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So my name is Dr. Paul Mason and I'm an exercise and sports medicine physician. Today I want to take you on a journey to explore the science behind low-carb diets and the process. I want you to take something away. First, we want to debunk the low-fat, low-calorie hypothesis for weight loss. I want to tell you that low-carb diets are actually good for longevity. People live longer when they eat low carb. And the sugar in sugar has some particularly unique and toxic effects on the body. So to start our journey, I'd like to introduce you to one of my patients. Now, this is the kind of patient I have as a doctor.
I like that she's very accommodating So she first came to my clinic with joint pain She's overweight, very clear To both of us that if she could lose some weight it would help her get her strength back So we had a chat and started talking about her current weight loss attempts It seems like she has a very traditional way Most doctors advise: Eat less fat Let's hear it in her own words I'm doing everything low fat and you see my fridge full of low fat cheese No oil touches any pan in my kitchen All the meat is as lean as you eat I eat Salad and I'm starving You work out like crazy six days a week I'm doing these classes. I'm doing back to back classes. So our popular class is followed by a pump class and Six days a week. So I felt very guilty on the seventh day because I don't exercise like that She follows the traditional advice She blindly followed that advice. She's exercising She's eating low fat but the problem is it's not working.
At the time she saw that I was 30kg overweight and gaining weight. So when I faced this situation as a doctor I had to ask myself Who is in charge? Who is to blame? So patients follow the medical advice they are given So is the patient or the doctor or medical professional giving the advice? So I think the doctor or medical professional is to blame Because the meaning of the suggestion is this If you are not losing weight you are lazy, you are greedy You just didn't try hard enough But this premise ignores key elements to understanding weight loss and hormones The traditional assumption of "burning calories" Ignoring the powerful science of hormone action So we have a lady here. She is 35 years old and has a problem called cortisol hormones She has just gained weight That's how she was given no more advice about exercise when her hormone problems were treated She was not told to eat less. We fixed the hormone problem and the weight problem went away The boy is three years old here.
He weighs 42kg and has a problem with the hormone leptin At the age of 7 he lost 10kg and was at a very healthy weight See what happens when you fix your hormone problems Most common now Hormones in people that cause obesity None of them, it's called insulin This lady has an insulin problem but she has a unique problem Her pancreatic tumor secretes insulin And pumps it into her circulation In this picture She is 107kg and only 152cm tall So she had surgery to remove the tumor which lowered her insulin levels Now these pictures were taken 50 days apart Her weight dropped to 89kg She lost 18kg If we look at her weight loss graph You can see she lost 14kg in 10 days Clearly there is an insulin problem here. makes you fat Now this patient also has insulin problems. This is one of the patients I saw here 46 years old, 20 years old Here's what happened when we fixed her insulin problems and she lost 40 kg Here she is about 8 years old The biggest difference is that she did not have surgery to fix her insulin problems. We changed her diet So you may ask how the diet on God's green earth led to such drama Changes in insulin levels
can make you lose a lot of weight. Let's take a look then. This is a picture The height of the line represents the amount of insulin your body releases And each line looks like this It represents one of the three main sources of energy in our diet: carbohydrates protein or fat So let's look at carbohydrates. Let's see what happens when you eat carbohydrates at your insulin level This is called the area under the curve and you get a huge sum Prolonged insulin release for over two hours Let's look at the same amount of energy in protein This is surprising to many less fat. So consider that high insulin levels are associated with obesity Carbohydrates are the most potent stimulator of insulin release in our body So in order to lose weight we need to control insulin levels We need to control carbohydrate intake Now we can do a broad classification Here on the left side eats in one of two groups We have what's called a low carb diet, on the right We have low fat diets and we tend to be higher in carbohydrates Because the energy has to come from somewhere So let's take a look at the evidence Comparing these two types of diets in terms of weight loss Between 2003 and 2018 There are 62
randomized controlled trials published Compare low carb diets under 130 grams per day low fat diet for weight loss 31 of the studies were statistically significant What does this mean The results are unlikely to be a fluke You can believe them So what I've done here is plotted these 31 studies that are statistically significant There's no cherry picking here I've compared the average weight loss of the two diets Low carb diets are shown in blue and low fat diets are shown in red And you'll notice that in each of these studies we had a low carb diet Cause more weight loss than a low fat diet So the question is which horse are you going to get back on? now let us shift a little bit, look at fat, look at how insulin makes fat tissue grow because if we understand this, by the time you're 2 years old, we can understand the causes of obesity every single fat cell that you could have so if you gain weight after the age of two that's because your fat cells get bigger, not because they multiply so if we can figure out what makes individual fat cells bigger then
we can determine what makes you fat So what I want to show you here is what you can see How to circulate these blood vessels are closely related to each blood vessel Each fat cell now understands this hormone Released by circulation and because of this relationship with the blood vessels It can be delivered to all the fat cells in our body These blood vessels also contain fats called triglycerides you can see here These wavy lines are represented there. So weight gain is these triglycerides In fat cells, the fat cells become larger.
