Friday, May 20, 2022

Free Workshop: Internet Keto vs Science-based Keto

Hi everyone and welcome to the free keto workshop going every wednesday evening through the holidays here hope you're having a wonderful holiday and getting together with family either in person or or remotely um or or not again we're affected by .

The covid um this year but um hopefully you didn't suffer too much damage over holiday eating and you know that's sort of the january in a weight loss diabetes reversal clinic we talked about the damage that was done and and and many cases there was no damage .

People can lose weight during the holidays if you take certain measures like we've talked about so far it's great to see everyone logging in chiming in and so one thing i wanted to be sure to talk .

About in this workshop so this is a three workshop series last time talks this time and then next time so if you are just catching this one for the first time go back catch the workshop number one and then next week will be .

More of the big picture wrap up on um just what medical care has become today which is medication care at least for chronic medical illness and how there's another way to go about things lifestyle basically so today i'm going to talk about the internet keto and the science-based .

Keto and i'm just going to tell you what i do what i tell people to eat and of course it's not just as simple as that for some people some people need the coaching and support and counseling up front and we have ways to provide that for you .

Other people just need the list of foods and they do great so um i'm going to give you insight to what i teach the the first few slides is is the list of foods that i use and it's on one sheet of paper i use that as a handout and then i'm going to go through the feedback we received from teaching .

People who had learned on the internet what was different about what we taught than what they learned on the internet and then i'll end up going through my list of foods and teaching the way i do it and you'll see that there are big differences perhaps between what you've learned and what we teach .

And a lot of ways to say it over-the-counter keto can work for a lot of people out there and it's amazing how well it works now if you need prescription strength keto however then you need to look at the detail more closely and i'll provide you with a look into how i teach it okay so again welcome .

And um let me go ahead and share my screen pull up some slides for you let's see well i'm just going ahead of myself there um okay .

So tonight's workshop topic is internet keto versus science-based keto and this i'm coming to you talking to you from durham north carolina where duke university is and i've been practicing since 1990 .

At duke opened the keto medicine clinic in 2006 and this is a presentation is also brought to you on behalf of adapt your life which is a company i helped to found in order to get this information to more people outside than than those who can make it to my clinic um so let me just go over if you were .

Coming in and uh learning from me how to get started here's what how i would start i would say when you're hungry eat as much as you want of these foods until you're comfortably full and that's meat beef hamburger steak of course no bun .

With the burger right pork ham bacon lamb sausage pepperonis hot dogs of course no bun no bread with the hot dogs or other meats canned meats or find poultry like chicken turkey ducky just be careful that there's no breading on the chicken you can have fish like tuna salmon .

Captures tilapia drought shrimp scallop crabs lobster just make sure it's not there's no breading on it eggs whole eggs including the yolks and whites are permitted and there's no limit to eggs overarching themes our protein comes first and you can run your body on carbs or fat .

At the very bottom now don't avoid fat in real foods but don't add fat if you're trying to lose fat weight so now i do want you to have two fistfuls of leafy greens and one fistful of non-starchy vegetable and you have to stay to the list of food or the vegetable and the greens on this list so a limited amount of leafy greens .

Means two cups measured uncooked a day you don't have to have them uncooked but you you measure them if you're going to measure but you know you really don't have to measure just eyeball two fists on your plate two fistfuls and that's roughly two cupfuls and the non-starchy vegetables you have .

To stay to the ones on this list of course the most common abcs are asparagus broccoli brussels sprouts cauliflower celery and cucumber but you could have any of these other ones and of course i would never ask you to eat anything you don't like non-starchy vegetables are limited to one cup .

Measured uncooked a day of course you can have them cooked and that's about one fistful for the non-starchy vegetables for the day now foods that are allowed in limited amounts because they do have a lot of calories in them even though they have no carbs you can have cheese up to four ounces a day including these cheeses you .

Can have creams and oils up to two tablespoons a day including butter half and half whipping cream light cream sour cream you can have mayonnaise up to two tablespoons a day you have olives up to six a day avocado half of a fruit lemon lime juice up to two teaspoons soy sauce up to two tablespoons pickles dill or sugar free up to two servings a day and .

Then if it's a zero carb item like these zero carb snacks they're basically unlimited you can have sugar free jello pork rinds pepperoni slices oh if you don't know what a pork rind is i i didn't know what one was either i grew up in wisconsin and was introduced to my first pork rind in 1990 i remember the patient who kind of laughed at me .

Because i'd never had one so uh yeah they have no carbs so it's a great chip substitute a a pretzel chopsticks it's something something crunchy you know pepperoni slices low carb jerky boiled eggs etc so that's what i teach so you know i i was one of the groups um that started .

Studying this diet going back to 1998 our first paper was published in 2002. other centers started studying it as well and by the you know mid 2000s so 2006 there was enough evidence to open a clinic based on this and so that's what i did it do science-based keto .

So i'm treating people in in having a great time reversing diabetes and doing all sorts of things that other doctors couldn't do with medications and but then people started coming in talking about what they learned on the internet i i'd never heard of bulletproof coffee and i i've never heard of adding medium .

Chain triglycerides to the to the the coffee i mean this was never in any of the the research that we did the doctors that we learned from in the late 1900s dr atkins dr eats dr bernstein these doctors never taught adding oils and butter so so what's happened in front of my eyes is that something that was so simple and i taught it and .

People did so well was becoming really complicated and when people started coming in saying and it cost so much money to do keto i'm like where is this coming from it didn't make sense to me so i probed a little bit talked to i talked to a lot of people including a lot of people who are smarter than i am .

And learned that okay what's what's happened is all of these three forces that independently exist on their own has coalesced into internet keto so you might find yourself learning from someone who's super fit in a gym and they never had a weight loss pro problem in their life .

Don't learn from someone like that you know unless what you're doing is working because you know that's an entirely different metabolism if you're trying to learn keto and trying to prevent epilepsy that's the upper left-hand side here you have to count your macros you have to worry about your ketone levels but i .

