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

So, my mention is Dr. Paul Mason, I’m a boasts and rehearsal medication physician and today I’d like to take you all on a expedition exploring the social sciences that underpins low-grade carbohydrate diets 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 carbohydrate nutrition is actually good for longevity People live longer when they eat low-grade carbohydrate And sugar 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 particularly compliant So she first came back my clinic with joint ache And she was overweight and it was very clear to both of us that if she could lose some load 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 extremely conventional approach the kind that is recommended by most doctors: munch low-fat So let’s hear her chronicle this in her own paroles And I was doing all low fat you were to see my fridge was just full of low-fat cheese No oil stroked any frypan in my kitchen all the meat was as lean as you could possibly get and I gobble salads and I was starving all the time and saw you practise Oh crazily six epoches a few weeks and I was doing those classes.I was doing back-to-back first-class. So an our reach first-class be accompanied by a shoot class and Six days a few weeks. So and then I felt genuinely guilty on the seventh day Because I wasn’t exercising So She was following the conventional advice She was slavishly following that suggestion. She was exercising She was eating low-fat, but the hurt 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 is to blame? So the patients following the medical admonition that they’ve been given So is it the patient or is it the doctor or the medical professional who leaved their recommendations? So I would disagree 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 avariciou You’re just not trying hard enough But this very premise forgets the key centre to understanding weight loss and that’s hormones The conventional “calories in calories out” hypothesis ignores the effect of hormones highly a very strong science So we’ve got a damsel here.She’s 35 years old 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 activity more She didn’t get told to devour little. We chose the hormone trouble and the load difficulty 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 set the hormone difficulty Now the most common hormone in the population that movements obesity Is not one of those, it’s called insulin and this lady has a problem with insulin, but she’s got a unique problem She’s got a tumor in her pancreas that secretes insulin And pumps 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 grades in her body Now these photos were made 50 dates 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 date season she lost 14 kilograms So clearly there’s a problem here with insulin. It attains you fat Now such patients likewise had a problem with insulin. This was one of my patients “youre seeing” her now 46 year olds and a length 20 This is what happened when we cooked her insulin problem, “shes lost” 40 kilograms and Here she is about a size 8 The big difference is she didn’t have surgery to fix her insulin problem.We changed her diet So you’re probably asking how on God’s green earth can a food lead to such startling Mutates in your insulin degree that you’ll lose that much weight. So let’s have a look. This is a graph now And the height of the lines there represents how much insulin your form is liberating And each of those individual cables is part of the three main sources of energy in our food: Carbohydrates Protein or solid So let’s have a look at carbohydrate. Let’s see what happens when you munched carbohydrates to your insulin levels this is called the area under the curve you get a massive and prolonged liberate 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 many people 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 to be allowed to for us to lose weight, we need to control that insulin rank ergo We need to control our carbohydrate uptake Now we can universally categorize Diets into one of two groups on the left here We have what’s called low carbohydrate diets and on the right We have low fat diets, 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 diets in terms of weight loss Between 2003 and 2018 There were 62 published randomized restraint inquiries comparing low-pitched carbohydrate diets less than 130 grams a day to low fat foods in terms of weight loss 31 of these studies had statistically significant findings what that makes 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 observes No cherry-picking here at all.And I’ve compared the average weight loss on the both diets the low-toned carbohydrate nutrition is depicted in blue and the low fat diet is depicted in red And you’ll note that in every single one of these studies that we’ve got now the low-grade carbohydrate diet Led to more weight loss than a low-fat diet So the issues to is which pony would you back? Now let’s Change pace a little bit and have a look at fat and envision exactly how insulin builds overweight 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 the age of two It’s because your fatty cadres have gotten bigger not because they’ve proliferated So if we can work out what makes an individual fattened cell bigger then we can determine what concludes 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 fatty 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 flab cell in our mas and these blood vessels likewise contain fatty announced triglycerides You can see here in these These wiggly line depictions down there.So what happens to gained weight Is that these triglycerides Get transported into the fatty cell and the overweight cadre comes 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 acids and as a whole this molecule cannot be integrated into a overweight cell 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 experience the triglyceride molecule and then it’s being converted to glycerol and fatty 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 once the fatty acids have been liberated they’re able to cross and supermarket obesity without insulin to activate Lipoprotein lipase you can’t storage solid. And if we have a look on the top there you can see glucose can also enter fat cadres and it does this through a little doorway or a transporter called the glute 4 transporter and again insulin is what initiates this transporter once the glucose is inside the fat cell it gets converted to glycerol then the glycerol will then compound with the fatty battery-acids And then you’ll have a ended triglyceride molecule.This is the storage pattern 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 layer 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 end up 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 overweight so insulin biochemically is the cause of weight gain, So for a final proof that insulin lawsuits weight amplification Let’s have a look at what happens to people who habitually inject themselves with insulin in the same site over a long period of time It leads to a condition we call lipo hypertrophy Hypertrophy meaning get bigger now these two On the left and