Carbs Are Killing You! | Dr. Rob Cywes

it's not cortisol cortisol is your anti- adrenaline hormone it's trying to put out the fire everyone cortisol cor cortisol is irrelevant to me what's relevant to me is adrenaline David Diamond who's an adrenaline specialist his day job is to look at stress response and he will tell you that when adrenaline surges and is up all the time because we're stressed out adrenaline overrides both insulin and glucagon it's your fright andf flight hormone and it overrides the release of sugar so we get this massive sugar response then cortisol afterwards put out the adrenaline fire so we measure cortisol it's elevated but the problem is not cortisol the problem is [Music] adrenaline welcome to the plant-free MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining me for another episode of the plan plant free MD uh podcast uh today I have a very special guest uh Dr Rob syes um I hope we proun just thinking about that yeah I'm not even sure we say it right Anthony but Rob is the right way to go my father's Dr cus I'm just Rob cus that's it yeah so um well thank you very much for joining us I've uh I've enjoyed a lot of your talks I actually saw you at low car San Diego the the the syposium on metabolic health and I didn't get a chance to go up and and talk to you but I had planned to so I'm really grateful to get the chance to talk to you now oh it's wonderful to be here and I you know again Watch so much of your stuff I follow you brilliant stuff you're putting out there and particularly the number of guests you've had in the space are just phenomenal and the the insights and the information is just way over the top um just as an aside you know I I have a PhD it says so on my Shir over here but um the whole pressure to publish papers publish papers publish papers well if you're not able to publish papers because they won't let you do the studies because they believe it's malpractice to eat the way we do then the alternative answer is to do what you do which is brilliant which is have all these extremely smart people that work in the space come out and speak from their hearts give that raw information I think in healthcare it's important to be scientific in peer-reviewed papers but that process has been so bastardized and so monopolized that it is no longer true independent stuff and what you're doing probably is the best peer-reviewed work that exists so I'm very thankful for your space for your YouTube channel it's brilliant oh well thank you very much I appreciate that well I mean that's the thing you know I'm just I'm still learning things I want to talk to people that are that are experts in their field and you know add everything together and try to get as clear a picture as we can and you know like you say you know we have to you it's important to get things in in the peer-reviewed literature and get studies out there but at the same time what what do was what does a study do it helps you guide your life and if you're if you're looking at things and say okay well what's going to what is what do the study say what does the literature say on how best to to be a healthy person you have to take that and then you have to apply it but at the end of the day if it makes you less healthy if it's not helping you if it's not making your life better well then it doesn't really matter what the studies say it doesn't apply to you for whatever reason and then you try something else that says oh my goodness this study says that's a bad idea but you're getting better and you're objectively getting better in all different uh metrics blood work and elsewise well then you know for you at least that's a that's an appropriate diet and a way to go so you know that's how I I sort of take it yeah it's the end of one experiment and um you know we are each our own Crucible and we can do experiments on ourselves we always do but if you're objective about it you figure that out and the other part also as a practitioner working against what everybody else advises I have something called impostor syndrome which is where I doubt everything I do how can I be right and the entire establishment the plant-based eat more vegetables eat more whole grains and fruit uh eat less red meat establishment how is it possible that their narrative is wrong how can so many people in the space be wrong and so I don't believe what I do but every time I treat a patient and they come in and they're off their blood pressure medication and they're off their diabetes medication and they're feeling wonderful and their head space which is what I focus on very heavily is just they've got that Clarity and that optimism and that happiness that wasn't there before when they were trapped inside their own obesity that reinforces that this has to be the right pathway yeah I think so too and I I I have that same thought those same doubts in my head where I'm just like I really want I really don't want to be leading people astray I don't want to be led astray I don't want I feel amazing I've never felt better and this and this works when I apply this to my patients and my family but I really don't want to to hurt anybody and so I'm I'm constantly having conversations like these and constantly looking at things and people say well this new study should should put things on its head okay well I go and look at that study just to make sure I'm not missing anything so far nothing's shaken it but you know I I think it's important to not just be dogmatic and just say nope this is the only way and there's no other way you have to keep an open mind and and you have to fully accept that you could be very wrong and especially when you're when you're you're you're treating people and influencing people and and recommending things to people because it's it's just irresponsible otherwise I think I agree and and this is