how we approach it in our clinic with our patients is trying to look at all these sort of disease markers that may not actually be right right in the guideline at the moment, but I for saying the future would get added.

Speaker 2: 30:55

Yeah, they're, and what you're saying is that you know, in terms of those five markers for people, it's the their blood pressure, their waist circumference, their triglyceride, their HDL and their blood glucose and you're lucky if you go to a standard GP and someone will make you a diagnosis of metabolic syndrome. That in itself isn't being made and that is the, the forewarner of what will come later, which is, which is forewarned, type 2 diabetes, and I really I like that approach and I think it's giving us this insight. And this point which you mentioned is that every patient is manifesting their metabolic dysfunction in a different organ at a different time. It's all very there's no prescription or there's no one size fits all and, as you mentioned, you look in ALT. So you're looking at like liver arrangement, so that some people might be putting ectopic fat in down in their liver first before they do anything else.

Speaker 2: 31:54

I read a paper that suggested that gout is a disease of fatty kidney, so some people could be putting ectopic fat on in their kidney, some people could be simply storing it in in their viscera, viscera and not having massive effect on their metabolism, and I think that's the the Caucasian type population that you mentioned. So it's a really useful thing to be looking at all these different markers and having an eye open for diagnosing metabolic dysfunction, even before we can make a frank diagnosis of metabolic syndrome and definitely before we can make a frank diagnosis of pre-diabetes or diabetes based on on on HPA1c. So I really like that. Do you have any specific ideas and maybe this can kind of go into the next point of why or why this there's this variation in propensity to develop um metabolic syndrome, um metabolic dysfunction? Why do you think it is, in terms of the mechanisms and to explain this variation?

Speaker 1: 33:02

It's a tricky one. I think that's a very complex question that probably has a very multifaceted answer. I mean, certainly, as Dieppe mentioned, genotype plays a big role. So as she mentioned, some of the people that we have, we have a lot of patients from Southeast Asia and India. In those sorts of places. Their personal fat threshold is just set much lower, so they're the sort of classical thing on the outside, fat on the inside.

Speaker 1: 33:25

So that topic that is building up there's very likely a contribution from the gut microbiome, whether that's the microbiome they inherit from their parents or from their environment. And certainly clinically in our practice we do see the leaky gut phenotype or leaky gut syndrome in a lot of our patients and the inflammatory cascade that that causes very likely is a contributing factor for some patient. So in that inflammatory cascade can present in many different ways. It can present in as autoimmune disease, it can present as neurological conditions, it can present as chronic pain, it can present as gut issues itself, so reflux ideas, all those sorts of things. So again, it's one of those truisms in low carb that the gut is where all the disease starts and to a degree it probably holds true that that's a big lever that you can pull and obviously if you change your diet you're changing what's occurring at that gut interface in a fairly significant way.

Speaker 3: 34:29

Yeah, yeah, definitely and the other factor that we're increasing visceral fat and particularly people who are becoming quite overweight, and there is that you know, obesity is something that's starting from a very young age now. So we're seeing one in four Australian children who are overweight or obese, so it starts quite young. So I think the time to disease is also skewed because of how early the disease is beginning and we're often not even identifying it. You know, purely out of you know, not wanting to disrupt a person's childhood, make comments towards children, so it's a very sensitive topic. It's often something that's kind of not addressed actively and I think a lot of consultations skirt the issue often. But if you look at the fact that you're accumulating this visceral fat over quite a long period of time and you're not really aware that there's got to be some effort put into muscle maintenance and growth, you're actually going to end up in a state of muscle atrophy and that weakens as well over time. So I think lack of muscle means there's also an increasing risk of problems with not being able to store blood sugar in that particular area, and so there's actually no. You can improve a lot of insulin resistance by by muscle growth, and I think that's one of the bigger issues too is that for some people, if they're getting actual muscle atrophy and that's it's becoming and getting into the areas of psychopenia, they're really starting to see an acceleration in metabolic illness.

Speaker 3: 36:09

So that's another aspect, I think, and I think there was this really amazing image that Dr Robert Lustig put together which talks about metabolic dysfunction.

Speaker 3: 36:23

I think he came up with eight to maybe 10 different pathways into the metabolic syndrome as we know it, and it's so complicated because it's everything from inflammatory substances and molecules in the bloodstream all the way through to your environment and what you're exposed to, things like endocrine disruption and how that can affect your metabolic health, and then the leaky gut issue and autoimmune problems.

