Well, hello ladies and gents, Robert Sykes, Keto, savage.com.
And today I've got special guest Laura Buchanan, MD on the line
and we dive deep into the world of blood sugar regulation
following a ketogenic diet, low carb diet.
She works with patients, She has got some interesting studies
coming out alongside the work she's been doing with Doctor
TRO. They have a massive client
demographic that they've been gathering data from.
They've got a rebuttal paper coming out and it's really
interesting. It's always interesting for me
to talk to people that are clinicians that are working with
people directly that are boots on the ground, kind of getting
their feedback on what they're seeing amongst their population,
patient population and then just honestly picking her brain about
how she's approached nutrition personally.
She's also got a 5 month old son, So what she's doing with
his nutrition, she has stayed pretty well keto low carb
throughout her pregnancy and breastfeeding and how that's
affected him. So just a great around
conversation around proper dietary guidelines and blood
sugar management, CGM, things of that nature.
So thoroughly enjoy the conversation.
I've got no doubt that you will take something from it.
Without further ado, sit back, relax, enjoy the podcast with
Laura and we are live. Laura, how are you today?
I'm doing great. Thank you so much for having me.
My pleasure, My pleasure. I'm excited to be chatting with
you. You work alongside Dr. Tro, whom
I've met several times, and you are like what?
What leg of his umbrella, so to speak, are you most involved in?
Yeah. So I see patients right
alongside and we work very closely.
We each have our own patient panel, but we curbside each
other, talk to each other about either interesting cases or just
get bounce ideas off of each other.
And we both are heavily involved with research and also on the
board of the Society of Metabolic Health Practitioners.
So many, many different hats staying busy with with that.
Many different hats indeed. And you've like on your social
profiles, you've kind of taken a stance with a lot of anti aging
content, correct? Yeah, Yep.
I my goal is to really help people age successfully.
And I think the way to do that is really through your lifestyle
choices. Yeah, I can.
And that's. Agree there?
Have you found the fountain of youth yet?
Have you discovered it? I I don't think I've found that
quite yet, but I I think a good healthy amount of low carb keto
and combination of physical activity, staying active is is
very important to that. Yeah, I always tell people the
trifecta of the fountain of youth is, you know, some form of
resistance training, you know, activity, a low carb ketogenic
diet and then potentially some some form of intermittent
fasting if done strategically. But honestly, just the low carb
and the real food and activity, that's that's pretty much the
the gatekeeper there. Yeah, absolutely.
I have. I've heard some interesting
theories from different, I mean pretty well impressive
researchers in the cancer realm. But believe if you do some
extended fasting, maybe whether that's three days or five days,
if it's once a year, there's some period of time that that
will significantly decrease your cancer risk.
Yeah, I. Believe it.
I don't do a whole lot of extent and fasting myself, but some of
the data is most definitely compelling.
I'd love to get some some back story on you.
Like what? What even got you interested in
this stuff? Like, did you have a health
scare in your prior life or what?
What happened was the catalyst for you kind of going down this
path? Yeah, so there's a few different
things. I grew up playing sports and was
very passionate about that. I played soccer, tennis, ran
track, and then in college I continued playing soccer and and
tennis as well. And I actually, while exercising
while playing soccer almost five days a week, developed pre
diabetes and you've kind of heard the old adage you can't
outrun a bad diet. And I think I I fit that bill.
I didn't necessarily at the time think I was eating a terribly
unhealthy diet, but truly in hindsight it was a a mix of the
standard American diet slash trying to be a a lower fat diet.
So I was avoiding red meat and did that for about almost a
decade. I avoided red meat due to
initial concerns back then that I have since changed about
cancer risk and heart disease risk.
And so that was kind of one piece of it of my own health.
But then I think more importantly, actually during
that time I saw people that I was loved aging very
differently. So some of them were aging
extremely well and others unfortunately were dealing with
complications from chronic medical conditions like
diabetes. And it was just so drastic, the
different quality of life that they were having in their final
decade. And so that really just set it
in stone. What I wanted to do, I wanted to
help people age successfully and the way I could see this
happening was through the way they were eating and living
their lives. A decade without red meat is
quite the feat. Did you notice anything like
abrupt when when you reintroduced it?
Like was there any significant changes like on an acute level
that you noticed right off the bat?
None. And you know, I probably I did.
I'm sure I did have a burger every now and then at a party or
something, but it was definitely I avoided all throughout college
and I I didn't have any significant issues.
I do remember one particular one where I I I did develop severe
abdominal pain, but I was. I wonder if that was more just I
I had eaten something bad rather than it having to do with not
having had red meat and then to have eaten a large quantity of
it that evening. But I I don't know for sure, but
I definitely now feel better and that could be multifactorial
because not only now do I eat red meat on a daily basis, but I
also eat much lower carb than I used to as well and and and
ketosis quite a bit. So you are well steeped in the
medical literature. You've got several studies
presented on your like Instagram profile for instance.
What are some like like what the red meat is an example?
There's all these studies that point to it as being
contributing towards cancer. When it comes to the research
that is hot and prominent right now, are there anything that is
just incredibly misguided that you feel is getting a lot of
press time that is likely steering people in the wrong
direction? Absolutely.
