Dr. Paul Mason – ‘Low Carb from a Doctor’s perspective’

So, my mention is Dr. Paul Mason, I’m a athletics and exercise medicine physician and today I’d like to make you all on a tour exploring the social sciences that underpins low-grade carbohydrate foods and in the process I’d like you to take away a few things. Firstly We wanted to debunk the “calories in calories out” low fat hypothesis of weight loss. I want to demonstrate to you that a low-grade carbohydrate food is actually good for longevity People live longer when they eat low carbohydrate And carbohydrate because of fructose has some particularly unique and toxic effects on the body So to begin our journey, I’d like to introduce you to one of my patients Now this is the kind of patient that as a doctor. I adored she was very extremely compliant So she firstly came back my clinic with seam agony And she was overweight and it was very clear to both of us that if she could lose some value that would help her condition so we had a conversation and started talking about her existing attempts to lose weight and it seemed that she had a particularly conventional approach the kind that is recommended by most doctors: feed low-fat So let’s hear her chronicle this in her own utterances And I was doing all low fat you were to see my fridge was just full of low-fat cheese No oil touched any frypan in my kitchen all the meat was as lean as you could possibly get and I dine salads and I was starving all the time and saw you exert Oh madly six eras a week and I was doing those classes.I was doing back-to-back class. So an our collision grades be accompanied by a gush class and Six eras a week. So and then I felt truly guilty on the seventh day Because I wasn’t practising So She was following the conventional advice She was slavishly following that opinion. She was exercising She was eating low-fat, but the difficulty is it was not working. At the time she saw me she was 30 kilograms overweight and gaining. So When I’m faced with this scenario as a medical doctor, I have to ask myself Who is responsible? Who shall be responsible? So the patients following the medical opinion that they’ve been given So is it the patient or is it the doctor or the medical professional who opened the advice? So I would argue the blame should actually lie with the doctor or the health professional because the implication of the advice is that If you fail to lose weight You’re lazy and you’re covetou You’re just not trying hard enough But this very premise neglects the key center to understanding weight loss and that’s hormones The conventional “calories in calories out” hypothesis ignores the effect of hormones very a very strong science So we’ve got a maid here.She’s 35 year olds and she’s got a problem with a hormone called cortisol, and she’s just been gaining load And this is what happens when her hormone problem was treated she didn’t get given advice to rehearsal more She didn’t get told to eat little. We corrected the hormone difficulty and the weight problem goes away This boy here 3 years old. He weighs 42 kilograms and he’s got a problem with a hormone called leptin Seven years old he now weighs 10 kilograms lighter and a very healthy weight See what happens when you tie the hormone trouble Now the most common hormone in the population that makes obesity Is not one of those, it’s called insulin and this girl has a problem with insulin, but she’s got a unique problem She’s got a tumor in her pancreas that exudes insulin And shoots it into her dissemination in this picture.She’s a 107 kilograms and she’s only 152 centimeters tall So she had an operation to remove the tumor which lower the insulin heights in her body Now these photos were made 50 epoches apart Her weight dropped to 89 kilograms. She lost 18 kilograms. And if we have a look at a graph of her weight loss You can see that in a 10 daylight point she lost 14 kilograms So clearly there’s a problem here with insulin. It obliges you fatten Now this patient too had a problem with insulin. This was one of my patients you can see her here 46 year olds and a length 20 This is what happened when we corrected her insulin question, she lost 40 kilograms and Here she is about a sizing 8 The big difference is she didn’t have surgery to fix her insulin difficulty. We changed her diet So you’re probably asking how on God’s green earth can a diet lead to such spectacular Changes in your insulin height that you’ll lose that much weight.So let’s have a look. This is a graph here And the height of the lines there represents how much insulin your person is secreting And each of those individual paths represents one of the three main sources of energy in our diet: Carbohydrates Protein or fat So let’s have a look at carbohydrate. Let’s see what happens when you devoured carbohydrates to your insulin levels this is called the area under the curve you