Speaker 3: 36:52

So I think it's such a complex ecosystem that that ends up arriving at this point. But the funny thing is, even though it's so complex, if you can just get at a few key components, you will create a full and domino effect. And I think nutrition is a huge component of that, because sometimes the sickest of our patients they can't do things like move, like asking them to eat less and move more, which is standard advice, doesn't get at the crux of anything and in fact just sets them up for failure and disappointment, particularly the move more part, because they actually can't move more. They're very unwell people and one of the two biggest things that are out in your control, I think, are the food and your sleep initially, and I think that's where focusing on just that alone can make such a big impact on this metabolic problem.

Speaker 2: 37:51

Yeah, great answer. I talked to Sean O'Mara and I think he's doing some very pioneering work in kind of identifying the earliest signs of metabolic disease and basically using MRI to basically scan people and look and see the deposition of ectopic fat depots well before they're manifesting in disease. And I guess his five kind of contributors to visceral fat is processed foods, carbs, seed oils, those kinds of things, stress, poor sleep, alcohol and chronic cardio exercise, so like jogging, so they're all very much contributing factors. I've been delving down the circadian rabbit hole and I think I've more and more come to the opinion that the allied environment is impacting our metabolic health and one of the most elegant studies, albeit in rats, was basically showed that the two groups of rats were fed the same diet but one, over a six month period, had circadian disruption, so they basically had a night shift mimicking work and those rats developed fibrosis of the adipose tissue, they developed inflammatory expression within their adipose, they had a dipocyte, a hypertrophy, so just dysfunctional adipocytes and insulin resistance.

Speaker 2: 39:24

So I'm really wondering about these specific people, especially South Asian and even African American, in these high latitudes, if we're disconnected from our ancestral, the amount of ultraviolet and solar information that we are and we're circadian disrupted. I really think that that is going to be a critical part of depositing or directing that fat into the wrong area and then adding the processed food on top of it is just kind of hosing everything with fuel and igniting the fire. But it's a lot too, as you said, to contribute. But I'm more and more thinking that the external factors that influence the non-diatri, external environmental factors, are getting more important for metabolic dysfunction rather than just what we're ingesting.

Speaker 1: 40:22

Yeah.

Speaker 1: 40:22

I think, even just within that sphere, it needs to be a holistic approach. You can't just be diet for everyone. Certain patients diet seem to be enough, but for some it's not enough and we need to be casting it wider. So, as you say, looking at circadian disruption, looking at mental health or emotional health and chronic stress or the raised chronic cortisol that comes with chronic stress certainly plays a role. So any of our patients have got a continuous glucose monitor on. You can see these factors coming in. So if they've had a stressful day or if they've had a really bad night's sleep, you can see it. So, just thinking, some of my patients got really stressful jobs. You can see their blood sugar looks really good on Sunday and then Sunday night starts creeping up when they start thinking about the work the next day and then the whole way through Monday. It's just that half a point higher and you can see it, and if you're not paying attention you'll miss that, but it's certainly there and it speaks to the costs that psychosocial stress can have.

Speaker 2: 41:22

Yeah, that's an elegant. I remember seeing my first continuous glucose monitor trace of someone and they had a spike and I said, oh, what did you eat then? And they said, oh, I didn't eat. And they had had a stressful phone call to someone I think about business phone call but there was a very marked spike in their continuous glucose monitor trace. And it gets to exactly what you said, which is our psychosocial environment. And if we're in a job that we don't like and we're dealing with people that we don't want to deal with and we're under the artificial light, then this is all going to, as you mentioned, raise blood glucose and deposit visceral fat. So lots of mechanisms to provoke this, but luckily, a couple of distinct ways to solve it. Can you talk about who you are using low carb specifically with? We talked a little bit about it before, but what are the main patient groups that you're finding benefit and success with?

Speaker 3: 42:27

I think the main patient groups are people with pre-diabetes and diabetes, of course, particularly type 2, but we also are increasingly seeing more type 1 patients as well, and I think that's great because a lot of type 1 patients are unfortunately trapped within the hospital system where it's not necessarily offered as an option or a way forward for their ongoing treatment and management, and that's quite a tragedy. When a diagnosis quite young as well, a lot of people just will want to follow their endocrinologist advice and unfortunately, if the endocrinologist doesn't mention that this is an option, then it becomes very tricky. And beyond that, there are people who are trying to manage their blood pressure better, come off medications that they've been put on Again, people who are looking at management of their cholesterol and how to improve that. Also in the field of fertility, so those people who've been experiencing sub fertility or just looking at optimizing preconception. These are some areas where using variations of low carb therapies is really useful.