Never did that in the research we did and in our clinic so i wonder where did that come from suddenly there are these apps that make you really concerned about putting in all your food and and worrying about the macro you might not even have eaten enough according to the app this was all news to me i we never .

Studied that in the science based keto for diabetes and for for diabetes reversal and for weight loss and then on the upper right hand side of this side paleo primal started talking about the ancestral diet the hell um hunter-gatherer diet and you had to have super clean food there are even programs based on this .

That aren't really low carb but they're trying to get all of the toxins out of the foods and but that doesn't really emphasize weight loss or a keto metabolism so and and that wasn't part of the research that we have had started now done all over the world on the low carb high fat or keto diet used for weight loss and for diabetes reversal so .

On the bottom here the emphasis is uh is on carbohydrate restriction and using total carbs not net carbs that was always the emphasis and in the clinical trials of using a low-carb diet for weight loss or diabetes reversal so these other factors just they weren't things that were important or necessary and in fact i noticed that the success .

Of my patients was being thwarted by this internet keto teaching if you will so i will ask you know where did you learn about keto first it's kind of just so i can kind of understand where the the gaps or pitfalls might be because people come to me with the belief that purchasing expensive products .

Is necessary to do keto well that's not the case i as you see i just teach people to eat food there's a belief that drinking or eating ketones or adding more fat is necessary to get into ketosis and that's that's a fundamental miscommunication because your body can .

Make ketones from its own body fat you don't have to drink or eat ketones or oils in order to get ketosis now you can drink ketones and get ketones elevated in your blood but why do that if you're trying to burn your body fat or fix diabetes you don't want to get ketones that way people have a belief that you have to .

Measure with an app because that's the only way they've learned well it can be a lot simpler than that it it can over complicate things and lead you to following the app rather than your own body signals which is a fundamental teaching of any really good weight loss long-term lifestyle program you want to listen to your own .

Body signals so internet keto has been very helpful to raise the awareness but also it's made things complicated and confusing and if that if it's done that for you i can help and and that's why we're doing this workshop why we're doing .

Classes online and so here over this last year we created the adapter life academy to teach people who couldn't make it to durham north carolina to to my clinic for example so it's to spread the knowledge about how to do a keto diet and to eliminate confusion about the keto diet so we've .

Educated people through online classes and this master class we started with was called keto made simple there's a waiting list and the opening in the beginning of january if you want to sign up for it i'll mention that at the end again but um so what we did is we taught people in different cohorts online each group was about 600 people .

And this analysis that i'm going to show you is based on 1200 students in two classes and the master class consists of videos print materials and pdf files and transcripts of the videos and three weeks of a private group to get started so i knew from my past experience that it wasn't going to be good enough just .

To tell people what to do we had to create a place where you could ask all your questions feel comfortable and that's how we've done it we we give three weeks of a in person you know with administrators high touch sort of support to get you started um the first group coming through lost 893 pounds which was .

An average of 5.5 pounds in just three weeks the second group came by it came through we taught them and lost over 1100 pounds so if you add it all up in just these two groups we help people lose over a ton of weight which are 20 uh you know over 2 000 pounds lost um so what we did with this class is we asked .

Um to a survey at the end of the class of what uh you know a little bit about where they were from what they had learned about keto before and then what was different about what we taught what was different the science-based keto versus what they learned on the .

Internet and um so that was the basis of the survey and the basis of what i'm giving you this lecture about the difference from what people said real you know in real time this year it's not just my opinion it's what people told us so in these uh two classes about over a thousand people 75 percent had already been on keto for a while so many of .

These people well the vast majority lost uh excuse me the vast majority learned from the internet 25 were just total beginners and i prefer to take people who who have not been um given the wrong information or thinking over complicating .

Information so 25 were beginners but 75 had already learned it in some way 94 said they learned something about keto that was new when compared to what they learned on the internet and what i'd like to do is go through the top 10 internet keto diet differences from the science-based keto diet that .

I'm teaching that adapt your life is teaching so number 10 measuring ketones is not required many people thought you had to measure ketones in the far left here yeah you can buy a monitor now that measures glucose and ketones but you don't have to i don't tell people to you can .

Measure urine strips in the middle here and you can measure the breath the the downside of measuring is if if you're having success and the tool that you're using says you're not in ketosis you'll be frustrated because you're not in ketosis but i have to remind you you're having success so the goal is not to get into ketosis the .

Goal is to have success and what we're learning is some people never get into ketosis as defined by these tools so wouldn't you rather have less worry about things and have success than to do all these extra things yeah most my patients don't want to do things that are complicated .

Excuse me number nine excuse me um number nine macro calculation is not required so you don't have to use an app i have never used an app in my clinic you know if you you're if you're using it and you bring in information i'm happy to look at it but macro .

Calculation is not required if you're using a keto diet for obesity weight loss or diabetes reversal many of my patients are relieved because this is very time consuming and they don't really want to do it number eight remember these are the top ten in terms of numbers of people who .

Reported them that's the number uh the ordering here medium chain triglyceride oils or ketone drinks or ketone pills are not required for a keto diet and this was a surprise to many people who have learned from oh people selling their products that this is what keto means and you don't have to purchase these things and i can save you .

A lot of money if you are and worry about how to find them number seven fasting is not required over the last few years the idea of fasting or intermittent fasting or total fasting has become popular and there's no question total fasting can work i mean all you have to do is watch a show on tv where they don't eat and they're .

Living they lose a pound or two per day but it's just not the healthiest way to do it so i see fasting as a secondary sort of technique fasting is not required when you do a real food based keto diet for weight loss and diabetes reversal or any other chronic medical condition number six .

Nuts nut flour and nut butter are not allowed they're not okay so i've taught uh in rooms where they're maybe three to five hundred people on a saturday morning this is pre-pre-covered and i would ask you know how many of you have trouble .