get a big and prolonged release of insulin for over two hours let’s have a look when you have the same amount of energy contained within protein much less And the surprising thing for numerous parties Fat is even less. So think about that for a moment high levels of insulin are associated with obesity and Carbohydrates are the most potent stimulus we have on our bodies to exhaust insulin So in order for us to lose weight, we need to control that insulin grade ergo We need to control our carbohydrate intake Now we are able to universally classify Foods into one of two groups on the left here We have what’s called low-toned carbohydrate diets and on the right We have low fat nutritions, which tend to be higher in carbohydrate Because the energy has to come from somewhere So let’s have a look an unbiased look at the evidence Comparing these two types of nutritions in terms of weight loss Between 2003 and 2018 There were 62 published randomized hold troubles comparing low-spirited carbohydrate diets less than 130 grams per day to low fat foods in terms of weight loss 31 of these studies had statistically significant findings what that necessitates is That the results were not likely due to chance You could probably trust them So what I’ve done here is I’ve graphed these 31 studies that had statistically significant meets No cherry-picking now at all.And I’ve compared the average weight loss on the both diets the low-toned carbohydrate diet is depicted in blue-blooded and the low fat diet is depicted in red And you’ll had pointed out that in every single one of these studies that we’ve got here the low-spirited carbohydrate food Led to more weight loss than a low-fat diet So the issues to is which colt would you back? Now let’s Change pace a little bit and have a look at fat and realise exactly how insulin induces fat material develop Because if we understand this we can understand the cause of obesity, by the time you’re two years old You’ve got every fat cadre that you’re ever likely to have So if you gain weight after persons below the age of two It’s because your fatty cadres have gotten bigger not because they’ve multiplied So if we can work out what makes an individual fat cell bigger then we can determine what manufactures you fatter so what I’d like to demonstrate here is that you can see how the dissemination, these blood vessels are intimately related to each and every fat cell now we understand that hormone Is released after through the dissemination and because of this relationship with the blood vessels It can be delivered to each and every fat cadre in our figure and these blood vessels also contain overweight announced triglycerides You can see here in these These wiggly thread depictions down there.So what happens to gained weight Is that these triglycerides Get transported into the fat cadre and the fatty cadre gets bigger. The problem is this triglyceride molecule is very big It’s composed to four different parts You’ve got this glycerol anchor, and then you’ve got three Separate fatty battery-acids and as a whole this molecule cannot enter into a fat cadre It has to be snipped up first and that’s where insulin comes in So what you can see in the left-hand side we recognize the triglyceride molecule and then it’s being converted to glycerol and fatty battery-acids it is being snipped up and the LPL transfer lipoprotein lipase This is an enzyme that is stimulated to act by insulin And then formerly the fatty battery-acids ought to have liberated they’re able to cross and collect fatten without insulin to activate Lipoprotein lipase you can’t accumulate fat.And if we have a look on the top there you can see glucose can also enter fat cells and it does this through a little doorway or a transporter called the glute 4 transporter and again insulin is what triggers this transporter formerly the glucose is inside the fat cell it gets converted to glycerol then the glycerol will then blend with the fatty acids And then you’ll have a ended triglyceride molecule. This is the storage form of fatty Now to add insult to injury if you want to actually burn that fat it has to be snipped up again to leave the fatty cadre because as you are familiar with, It can’t cross the overweight cell membrane and to be snipped up.It has to be activated by or Cleaved by an enzyme called hormone confidential lipase Insulin turns this enzyme off So you be brought to an end with a triple whammy you have lipoprotein lipase and the glute four transporter being activated that’s stuffing fat into the cell and And then you have hormone feelings lipase being deactivated so that you can’t burn the fat so insulin biochemically is the cause of weight gain, So for a final proof that insulin compels weight advantage Let’s have a look at what happens to people who habitually inject themselves with insulin in the same site over a long period It leads to a