Speaker 3: 43:46

And again, in things like which is a bit of a, I suppose, a relationship to that is polycystic ovarian syndrome, where you see more than 50% of the women with this condition are affected by insulin resistance. And I think, beyond that, things like kidney disease and in heart failure. These are two other areas that are emerging and there's a lot more evidence that's escalating at the moment for the use of ketogenic therapies specifically, so therapies that are actually inducing ketosis, and in cancer care particularly Alex can talk to that in a moment but I think just such a wide variety of disease conditions where this works and the other areas in autoimmune disease, such as in Hashimoto's, which causes underactive thyroid disease, and in inflammatory bowel diseases. So those are some of the biggest, I suppose, issues that that our patients present with and I think for me.

Speaker 3: 44:55

I see a lot of the women who are experiencing perimenopause and often it's about weight, but once we sit down and have a chat we realise it's about a whole lot more than that and that's one of the biggest takeaways I want to be able to give my patients who are going through that part of their life. I know that maybe the reason they're presenting is weight, but there's actually a lot more to it than that and I think it becomes quite an insightful and rewarding journey for those women to go on, because they start to understand where their health is or how their health became the way it was, and then how they can actually get out of it without having to go on a whole bunch of cascade of medications, which is really nice, nice to help them avoid that pathway. So I think Alex is going to have a bit of a chat about the cancer side of things, because that's something Alex tends to see a bit more.

Speaker 1: 45:53

Yeah, yeah. So before I jumped into general practice, I actually worked in Sydney Cancer Services for several years as radiation oncologist. So again, similar to the whole hospital job environment, you're really dealing with acute medicine A lot of the time. You're dealing with sick patients. You're not really doing a lot of prevention. And even within that sort of treatment paradigm, 50% of our patients were not curative treatments, so they weren't patients we were trying to cure. So in many ways we're already getting to them too late.

Speaker 1: 46:23

And what struck me from my time there was there was really little training on sort of how to prevent cancer or any other sort of approaches. So I was really blind to the idea of the metabolic theory of cancer back then, as most people were. But these days, more and more, there's there's growing evidence that cancer is a metabolic disease. So if you've got a metabolic treatment for a metabolic disease, it may well be helpful. So unfortunately we don't have all the data yet, but it would appear that a ketogenic diet and this would be quite a strict ketogenic diet is is well tolerated and could be potentially effective for a variety of tumor types. So that's something we're seeing more as patients looking to adopt a ketogenic diet, to use metabolic therapies to help their cancer treatment and, and you know, in most cases there's need not be an either or situation. You know, so often we use this in addition with the standard therapies, and I tell basically all my patients I do the treatment that the oncologist suggested, so it's more of an adjuvant. Or in cases where there are other patients have exhausted their treatment options, that's something that they can try.

Speaker 1: 47:34

And as far as anti cancer treatments go, it's quite useful in many regards because it's not a toxic treatment. Going on a ketogenic diet has many other health benefits anyway. So it's, you know, in that regard it's cheap, it's non toxic and it's something that potentially offers a lot of utility. And to combine with that, often we 'll use some other medications which we commonly use for metabolic disease. So if you're listening, as you're interested, care oncology C-A-R-E is an organization that puts together various protocols for different tumor types and their real thrust is to use certain medications or repurposed drugs, so in other words drugs that have been used for other things, and then sort of reusing them for an anti cancer effect. So commonly used medication will be something like metformin, which is a really commonly used anti diabetic drug. So it's been well studied in many different cancer types as potentially useful. Now, in and of itself it's not going to cure a cancer, but when combined with this sort of holistic metabolic approach, it would appear that it's potentially helpful for cancers.

Speaker 2: 48:44

This idea of oncology, amongst all these specialties, I think we've got a centralized treatment paradigm in all our subspecialty medicine and some of the most, I'm going to say, harmful in terms of their focus or myopia, is something like psychiatry, I think, because there's such a default to prescribing psychotropic, antidepressant, mood stabilizing medications without looking at the metabolic milieu and circadian milieu. But also endocrinology, which you mentioned, dpa, this idea that if you have a type 1 and adolescent type 1 diabetic, they're advised to eat carbs and chase that carbs, those carbs, with a shot of insulin and a shot chaser a shot chaser for your whole life. Then they wonder why their HB1 sees it at 9 when they're supposed to be doing everything right following their advice. It's like a gas sliding operation. I really think that there's so much benefit to low-carb and in type 1s it really makes me sad and angry that a lot of mainstream or a lot of centralized endocrinologists aren't adopting this, because it's really possibly one of the diseases that could be helped the most by adopting a low-carb approach.