Stopping eating nuts and it's about half the room raise their hands and so instead of letting you perhaps have a 50 rate of not being able to control the nuts i just say don't have nuts in fact i had a recent doctor visit and and he mentioned that you know this is not commonly known and well i said well .

I know but that's why you want to learn the prescription strength method and do it right the first time so i recommend no almond flour no trying to reproduce breads and all these other things and no peanut butter and sorry about that but really after a day or two you just won't miss it which is still pretty amazing .

About this approach number five the top ten misconceptions about a keto diet vegetables are not unlimited many people come to me kind of carrying over the in the low-fat world you could have as many vegetables as you wanted because there's not much fat in the vegetables and it keeps the calories .

Pretty low that's not how we do it on a low carb or keto diet vegetables are limited because they have carbs so not only do you stay to the non-starchy vegetables you limit the amount of the non-starchy vegetables to make sure that it's going to work for you number four getting up now to the number one mistake or misconception number one use total .

Number four use total carbs not net carbs so think of net carbs as the over-the-counter type of of counting just changing from net carbs to total carbs may be the answer to a stall or why it's not working for you even at the beginning so all of the research that was done in the .

Year 2002 up until today that in publications i would say just about all you may be able to find an exception in the low-carb keto studies total carbs was used for the calculation and not net carbs so just to demonstrate here on the left the .

The labeling might say zero net carb well zero carb with a net put in there between there so maybe you won't even notice it but so you don't want to look at marketing labels you want to look at the nutrition facts and we're fortunate to have the total carb be really the total carbs in the u.s if you're in other countries outside the .

U.s the total carbs might actually represent the net carbs so you just have to check with an expert in your own country but total carb here is 7 grams g mease grams so what is billed as a zero carb net carb bread which is zero net you try to subtract out the seven fiber you have zero net but i don't let you subtract .

Out the fiber because the blood sugar can go up you can absorb non-absorbable fiber the names are not really precise enough so use total carbs not net number three artificial sweeteners are not forbidden i need artificial sweeteners and or even or non sugar sweeteners like monk fruit or stevia .

Included in here but even other sugar alcohols and splenda and all these are fine i need them to get you off of sugar if you are a true sugar addict and sugar addiction is real and um the sugars and starches like potatoes and pasta are digested to sugar so when .

I say sugar addiction i'm including starch addiction many people come in and say oh i'm not a sugar addict i it's the bread that gets me i say yeah well that's because bread is diet is digested to sugar so it's all the same thing so the sugars and starches get digested to sugar you can be a bread addict and a sugar .

Addict at the same time but i know that can be a little confusing so it's okay to use artificial sweeteners in in you know moderation um number two and this is very interesting because this is more kind of an environmental uh awareness sort of thing a lot of people thought they had to have expensive clean food and clean food is .

Not required to do a low-carb keto diet and to be successful for weight loss and reversal of diabetes and remember this is that paleo primal kind of movement that has raised awareness of these issues which i think is very important but if a patient of mine cannot afford these kinds of foods or get access to the foods we're .

Needlessly limiting people to have access to the program because you can eat at fast food restaurants for example just keep super low on the carbs stay within the program and be successful i know that's a shocker to a lot of people and now number one the top thing that was a misconception before from keto on the internet to keto in a .

Clinic like mine the science-based keto is that cheeses fats and oils have a limit they're not unlimited many people come in over well eating so much cheese and having so many oils maybe even added to the coffee or or on steak and chicken thing and things like that that the caloric intake is so high that you're not going to be .

Accessing your body fat stores because you're eating fat and calories and not burning them off your body so another way to say that is that you have to have a limit on very high calorie items even though it says zero carbs and i know you might have heard well if it's zero carbs you have as much as you .

Want remember my program has a long history of use in clinical publications and if what you're doing isn't working consider limiting the fat cheese fats oils and it may start working for you so let me just loop back to do my brief overview you know if you if you couldn't read or or write or take a picture of the food on my wall here's what i tell .

You that when you're hungry eat as much as you want of these foods until you're comfortably full the meat like beef and burgers and steak and pork ham bacon lamb sausage pepperoni hot dogs of course no bun with a hot dog no bun with a hamburger you can have chicken turkey duck of course watch out for the breading and things um .

So don't get breaded chicken uh get the grilled chicken or rotisserie chicken any fish including tuna salmon catfish tilapia trout shrimp scallop crabs lobster a little sidebar here oysters aren't on the list because they do have some carbs in them so you'd have to limit the oysters they're not unlimited whole eggs including yolks and whites .

Don't avoid fat and real food but don't add fat if you're trying to lose fat weight off your body or if you're trying to fix diabetes two fistfuls of leafy greens one fistful of non-starchy vegetables for the whole day that's not per meal that's for the whole day you got to stick to these vegetables on this list you can estimate .

Guesstimate two cups is two fistfuls one cup as uh one fistful of course compare your fist to a measuring cup size at home i've met people whose fists are two cup size well then you wouldn't want to eat all of that you know so it's just a way that you don't have to be carrying around a measuring cup or a scale when .

You do a real food based keto diet foods that are allowed in limited quantities remember because these are high calorie items you have to limit the cheese and the creams and oils and mayonnaise for variety and because they're low in carbs you could have olives avocado lemon lime juice soy sauce pickles in those amounts and then zero carb snacks .

Uh sugar-free jello pork rinds or chicharrones uh some people call them meat skins um i i find them palatable or i can have them if i dip them in things like ranch dip or or cream cheese or or salsa or guacamole so i i'm not a big pork rind fan but that's because i didn't grow up with them it's a comfort .

Food for many people in north carolina pepperoni slices low carb jerky boiled eggs because there's zero carbs and they're not the high calorie oil things they really are unlimited at first so i should just pause and say the the way this kind of diet works is that the hunger goes away .

In just a day or two for just about everyone now there's always an exception and it could be that you're on medication it could be habit eating it could be the stress you're under all these other factors but for just about everyone the hungers and craving goes away after a day or two and you start losing about one to two pounds per week .