condition we call lipo hypertrophy Hypertrophy meaning get bigger now these two On the left and on the top freedom These two gentlemen inserted insulin habitually into these locates in their lower abdomen over a long period the person on the bottom right their preferred injection area was on the front of their thighs about twenty to thirty percent of patients with sort 1 diabetes Will actually end up with this condition because they inject insulin high enough doses for long enough So whatever happened To my excellent patient, you know The one who was slavishly following the low fat exercise advice before she saw me was thirty kilograms overweight Well, we had a discussion She cut the carbs out of diet and she increased the overweight and by doing that she prepared her insulin difficulty And then this happened At last-place counting three years later She’s maintained a loss of 36 kilograms and “shes lost” 28 centimeters off her waist and such is her actual photos.So Let’s have a look at what is it about carbohydrates that can lead to this increase in insulin that starts Obesity. So begin to understand we have to have a look at what carbohydrates are on the top now we have a molecule of glucose and Throughout the middle there. We have a depiction of what we call a complex carbohydrate You know the kind of carbohydrates you’re getting unpolished rice and whole grain meat the stuff that you’re told is good for you It’s made of glucose is carbohydrate Carbohydrates are made of sugar and when you eat them and digest them they end up enrolling the bloodstream To increase your blood glucose level When you participated Rod and he decided to have some rice The glucose that drawn that rice up participated his bloodstresm And in response to this increase in blood sugar the pancreas this part tucked up in our abdomen now liberate something called insulin And then the number of jobs of this insulin is to remove the sugar from our circulation it places it preferentially into our muscle material and our liver tissue and then if there’s any leftover that get stuffed into the fatty the problem is that if you have high-pitched insulin stages for long enough that create a condition called insuline resistance Se we know that when you chew carbs you get this masive spike of insulin and if you do that habitually six times a day As many of you have probably been recommended to do your form becomes insensitive To the high level of insulin.It’s like when you walk into a area with a bad smell At first its overpower and after a few minutes you don’t notice it anymore It’s the same with insulin Except it simply happens chiefly at the muscle and the liver tissue so they stopped taking in the carbohydrate Your body reimburses by release more insulin and then the body is able to stuff that additional sugar into your overweight tissue so this actually explains why a lot of people come in and they say You know what when I was 20 I sat on the couch eating potato chips no usage and I was skinny and as I’ve gotten older I’ve just gradually stacked on the kilograms and this is despite becoming Health-conscious I now go to the gym three days a week.I now chew salads So the reason that they’re gradually gaining weight is because over its first year and this happens over 10 15 or even more times They’re becoming insulin resistant And we can actually test for this so in my clinic with my patients We do a test where cases will drink 75 grams of glucose And then we mesure their glucose positions and insuline status Over the course of a 2 hour interval And We can actually assess their level of insulin resist based on the results. So let’s have a look So in the red now this represents insulin degree and the blue line represents blood glucose level So this is somebody who’s metabolically healthy.We give them the loading of glucose and two hours later We’re having a look They say that blood Sugar’s not heightened beyond what it should be and the blood insulin is not hoisted beyond what it should be perfectly healthful Then in the first stage of insulin fighting or metabolic i’ll state you’ll note that inlsuline position starts to creep up But it’s still doing a good enough job of remaining the sugar out of the bloodstream So the blood sugar is not yet promoted if you had a blood test a standard oral glucose-tolerance test done at this stage Your doctor would tell you you’re perfectly health. Don’t worry go home you are fine And yet you’ve got the first signs of insulin opposition. You’ve probably previously gaining value at this stage as it progresses And it starts to creep up a little bit. The insulin starts even higher and this stage is where your doctor would say: oh you’re pre-diabetic you know, have you thought about doing a little bit of exercise? still not too worried about the whole process And then over era this blood sugar starts to damage the cadres in the pancreas