Speaker 2: 50:10

This idea of the endocrinology, of oncology I think it's the most profitable of the specialties. The amount of money that gets washed around in using various oncological treatments for the return on dailies or disability-adjusted life years. I think you're probably getting your worst return on investment the fact that you're able to use something like a ketogenic dialyx as an adjuvant and no one's advising people not to use whatever their oncologist has prescribed, but to use ketogenic therapy as an adjuvant and have an effect which, as we both know through the work of Dr Thomas Seafreed, provides very, very strong evidence that this is a mitochondrial problem. To improve a mitochondrial problem, you use these mitochondrial solutions, of which fasting and a ketogenic diet is one of them. It's really great to see that.

Speaker 2: 51:10

I interviewed a gent who had a friend who had basically reversed his lymphoma with two weeks of extremely cold water swimming this idea that he'd obviously built up a massive amount of brown fat and it was just sucking out all the energy substrate out of his body and reversing his insulin resistance. There's so many things to ways to discuss it, but I really like that you're using these approaches. Can you talk a little bit about do you have any specific treatment guidelines in terms of goals for cancer? Do you try and aim for a certain glucose ketone index or what's your general approach? If you have any comments on what I've said as well, feel free.

Speaker 1: 52:00

I think you're on the mark with some of the limitations of the centralized oncology models. Again, as DC alluded to before, everyone's a caring doctor. No one's malicious with this. Everyone's trying to do their best in cancer. It's a really difficult treat, horrible disease, but I guess with the tools that they have to use, they're by nature not going to be perfect. If you treat cancer as a genetic disease, you're going to run into some significant limitations. The other thing I consider a lot of oncologists have, unfortunately, is a lot of their patients do get scammed. They get taken in by charlatans. They're going to tell them everything's going to work, from apricot kernels to all the different fad things. They end up blowing a lot of money on all these things. By nature, a lot of oncologists are conservative and suspicious about adjuvant therapy. I can get that.

Speaker 1: 52:52

In terms of GKI, the glucose ketone index, which is basically just a measurement of your glucose divided by your blood ketones. You're typically aiming for a GKI of under two, ideally, just assuming this is someone who's not been in ketosis for a long period of time. Anyone who is fat adapted, this becomes somewhat unreliable because their blood ketones tend to drip down over time by design. That's going to mean that if your blood glucose is four, which is fairly low, your ketones need to be at least two. A lot of the time these sorts of KJN protocols they are actually very high fat, they're incredibly low carbohydrate and they're actually fairly low protein.

Speaker 1: 53:29

This is not the same as a KJN diet for someone who wants to be doing longevity stuff or someone who's going to be trying to fix their diabetes or lose some weight. This is quite a specific approach. It's more akin to, I guess, the epilepsy type therapeutic KJN diet. Patients need to understand they're going to be eating a lot of fat. It's not the easiest diet to stick to, but I guess the counterpoint there is when you have cancer that's incurable or that you've gone other options, you tend to be highly motivated. A lot of patients are very much willing to push through to get that GKI where they need to be.

Speaker 2: 54:08

Yeah, it is surprising the amount of fat and a surprisingly low amount of protein to really maintain that level of therapeutic ketosis. Definitely not a lifestyle protocol. That's a really big point. I'm glad you brought it up. And that I really want to emphasize is that people and patients, especially when they're doing their own research and maybe they've followed someone like Dr Paul Saladino for a long time and he was a long time kind of advocate who's now advocating for fruit consumption the nuance that gets lost, especially with his message, is that there is a very distinct difference between someone who has stage 4 cancer, inoperable, and then someone who is simply wanting to perform better in their job. What you've discussed, what you just talked about, is a therapeutic protocol. I make that really clear myself If you're sick, you need a therapeutic protocol, and that is completely different to someone who is surfing four hours a day and living in Costa Rica. I really want to emphasize that point. Ketosis is one of the most powerful tools that we have in helping people who are sick, this sick.

Speaker 3: 55:27

Absolutely. I think that's really key is that people know there are different forms of achieving nutritional ketosis, and even the height of the ketones doesn't necessarily other than these few specific conditions where we're really needing to achieve a particular GKI. It doesn't necessarily need to be the driver for what you're doing and why you're doing it. Actually, first and foremost is about how you're feeling when you're eating this way. That's one of the first questions we ask people when they come back to see us is how do you feel? Is this working out as a sustainable approach for you? If it's not sustainable, it's going to be tricky for someone to continue.