That's four to eight pounds per month 50 to 100 pounds per year no pills no products no apps no no medium chain triglyceride oil no so that's the science-based keto and the publications are there to back it up so enough research has been done to just summarize the slides for tonight .

That science-based keto is safe and effective when it's done right beware of the use of products or methods that may impair success or safety you might think you're doing a keto diet and but who did you learn from your friend your neighbor your your the the guru on on youtube who is selling your products .

And and i'm looking now at all these different boxes of keto junk foods that sent you no no use real food so internet keto is like over-the-counter medicine it will work for some people but not all people it's in another way you have a headache you go you get an ibuprofen from the .

Pharmacy the drugstore it works for you great if you have a real serious pain you might need to see a doctor for it and get a stronger pain medicine science-based keto is prescription strength so it will work for just about everyone and that is my goal because there are people who wait you know months to see me they don't want to .

Waste time doing something that doesn't work and that's what i've i learned from the gurus from the late 1990s who people were traveling to see these doctors and what they did had to work and so that's just my perspective and if you follow the program that we have it will work but you have to follow it and you have to follow it strictly .

And then of course if medical conditions are present if you have medical problems you're on medications please please please get monitoring to safely de-prescribe the medicines it's um just uh it'd be tragic if you had a low blood sugar you didn't know that the blood sugar came down 100 points on the first .

Day if so if you're on insulin you're on any injectables for diabetes be very careful be monitoring your blood glucose like crazy at the other extreme if you're not on any medications you have no medical problems i think this is so much a real food kind of plan that it's safe and healthy for anyone so .

That extreme so i'm only worried if you're on medications you're taking medical uh beyond have medical problems that need monitoring but it's amazing what this can do in a medical clinic i fix medical problems that my colleagues or internal medicine specialists just manage with medications .

Oh that's next week so next week i'll give you the big picture view of why you don't want to go down well why there's a different path than the current medical care path which we is which is doctors don't teach you about food they don't even ask you what you eat then they diagnose things and give you .

Pills for things and shots for things and and even might make things worse by giving you medicine that makes you gain weight and so that's next week's talk on the medication versus lifestyle approach to to health and staying healthy well good i hope you enjoyed the internet keto versus science based keto .

And i'm going to kind of see just checking in with questions now on the side and let me start yeah great to see so many people um .

And well yeah if you need to see me that you can call the duke appointment hub and get a uh appointment please um and let's see i consume a lot of stevia uh well it may or may not make be a problem is what you're doing working and so the way i troubleshoot is .

Um going back to the food list i if you're eating something it's not on that list i'll say if you're if it's not working then drop anything that's not on the list so the um fail-safe kind of thing is to stay to those real foods standard the 20 total .

Grams which keeps you there pretty much automatically so you don't have to count will be a link to the slides uh well you know i just cobbled them together from talks i did over uh we'll see uh i think um uh not sure how to operationalize that i'll ask the adapt team um oh you saved my life well .

You know i i'm i'm carrying a baton and i'm like in a relay race giving you a baton of things that the doctors and the the scientists who did this uh before me are deserve the credit really but our our job or our contribution was to formalize this kind of approach into research papers in humans and studied .

Them in randomized controlled trials and we've done that over the last 20 years now let's see um let's see joyce says um i did keto and i did the fasting i lost the weight i couldn't stay with it because you can't tell people they can .

Only eat certain foods and not have other foods well i don't know what you mean i do that all the time i'm a doctor and if you eat a food that's that's harmful i'll tell you not to so you may feel like you can't eat not certain foods well .

You know i've been doing this about 20 years not eating much carb and when i do i'll eat the real thing because i my metabolism is not my history is not one of you know 100-pound weight loss story there are a lot of doctors who have that story i followed the research and did the .

Studies and have listened to so many people do this um and because my metabolism looked really good and i saw all these other things like lower the insulin levels and insulin high insulin being linked to all these other medical and metabolic problems and even shorter lifespans you .

Know so joyce i mean there are things you think you can live with or can't live without and actually you can it may take a little help a little coaching a little a little cheerleading along the way uh but um in fact uh um .

I'm learning all the time and the young doctors today are are just there are some who are just really into this they'll help you too and they'll have no problem telling you that you can't have a candy bar i mean it's like they're they're they're way beyond the junk food thing that's just not food .

So um stuck yeah so uh if edgar if you're stuck at 20 pounds um reboot just like uh starting over that's my best um best advice and um oh um the weight loss is not a a like a ramp going down linear it's more like a stair .

Step pattern and in fact you might regain some water weight and so that's why we recommend you don't measure every day you don't get on the scale every day and measure once a week so that you don't see these daily fluctuations that can be quite quite disconcerting .

So thanks amy for amy berger is answering some questions thank you and jenny thanks for chiming in as well um let's see yeah um debbie says it's it's um following the list is always is not .

Always easy but so one of the coaches out there that you can take advantage of the um and coaches meaning it could be a youtube channel it could be paying for coaching casey durango who lives here in north carolina and has done our support groups once a month in durham for a long time .

We're doing that on comcast or crowdcast but um she says yeah it's it's simple in terms of what food there is but it's not always easy and there's a lot of of uh behavioral sort of and mind change mindset change that has to occur for some people not everyone uh but um if you stay away from sugar .

The sugar cravings will go away excuse me so the main thing is to stay away from foods that are addictive for you and learn which ones those are let's see uh adding more fat is a huge message from lots of things i've read about keto .

That's right i was listening to a podcast where the hosts were insisting you have to make fat intake the most important thing and even limit protein well um yeah that is a a misconception or let's say that it's a .

Hyper focus on that group of people who need to have ketone levels all day long a certain level in fact there are some influencers on youtube who are claiming without any evidence to support it that you should be at a certain ketone level all day long and even like having you worry if you're not between 0.5 and 3.0 on your meter and that's just not .

Supported by any evidence that's in people and humans and and over time and so i'm not going to recommend that until there's more more data more more studies let's see tammy says i learned from dr berg we got frustrated with the expense while he ah right dr berg so um i learned about dr berg in china i never .