The problem is that this triglyceride molecule is very large it's made up of four different parts You have this glycerin backbone, and then you have three separate fatty acids and whole molecules cannot enter the fat cells It has to be cut up first, and that's where insulin comes in so you can see on the left we see the triglyceride molecule It's then converted to glycerol and fatty acids it's been cut up and LPL lipoprotein transfer lipase This is an enzyme stimulated by insulin So once the fatty acids are released they are able to cross over and store the fat without the need for insulin to activate You can't store fat with lipoprotein lipase. If we look at the top there You can see that glucose can also enter the fat cells It does so through a little gate or transporter Gluteal Transporter 4 Again insulin is responsible for activating this transporter Once the glucose enters the fat cells it converts to glycerol Glycerol will combine with fatty acids So you have a whole molecule of triglycerides This is the stored form of fat Now if you want to actually burn this fat you will do more damage As you know it has to be cut up again to leave the fat cells It cannot be cut through the fat cell membrane It has to be activated by or cleaved by an enzyme called hormone sensitive lipase Insulin releases this enzyme So you end up with a triple whammy Lipoprotein lipase and
gluten tetratransporter are activated to fill the fat in the cells and cells then you have hormone-sensitive lipase deactivated That way you can't burn fat, so biochemically insulin is responsible for weight gain, So it turns out that insulin causes weight gain Let's see what happens to people who habitually inject insulin in the same site for a long period of time causes a condition we call lipomegaly The meaning of hypertrophy is now greater These two on the left and right Both gentlemen usually inject insulin Prolonged entry into these areas of the lower abdomen person lower right His preferred injection site is in the front of the thigh About 20% to 30% of people with type 1 diabetes will actually end up in this situation because they inject insulin dose
long enough no matter what happens For your perfect patient you know The guy who quietly followed the low fat exercise advice before he saw me Thirty pounds overweight Well we had a discussion she's on a low carb diet she gained weight By doing that she solved her insulin problem So this happened Three years after the last calculation She maintained a 80 pound loss Her waist has shrunk 11 inches here's her real picture. so Let's take a look at what carbohydrates are and can they cause a spike in insulin obesity. So starting to understand we have to look at what carbohydrates are Here we have a glucose molecule Go all the way to the middle there. We describe what we call complex carbohydrates carbohydrates you know you're eating brown rice Whole wheat bread You've been told is good for you it's made of glucose it's sugar carbohydrates are made of sugar when you eat them and digest them they end up in your blood raising your blood sugar levels
When you see Rhodes, he decides to eat some rice Glucose that made the rice rise in his veins and in response to this increase in blood sugar The pancreas is an organ tucked into our The belly releases something called insulin here And so this insulin works yes to delete sugar that we circulate It prioritizes our muscle tissue and liver tissue So if there's anything left stuffed in fat The problem is if your insulin levels are high long enough This creates a disease called insulin resistance We know when you eat carbs peak time you get this insulin If you usually do this six times a day Many people may have been advised your body goes numb Reach high insulin levels It's like walking into a room with a bad smell It's overwhelming at first, and after a few minutes you stop paying attention to it Just like insulin except it happens mainly in muscle and liver tissue so they stop consuming sugar Your body compensates by releasing more insulin
The body is then able to store the excess sugar in the adipose tissue So this actually explains why so many people come in they say you know when I was 20 I'm sitting on the couch and eating chips No exercise I'm skinny I've gradually piled on the pounds as I've gotten older Even so this still Health consciousness I go to the gym three days a week now I eat salad now So the reason why they gradually gain weight is because Over the years this has happened in 10 years or so they become insulin resistant We can actually test with my patients in my clinic We do a test where the patient will drink 75 grams of glucose Then we measure their glucose levels and insulin levels in 2 hours and we can actually Based on the results their insulin resistance levels have been assessed. So let's take a look So here red is the insulin level The blue line represents the blood sugar level So this is a metabolically healthy person.