Speaker 3: 56:21

Often, the reasons that we need to start looking at are making sure that people are aware of what is the why or the motivation for doing it. As you said, if you're on the internet, you might be reading something else about someone who's doing it for a particular disorder and think that everything they're saying, including the supplementation regime etc. Must apply to you. We've seen people walk through our doors who are on 20-plus supplements because they're following someone's online supplement protocol. Of course, when you explore that a bit further, that person's got some conditions that are reasons for why they're on those things and they're just taking it because they thought it was the right thing to do to support their dietary framework. I think it's really important that people are guided by what is needed for their health, rather than their friend or their family member or someone they read about online and just look at online information as a general information only, because that's really what it is.

Speaker 1: 57:23

Especially if they've got a significant medical condition that they're trying to reverse. It really should be ideally guided by someone who knows what they're doing. For instance, diabetes if you're on insulin, insulin's the most dangerous drug a diabetic can take. If you're going to go on a low-carb diet, you ideally want someone who knows how to wean that or deep ascribe that Same thing with certain diabetic tablets. Ideally you want someone to manage that safely so you know you're doing it safely.

Speaker 1: 57:51

Heart failure is similar. A lot of electrolyte issues can happen with patients with heart failure. Acid inhibitors and spruinal lactone and beta blockers they tend to raise your potassium, whereas thiozone frizomide diuretics tend to lower it. So it's often a balancing act between those Deep ascribing. Something we do quite a lot in our clinic and it's one of the best parts of being a metabolic practitioner is to get people off medication, which the average GP doesn't do that often Getting patients off blood pressure medications, getting them off PPI's and making sure you wean them, because often patients will get rebound reflux if you stop them, if they've been on for a long time. As you mentioned, max is psychotropic. So the SSRI's a lot of people don't realize. The withdrawals from those can be significant and protracted. Often you need to wean them slowly to limit those withdrawal symptoms.

Speaker 2: 58:41

Yeah, the point I want to make is that people are going to do this, whether or not they we're there. This is another call and maybe a message for any other doctors listening is that your patients are going to put themselves on a ketogenic carnivore diet. They're going to take a laundry list of supplements, whether or not you're there. I sometimes think about this as like harm minimization If you've got a heroin addict in your city, you provide clean needles and you don't ignore the problem and pretend that it doesn't exist. What we're doing and I completely echo your call, alex is if you're sick, if the patient is sick, they need to see someone who knows and has experience in this area. That is why, as doctors, we need to have this knowledge so that we can guide and help our patients who are going to be doing this regardless.

Speaker 2: 59:37

Maybe, on that note, we should probably make a quick note of the medications, particularly that people should be aware of. Typically, insulin is. If you're injecting insulin, then that definitely, typically almost needs to be halved and obviously don't do this yourself, but typically it needs to be halved with someone who goes low carb. Talk to us about the other medications. That as a warning sign for people. If they're taking them, what are the ones?

Speaker 3: 1:00:06

Another really common diabetic medication is the SGLT-2, and he was such as things like Giants and sometimes combined with Metformin, giantomet. It's really important for us to recognise that it can actually be continued for people who have diabetes, and with some close supervision, because where it can go wrong is a very rare but still possible side effect of euglycemic ketoacidosis, where the blood glucose doesn't necessarily look dangerous but the ketones will be rising quite significantly in the background, and that's because SGLT-2 inhibitors can actually increase the ketones present in bloodstream. So that is one of the ones that we'd probably carefully look at and we used to try and bring that off quite early, and now, with some more new research that's come to light, we're happier to leave people on it, with certain caveats about sick day treatment and regimes that they can engage in if they actually become unwell. And then another is Frisomide in the setting of disorders like heart failure. Again, alex spoke about how it can actually cause electrolyte deficiencies for people who are going on a strictly low carb or ketogenic approach, but also we know that Frisomide is known to cause insulin resistance as well. So it's actually one of the ones you want to try and bring off earlier in the piece rather than leave on for too long. So again, that needs to be closely monitored.