Met him in the u.s until i came back i heard about dr bird because the the chinese internet group low carb group knew about dr through the youtube uh channel and so i called up dr emailed him and chatted and he was having his .

First dr berg summit at the gaylord in washington dc and i i helped him get speakers the first year yeah it was fascinating because he didn't really know anyone else was doing it you know so there are people who sort of teaching .

Who just kind of you know get in their own little silo or or grow up like this and because it's a business and because um uh you know he's i assume he's making a lot of money which you know he's selling products that a lot of people think they need but maybe don't need um so uh yeah this is a very different um .

Way about it in fact let me one memory i have tammy from the first dr berg summit was um i got up and gave this kind of talk where you had to have one cup of vegetables for for you know the prescription strength and he got up and he said five to seven servings of vegetables per day and i'm thinking .

Even if they're non-starchy this is not going to get everyone into ketosis so you know you can be you can be successful with a fraction of humanity and have a good company and a good business and people will follow it and do great but if you want it to work for everyone well that's a different different way to go about it so for .

Example a car dealership doesn't sell to everyone in the u.s they sell to a fraction of those people and it's a business and it sells and you know you and you when you buy a car and you drive down the the the where all the cars are you don't worry .

About getting another car you already have one so if what you're doing is working for you and it's healthy you don't need me but if it's not let me teach you the what the science-based keto is um let's eat meat and green to get lean that's great jennifer like that .

Maybe you should trademark it um um day for me day three for me and really not that hard great yeah so uh hang in there and you know most people don't get keto flu or what or keto adaptation it's called if you don't have high blood pressure or history of heart failure or kidney failure .

For example on dialysis you can add salt and that will reduce your chances of getting keto flu or keto adaptation let's see i am pre-diabetic and i could i prevent it by a keto diet without medicines absolutely yes yeah and you might not actually have to be totally keto .

We get into that and end your carb confusion a book that amy berger and i wrote but for maximal weight loss i would recommend doing the keto level of of the low carb kind of diet i need this refresher you're welcome um yeah uh so kathy says um you may get some friction or i'm inferring getting .

Some friction from your other doctors you know i'm gonna get into this next time next week and explain my perspective of why you might get friction from other doctors on and why you shouldn't worry about it and go well go with what is working for you it's kind of a general principle let's see i have two meters i never read .

The same thing so i gave up on the meters yeah well sorry about that i mean um uh you know i know uh the uh owner of keto mojo he and his wife are fabulous people they they they're they're committed to helping people and and so if you want to .

Measure the keto mojo is a great one to get but i don't recommend it for everyone it can be again distracting and confusing um and i hardly ever register ketones shelley says however i've lost 40 pounds that's right so don't worry if you're not in ketos ketosis .

You're getting results and that's what you want um so i used to measure when i got started yeah and that's a good approach until you get down you know you learn with foods especially if you're you know the kind of person who wants to have some kind of external .

Validation of what you're doing you're not you don't want to wait for the week or two for the weight to come down of course you can just notice the hunger go away which is you know sign number one that it's working but using a ketone measure can help early on to just make sure you're sufficiently low .

On the carbohydrates yeah let's see uh good great thanks for the the comments um uh peanut butter fetish oh well malia um you know i think peanut butter is a um .

If you grew up with it and um you know it's interesting it's not a worldwide phenomenon i remember being in europe and people didn't really know what peanut butter was of course that was back in the 1980s uh but um you know so there's a a way to to um have a just a little bit of things .

If you can get away with it but at first i'd say don't test that it's just kind of messing with fire um you know for me a peanut butter serving size as a jar you know like also like a ben and jerry's pint you know if i have them very very infrequently but i i'll eat the whole pint and like the whole peanut butter jar .

Other people have various things that these are trigger foods and you can't stop eating them especially just not to have them at first uh let's see a says glad i'm not a prescriptionist well i prescribe food how's that i know i do i have a .

Handout as food that's my prescription i'm not a medication prescription okay thanks that's um yeah almond butter so the nut butters are again early on don't don't have them if you're out of stall cut them out it's just really difficult to control them um .

And let's see um i wanted to a good question can you touch on high cholesterol so um a lot of comments a lot of questions in my office and online about that and the low carb keto fixes the metabolic syndrome .

Which is the triglyceride and hdl part of your lipid or cholesterol panel it's really kind of called it's the new way of looking at your lipid panel a lot of doctors are stuck in the old way looking at total and ldl cholesterol and you just have to say well this approach is treating the metabolic syndrome and not to worry about it and .

Yes you might have a doctor get upset about a high ldl level when your hdl level is over a hundred which is a number in milligram per deciliter which is which is like so protective it doesn't matter what your ldl is so if you you know you don't have to teach your doctor how to look at a lipid panel and in fact i .

Had so many questions on this that was that i created or wrote the end your cholesterol confusion class this summer and we launched it this fall it will open a class as time goes on for end your cholesterol confusion if you really want to listen to you know me for a couple hours telling you what cholesterol really is .

But um if the triglyceride and hdl look great you don't have to worry um so let's see um great uh so laxmi says how to get past brain fog leg cramps um so using salt is a way to .

Kind of smooth everything it helps with leg cramps it helps with constipation it helps with fatigue it helps with brain fog and i know we've been taught to not have salt well and i know i remember i've been doing this a while i'll say have salt and then people go home and they don't have salt because .

Their other doctor says don't have salt or they read online that salt causes all these problems so it turns out that you need salt and magnesium and magnesium is great for muscle cramps an immediate sort of relief or or relief let me phrase that immediate relief for .

Muscle cramps is a squirt of mustard or pickle juice prevention or of bothersome muscle cramps is the daily use of a magnesium supplement because it's so widely available i recommend milk of magnesia as the supplement so um and the the sodium and in the in the bullion and the magnesium .