And it seems like there's something coming out all the
time, but it's the same bad type of research that just keeps
looping around. So the with a lot of these
studies they give people a food frequency questionnaire or a 24
hour food recall and say you know either what did you eat in
the last 24 hours or what did you eat in the past year and you
answer 100 questions about that. And then they follow those
people for a decade without any additional follow up.
And they say based on that one food frequency questionnaire or
that 124 hour food recall, we are going to make the claim that
it is those dietary choices that led to this disease condition.
And that I mean that by itself is just terrible data.
We know food frequency questionnaires are not very
consistent if people were to fill them out on separate
occasions. Additionally, though, you don't
get the nuance. I eat and I'll eat half a pound
or more of ground beef at a single sitting.
But that's ground beef that I just cooked in my pan at home
with really nothing else in it. Maybe I maybe add a little salt
and pepper, but you compared that ground beef to someone who
has gone to McDonald's and got a burger with French fries and a
milkshake or a soda in front alongside and those are two
completely different diets. Yet both of those are going to
check off on that food frequency questionnaire that you're eating
half a pound or a pound of ground beef.
Is there any solution to that problem?
Like like I don't know if the the way to gather data at scale
among such a large population demographic would be some form
of questionnaire, like what are some viable alternatives then?
One that's has been done with some of the intermittent fasting
research that's pretty cool is they actually have people use an
app and take pictures of their food.
And so that way you definitely would see, you know, what is
that individual eating alongside at that single meal.
And that's of course a lot more work both for the researchers
and for the person in the study because they're having to take
pictures of the food. And then the researchers are
having to quantify that potentially with more AI coming
out, maybe there will be a newer way that will help us get some
better nutritional research going.
But I think that's currently one of the more more able ways to do
it. The other way too is if someone
says they're eating a ketogenic diet, just measuring ketones,
you can't again guarantee what exactly what they're eating.
But if they're in ketosis, you know, they are excluding a large
amount of carbohydrates. So that would be another way of
just kind of verifying a little bit what someone is reporting on
their questionnaire because that's that's another problem I
see with one of the study that came out this year from the
American College of Cardiology, I think had wrote about it and
said that low carb increased cardiovascular disease risk.
But the low carb individuals, if you trust the way they collected
the data, we're still consuming over 120 grams of carbohydrates
per day, which although is it lower carb than the Standard
American diet, it is still not low carb and definitely not
keto. Yeah, I would think, you know,
with all the people that are tracking their intake via, you
know, apps like MyFitnessPal or you know, just the different
apps out there, they can certainly find some way to
synchronize all that data. Now granted that would probably
contribute to the healthy user bias because people that are
tracking their intake probably are doing other healthy habits
as well. But I feel like just from a
shared data standpoint, being able to access that would be
much more viable and informative than just a basic food frequency
questionnaire. Yeah, I know that's a great
idea. So when it comes to the the
fountain of youth, kind of going back to that when when you were
seeing family, friends and loved ones going through these health
declines, what were some of the common denominators that you
were noticing amongst those that were more resilient as they age
versus those that seem to decline at a rapid rate?
Yeah, so definitely it was eating home cooked food.
Just whole real food. Not a lot of packaged food and
sweets were very rare, limited, and if they did have them it was
a special occasion. Again, it was home cooked.
Wine or alcohol was also limited to about no more than a glass
granny I'm thinking of. She had one glass of wine per
day and then she played tennis several times per week until she
was 88 and then she continued to be to walk and do activity.
After that, actually. So whereas on the other side it
was eating a lot of fast food, probably at at least multiple
times a week, sometimes more than once in a day, and enjoying
some of the processed sugars and candy on a regular basis as
well. And not being as physically
active, it's all kind of just opposites from one to the other.
What is what is your take on this big push as of late towards
kind of putting the the limelight on seed oils like do
you think because it's interesting, I've listened to
some podcast with you know, M DS and medical professionals that
say look there's not enough data to showcase that in a negative
light. Other people are very, very, you
know, staunch on their stance that hey look this is 100% the
main contributing factor. Like what?
What is your take? What is the research showing as
it pertains to seed oils? Yeah, I think I've, I've
listened to some podcast too with Brett Palmer who had
several researchers on that were were great.
He's, he's the low carb cardiologist that brought up
really good points pointing towards seed oils being very
harmful and then the others having logical reasoning
actually why they were not harmful.
And so my precautionary principle for me is I avoid them
because they're heavily manufactured, very highly
processed. And there is we've seen in our
patients just through using thousands of continuous glucose
monitors that some people actually do seem to have a
glucose response to them, which is interesting and a little bit
hard to explain. Then also there is definitely
some mechanistic data about how they can be damaging to cells.
I Chris Kenobi, he's recently wrote a book actually, where
they say they have met the Bradford Hill criteria is to
showing that these are causally very harmful to our body.
And so he's he does have some really interesting lectures that
make me feel cautious enough and concerned enough to avoid them
and to recommend that my patients avoid them until I
think we have more data with human studies.
What do you think 'cause like with the, if you're noticing
increase in blood glucose with patients that are consuming more
seed oils, is that 'cause there's no carbohydrate in the,
so it's just is that just an acute form of inflammation
that's causing that glucose response?