That freeing insulin so even though you’re becoming insulin resistant and you need more insulin your person causes less And then when your insulin positions start to fall you have a precipitous an increasing number of your blood sugar stages, and that’s when diabetes is diagnosed So let’s have a look at a couple of instances So such patients now low-pitched blood sugar low insulin statu Perfectly healthy.I like this comparation This patient now probably putting a litle value You can see the blood Sugar’s quite low at two hours 5.6 but “youre seeing” the insulin has now risen to 83 Okay, we’re starting to see insulin resistance now. We’re starting to have a problem And now you can see that blood sugar has now come up of the floor insulin is a bit higher again and the blood sugar is rising to 8.3. And then what happens in the more advanced stage? Blood sugar 11.4 this is when you would be diagnosed with diabetes under standard blood tests, by the way, And the insulin level has slipped the pancreas is starting to fail Now it’s all well and good to say, okay you’re a doctor you can test for insulin resistance in your laboratory but a lot of people are curious to know if they have insulin resistance And whether they can check themselves and you’ll be interested to know that you can see a great deal of indicates of insulin resistance by looking at the surface And I’ve got several cases here today and you know that i’ll inspect your surface These are what’s called skin tags The most common cause of skin calls it is insulin resist If you have skin calls You are almost certainly insulin resistant And a lot patients tell me Well, I going to see my GP and ask what causes it they say in one sentence I don’t know, but would you like me to burn them off? They’re a warning sign They’re often in the armpits around the neck in the groin neighborhood This sign here is called pay can ptosis nigricans it’s Pigmentation of the surface we often see it around the neck in the armpits in the groin Or more interestingly on the back of the paws The surface creases now and there’s good experiment that shows that even before you start gaining an excess amount of weight You can be found in The modifies on the back of the digits before anything else.I can see a few people having a look at their paws now I examine a lot of patients who come in with problems with their surface complexion and what we find is that when we improve the insulin resist that Hugely improves have a ketogenic diet lower your insulin status bark gets better. It’s very nice. And that’s one of the reasons why Acne is very common in the state of adolescence because the state of youngsters puberty is associated with insulin resistance Now for the good news that had to be coming We are truly make this If you go on a low carbohydrate diet and reduce your chronic elevated levels of insulin your insulin sensitivity will improve have a look at the insulin levels of this patient here and 3 months later big-hearted fells Here’s another example we can see that one hour insuline he was 114 an again to 71 really in the room of a few months An there is also a nice asocieted weight loss to boot So, I think it’s pretty clear A low-spirited carbohydrate diet is the best diet for weight loss But some of you are probably still concerned you probably thinking well, it’s all well and good to be skinny But what happens if it’s going to kill me all that saturated overweight, right? so let’s have a look at the Bigest study that’s been done to date on this topic.It was published last year And it had over 135,000 players they were followed for more than seven years across 18 countries. This was a huge large-scale study So what we can see is that the group that was having the least amount of overweight had a mortality rate per 1000 being years of exactly under 7 Let’s see what happens to the group that was getting more of the energy from fatty more than three times so much better from solid their mortality rate descent at 4 more fatty live longer and if we have a look at a graph from that same study revealing this where your risk of dying Is on the axis going up the higher the worse it is and the effect you’re having is going to the right hand Side and you can see there’s no point at which having more fat becomes problematic in actual fact It seems the more fat you have the total mortality continues to drop So now let’s flip-flop this on its brain and have a look at carbohydrate intake if you have 46.4 percentage of your intensity from carbohydrate the mortality rate per 1000 being times gamble was about 4 And by the way, this is not considered a particularly low-pitched carbohydrate nutrition, but it’s low-toned Carbohydrate compared to the average diet.Let’s have a look at the group of the population that was getting far more 72.2 percentage of their vigour from carbohydrate their risk of dying went from