on the top claim These two gentlemen introduced insulin habitually into these locates in their lower abdomen over a long period the person or persons on the bottom right their preferred injection place was on the breast 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 dosages for long enough So whatever happened To my perfect case, 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 chipped the carbs out of diet and she increased the solid and by make that she specified her insulin question And then this happened At last counting three years later She’s maintained a loss of 36 kilograms and she lost 28 centimeters off her waist and these are her actual photos.So Let’s have a look at what is it about carbohydrates that can lead to this increase in insulin that crusades Obesity. So begin to understand we have to have a look at what carbohydrates are on the top here 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 brown rice and whole grain eat 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 registering the bloodstream To increase your blood glucose level When you realized Rod and he decided to have some rice The glucose that prepared that rice up opened his bloodstresm And in response to this increase in blood sugar the pancreas this part tucked up in our abdomen here liberate something announced insulin And then the number of jobs of this insulin is to remove the sugar from our circulation it keeps it preferentially into our muscle material and our liver material and then if there’s any leftover that comes stuffed into the fatty the problem is that if you have high insulin stages for long enough that create a condition called insuline resistance Se we know that when you eat 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 torso becomes insensitive To the high standards of insulin.It’s like when you walk into a chamber with a bad bouquet At first its overpower and after a few minutes you don’t notice it anymore It’s the same with insulin Except it merely happens chiefly at the muscle and the liver material so they stopped taking in the sugar Your body compensates by loose more insulin and then the body is able to stuff that additional sugar into your fatty 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 few weeks. I now snack salads So the reason that they’re gradually gaining weight is because over the years and this happens over 10 15 or even more years 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 imbibe 75 grams of glucose And then we mesure their glucose status and insuline heights Over such courses of a 2 hour season And We are truly assess their level of insulin opposition based on the results.So let’s have a look So in the red here this represents insulin tier and the blue line represents blood glucose level So this is somebody who’s metabolically healthful. We give them the load of glucose and two hours later We’re having a look They say that blood Sugar’s not hoisted beyond what it should be and the blood insulin is not elevated beyond what it should be perfectly health Then in the first stage of insulin defiance or metabolic i’ll health you’ll had pointed out that inlsuline rank starts to creep up But it’s still doing a good enough job of stopping the sugar out of the bloodstream So the blood sugar is not yet elevated if you had a blood test a standard oral glucose-tolerance test done at this stage Your doctor would tell you you’re perfectly healthy.Don’t worry go home you are fine And hitherto you’ve got the first signs of insulin defiance. You’ve probably once gaining weight at this stage as it progresses And it starts to creep up a little bit. The insulin runs 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 concerned about the whole process And then over occasion this blood sugar starts to damage the cells in the pancreas That freeing insulin so even though you’re becoming insulin resistant and there is a requirement to more insulin your person produces less And then when your insulin heights start to fall you have a precipitous increase in your blood sugar degrees, and that’s when diabetes is diagnosed So let’s have a look at a couple of patterns So this patient now low-pitched blood sugar low-spirited insulin height Perfectly healthy.I like this comparation This patient here probably putting a litle value You can be found in the blood Sugar’s quite low at two hours 5.6 but you can see the insulin has now risen to 83 Okay, we’re starting to see insulin resistance here. We’re starting to have a problem And now “youre seeing” that blood sugar has now come up of the flooring 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 grade has descended 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 opposition in your laboratory but a good deal of beings 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 lot of signals of insulin opposition by looking at the surface And I’ve got several patients here today and you know that i’ll inspect your skin These are what’s called skin calls The most common cause of skin labels it is insulin opposition If you have skin calls You are almost certainly insulin resistant And a good deal cases 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 generally in the armpits around the neck in the groin region This sign here is called pay can ptosis nigricans it’s Pigmentation of the skin we often see it around the neck in the armpits in the groin Or more interestingly on the back of the fingers The scalp puckers here and there’s good investigate that are demonstrating that even before you start gaining an excess amount of value You can be found in The alterations on the back of the paws before anything else.I can see a few people having a look at their thumbs now I receive a good deal of patients who come in with problems with their skin colour and what we find is that when we improve the insulin fighting that Significantly improves have a ketogenic nutrition lower your insulin tiers scalp 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 teens adolescence is associated with insulin resistance Now for the good news that had to be coming We can actually switch this If you go on a low-grade carbohydrate food and shorten 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 large-hearted drops-off Here’s another example we can see that one hour insuline he was 114 an again to 71 really in the infinite of a few months An there is also a nice asocieted weight loss to boot So, I think it’s pretty clear A low-pitched carbohydrate nutrition 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 fat, 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 participants they were followed for more than seven years across 18 countries. This was a big big-hearted study So what we can see is that the group that was having the least amount of fat had a mortality rate per 1000 being years of precisely under 7 Let’s see what happens to the group that was getting more of the intensity from fatty more than three times so much better from solid their mortality rate removed at 4 more overweight live longer and if we have a look at a diagram from that same study displaying 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 fatty becomes problematic in actual fact It seems