That's I wonder, yeah, it's somehow impacting insulin
resistance. And for some people, I think
like you point out, the inflammation component there is
very interesting. A case report was written in an
individual with Crohn's disease and they reversed his Crohn's by
putting him on an animal food based ketogenic diet and they
removed all seed oils from diet and were very strict on that and
even things as far as avoiding certain spices like cinnamon
that had oils in them. So they truly just wanted animal
based only and he had an extremely leaky gut so that you
can measure that by having people take certain proteins in
and you can see which proteins go through the gut barrier.
And his was entirely reversed and inflammation gone by
consuming only animal products. Yeah, that is pretty compelling
indeed. I I think the jury is still out
on the seed oils and and to what degree they are contributing
towards the obesity epidemic for sure.
But for me, it's like you just simply look at how it's made.
The fact that they have to go through all these processing,
there's it's deodorized, it's rancid.
Like if if it was not deodorized, you wouldn't even be
able to get it past your nose to consume it in the 1st place Like
that just doesn't seem like something I would want to eat on
a daily basis. Yeah, that's that's exactly you
look at the if you've seen pictures that are manufacturing
plants and they're just this enormous industrial complex and
they go through yeah like you mentioned deodorizing and
several other heavy heavily processed.
So I I do tend to focus more towards whole food as the goal.
I mean I definitely use and for patients especially as they're
initially starting a low carb ketogenic diet, do use
replacement products, replacement low carb foods to
kind of help when the cravings hit Or if they're in a situation
where people are eating cake around them to use a low carb
replacement that maybe does also have some of that heavily
processing. And I acknowledge that's
probably not a health food, but if it's helping them maintain
their ketogenic lifestyle over time, you can slowly start using
less of those replacement products and that's that's the
goal of working towards more all natural whole food, less
processed things. Yeah, 100%.
I mean, I feel like, you know, if if somebody was to come into
the space having not known anything and following the
standard American diet and everybody was just hand them all
the information, things they needed to avoid right off the
bat, it would be incredibly overwhelming and not likely
sustainable. But finding stepping stones
where they can just gain some momentum and make it sustainable
is key. And if you know, if it's better
than what they were consuming the day prior, then it's
certainly a step in the right direction.
There shouldn't be this, you know, food judgment that's going
on in the space right now. Like people just need to get
better than they were yesterday. Absolutely.
Oh, I love that. Better than you are yesterday.
Totally. So you like what does your
day-to-day look like? Are you primarily working as a
clinician with patients or is it more on the research side, like
what? What does that look like for you
on a day-to-day? Yeah, so I am blessed in that I
now have a 5 month old and his his name is James and he's just
the the light of my life. But I I get to hang out with him
in the morning before my nanny arrives.
And then once my nanny arrives, I start seeing patients and I'm
just part time seeing patients. And so I do that four days a
week, and I have blocks cut off every couple of hours so that
I'm able to go downstairs and actually continue breastfeeding.
And then on part of the days when I don't have patients
scheduled, that's when I'll do a little bit of research during
the middle of the day. But come 4:00, my nanny leaves
and then it's back to getting to just hang out with James for the
rest of the day. And yes, it's great.
What? What is your typical patient
avatar like? What are they generally coming
to you for? Yeah.
So I see almost two separate kind of patient populations, but
a handful of patients that are looking to improve their
metabolic health and specific kind of focused on weight loss
and often times diabetes or hypertension kind of other
metabolic issues and coming in for a weight loss program.
So we have two different programs you could come in for a
six month kind of high, high accountability.
You're having weekly appointments with myself for the
health coach for that six months.
And then the other program is it's just seeing me and we can
we might have you know five or six appointments maybe a little
bit more during that first year and that again it could be
people who are focusing on weight loss.
But also, and I I really like working with both populations,
but people who are already healthy but they're trying to
optimize their health, trying to figure out what is that next
thing I can do. I feel like I'm already eating,
right? I'm doing some exercise.
What additionally can I add to age better and to stay active as
I get older? Because that's, I think
something that is underappreciated is sarcopenia,
which is just a loss of muscle mass and function as we get
older. And it is so prevalent now that
we have to see people who are suffering in their later years
because they just don't have the muscle to actually be able to do
the things they want to do. What would you say the average
age of the demographic you're working with is?
Oh, that's tough because I see people all over the place, but
it's maybe 40s to 50s. It would be average, but I see
people in their 20s as well as in their 70s.
Are those older demographics, are they starting to come to you
proactively asking about keto and low carb, or is that
something that they're just not familiar with at all?
Some of them are actually wanting to use low carb keto and
I've had a few that have. They've started on their own,
but then kind of want some additional guidance or
accountability. And definitely in the
demographics where it's kind of this the 70 year olds often
times it's wanting to figure out how we can make these final
hopefully, maybe hopefully several decades, but these final
years maintain their level of activity and functional ability
during during that time. And a lot of that is I think
actually trying to like you mentioned earlier but get people
resistance training. So you've got to muscle mass and
strength is just going to naturally decline with age and
it it it increases definitely over 50 and then even further
over 60. So really trying to help people
get resistance training back into their lives.