Speaker 3: 1:01:45

Blood pressure medication is a big one, so often we are halving that within a few weeks of someone commencing a strict ketogenic protocol. And also things like SSRIs need very slow weaning and we really want to limit withdrawal symptoms. So they need close supervision and sometimes that has to happen over a few months. So that's the first six to eight weeks we watch quite closely and then we can make reductions in medication, but also keeping in mind what someone's sort of social environment is at the time as well, because we know a lot of disorders actually don't just have that effect with what's going on biochemically, but it's also what's happening externally to the individual. So making sure they're not stressed, they're in a good position, their mental state is quite stable.

Speaker 3: 1:02:35

So there's a whole number of whole host of factors that go into deciding when to start to deprescribe medication, and one of the biggest ones and the ones I enjoy doing the most, is taking someone off Panadol osteo. It's like one of my favourite things to deprescribe because often it's the thing you mentioned earlier in our discussion about patients who are more elderly and they may have osteoarthritis, and it's a very common condition in general practice that almost everybody with that condition is on two tablets three times a day of Panadol osteo and they're just taking it blindly, thinking that that's helping limit the pain. And often within a few weeks people mention to us they're feeling less pain and they're still taking the medication. But we often say to them look, actually you can start to come off, that you know you really don't need to be taking these extra medications and it's really lovely for them to see them come off a medication that they thought they really needed and had to take long term. So that's a wonderful thing to deprescribe pain medications, particularly opioid medications too, so the reliance on that sort of medication becomes less and less over time.

Speaker 3: 1:03:48

So, yeah, there are a number of medications there that can be deep prescribed quite safely. And I think we didn't mention anything about the medications for autoimmune disease, because of course that needs close supervision and we try to work with people's specialists as well, because often they are seeing rheumatologists or immunologists. So I think that's actually an area where, yeah, they also will require less overtime, so just less frequency and dosing, particularly of the biological type agents. So, yeah, that's hopefully a bit of a roundup of some of the medications people need to watch closely if they're gonna put themselves through a lower carb eating approach.

Speaker 2: 1:04:34

Yeah, and I wanna emphasize how abnormal it is to be actually deep prescribing medications. I mean, for us who do it, it becomes routine and part of the job. But for most other doctors the fact that you're actually removing rather than adding new medications to a patient's list is almost unheard of. So just to, I know that you made it sound almost very, you know, ho-hum, but I wanna really make the point that this is a very special event. It's a very, it's a joyful event. It's someone it's like, you know, unshackling a chain from someone's leg, metaphorically speaking. So I don't think we can't, we shouldn't, minimize that. It's a very great event. That speaks to the effort and dedication of the patient to improve the health. It speaks to the dedication of the doctor to be aligned with that patient's best interests and go through a process of a long process it's not necessarily, it's not happening overnight to work with that patient to help them.

Speaker 2: 1:05:47

This is what I think we went into the job for. So, yeah, I really wanna make that point and I guess, the mirror of that point, which is how sad it is that basically, patients getting entrapped in this list of medications, they're getting entrapped in interactions, they're getting entrapped in dosing. It's not easy to come off, as you've just given us an idea. It's not easy to get out of this trap and you, ironically, need more medical care and more close supervision. Not ironically, you do, but the sick you are.

Speaker 2: 1:06:23

So, yeah, thanks for that summary, and I really hope that more doctors will consider learning about this so that they too can help their patients, because, I mean, at the end of the day, no one wants to be to use a semmel a vice analogy no one wants to be the doctor that's still kind of doing the cadaverous dissection and then delivering a baby. I mean, you guys are the equivalent of the one saying that we need to wash our hands before we do a dissection. And I'm there with you and we're trying to tell people that you should wash your hands before you do an obstetric delivery. But it's an ongoing process. So talk to us about the society that you've just started and kind of making this movement become more widespread.