we've proven over and over again that this is safe and a lot of people will by the the greatest challenge in our space I think there two narratives that are are an issue or concern that still need pivoting the first thing is I think that we are trapped in uh a nutrition and a healthy I hate that word healthy food food because it's how you define it healthy food space which is OB which is more just the pragmatic what I eat and certainly with with illness um as opposed to health you've done this to improve your health I most of my patients although there have a lot of people that are super healthy in the space did it for that reason the majority of my patients are trying to escape illness and um the the issue there is not a dietary or a nutrition problem that's the first thing and I think that's something we can get into because I'm heavily focused on the mental health aspect of this and the Second Challenge is sustainability you know so many people did Atkins uh who was the Forerunner the right Brothers airplane of in the modern era of what um we do and everybody lost weight and did great but the reason we're now gone through paleo and keto is because while those things do amazingly well for a period of time people fail and everybody that comes into my practice is ultimately an expert at failing weight loss programs at failing diets and we have to have a different methodology because if you do the same thing over again you know the the story you don't expect different results so while the ketogenic space is just a an improvement in a modified version of Atkins and that's all it it really is but because it is the proper human diet as my friend kenberry says um there has to be something else that we are remiss and not addressing and that's kind of as I said Central to our management style in our office yeah absolutely and uh and you know as someone someone uh pointed out to me the other day that was that the ketogenic diets in general are are some of the most studied diets on earth and the most rigorously studied ones that have I would tell you they're the only studied diets yeah well there's too yeah there's not a lot of studies on other diets except for maybe a few weeks worth of them we're not getting robust data over years which nobody else really has effectively and and to ask I I have people in the um women's health study in the US patients of them and they call it these longitudinal studies um the Framingham studies and that kind of thing well there's a nurses study as well in the US I have one of those nurses is a patient and she says once a year they email her a questionnaire and she's supposed to recall what she ate in the last year and then that's the Bas that's the foundation of what they did uh which is just nuts and then we promulgate dietary advice based on their dietary call of a year in a little questionnaire uh that's not science Anthony that's that's uh manipulation of data yeah yeah definitely and yeah exactly and then and then they they classify things as as something you know how many times have you had fast food in the last week they're like oh that's all meat and pizza and lasagna and things like that it all counts as meat and it just lasagna and pizza are meat you must remember that in that study that was published by the Chan Public School of Health where they said red meat causes diabetes MH those were included you know but uh that's I did a video a little while ago that said water causes uh um therosis if you ignore the whiskey yeah right the same principle if you know meat causes diabetes if you ignore all the carbohydrates that go along with them that's what they did and they published that and because it's Harvard uh it got in there now Harvard's got some great people you did an interview with Georgia Eid a good friend of mine uh who wrote a psychiatrist so I I mean there's some great people there Chris Palmer who are shifting The Narrative but the Chan public school of health is probably at least in the space I work in the worst Advocates of healthy eating uh and most obstructive to what we're doing and their agenda is not driven by science and I'm I'm happy to say that and I'm happy for them to come after me if they want to as Tim notes did I'm happy to go toe-to-toe with the data yeah ABS yeah absolutely and that's the thing is uh you know we we are trying to flesh out truth and we are trying trying to talk about things in real terms and so we're not we're not afraid of those those discussions you know that that's fine that those are the discussions we want to have and so yeah well you know to to that end um you know for people haven't come across you can you tell us a bit more about yourself in your practice Yeah my name is Dr Rob cvis I have three levels at which I work um I'm a a practicing physici in what I call the metabolic Health space which to my mind is a uh an emerging specialty uh again mentioned Tim NOS when he was a young man and I was in his first physiology class way back in the in the 1980 uh 8081 um which is kind of goes back but at that time Sports Medicine didn't exist and he was a fledgling practitioner of sports medicine uh right now the majority of people that die in the world die because of metabolic illness and um we don't have a metabolic Health specialty well Society metabolic Health practitioners all over the world more and more people are practicing in the space so I'm a metabolic Health practitioner that is my space I am also a board certified surgeon both in pediatric and adult general surgery so I can take the full gamut of things and I'm happy to get into um how we help people who are unable to be completely successful in the space evangelism in the ketogenic space is as rampant as it is in the vegan space and everywhere else and sometimes Mortals can't cope just by themselves they're too far gone and they need ancillary