And the milk and magnesia basically these are called electrolytes that's why you're going to see these electrolyte products sold and the way i teach to get electrolytes is through kind of widely available inexpensive things rather than things you have to buy from other people at higher price .

Um so amy says if fiber is not absorbed why does it count amy fiber is absorbed even if it's called non-absorbable fiber and i i didn't create the term i met with joanne slavin at the university of minnesota some years ago and she was upset because she was trying .

To get this term non-absorbable fiber out because it's not true most people absorb fiber actually this was echoed and some young doctors who came to me recently wanted they want to do what i do and they're they're wearing continuous glucose monitors and all they were doing is eating foods that were net carb zero and .

Their blood sugar sugars shot way up because of the fiber so that's one reason why total carb counting works so much better than net carb county the name you can't look at the name sorry but that's um uh kind of like a peacekeeping missile .

Is actually a it's a weapon of war but you know it's it's kind of that weird name you know um let's see uh the adapt group is uh we're hopefully you know knock on wood i'm gonna be in live events in february be sure to check out adapt your life .

Dot com or so let's see don't see many questions a lot of comments thanks for those um i met a chinese buffet is cat meat okay well yeah if it has no uh no carbs added to it any meat like that's fine .

Um and um microbes and fiber yeah let it go um don't need fiber and um well i'm not sure if that was your comment before but um you know around keto meetings we kind of just .

Pull our hair out when people focus on things like fiber and and um and the microbiome because those things don't work and what we do works so but don't take my word for it try this see what you think um and um fiber is not actually .

If you want the longer more intellectual discussion when fiber was studied in randomized controlled trials to reduce colon polyps or colon cancer it didn't work so either the amount that it works was so low it was undetectable in the clinical trial but it was large clinical trial a lot of .

Patients in it so there's a lot of teaching about how it reduces cancer and all this when it was studied in the large like it's like the the experimental study didn't show that it worked so now you have to go out and on the internet erase every mention of fiber related to that because of that study .

It's not going to happen so that's why you want to get you know information from great great sources evidence-based medicine is my beginning in training that's what i learned how to critically appraise or to see to look at papers to see what .

What the level of evidence is meaning how much should we use this paper this information to to change the clinical practice the bar is actually pretty high you know i still haven't found a study among keto dieters of things like apple cider vinegar or mct or all that so what you run it your .

People are selling that on the idea that people feel good with it or or they they're um using in the context of something else that works as well um and oh well great testimonials if you can't see these daryl says uh i follow dr wessman program for the last 200 days i've lost 170 107 pounds at 20 carbs a .

Day total in that net yeah that's great so if that would fall within the one to two pounds um per 200 days 100 pounds so a half yeah well that's that's great uh one to two pounds per week what i typically see so um let's see what about water do i have to .

Drink a certain amount of water well no uh the water at thirst if you're if you're able to respond to your thirst meaning you have access to fluids and uh and you're not um taking a medicine that interferes with your thirst drive to drink .

Thirst is so strong you're going to drink you know it's very rare for someone to avoid thirst signals and the only time i do recommend a certain high amount of liquid including water i think other liquids count is if someone has a history of kidney .

Stones you want to make sure that you're flushing out the urine has a constant flow um if you have a history of kidney stones now you should have been taught that from the doctors who were treating you for kidney stones it's nothing new about a keto diet it's just general teaching about diet and fluid if you've had that .

Problem so let's see um um all right thanks lucy do you drink diet coke yeah well most people can have those sugar free jell-o most people can have those no low-carb protein shakes at all .

Premiere well patricia let me tell you it's probably okay so the protein shakes depending on which ones you get some have five carbs for a carton and the chocolate ones have five to seven .

Carbs if you can stick to one of those so the sidebar of this teaching if you just stay to this list of foods it's going to work fine it'll keep you under about 20 total carbs per day so if you want to eat something off the list you have to count the carbs of anything you eat and make .

Sure you're under about 20 carbs for the day as a general this is where to start so a lot of people do get their chocolate from a swig of a chocolate shake put it back in the refrigerator remember it's you don't get your protein from shakes you're getting it from food so don't think you have to drink the whole .

Protein shake to get my whatever protein grams in for the day no you're getting that from your food i look at these shakes as just kind of a sugar chocolate or sweet fix um and um so don't so if you you know glug down two or three shakes every day it just .

Probably won't work and and then in that case i'd say okay come out go back to the list of foods see how you do sometimes that's all you have to do and it starts working again so keto rash from australia so i i've only seen it once in my practice the keto rash which means that .

This can't be very common but then we get people the internet is amazing i mean you can connect one person with one person all around the world and uh you think everyone has it well you know you just wait it out um i the person i've had has had it for several months and even went to a dermatologist who .

Prescribed some antibiotics for it so you might if it's driving you crazy you might want to see a dermatologist for it but it's it's really rare and you don't have to start eating carbs again it will resolve on its own nobody knows what causes it let's see you're welcome you're welcome .

Can you eat too little sure um so um yeah when when we're teaching uh you the range of foods to have and you're eating to your own satiety and hunger .

Or when i'm teaching at other doctors and they're using nutritional sorts of programs we have kind of a rule that you don't go under 800 calories a day for a prolonged period of time without medical supervision now that's the general rule that you know it's common for me to .

See someone with high blood pressure diabetes all these different things so if you have no medical problems you can see that if someone's doing total fasting that's zero calories per day they're not eating anything if you're doing intermittent fasting and eating real food having one meal a day that might be all you need .

Yes if you're if you're so appetite suppressed that you don't want to eat at all the general view of the consensus nutrition people is that you should have some protein every day i don't know how much that is actually for the test we teach for the doctors are taking a test we teach one to one and a half grams per .

Lean per kilogram of lean body mass i don't want you counting all those different things so that that's kind of the deep dive into it yes you can eat too little but it's pretty rare uh pretty rare for someone to be so appetite suppressed that um .

That you don't eat anything let's see engleberg says please address the criticism that it's not healthy long-term well um now this kind of program has been studied for you know as long as any other diet that we have .