the more overweight you have the total mortality continues to drop So now let’s move this on its top and have a look at carbohydrate intake if you have 46.4 percent of your vitality from carbohydrate the mortality rate per 1000 person years risk was about 4 And by the way, this is not considered a particularly low-spirited carbohydrate nutrition, but it’s low-spirited Carbohydrate compared to the average diet.Let’s have a look at the group of the population that was getting far more 72.2 percent of their force 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 merely obstructs on descending So low carbohydrate high fat diets 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 daytime Rod says his limit was 50 Some other parties may only be able to have 20 grams of carbohydrates a daytime to be in optimal health And we use something called the ketone meter to determine your optimum level of carbohydrate regulation now the only discrepancies between a low-spirited carbohydrate diet and a Ketogenic diet is the degree of restriction of carbohydrates If you shorten your carbohydrates enough to lower your insulin ranks to permit fat-burning Some of that fatty 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 fatty metabolism nothing else So if you have ketones in your bloodstream that indicates that your torso is burning fat So we can take a drop of your blood introduced 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 fatty metabolism For suppressing your lust what we find in the clinic is over The last few years is that people who come in with ketones wavering around stage 4 or higher. They often say you know what I’ve only devour twice a era 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 influence So is not simply Are you burning more fatty But the whole “calories in calories out” first ordinance of thermodynamics equation you positioned less vitality into the system So this actually dovetails in quite nicely with the conventional wisdom of “calories in calories out” But it lends another coating. It starts to explain how you can kept less calories in so This is an example here of a menu 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 equating it to your food.You can actually start to understand which meat are stopping your burning flab let’s zoom in a little bit so we can see down the right here. We’ve got a few ketone counts 1.1 that’s good 0.7 That’s okay. 0.4 That’s still okay, and then we descent to 0.2 why? A big patch of sponge 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 assembles table carbohydrate, sucrose and you can see that it’s Sucrose is exactly 50% fructose And that’s important because a lot of people say we don’t have a problem in Australia because we don’t have high fructose corn syrup well high-pitched fructose corn syrup is only between 42% and 55% fructose So they’re very terribly analogous the table sugar 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 sugars 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 affection self-gratification We’ve got this pathway in the brain called the mesolimbic pathway and this is the reinforcing pathway reinforces our behaviour And when we stimulate our brain with something sweet we get a release of a chemical announced dopamine and it says yes do that again and fructose Activates this pathway by virtue of it being more than double the sweetness of glucsose It initiates 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 happiness from a snack Obese people need to eat more And this is where sweetness fits into it. Over experience this deepens will down settle But the problem is that untill they down adjust over day you have to restric the sweetened nutrients in your diet Now fructose has another particularly toxic effect and that Leads to insulin resist Fructose far more powerfully than glucose leads to a fatty liver So when you dine 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 faculty 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 points up going to the liver and going to the mitochondria within the liver Is exclusively 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 collected so Every gram of fructose you snacked comes delivered to the mitochondria in the liver.And when those mitochondria get overloaded They produce fatty liver Process called DNA vapor Genesis. This is a slide those white pellets There are pellets of fat in a fatty liver and excess fractose can do that and this is strongly associated with insulin resistance Another question is that Sugar can pays special attention to protein And you’ve got carbohydrate Bathing the cells of your form and that sugar over season Can is not simply pays special attention to it that can form these Complexes called advanced glycated end product 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 question with fructose And when we have a look at the consequences of these advanced glycosylated end products They alter a good deal of the tissues that we attend people with diabetes have nerve difficulties 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 simply to illustrate the level That these advanced glycosylated end products are associated with aging this is some ground-up rib cartilage on the top left “Its from” “two weeks ” age-old and on the bottom right from 88 and this is something that ordinarily 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 go 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 status even more? now We know that the most common sources of lent carbohydrate in our nutrition are sugareds Maybe some people be surprised to know that cereals is one of the major courses of supplemented sugars in our diets But sugars are also hidden in a lot of foods Not many beings will realize that a squirt of tomato sauce probably Far little 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 carbohydrate and There’s other highways that sugar can be obstructed. I’ve got an organic almond milk here. Perfect You can see lactose free soy free. Gluten free no cane sugar. 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 know 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 label acquires it very difficult Now some people say but fructose it’s natural, right Maybe it’s natural, but we don’t exhaust it in a natural channel 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 demand, sugar Well, you don’t get to go to Cole’s traditionaly You had to go and ask the bee if it would string if you had his honey So we expend 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 take out So just as an aside, don’t booze your result. Just do not drink your result 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 demeanors and Artificial sweeteners do precisely 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 heavines addition Increase weight circumference metabolic condition type 2 diabetes and heart attacks artificial sweeteners don’t get a leave pass So, I’d like to leave everybody here 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-toned, carbohydrate foods are the best diet for weight loss because they lower insulin and finally beings live longer on low-grade carbohydrate diets Thank you

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