help so I do do some bariatric surgery although the last Resort very rarely um but I can offer absolutely everything for medications our foundation is the the Medical Practice itself helping people to change themselves but sometimes you know if you're trying to quit smoking and you failed several times chanx is not a bad idea as a transitional step that's how we view it so that's what I currently do uh very vested in that I've got a YouTube channel that discusses kind of what we do it's called carb addiction doc which gives you some Clues as to how we practice um but my background is that like you I played rugby for a long time and you know rugby was my culture it was my home it was my head space not just the game itself but going to the pub afterwards the guys that I played with it was a cultural I I if you haven't played that level of team sport uh maybe ice hockey in the U in Canada the US that kind of thing you you don't understand the culture and it was my home for 32 years and the year I hung up my cleats I gained well over1 I was living Canada at the time and I just blew up like a balloon and I didn't realize that I really had a mental health problem in terms of emotion management and my emotion management my my emotional offset came through the game came through my fitness came through the guys I was playing with and when I suddenly lost every one of those things I was depressed I was in morning I didn't have coping strategies I was alone in Canada in a foreign country and what was left because as a rugby player I was always trying to gain weight what was left was eating and drinking and while it was balanced by all the other things when it became exclusive I ballooned up like crazy and I'm highly obesogenic which is another thing uh the risk of me having diabetes is pretty close to zero but I walk past a donut I'm going to gain 5 pounds that's my genetic biology and I Know It Was 80 plus per of my diet was carbohydrates and I was snacking my way through my day as if it was a cigarette little bit here little bit there by the of the day it was a massive amount so I ballooned up and I had to have insights into myself and treat myself and I failed so many diets until I realized the problem wasn't what I was eating it was why and once I understood the why and I started to address the why it's been an ongoing 24e Journey For Me of correcting that hey guys just want to take a second to thank our sponsor at carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys at the same time when order this happened I was doing my PhD in Toronto in liver metabolism and liver transplant U metabology and I was working with a guy called David Jenkins he was on my committee and David Jenkins is a vegan but he's the guy that created the glycemic index that is the foundation for the current mistreatment mistreatment of diabetes and I understand why it happened in the 1980s and it was a very valid approach in the 1980s when we didn't have accurate blood sugar monitors and we didn't have accurate or effective insulins but we're now 2024 we've got wonderful insulins we've got wonderful cgms we don't have to fear hypoglycemia anymore and yet we're trapped in a diabetes management system that's still treats toward preventing hypoglycemia and tolerating hyperglycemia that is the cause with your type 1 type two ad gustation that is the cause of all the diabetic complications um you know insulin using diabetics should be help ithier than anybody else on the planet and we can explore that but um during my PhD I realized a few things because I was studying inflammation in transplanted livers so we were creating an inflammatory response in the liver and in my Master's thesis we created a model and we weren't sure what it was at first we thought it must be lipids it must be fat so we'd isolate livers and we'd Infuse these massive amounts of fat polyunsaturated fatty acids seed oils because that's what tpn is kind of have saturated fat in the diet you know it's bad for you um so we infused high high levels of fat into the and Seed oils into the uh livers by themselves these were isolated livers and guess what pristine endothelium no response no inflammatory response to the to the cells at all now I'm not I'm not giving seed oils a free pass but seed oils by themselves not an issue we then Infuse protein amino acids the the endothal elv loved the amino acids they were pristine they were beautiful then in an incremental dose response way we did what we so remember our hypothesis of the time was that the liver was running short of sugar that's why it died that's why it didn't function when you transplanted it it was a substrate issue it must be running short of sugar because everybody's brain needs sugar we have to be eating sugar don't you know um carbohydrates are essential in our diet for our brains and for our organs so we started infusing the three different sugars glucose gas galactose fructose at a dose dependent uh manner with an insulin clamp now the liver doesn't need insulin to take up to take up glucose but we maintained uh ug glycemia but we escalate increased our sugar concentration and in a dose dependent manner within 3 to four hours we saw a dramatic inflammatory response by the endothelium the endothelial cells would swell up they'd start shedding cells they they destroy just the the uh uh um endothelium and it wasn't super normal doses of insul of of glucose and Insulin that we gave it's the same as what we found in in these donors on steroids so we realized at that time despite the fact that I was working in a PR glucose uh laboratory we found that that was the that was the substance that was damaging the endothelium then in my PhD we sequentially put in uh um non-cellular uh clotting factors so your fibrin and that kind of thing we put so we we created a white clot and then we cellularized