about 4 to over 7 With more carbohydrates. And again, we have a look at this graph the more carbohydrates you have your mortality really stops on descending So low-pitched carbohydrate high fat nutritions you will live longer Now this is not a one-size-fits-all diet Some beings might be able to have 80 grams of carbohydrates a day Rod says his limit was 50 Some other people may only be able to have 20 grams of carbohydrates a epoch to be in optimal health And we use something called the ketone meter to determine your optimal level of carbohydrate rule now the only difference between a low carbohydrate diet and a Ketogenic diet is the degree of restriction of carbohydrates If you shorten your carbohydrates enough to lower your insulin tiers to permit fat-burning Some of that overweight when it’s metabolized will be converted to a chemical called a ketone Now the thing to realize is that in the human body. The only source of ketones comes from solid metabolism nothing else So if you have ketones in your bloodstream that indicates that your organization is burning fat So we can take a drop of your blood positioned it on a meter and within 10 seconds We’ve got the answer now down the bottom.This is the scale that we generally use and it’s also useful As well as indicating your magnitude of overweight metabolism For suppressing your stomach what we find in the clinic is over The last few years is that people who come in with ketones hovering around extent 4 or higher. They often say you know what I’ve only dine twice a daytime now, I’m just not hungry And this is demostrated in the research we know when you have higher levels of ketones that has an apetite supresing consequence So not only Are you burning more solid But the whole “calories in calories out” first principle of thermodynamics equation you applied less exertion into the system So this actually dovetails in quite nicely with the conventional wisdom of “calories in calories out” But it computes another bed. It starts to explain how you can employed less calories in so This is an example now of a meat journal with ketones being recorded down the right-hand side the numbers down the two sides and the reason we do this is because By recording your ketones and likening it to your meat. You can actually start to understand which meat are stopping your burning fatten let’s zoom in a little bit so we can see down the right here.We’ve got a few ketone amounts 1.1 that’s good 0.7 That’s okay. 0.4 That’s still okay, and then we decline to 0.2 why? A small-minded patch of rinse patty, okay Probably not the very best But it’s ok because the next day they’re back up to 0.7 Piece of toast Bumps it down to 0.2. This person is very very sensitive to carbohydrates And without doing this They would never have known so now I’d like to take a closer. Look at sugar and the uniquely toxic effects that that has So we’ve already seen about this glucose molecule on the left the one in the yellow-bellied But the one on the right is called fructose and when you join one of each of these molecules together it words table carbohydrate, sucrose and you can see that it’s Sucrose is exactly 50% fructose And that’s important because a great deal of people say we don’t have a problem in Australia because we don’t have high fructose corn syrup well high fructose corn syrup is exclusively between 42% and 55% fructose So they’re very extremely analogous the counter carbohydrate we have here in Australia is every bit as bad as high fructose corn syrup Now When we have a look at the swetness of diferent carbohydrates the reason fructose is a problem is it’s more than twice as sweet as glucose and And this is a problem Because as humas we love self-gratification We’ve got this pathway in the ability called the mesolimbic pathway and this is the reinforcing pathway reinforces our practice And when we stimulate our brain with something sweet we get a release of a chemical called dopamine and it says yes do that again and fructose Activates this pathway by virtue of it being more than doubled the sweetness of glucsose It triggers this pathway more strongly And when we sacan the brains of obese souls And have a look of dopamine receptors we can see there’s a reduced number Of dopamine receptors in the brains of obese people.So this means to get the same level of satisfaction from a meal Obese people need to eat more And this is where sweetness fits into it. Over time this reforms will down modulate But the problem is that untill they down govern over occasion you have to restric the sweetened meat in your food Now fructose has another particularly toxic effect and that Leading to insulin resist Fructose far more powerfully than glucose should contribute to a fatty liver So when you chew fructose Normally about 80% of it gets taken up by the muscle, gets taken up by the liver and then It goes to the liver and there’s