Have you noticed that a lot of your older population is just
simply not eating enough food in general?
Like I think of my own, you know, grandparents and my my mom
and she just often times was not eating enough.
She is now because I've kind of talked about this, but so many
of the older demographics especially that the women, they
just, they don't move as much, they're not as active, they stop
eating as much and that obviously contributes to the
sarcopenia as well. 100% You know, I initially I always ask
people what they're eating on a daily basis and each meals,
snacks, all that stuff. But almost inevitably they're
not getting enough protein in their diet and they're not
getting enough protein in a single sitting.
Because there is, as we get older, we developed this
anabolic resistance where we basically, in order to trigger
muscle protein synthesis, we need to consume a higher level
of protein in a single sitting. And often times that's just hard
for them that you have to actually work with them to
increase the proteins at A at a given meal.
And most of the research as of late is showing that to be about
30 grams, kind of as a a rough minimum.
Yeah, that's what I've seen as well.
Yeah it's it's crazy cause like I think of what I eat in a
day-to-day basis and I could put down, I could put down a lot of
protein without even batting an eye.
But so many people just under eat and they're eating all these
a lot. A lot of the older population,
they're they're turning to like boost shakes or something like
that, something that says contains 8 grams of protein with
an exclamation point. And they're like, oh, I'm
getting my protein in for the day, but it's like not nearly
enough in a sitting, not nearly enough for the total day.
There's just so much ignorance around what adequate nutrient
intake is. And people are especially like
as they age, they they lose muscle, they gain body fat, and
they want to lean out. So they kind of eat less by
default. But they're not eating any of
the right foods by default. So it just is a downward spiral
that plagues them for years. Yeah, I I couldn't agree more.
The, you know, I was thinking like you mentioned your mom, My
mom as well, I've talked to her about this, this I'll tell her,
hey, you need to eat 4 eggs to get close to about 30 grams of
protein. And she looks at me like I have
to eat 4 eggs at once. And meanwhile, you know, I'll
eat 6 eggs at a time and my husband will eat six or more.
And in addition to the other food we're having alongside
that, but it's people wouldn't bat an eye about eating, say, 2
slices of pizza and two slices of pizza if you decide to equate
the calories you're going to be eating.
I mean, you might be eating 12 eggs depending on how large of a
slice of pizza, or maybe 6 to 8 eggs.
But there's also, I think, something been lost there with
just our processed food. Do you notice more pushback from
that older demographic when it comes to increasing dietary fat?
Because I feel like so many of them are steeped in that old
school way of thinking of you can't eat fat or else it's just
going to make you fat. Yeah, I think it just needs a
little bit more education because it is true there.
There is that concern there. But I have a PowerPoint that I
like to go over with patients. It's really the carbohydrates
that are driving your insulin levels to go up, which are going
to be driving storing fat rather than fat, which actually has a
very minimal response on insulin will not be driving that
process. And so usually once we go
through that, they're OK with trying to alter their diet that
way. How do you get them to cut out a
lot of the the sweets, you know like these?
Again I keep going back to the older demographic, but I feel
like you know we all, everyone listening to this has parents,
grandparents, great grandparents that we'd want them to get
healthier but they they seem to be the hardest population to
educate. I don't know if it's just
because they're just they're they're steeped in their own
ways of thinking they they've got their own pattern routines.
But in family especially family is the hardest demographic to
get this shift. I mean, how have you, how have
you navigated those waters? Yeah, I think just often times
it's starting with finding replacements and you know if
they if someone says I can't live without that food, then
that's a food you really typically want to get out of
their life and but then find something that they can replace
it with. Because if you just try to say
you're never going to have that again and you don't give them an
alternative and that's really hard and it's probably not going
to be going to work. So that's the the first thing.
And then often times, you know, I think I've, I use a lot of
continuous glucose monitors. And when my patients put those
on and they see what these foods are doing to their blood sugar
in real time and they see the monitors kind of spike up, they
realize wow this is not good for my body.
I'm going to try to remove that food and then they can go have
the alternative and they see that their sugar stays nice and
flat and that that is some great motivation.
When it comes to the CGM's, I'm a huge fan of CGM's.
I don't have one in currently, but I'll I'll throw one in
whenever I'm doing any type of experimentation and mine always
stays relatively flat as well. When you're when you put ACGM on
someone that's not following a low carb diet and they do
experience a spike but then it has a healthy drop afterwards
because their body is insulin sensitive and doing as it
should. Is there like how would you have
a conversation with them around that?
Like do you try and suggest that it's better to to not have the
spike in the 1st place? Or if it's responding as it
should, you just kind of let them go about their ways?
Yeah. So it depends if they have pre
diabetes or diabetes then even if their body actually responds
fairly quickly then I'd still say hey we've we've got work to
do. And same thing.
If we see a lot of insulin resistance either through
checking something called an LPIR but a lipoprotein insulin
resistance score or their fasting insulin and their
fasting insulin level is really elevated then their sugars they
might respond and look OK but we know that insulin is actually
still damaging their body. So kind of explaining that
they're still having damage done to their body even if that
monitor is showing an OK, a healthy looking response.