We load them with glucose, two hours later we'll see They say your blood sugar is not higher than it should be and your blood insulin levels are not higher than they should be very healthy So in the first phase Insulin resistance or metabolism My health You'll notice that your insulin levels start to rise But it still does a good job of getting the sugar out of your blood So your blood sugar hasn't gone up If you have blood tests, a standard oral glucose tolerance test at this stage Your doctor will tell you that you're perfectly healthy. Don't worry about going home you'll be fine However, you already have the first signs of insulin resistance. You may already be gaining weight at this stage as you progress You've started to twitch a little bit. Even higher insulin And this stage Is what your doctor will say: oh, you're prediabetic You know, have you thought about doing a little exercise? Still not too concerned about the whole process So over time this blood sugar starts to destroy the cells in the pancreas releasing insulin So even though you are becoming insulin resistant you need more insulin and your body produces less So when your insulin levels start to drop you drop drastically Your blood sugar levels will rise and that's when diabetes is diagnosed So let's look at some examples So this patient is here Hypoglycemia low insulin levels Totally healthy. I like this comparison This patient may be a little bit mild here You can see that his blood sugar is very low at 5.6 in two hours But you can see that his insulin has gone up to 83 Okay,
we're starting to see insulin resistance here. We're starting to have problems Here you can see the blood sugar has now come up The insulin is a little bit higher again The blood sugar has gone up to 8.3. So what happens at a more advanced stage? Blood sugar 11.4 By the way, this is when diabetes is diagnosed on standard blood tests, Insulin levels have dropped The pancreas starts to fail Now say that's okay, well you're a doctor You can test for insulin resistance in the lab But a lot of people wonder if they have insulin resistance they can check for themselves And you'll be interested to know that you can see a lot By looking at the skin for signs of insulin resistance and I have a few patients here today you know I'm going to Check their skin These are called skin tags The most common cause of skin tags is insulin resistance if you have skin tags You're pretty sure you're insulin resistant A lot of patients tell me Well,
I went to see my doctor and asked why in one sentence I don't know but do you want me to burn them? They are a warning sign They are usually located in the armpits of the neck in the groin area This sign is called pay can ptosis nigricans Skin pigmentation we often see in the groin, armpit and neck or more interestingly on the back of the finger skin folds here and there is good research showing that even before you start gaining excess weight you can see Changes in the back of the fingers before anything. Now I can see some people looking at their fingers I see a lot of patients get involved their skin complexion we found that when we improve insulin resistance The ketogenic diet significantly improved reduces your insulin levels and the skin looks better. This is very cool. This is one of the reasons Acne is common in the state Puberty occurs because the state of puberty is associated with insulin resistance good news now should come we can actually change this Reduce your chronic insulin spike if you continue a low carb diet Your insulin sensitivity will improve
Check out this patient's insulin levels here three months later Huge drop Here's another example We can see that one hour insulin is 114 back to 71 in a matter of months There's also a good weight loss guide attached So I think it's pretty clear Low Carb Diet is the best diet for weight loss But some of you might still be worried that thinking too much and being skinny is fine But what if I kill all my saturated fat right? So let's look at The latest research on this topic so far. It was published last year It has over 135,000 participants They were followed for over seven years in 18 countries. This is a great study so we can see Death rate per 1,000 people with the lowest fat content under 7 years Let's see what happens to the group That is getting more energy from fat 3 times more fat your death rate dropped to 4 More fat lives longer If we look at the graph from the same study to demonstrate this your risk of death is the higher the axis goes the worse the effect you have is the right hand On the other hand as you can see it doesn't make sense having more fat being a problem It seems the more fat you have the overall death rate will continue to go down So now let's turn around and look at carbohydrate intake if you have 46.4 your