a capacity for storage in the liver for glucose has something called Glycogen so that sets up a little bit more So the amount of energy that objectives up going to the liver and going to the mitochondria within the liver Is only a fraction of what you ingest but with fructose it doesn’t go to the other tissues and it doesn’t have this basin where it can be taken up or stored so Every gram of fructose you feed comes delivered to the mitochondria in the liver.And when those mitochondria get overloaded They produce fatty liver Process announced DNA vapor Genesis. This is a slide those white-hot bubbles There are pellets of fat in a fatty liver and excess fractose can do that and this is strongly associated with insulin resistance Another difficulty is that Sugar can attach to protein And you’ve got carbohydrate Bathing the cells of your person and that sugar over go Can not only pays special attention to it that can form these Complexes called advanced glycated end products and they can affect nearly every type of cell and molecule in the body the problem is That fructose does this seven times more than glucose Yet another problem with fructose And when we have a look at the consequences of these advanced glycosylated end product They change a lot of the tissues that we learn beings with diabetes have nerve questions we’ve already has spoken about how the pancreas can start to fail and Reduces it’s capability to secrete insulin kidney difficulties, blood vessel questions You can go blind arthritis is really really comon Now just to illustrate the place That these advanced glycosylated end products are consistent with aging this is some ground-up rib cartilage on the top left “Its from” 2 weeks old and on the bottom right from 88 and this is something that normally happens across the lifespan It’s very similar to a process called the Maori action on the Browning reaction caramelization if you will not quite the same but along the same arguments and over experience The carbohydrate in our circulation will change Our tissues and I’d have a question.Why would you want to accelerate the aging process by increasing your carbohydrate grades even more? now We know that the most common sources of included sugar in our diet are sweets Maybe some people be surprised to know that cereals is one of the major the curricula of included sugars in our diets But carbohydrates are also hidden in a lot of nutrients Not countless parties will realize that a squirt of tomato sauce probably Far less than what they actually habitually put one across as good one of the health teaspoons of sugar in it But the real surprise is down on the bottom right here.This is a medium-sized mango liquid 12 and a half teaspoons of sugar and There’s other ways that carbohydrate can be concealed. I’ve got an organic almond milk here. Perfect You can see lactose free soy free. Gluten free no cane carbohydrate. Okay, you’re feeling pretty good right now Let’s have a look at the part Still look okay? Show our hands who thinks it doesn’t look so bad organic agave syrup you are familiar with agave syrup is 75% fructose it’s even worse than table sugar. It’s worse than cane sugar And this here is a list The figures That sugar is disguised in in Australian nutrition labels Food creators are allowed to use every one of these euphemisms of sugar on their name induces it very difficult Now some people say but fructose it’s natural, right Maybe it’s natural, but we don’t eat it in a natural route You wouldn’t know it but this is a fruit tree on the left. It has no fruit. It’s because fruit is seasonal We don’t have access to fruit year-round and if you want, honey Well, you don’t get to go to Cole’s traditionaly You had to go and ask the bee if it would line if you had his honey So we destroy result in a very different way.We now have 500 mils of orange liquor which contains 6 oranges And it’s had all the fiber taken out So just as an digression, don’t suck your return. Precisely do not drink your return Now I’d just like to touch on one more point before I finish and that’s artificial sweeteners So we’ve already talked about them as a Olympic pathway reinforcing behaviours and Artificial sweeteners do accurately the same thing when we have a look at the evidence all the cohort studies They show that uptake of artificial sweetness is asociated with load increase Increase weight circumference metabolic disorder nature 2 diabetes and heart attacks artificial sweeteners don’t get a leave pass So, I’d like to leave everybody now with three key points Number one: You are not held accountable for being overweight if you’ve been folloing bad advice Critical Number two: low-pitched, carbohydrate nutritions are the best diet for weight loss because they lower insulin and finally people live longer on low carbohydrate diets Thank you


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