Now say they have no signs of insulin resistance and they are,
you know, they're healthy, they don't want to go keto
necessarily If they're not having big spikes over kind of
40 points is what I've recommend, then I'd say hey,
it's it's looking good. And the reason I picked 40, I've
talked with several other docs and a researcher who's been
studying diabetes for decades is on the initial Accord trial.
But we think 40 is a safe guess because we really don't know
what is the acceptable or what is the optimal increase that is
not going to be damaging the body when you eat carbohydrates
because we know there's going to be some increase that's that is
normal. But there is some data
suggestive that if you have blood sugar increases above 65
points that that is causing damage.
So even if you have a normal A1C, but you're having that much
glucose variability that it can increase risk for heart disease.
So if 65 is damaging, hopefully 40 is safe until we have more
studies done with. Now, I think as prevalent as
continuous glucose monitors on these studies will be done,
probably not in the too distant future, but that's that's my
typical approach to people. So generally speaking, a healthy
glucose range being between 70 and 90 for instance, so not
exceeding 40 beyond that baseline at any point.
Yep, exactly. Gotcha, gotcha.
Yeah, I'm constantly trying to get my family to prick their
finger or use ACGM just to enlighten them.
I feel like if they're if they see the date, if they see
something reflected back them on a screen, that can be incredibly
empowering, especially if they're not really well versed
in low carb keto, how it works. But they could just Simply put
them their arm, eat as they normally would, but then
retroactively look at what the data is showing.
It kind of opens their eyes. Yeah, yeah, because that's, I've
seen many people who, you know, they're an A1C of 5.9, so it's
slightly elevated in the pre diabetes range.
They put on ACGM and they see the oatmeal they're eating as an
example, bumps them up to 180 or 190 and for them it's not a big
deal. That's an eye opener and they
just switch from oatmeal to eggs.
And even that little change right there can be enough for
some people to normalize their sugars.
What are some other signs and symptoms apart from blood
glucose? Like if somebody is honestly, if
somebody is not overweight. And I feel like with the people
that are not overweight, they are often times more blinded to
the fact that they may be not optimal because there's no
outward expression of that in the mirror that they're seeing
every single day. So what, what are some other
signs and symptoms independent of being overweight that you
would suggest people kind of take proxy of?
Yeah. So if blood pressure is rising
that that's something if you're checking labs, the insulin level
you can definitely still see rising even if they're they're
not overweight. The CGMI think is still one of
the best features or tools in individuals like that.
I mean, my mom is a perfect example of she has, you know, a
BMI of probably 21 and when she put on a CGM, she was seeing a
lot of variability with what she was eating sugars hitting the
200 point, which would be a diagnosis of diabetes.
If if you're having symptoms and sometimes people can get what
you call acanthosis. Nitricans, which is darkening of
the skin folds underneath armpits or behind the neck.
Skin tags can also be a sign of insulin resistance.
And then other labs you can see the liver enzymes start to go up
so math will be or massively metabolic associated fatty liver
disease. We also see that individuals
with normal BM is, but are eating kind of the typical
standard American diet or a lot of higher sugar, higher
carbohydrate foods. Gotcha, gotcha.
What about as far as the CGMS go?
Is there like a specific brand or company that you tend to
point people through? I know there's been several that
have popped up lately, like Nutrisense levels.
Is there like a good user friendly one that people can
just be directed towards? Yeah.
So those are both great if you know you pay for the monthly
membership, you actually get feedback on your what's
happening with your blood sugar responses if your doctor will
prescribe you one and you don't necessarily need kind of that
program associated with it. The Dexcom or the Freestyle
Libre are both great. The Freestyle Libre is typically
much more affordable when insurance does not cover it.
You can get it for about 75 to $100 per month and each sensor
lasts for two weeks and that's if you when you go to the
pharmacy you say hey I'm paying out of pocket I'm not paying the
the with my insurance company as they will not cover it And if
your doctor does not feel comfortable prescribing you a
CGM because you maybe you don't have diabetes, you're not on
insulin, then people can actually go into the doctor tro
app and you can order ACGM from us on the app.
We have to have one face to face visit just to give let people
know some risks and benefits required by state laws.
But after that, if you want to keep on refilling it, there's no
more visits required and we can keep on sending you the CGMS.
And that's with the the Freestyle.
Can we do it with the Dexcom as well?
Just with the freestyle. Gotcha.
Well, shoot, I might. I might have to do that because
I've got I've, I've used the freestyle several times.
But that would be something that I would totally do for my family
and friends. Like, just simply, proactively,
hey, look, here's the CGM. Slap it on your arm for two
weeks and see what happens. Yeah, yeah.
It's really I just there's not another tool currently that we
have available where you can get that type of immediate feedback.
Yeah, you mentioned that you have a 5 month old son named
James. Talk to me a little bit about
how you've approached his nutrition through your pregnancy
and breastfeeding. Like, how is what you know now
about nutrition kind of shaped how you've started your
parenting journey? Yeah, so I throughout my
pregnancy and postpartum while breastfeeding, I've been low
carb and probably I don't know the percent of time in ketosis,
but because I only check my ketones periodically, but most
of the time when I would check them, I'm in some mild level of
ketosis, maybe .5 to one, and I just eat.