percentage of energy from carbohydrates The risk of death per 1,000 person-years is about 4 By the way, it is not a particularly low-carb diet, but it is very low Carbohydrates compared to a normal diet. Let's look at these populations that are growing in size 72.2% of their energy from carbohydrates The risk of death increases from about 4 to over 7 Contains more carbohydrates. Let's look at this image again The more carbs you have the higher your mortality rate You'll live longer on such a low carb, high fat diet Now this isn't a one size fits all diet Some people can have 80 grams of carbs a day Rhodes says your limit is 50 Others can have as little as 20 grams of carbs a day for optimal health We use something called a ketone meter to determine your ideal level of carb restriction Now the only difference between a low carb diet and a ketogenic diet is the level of carb restriction If you cut carbs enough to lower your insulin levels, you allow fat to be burned Some fat when metabolized is converted to chemicals called ketones
What to realize now is in the human body. The only source of ketones is fat metabolism No other So if you have ketones in your blood it's a sign that your body is burning fat So we can put a drop of blood on a meter in 10 seconds Now we have the answer. This is the scale that we usually use, it's also useful as an indication of your fat metabolism To satisfy your appetite, which we've found in the clinic over the last few years, those who have gone keto have hovered around a 4 or so. They usually say what you know I only eat twice a day now, I'm just not hungry This is borne out in research We know when your ketone levels are high It has a persistent upward effect so not only are you burning more fat But the first law of all thermodynamics equation "calorie in calorie out" You put less strain on the system So this actually fits perfectly with the conventional wisdom of "calorie burning" But it adds another layer. Start explaining how you can reduce your calorie intake Here is an example of a food diary Record ketones on the right, numbers on the side The reason we do this is because Recording
your ketones and comparing them to your food. You can really start to understand what foods stop your fat burning Let's zoom in a little bit So we can see here. We have some keto numbers of 1.1 which is good 0.7 is good. 0.4 is still good so we dropped it to 0.2 why? A small piece of sponge cake, okay probably not the best But that's okay because the next day they were back at 0.7 a slice of toast Drop it down to 0.2. This person is very sensitive to carbs and didn't do it They'll never know so now I want to get a little closer. look at sugar and It has unique toxic effects So we saw this glucose molecule on the left is yellow but the one on the right known as fructose when you add one of these molecules together it forms table sugar, sucrose you can see that Sucrose is
exactly 50% of fructose is important because a lot of people say we don't have a problem in Australia because we don't have high fructose corn syrup high fructose corn syrup only 42% to 55% of fructose so they are very comparable our table sugar here in Australia is just as bad as high fructose corn syrup now when we look at the sweetness of different sugars fructose is the cause of the problem it contains more than twice as much glucose and dextrose this is a problem because as humans we like self gratification we already have this pathway in the brain mesolimbic pathway this is the way we strengthen reinforce our behavior when we stimulate our brains with something sweet we have a chemical called dopamine it says yes do it again and fructose because it is twice as sweet as glucose it activates the pathway it activates the pathway more strongly when we sacrifice for the brains of obese individuals and look at the dopamine receptors we can see that the number has decreased dopamine receptors in the brains of people obese. So this means getting the same satisfaction from the meal Obese people need to eat more That's where sweetness comes in. Over time, this change will be inactive But the