Speaker 3: 1:07:15

Yeah, so the society that was incorporated last year, mid-last year, was the Australian Metabolic Health Society, and that's really to address the need, the absolute need in Australia to have professional education for all health professionals that revolves around improving metabolic health, particularly with reference to the use of low carbohydrate therapies, including ketogenic therapies, and, unfortunately, with all other societies, they have not been open enough or evolving enough to include an open discussion about ketosis, nutritional ketosis, and its benefits across the plethora of diseases and conditions, as we spoke about. So the aims of our organization, which at the moment has three directors, two of which are Alex and myself, but the director is Dr Lorraine Lawless-Smith from South Australia, who's a fellow GP as well, and we've got a nine-member scientific committee as well, made up of primarily GPs, but we also have Professor Karen Dwyer, who's a nephrologist from Victoria, who's joined our scientific committee, and so together we have established an upcoming course that's to take place in Melbourne on Saturday 16th of March this year and that's specifically for doctors who would love to learn more about the foundations of low carb medicine and how to apply that within their consultations, even in short consultations, as we spoke about, in general practice, because planting the seed and giving small snippets of education and actually providing it as an option is the first step, and then the second step after that is understanding all of these intricacies about deprescribing and how to apply it to particular disease conditions. So that's really what that course is about, and that's a one-day course. So we encourage anyone who's listening to your podcast to join up for that, because that will be a great way to enhance your professional development in the area. And the other aspect to our society is in advocacy. So we're really privileged to have the support of the Society of Metabolic Health Practitioners, which is our sister organization, and that's sort of how we established with their support in Australia. They're actually based in America, but they've been incredibly supportive of our endeavors here and they share the same vision for increasing health professional education but also advocacy amongst the community, but also at the government level too, because we recognize needs to be done at a grassroots level.

Speaker 3: 1:10:16

The community awareness is incredibly important, but at the same time, for us to make big change, we need advocacy at government levels as well, and I think, with some of the changing guidelines that we can see just recently, there's been some tireless people within our community who've managed to recently get the Australian Diabetes Society to endorse low carbohydrate therapies for diabetes as a guideline, and the diabetes Australia has actually changed the wording around diabetes no longer being a chronic progressive condition but now being something that can be put into reverse and can achieve remission. So it's just terminology that's changed in some ways. But that is huge for the acceptance amongst health professionals in Australia and gives people confidence to prescribe things and to provide it as a way or an option. And, as you said, you know not every patient needs to take it up, but just to even have it as an option is huge. So that's something that I think giving professionals the confidence to mention it and to have some knowledge around it, so they're not thrown when someone mentions they're on a carnival diet or they're on, you know, some form of a low carb, you know protocol, that they can actually support them really well and even point them in the right direction of where they can find more assistance, which is important.

Speaker 3: 1:11:46

So, yeah, so I think you know one of the aims or divisions we have as time moves on this year is that very shortly we're going to be able to offer a membership to the Australasian Metabolic Health Society and that will be about having access to monthly grand rounds where we're going to have presenters that people can listen to within the Australian or Australasian setting, which is quite useful because our local practice of low carb has certain elements to it that don't mirror what happens internationally. Sometimes our units are different. Just the way we go about navigating our healthcare system is different, so it's nice to be able to have that as something people can tune into and get real community support amongst health professionals, and when I say this it's not just the doctors. This membership it's for anyone who has a health professional background or training, so that includes allied health professionals, psychologists, dentists, nurses so we really want this to be an all encompassing umbrella for people who are interested, because we recognize metabolic health transcends any one specialty area. It's about a fundamental shift in the way we look at health.

Speaker 3: 1:13:10

So that's and then I guess you know what people gain as a part of being a member is that they can use it for their continuing professional development, which is important, and also for networking and access to a lot of our courses and workshops that we plan to provide. And I think, importantly, we really want to reach medical students and or help professional students of any kind, because we know the next generation is where we're gonna get the biggest shift forward in using this metabolic therapy, and we're trying to keep the membership rate very low for our trainees any trainees out there or students, to be able to join and support this foundation, because the more support we receive from the community, the more we can do as well. We are not taking pharmaceutical sponsorship, and that's something that we wanna try to be very transparent about because, unfortunately, previous societies haven't done that. Has it been offered? No, no, I probably won't expect any forthcoming pharmaceutical sponsorship.

Speaker 1: 1:14:21

I think that's been a real point. That's let down. Some of the other society health societies in Australia who might have been taken on this mantle, you know, five or 10 years ago, Is that connection to either pharmaceutical companies or supplement companies and that sort of thing. So we're gonna try, we are going to be separate from all of that because we wanna maintain that independence. I think that's a critical point because that sort of pharmaceutical industrial complex has really interfere with the practice of good medicine in many ways.

Speaker 2: 1:14:54

It has, and that's a great way of putting it. I think most doctors, as you mentioned, you know all our colleagues are all well-meaning, everyone's gone into this for the right reason, but they're trapped within the greater system and those profit motives of the pharmaceutical industry, unfortunately, I think, are the main driver behind the guidelines-based approaches that you mentioned earlier. So what this Australian Metabolic Health Society represents in my mind is really the opposite. It's a grassroots, decentralized response to the lack of options or the lack of formal top-down training for doctors to administer effective, evidence-based lifestyle treatment to our patients. It's emerging. It emerges a need you guys are addressing a fundamental need that we need to offer and that our patients need. So very, very excited for this, very excited to be attending. I'll be there in Melbourne next year sorry, this year and I'll definitely be there.