I make sure I get enough protein during my pregnancy and still a
while now, breastfeeding. I'm probably getting close to
150 grams of protein a day and that's through rib eyes, ground
beef, salmon, sometimes chicken. And then I do eat non starchy
vegetables and salads and sometimes it's just the quantity
of non starchy veggies that will sometimes bump me out of ketosis
and James. There was one point during my
first trimester where I actually had the most intense
carbohydrate cravings I can remember truly ever having.
And I did have a little bit of carbohydrates for about 3 weeks
during that first trimester. And then after those cravings
passed, I went back to low carb in ketosis and and everything
went great. I you know, I'd never developed
any leg swelling. I played tennis up until 38
weeks pregnant. I played on a tennis team until
32 weeks pregnant and it was after that 32nd week I decided
to stop playing in matches and and then the delivery and I was
very fortunate. Everything just was, you know,
very smoothly and now with breastfeeding it's been going
really good and he I'm still been in ketosis for probably
most of it and he just seems to be thriving on that.
Yeah, it's it's crazy that there's so much information out
there suggesting that, you know, pregnant mothers should be
consuming these excessive amounts of carbohydrates in
order to further the development of the fetus.
And it's like I I don't think that's the way it works.
I mean, like my wife Crystal, she was keto all throughout
pregnancy as well and has been all throughout the the
breastfeeding. And our son is in like the upper
99th percentile of all the growth metrics.
It's like I don't know where that misnomer came from, but it
certainly doesn't seem to be the case.
Yeah, and it's it's really interesting.
I actually there's a something called lactation lab where you
can send your milk till you get analyzed.
And so I wanted to just do some testing and I'm still in the
process of a couple other tests. But I wanted to test what the
composition macro nutrients of my breast milk when I was in
ketosis versus kind of lower carb versus kicked myself out of
ketosis. And the if you look at the K
cal's per oz kind of the average is about 20 K cal's per oz for
kind of your regular milk or the common formula.
And while in ketosis mine was 27 K cal's per oz and it was kind
of above the normal on fat and then upper limits of normal on
carbohydrate and protein. And then when I ate sweet
potatoes and had some grapefruits got me out of
ketosis, the the fat content dropped was cut in half,
actually still in the normal range and the fat and or in the
carbohydrate and protein stayed still kind of in the upper end
of normal. Because I still.
I think I was getting close to 150 grams of protein even though
I was just adding extra carbs in and the cacals per oz dropped
down to 23 compared to 27. So the carbohydrate content of
milk stayed the same whether you were consuming higher carbs or
keto. Yep, exactly, which I was very
interested to see that high carb count.
I was wondering if that would be impacted, huh?
That is interesting. Yeah.
We we've saved some fur breast smoke, so may have to send that.
What? What's the name of the the lab
company again? Lactation Lab and they actually
have a 20% off right now with the holidays.
Yeah, we may have to try that for sure because I'd I'd be
curious to see what that data comes back as because I look at,
you know, it just, it just makes intuitive sense like we are a
species, I mean we're monogastric species.
We're not really up regulating what we're consuming like a cow
or something would be. And you look at a a fetus that's
developing or some of this drinking the breast milk an
infant, it's like you really need to just prioritize the
quality of food that you're consuming for their benefit.
And if you're following a real food ketogenic diet, it seems
like that would be the most definite way to do so.
Yeah, absolutely. And that's James, his demeanor,
he's just he's such a happy baby and he, you know this first
month of life I think he maybe cried for a couple of minutes.
I mean there is and he now is just is the biggest smile and
he's so he's just happy all the time and I definitely think the
the nutritional healthy eating is helping that and he with his
milestones. I mean he, I have a picture when
he was a few days old he was holding his head upright.
I was just a few days old and you know he's continued to just
have really incredible muscle strength from that developmental
standpoint. And I, you know, could be
genetics, but I think there's also definitely got to be some
the fact of the way I'm eating and therefore his nutrition.
So at five months, he does not likely have any teeth coming
through yet, right? Yeah, no teeth yet.
We've we gave him just like a lick of peanut butter just for
hopefully decreasing chance of allergy.
There's about maybe a 5% reduction in some of the studies
if you look at in developing an allergy if you introduce those
more allergenic foods early on. But his first real meal, our
plan is going to be rib eye. Nice, nice.
That's a good first meal for sure.
Yeah, Rigel's eating like steaks and eggs.
He eats the exact same things we eat, just in smaller quantities.
Cut up into smaller pieces, obviously.
But this idea of there needing to be a baby food or an infant
formula are just something separate from.
What we as adults consume boggles me like if it if it
fuels us properly, it's going to fuel them properly.
I am totally with you. That is our plan all the way.
We we are, you know, eating healthy, whole, real food like
you are. And he's going to do the same.
And that's there's a lot of processed food now that's just
geared towards kids or fortified with different things.
And recommending cereals is kind of some of the first
introductory foods to kids, and it's the the nutrition content
of those is just not the same as the animal products.
Yeah, I mean, you got a ways to go, but have you kind of thought
about how you're going to mitigate against him just eating
everything that he does at home, but then going out and, you
know, going to school, going to daycare, going to social
settings outside the home and not having that control?