Um and the the view of the metabolism is that it looks really good and um so that it's kind of fear-mongering to say that oh if you do it oh for that so such a long period of time it's going to be bad for you there's no evidence of that either .

So i've been following this way of eating for about 20 years on the that's after learning about this through people who have done it for 30 years before that and now that doesn't say that it's going to be healthy for everyone and it just .

Doesn't say that it's not the only way to do it so i think among all the different ways to be healthy with what you eat one that's very low on sugar and junk foods is a healthy way to do it and if you want to talk with other people especially other doctors say you're doing a mediterranean diet and not a keto diet because keto is a .

It's a buzzword it's a trigger oh that's not good but if you say you're doing a mediterranean diet and this is similar to what is eaten and some days in the mediterranean basin there's a lot of different ways to eat called the mediterranean diet but doctors know that that's the best which is this is the irony and sarcasm here .

Because we don't know that that's the best but that's the current thinking that's so pervasive so just say you're doing the mediterranean diet let's see xx says what's the best cheese the best cheese is the one you like um and then there's a limit if you're if you're not able to lose weight or if .

You're trying to lose weight and can't then there's a limit on the cheese um and you're welcome you're welcome uh why not almond flour well because almond flour has carbs and it's very easy for that amount of carbs to sneak up on you so have things that are crustless the crustless cheesecake recipe that i give .

Out is a it's a great prescription strength sweet tooth quencher let's see you can do uh ready whip on sugar free jello sure watch the cars remember it's about watching carbs and there are carbs in ready whip just and there's not very much um but there's .

Also a limit on cream and fats and oils which this is where the the teaching of it kind of gets blended and it might be confusing if you just want marching orders there is a if then kind of system here where if you're going to have cream you look at the carbs on the cream but you also look at the limitation of the .

Cream on the list and you know i didn't make this up this was a this is a clinical format of a list that was through tens of thousands of people and i just studied it so on that you can um test it out and see see how it works for you .

Can i do this keto if i had bare active surgery you can do a real food science-based keto diet sure if you've had bariatric surgery i've had lots and lots of patients with various types of bariatric surgery do we keto-ers need to take vitamins well it depends what you're eating if you're eating .

Mainly the meat poultry fish and shellfish and eggs you're going to get all the vitamins you need and most doctors will say take a vitamin because just in case so if you can afford it get the store brand one that's kind of like the .

Centrum equivalent that's matched to your age and gender then that's probably going to be fine um i don't remember taking vitamin so i don't you know many of my most my patients don't remember or don't they're not in the habit to do it um having a hard time with sugar cravings .

Well um if you're craving sugar you're having sugar right um you know i'll go through the exercise of uh ask me if i crave fruit and you know might what do you mean no ask me if i crave fruit and the person will say do you crave fruit and i was like no .

I don't eat fruit so if you tell me you're craving sugar you're having sugar so and i know it sounds funny or it might seem mean but you know with all i i'm reminded of the seller who said the best way to quit the best way to curb my cravings for cigarette is to have a cigarette .

Well we know having a cigarette curbs a craving for a cigarette we don't want you to have cigarettes so to get over the sugar cravings have sugar-free things now you might have to give up sugar-free things if you can't stay away from sugar while you're having sugar-free things .

But if all you're having is sugar-free things and you never have sugar you can be quite successful and still have sweet things so i know that's a point of big confusion out there on the internet keto but just try some try the sugar-free things and um .

And i can remember when i i still remember when i started i would have that whole basin i mean it was like a a big bowl of sugar-free uh the the um no-bake cheesecake recipe which basically is cream cream cheese and and and some splenda or sweetener and um and .

I would um eat the whole bowl this is like during the first week because i i had such bad sugar cravings i i remember that and but i don't want you to ever have to go through that again and um so have some other and what happens is you have these .

Sugar-free things and that fades away over time it's it's not giving your brain what it really wants which is the glucose the sugar the sugar-free things it's a temporary measure to get you away from sugar until the sugar cravings fade away let's see what about alcohol well .

Alcohol is not on that list if you're coming to me saying you want to want this to work the first time every time and and you drink alcohol say alcohol's not on the list .

You can't however if you have time to you know and you wanna okay well i'll have a drink i'll test it out generally people most people in my experience can have one drink a day and be fine and a drink is defined by a light beer 12 ounces four or five inches of wine in a wine glass hard liquor shot .

It could be vodka it could be tequila so now you're gonna get i see the other question about alcohol gin vodka so you're gonna get these um people fine tuning over the car blitz let me give you an example if um i had a patient who tested the ketone level based on different types of of alcohol that she took and and wanted to .

Be that precise now most people aren't going to do that you'll hear out there that this alcohol is better than another than a better that i don't think of it that way i think of it you want to just limit the amount choose what you like so so it'd be terrible if you hated vodka for example .

Christine you hated vodka but people said you have to have vodka you know for example i don't like gin if someone said you have to have gin well then i can't do the keto diet because i can't have my i don't know light beer or a glass of wine so that's how i kind of practically think about it what you like keep it in moderation keep .

It to the weekends if you can but if you want it to work first time every time you know no signs or buts don't do it don't have it those are that's the way i look at it i'm glad this has been enlightening accountability yeah you know get a .

Friend get online in a support group try out the adapt your life academy we have we've created our own support group for folks there's a small fee for that but um yeah keep it simple sauerkraut you know it's great you just keep it under a cup uh for the day it's not unlimited yeah coconut flour for some occasional baking probably or maybe not so again it .

Depends on your situation that you're in if you're trying to fix diabetes you have maximal weight loss just don't go for those flowers or or have them every now and then like that so you know we're going through the holidays where i see people um have um carbs on thanksgiving or you know on .

The holiday and then they have cravings for the next week or two so they're coming in now like you know i'm still craving well it was that holiday that did it so remember you're just learning about how your body responds and there's no right or wrong you can crave for two weeks after having one carb that's just the .