Speaker 2: 1:16:05

I think what you said about the medical students being the next stage, I completely echo that and for any medical students listening or if you know any medical students, please send them this podcast you can be part of a changing paradigm. You don't have to perpetuate a scientific and intellectual paradigm that is, it's a legacy paradigm and anyone who's a student of history will realize how, as a humanity, we get trapped in different intellectual and thought paradigms. Whether the earth, whether the sun planets revolve around the earth. You wanna be the one talking about the heliocentrism early on. You don't wanna be a late adopter of heliocentrism and, just like that, you don't wanna be the last person to offer your type one diabetic low carb diet that can get them into a normal HPA1C range.

Speaker 2: 1:17:04

So I really love what you guys are doing. I think it's fantastic. It's very sorely needed and I'm very optimistic that this is gonna be a major catalyst for giving our patients options, giving them better medical care, which is again why we went in this in the first place. So I will include a lot of information in the show notes and maybe anyone who has a medical background can also, or affiliate allied health can also attend. Maybe someone will send a link to their doctor. They might help them to open their mind to these ideas. Any final thoughts or anything else that I haven't asked you guys that you wanna make mention?

Speaker 3: 1:17:51

I really think that we've covered quite a bit in the podcast, but you know, I think, moving forward, I think the practice of this type of medicine is going.

Speaker 3: 1:18:04

It will be mainstream, it's going to be part of just all of the options we offer people and but we do it really is going to take a whole environment shifting, so it's not just going to be doctors all of a sudden offering this.

Speaker 3: 1:18:22

It's got to be patients wanting it and understanding that this has a role and other health professionals understanding it and then a broader community understanding as well.

Speaker 3: 1:18:32

The government actually backs the kind of services that will help people eat in a way that is going to be conducive to their health, and things like regenerative agriculture is incredibly important and critical to this becoming sustainable long term and available to more populations, rather than us having to rely on a lot of processed food to meet the shortfall for nutrition, because that, unfortunately, is where a lot of populations, marginalized populations, even within Australia, will find and but the cost of living increasing, people will start to turn to the cheapest foods and, unfortunately, a lot of the time, that is the processed foods.

Speaker 3: 1:19:17

So we need to make it affordable and that's a huge like it's going to. It's a big task, but I think just nearly having this conversation and having more people hear this message increases, and my biggest message is that people put their money into, invest their money into these people, the people who are growing and providing us with food, actual whole food, not the processed stuff because that's market demand and that's where where more of the supply is going to come from is if we put the money towards that area.

Speaker 2: 1:19:52

So that's what I hope to see shift and shift quickly, because we need that to happen as soon as we can yeah, quickly on that point and you think, get fully grass fed, chemical free, antibiotic free, regeneratively raised beef for $20 per kilo if you buy in bulk. So that is the kind of shutdown on anyone who says that this is unsustainable or unaffordable. It takes a little bit of budgeting, it takes you a little bit of initiative and forethought and planning to have an off freezer space. But low carb carnivore, it's all possible, it's all affordable and if you are intentional in your lifestyle and that's something I've talked about extensively on previous podcasts. So I urge everyone to check out my previous interviews with regenerative farmers and for more information on that. But yeah, thanks, deepa, for bringing that up, because that is a critical piece of the puzzle. And if we want people to eat healthy, healthy meat in large amounts to reverse their disease, then we want them to be eating it in with the highest quality. So, alex, anything else that you want to add?

Speaker 1: 1:20:58

No, I just echo both your points that I think I'm optimistic about how this is heading, but it does need that fundamental change. I think the fundamental change of perception of health is really important. So our birthright is not to be chronically diseased. This is a relatively new phenomenon. It's not how it's been for the vast majority of our species history. So getting back to our birthright of being in full health, full connection with our planet, really in all aspects, that's part of our goal, I think, going forward.

Speaker 2: 1:21:34

Yeah, I love it. And yes, a final call to people and patients. I mean, you've got the power. You've got the power to demand this from your doctor. You've got the power to implement any lifestyle change. You don't have to be sick. So, thanks very much. I really appreciate the conversation for you both and, yeah, I really encourage everyone again to attend the event. So thanks again and we'll keep in touch.

Speaker 1: 1:22:01

Thanks a lot, max. Thanks Max.

Speaker 3: 1:22:10

Thank you.