Like how do you plan on navigating that?
That's a great question. I think we're still trying to
figure it out. We, you know, we want to and
hopefully just instill in him that we're eating healthy food
to make our bodies strong. And so the other foods are not
going to be making his body strong.
And if he can focus on, I've just eating things to improve my
body's health. And you know, at a young age, if
we can start getting him to think about things that way,
hopefully that will just make him less likely to be tempted.
But I think it is going to be really challenging.
We'll probably have to do a little bit more figuring out
things when when he is going to school and has the option to eat
all those things. Now, I've heard other people who
have, they try to help make their kids have associations.
So say they went to a birthday party and they ended up eating a
lot of cake and pizza. And then they have a stomach
ache later and say, you know, what led to that stomach ache?
What did you did you do something differently than you
usually do? Oh yeah, I ate the cake.
And just trying to make them make the associations of how
their body feels based on what they're putting in it.
How young is too young to slap ACGM on a kiddo?
Oh man, that's a that's a great question.
I don't, you know, with James, I think I I don't see myself
putting one on him anytime soon. I think Tro's, I want to say,
one of Tro's kids did, he wanted to put one on, I want to say
around nine years old because he was just very curious.
So I think if James saw me wearing one, which he definitely
will see me wearing them and was curious, I'd be OK with that
because I don't think there's going to be harm from it and I
could just help educate him what he's seeing on there.
Yeah, I think that would be super cool.
I mean, like if if you can kind of parent in such a way that
makes that seem like a cool thing.
So like if they're out with their friends and they they've
got CGM on and you obviously don't want to make them
obsessive or like, you know, fixated on it in a negative
light. But like if they can just simply
look at that and be like, OK, this is this blueberry muffin
that my friend's mom made that's full of sugar.
It's probably not the best thing for me.
I think just giving them that as an option and empowering them
would be great. Yeah, yeah, I I love that idea.
And I think I'll probably let him kind of make the decision of
if, if and when he wants to try one on.
But I I'm sure seeing the excitement and the fun that I
have with it, it's he'll probably be curious to try one
at a fairly young age as well. Yeah, totally, totally.
Well, what is in the the pipeline for you?
What studies have got your interest?
What are you working on that's specifically exciting?
Like what, what? What's got you stoked right now?
Yeah. So right now the Society of
Metabolic Health Practitioners, the and you find out more about
them about the US on the smhp.org.
I'm a board member of that society.
But we have now, we have now have an Official Journal, the
Journal of Metabolic Health and this is going to be focusing on
therapeutic carbohydrate reduction, so low carb keto, but
the actual hopefully either case reports, prospective trials,
case series on different medical conditions that TCR benefits.
So there's so much data now coming out there, but there's
not an Official Journal really or there wasn't prior to this
that emphasize this. So I'm very excited that this is
now it's set up and we are actually going to be having, we
have, we still have to submit to the journal, but we are
hopefully going to be having a a rebuttal published to the
American Academy of Pediatrics paper that was just recently
released on implementing low carb for children with type one
diabetes, type 2 diabetes or at risk.
So children with obesity and they basically medicalized low
carb eating to such a degree that if I were a doctor not
trained in this area, I would never recommend that diet for of
the patient. Because they said you needed to
check their the child blood work five different times during the
first year that they started a low carbohydrate diet.
And they had you check 14 different blood markers of
concerns and deficiencies. And these included things like
carnitine and selenium, which carnitine you're the primary
source of that is actually from animal products.
And so the idea that going on a low carb ketogenic diet would
lead to a carnitine deficiency is just silly.
And the how this happened was the studies that they were
citing in their paper were based on primarily 4 to 1 ketogenic
diets, meaning diets that are made-up of 90% fat and only 10%
protein. And these are some of the kind
of earlier initial main diet used for children with epilepsy
who must have very high levels of ketones to keep their
seizures in remission. But because of that very high
fat, much lower protein content, you do have to worry about some
nutritional deficiencies and you have to be cognizant of that.
But on a well formulated ketogenic diet, you really
should not have to be worried about that.
It is a very nutritionally dense diet of whole real food and you
can still eat your non starchy veg cheese and you can still
even eat some fruit and maintain great improvements in metabolic
health for children with either type one type 2 or at risk for
diabetes. And so we, we wrote a rebuttal
to kind of go over some of the different concerns they brought
up and kind of explained why they're not valid and we need to
actually really reconsider this. So hopefully that'll be
published in the not too distant future.
And and then I'm also working with TRO right now on our, we're
making data, one year data from a cohort of individuals.
We've been working with this employer program and with it was
less than about 100 patients in the past year.
We've had about 3000 lbs of weight loss, so that that's
really exciting. And there's some other pretty
cool improvements as far as stopping think over 70
medications while having improvements in their A1C, in
their blood pressure. And so we'll be presenting a
poster at the Symposium of Metabolic Health in Boca Raton
in January. Nice, nice.
That's awesome. I'm super excited about seeing
that information. Yeah.
Thank you. When when you like, if you were
to step back and look at all of this from a 30,000 foot view and
you, you look at the cause, like when you look at diets and
dietary trends, you know you see things come and go.