The problem is that until they decrease over time, you should limit sweets in your diet. Now fructose has another particularly toxic effect. So it leads to insulin resistance. Fructose is much stronger than glucose, causing fatty liver. So when you eat fructose. Normally, about 80% of the muscle is taken up by the muscle and taken up by the liver. So it goes to the liver. And the liver has storage capacity because glucose has a substance called sugar that makes it set a little bit, so the energy that ends up in the liver then goes to the mitochondria in the liver. Only a fraction of what you eat, but with fructose, it will not go to other organizations. It does not have this reservoir where it can be occupied or stored. Every gram of fructose that you eat is sent to the mitochondria in the liver. When these mitochondria are overloaded, they produce fatty liver. The process is called DNA vaporization. Here is a slideshow of these little white balls have fat globules in fatty liver The superfluous fractals can do it This is closely related to insulin resistance Another question
is sugars can attach to proteins you have sugar Bathe your body and cells sugar over time can not only attach to it but can form these advanced glycation end products They can affect almost every type of cell and molecule in the body The thing is This fructose is seven times more than glucose Another problem with fructose When we look at the consequences of these advanced glycation end products They affect many of the tissues that we see in people with diabetes nerve problems We've already discussed how the pancreas starts to fail decrease its ability to secrete insulin kidney problems blood vessel problems you can go blind Arthritis is actually real Now just to illustrate the point These advanced glycation end products are associated with aging Here's a rib cartilage from the molar on the top left This is 2 weeks old from the bottom right 88 This is what typically happens throughout the life cycle This is very similar to how Maori reacted to Browning Caramelization if you're not exactly the same but along the same lines Over time The sugar in our
circulation changes Our organization and I have a problem. Why accelerate the aging process by increasing sugar levels? We now know that the most common source of added sugars in our diets is sweets Some may be surprised to learn that grains are one of the main ways sugar is added to our diet But sugar is also hidden in many foods Few people will realize that there may be a skewer of ketchup Much less sugar than the healthy teaspoon that they usually add But the real surprise here is in the bottom right corner. This is a medium mango juice 12 teaspoons half sugar and There are other ways to hide sugar. I have an organic almond milk here. Complete You can see the lactose-free soy. Gluten-free and free
sucrose. ok you feel good now Let's take a look at this ingredient Does it look good? Show people we think it doesn't look so bad Organic Agave Syrup you know agave syrup 75% fructose is even worse than table sugar. it's worse than sucrose this is here is a list name This sugar is disguised on Australian nutrition labels Euphemisms to allow food manufacturers to use these sugars on their labels make it very difficult Now some say but fructose is natural right? Maybe it is natural but we don't consume it naturally You wouldn't know it but this is the fruit tree on the left. It has no fruit. This is because fruit is seasonal We can't get fruit all year round if you
want honey Well you didn't go to Cole traditionally If you have his honey you have to ask the bee if the bee is in line So we consume fruit in a very different way. now we Have 500 mils of orange juice, containing 6 oranges and taken out all the fiber So other than that, don't drink your fruit. just don't drink your fruit Now I want to talk a little bit more before I finish This is artificial sweetener So we discussed them as a way for the Olympics to reinforce behavior and Artificial sweeteners are exactly the same When we look at the evidence All the cohort studies They
show that consumption of artificial sweeteners is associated with weight gain weight gain girth metabolic syndrome type 2 diabetes and heart attack Artificial sweeteners will not be approved So I want to leave everyone here There are three key points First: Being overweight is not your fault If you have been receiving bad advice critical Second: Low carb diets are the best diet for weight loss because they lower insulin After all People live longer on low carb diets thanks
Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Sydney 2018, #LowCarbSyd, Low Carb Doctors, Paul Mason, Low Carb High Fat, LCHF, Carbohydrate Restriction, Ketogenic Diet, Type 2 Diabetes, Weight loss, Obesity, Insulin, Blood Glucose, PURE Study