Reality of it so do your best to just stay clear of the carbs here over the holidays or you know use this time to refocus start over tomorrow like you're starting over um and um so anyway yeah i i just kind of um .

Look in and kind of i don't know just wonder and shock at the same time when this fellow tells me you know well he ate some carbs and you know the weight didn't go down as much and and he has diabetes and i said well and what happened to the blood sugars well and they went up and you know well that's what happens .

So uh there's once you understand how these foods affect your metabolism you'll you'll learn and stay clear while you want maximal effect and yeah it's a myth to drink a gallon of water a day .

I remember unless you've had um kidney stones um my doctor flipped last month when you got to see my weight loss i'm assuming that's a good thing the doctor flipped um let's see food addiction yeah great well i think um .

Let's see oh hey hey wendy um hope you're doing well i miss you guys um ham sausage hot dogs are unlimited what about most of those having sugars or fillers well you know again for most people the hunger goes down .

Automatically and so you eat less automatically it's not a competition you know to because i can say because so i say unlimited but but stop when you feel full it's not a competition i did have someone who ate you know two three pounds of bacon a day but the thrill wears off and you know so the these kinds of you don't have to .

Follow the rules precisely from the get-go every day all this you need to learn the rules that work for you and you know you can find hot dogs or sausages that have no filler and no sugar if that's too expensive find the ones that have the lowest amount if a hot dog has one or two grams you have two hot dogs that's really not .

A big deal in the context of what else you're having for the day right um uh and you're welcome let's see um yeah i already talked about alcohol um .

You're welcome what about um the vital protein sparing modified fat bread well um how many carbs so if you ever ask me what do i think about something i'm gonna say how many carbs and it's total not net .

You now know the secret actually no i teach everyone that so i can't be out there looking at everything and and i think that's just a re-rehash of the atkins revolution role with egg whites i think but but if you so i'm not a big product guy you know maybe maybe i need to sell protein powders and then .

Say here have this protein powder and then you'll be relaxed about it no i won't do that eat real foods and if you use uh protein powders and something that i mean that's just don't you see that's kind of gimmicky you know it um .

Let's see protein is the fulcrum around which are carbs and fat lever okay people felt that it's high fat but it's just in relation to carb intake and standard diet yeah yeah so um depending what you're trying to accomplish if you're trying to prevent seizures be in .

Ketosis every minute of the day some of these children get a seizure with a bite of a candy bar that's how strict they have to be you don't have to be that strict if you're doing this for weight loss diabetes prevention fibromyalgia going away pcos going away got a couple christmas cards one was from a patient who thanked me .

And showed me the picture of their keto baby and that was very nice to get that christmas card um and it was someone who had trouble getting pregnant had been through other kinds of approaches and the keto diet fixed it and the keto the baby was .

Basically in utero uh grew inside the mom while the mom was doing a keto diet so it's a brand new world um oh wait it's just going back to what had been done for the ancestral undergathered kind of diet and you know if you haven't um .

Read much about the history of nutrition and and what people eat it's well worth doing that an essay by steve finney or lauren cordain the the ancestral kind of diet sugar wasn't around you know until a hundred years ago you know and to have someone say that you have to have sugar or starch it's just not scientific so uh .

And then even bread and pasta rice these kinds of things we're only around the last like several thousand years it's not you know hundreds of thousands of years so it's okay to be without those things especially if it's going to fix your chronic medical problem you know and let's see welcome so next week i'm going to be .

Giving kind of a big picture overview of you know our medical care system focusing on medications and how there's another approach and that is to change the food you know so that'll be next and .

Great well that seems like i'm getting to the bottom thank you for all the questions um and i will see you next week oh you know maria fine one last thing about alcohol and i learned from these young doctors coming they you know saw me as the guru .

Learning what i'm doing i learned from them in fact you know you teachers know that as a teacher you learn from the students you know in fact you probably learn more than the students do if you know you're paying attention so these young uh young doctors in their you know their .

Late 20s have learned that different alcohol has different effect and for example so this one case well it was husband and wife with two cases the red wine didn't raise the blood glucose but beer did so that's gonna you know throw off all my teaching well .

No it's not it was one individual and um and if you stayed in just one drink it doesn't really matter if it's a light beer or so he was testing regular beer and red wine you know but there are all sorts of things you can learn um if you really want to become a kind of neurotic biohacker which i don't .

Recommend there are plenty of those folks around but yeah so different alcohol may have different effects if you have a lot of the alcohol and that's kind of one general theme of this approach is you never get to have too many vegetables you never get to .

Have too many leafy greens or or cheese mayo things like that um and um let's see um yeah i'm not sure when the adapt products will be back that's sorry i'm not up on the on the sales of those at the moment um .

And um let's see how long you should not be eating before you go to sleep oh well that's kind of a um uh there's so many variations on that you don't you can eat before you go to bed you know there's a misconception that um so a lot of the research is done when .

People eat carbohydrates and there's something called the sumo wrestler effect where if you eat carbs and proteins and fats and then you go to sleep basically your body sends all of the extra energy to fat storage and that's what sumo wrestlers want they want to maximize their fat creation and fat storage so if you were .

A carb eater you would not want to eat before going to bed because you'll turn all those carbs through the insulin effect into fat but if you're not a carb eater you're not generating the blood glucose not generating the insulin signal you're not going to be storing fat at night so that's it's different .

If you're in the keto world where you're not eating carbs it's if it's different than if you're in the carb eating world and uh let's see yeah i think i yeah oh my goodness way over the hour um and thank you so .

Much for your questions and um uh for for information about what i do what options are available the most up-to-date information is at my website which is that's .

E www.eric t m a n m d dot com and there are resources there that you can check out so next week i will be talking about the kind of perspective of being a a professor at duke now for gosh .

31 years and seeing how my colleagues are using medications to manage everything and there's another way to go about it and that's going to be next week's topic so um thank you all for tuning in tonight i'll see you next wednesday same time 7 30 eastern time .

And have a great week and of course happy new year between now and then take care


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