You see these hypes form and then fall off.
And a lot of people assume the same is going to happen with
keto. But I feel like from a a medical
standpoint, there's just this overwhelming sea of data and
research studies being done that all cater towards a well
formulated ketogenic diet. And I would think, and I would
hope, that as more legitimate medical scientific research
comes to light about the benefits of a ketogenic diet,
the general public will start to see it more as an efficacious
way to go about eating, as opposed to some dietary trend
that comes and goes. Yeah, I think you are on track
that it's in the early 2000s when Doctor Westman really
started doing some of these studies with kind of showing
that a ketogenic diet is safe and effective and kind of for
metabolic health. The from there it's just
exploded and we're seeing case reports of Crohn's disease,
ulcerative colitis, so that's inflammatory bowel disease.
There's so many anecdotes now and we need more of these
anecdotes to actually be written up as case reports but of
different autoimmune conditions, rheumatoid arthritis and
psoriasis. Just kind of debilitating
conditions being reversed entirely on a ketogenic diet and
for some individuals even go into a carnivore diet having
this amazing improvements in their health.
And I think 1 area that I'm excited about and will actually
help maybe have the the public become more accepting of this as
well is if we can get the medical professionals as trained
in it. And when I went through medical
school, we had a two week nutrition elective that was just
very underwhelming. And if we can actually create
and we we did actually in our residency, me, my husband and
another one of my Co residents, we created a nutrition elective
that people would take that was a month long.
That started with how did we get here?
How did the dietary guidelines come about and how do you
properly analyse studies? Why are those studies that said
red meat causes cancer? Why are they not valid studies?
And then went into low carb nutrition and the benefits that
it can have on the body. And another resident actually
took this course and since then the other resident has stayed on
his faculty and she is continuing this forward and is
continuing to grow it. And if it is successful and
residents continue to take it, provide positive feedback, then
potentially that could spread to other residency programs in our
area, other medical schools almost like a grassroots
movement of getting low carb nutrition accepted from the
ground up. Yeah, that.
I mean I think it's definitely going to be a grassroots
movement, but seeing how much has come to light from the
medical space, from the scientific community, I'm
hopeful that it just keeps making itself more mainstream
and that trajectory continues to to go as such.
Because I mean like the the anecdotal data is hard to deny.
And I just speaking for myself, like how I feel and perform on a
day-to-day basis is night and day compared to what it was when
I was following the Standard American diet.
And yeah, the more people we can get to move in that direction,
the better. So hats off to you and the
people in the medical space that are, you know, boots on the
ground, working with patients, working with clientele and
making a difference. I feel like that is what it's
going to take. Yeah.
Thank you so much. And I mean it's what you're
doing with this podcast as well and the information you're
helping spread and get out there and that's it's also I think
really going to be so important to to just increase awareness.
You know, another area that is just want to bring up because
it's so exciting is this work that Chris Palmer is doing and
he's yeah, the work in the mental health field showing so
much significant improvement and bipolar, schizophrenia,
schizoaffective and other mental health conditions is just it's
really incredible. It truly is, yeah.
I think I've, I've seen him speak at a few different
conferences now and there there's just so many different
angles that that this is coming to light from Now you get it
from a a diabetic standpoint, you get it from an overweight
and obese standpoint, you've got it from a psychological
standpoint. Now with Chris Palmer's work,
you I'm, I'm trying to move the needle from a performance
athlete standpoint realm. And.
Like, I feel like the more people from all these different
facets of life that are showing the benefits of this way of
eating, like you can't ignore that forever.
Yeah, yeah, that's. It's one of my mentors, he he
said. It's so unbelievable, it's
unbelievable. But as as the data accumulates,
I think you just you can't, you can't deny the data.
Yep, 100%. Well, Laura, I can't thank you
enough for taking the time, sharing your story, talking
about the, the demographic that you've worked with and just what
you're doing in the space right now, what you've got coming with
this research study and just how you're educating people.
So huge appreciation there. Where do people go to find out
more about you get plugged in and just see kind of what you're
working on on a day-to-day basis?
Yeah, so you can find me on Twitter and Instagram at Laura
Buchanan, MD and I've got a sub stack
agingsuccessfully.substack.com and then if you go to
doctortro.com if you're we are a telemedicine practice and are
accepting patients in about all 50 states, so would love the
opportunity to try to help improve your metabolic health.
I love it. I'll link out to all those, make
it easy for people to find you all totally separate question.
But how do you like sub stack like when it comes to different
mediums to relay information like how is sub stack compared
to the others? I I've enjoyed using it, I've
just only follow a few people right now.
Anita Tyshols as a great sub stack, so I haven't delved into
it honestly a ton compared to say Twitter, but I have my
little experience in it. I I have enjoyed using it.
Nice. Well, I will definitely have to
check that out myself and see how it works for sure, because I
don't even know how to use Twitter.
I'm kind of, I'm kind of behind the 8 ball in some of this
stuff, but awesome. Thank you so very much Laura.
I can't thank you enough. I appreciate your time and keep
making a difference in the world out there.
Thank you so much. It was my pleasure.
Have a good one all. Right, you too.