it with platelets and with white cells and I was working with a group of other folks some were studying white cells I personally studied platelets and we realized that with the infusion of high levels of sugar and the infusion of these cellular elements we could recreate the atherogenic vascular blocking DVT causing inflammatory response in these cells and then we treated it so that's where why I'm a big aspirin guy because we could prevent the proper ation of a white clot to a red clot that means where the cells come in by using aspirin which is the thrombo and A2 inhibitor so I understood inflammation at that time uh unexpectedly at a very high level before anybody else was really looking at this and I realized that sugar was the culprit that was our model we create inflammation with sugar and then try to treat the inflammation and yet it was polar opposite to the running narrative and that was that was where my conflict with the current science began in the early 1990s and and it's been ongoing since that time but it was very obvious Malcolm Kendrick has written a beautiful book the clot thickens it was so obvious to me in the laboratory that's how we die and the majority of Americans and I guess people all over the world in First World countries are going to die of a heart attack or a stroke and that is the methodology the the ultimate cause over time and it's it's so obvious and yet what do we do we put them on stattin yeah absolutely well you know it was something that I that I've sort of uh thought about recently which is you know people like Malcolm Kendrick obviously are making this this counterargument to uh the why we are getting cardiovascular disease which I I I think is more accurate this let me stop you for a second Anthony um telling us that lipids cause cardiovascular disease is the counterargument it's a narrative right it's the narrative that defended smoking and nicotine in the 1950s and 60s is a culprit for cardiovascular disease very carefully orchestrated industrial pivot had nothing to do with science I mean none of the science is relevant if you even if you look at these papers that are being published on lipids um a beautiful paper was recently uh uh published it's the Danish uh study uh cardiovascular study published in October of last year the title is in one of my talks but um these guys looked at 500,000 patients over 10 years and they were either diabetic or not diabetic and they looked at heart they didn't look at LDL they looked at that but they didn't focus on ldal they focused on heart attack risk stroke risk and death from heart attack or stroke hard data and uh they separated them out the people with diabetes or hypoglycemia had a massively increased statistically significant increase of a heart attack or a stroke than those who were not uh did not meet diabetic criteria even though they weren't completely normal because the normal A1C is 5.2 but 6.5 is what we use for diagnosing diabetes so so even there they showed a difference but here's the key thing they then looked at those on stattin and those not on stattin and surely the statens should prevent a heart attack or a stroke and they divided into 10 10 de or decade cohorts of age and they found there was not a single it's their supplement number 11 from this paper at not at a single interval was there any benefit shown for a stattin so stattin did not reduce that risk and interestingly people over the age of 80 and people under the age of 40 had a 2.6 and a 2.5 fold increased risk of having a heart attack on a stattin than those not on a Statin now Gary taber's counterargument says well those people that were put on statens had higher risk um which may be true but still this study did not show any benefit whatsoever of being on a Statin And yet when you treated diabetes things got better so it's a sugar problem not a fat problem and again count we've got to counter the vegan um Seventh Day Adventist um Blue Zone narrative the Neil Barnard narrative that fat causes diabetes I mean that is just there's nothing to support that so uh you know uh um we've got to put into that context speaking of pseudo science no I think I think that's very important to to frame it in the proper way as well like like yeah you're right I mean that that was never there was never a serious scientist that sat down and said oo I think this is cholesterol it was it was wholly from the different industries that just said we need we need count something to counter this and then they found people that they could pay off to uh you know to to push this sort of thing and that that's been published in jamama it was published in jamama in 2016 from the sugar Research Foundation paying off uh professors from Harvard and so I think that's very good to to frame it that way there was a there was an article I came across from jamama in 1956 and it was about cholesterol and they they were talking about how it's basically accepted in the medical establishment that cholesterol causes heart disease however that's based on very shoddy conflicted evidence and they just made this 12-page paper just just ripping and just excoriating uh all the different sorts of pieces of of evidence as it were uh against cholesterol so this was hotly contested for a long time um but you know that's the thing with with meat people are saying that oh my gosh you if you eat meat you're going to get sick but like what well when has meat ever caused us to get sick we've been eating meat for Millions well let me stop you because you will get sick if you eat meat oh yeah depending on how you no it's absolutely true I can prove it to you because I've got plenty of blood work in my office that's true if you believe that LDL elevated levels of LDL and total cholesterol are a problem then clearly you are going to get sick if you eat red meat because your LDL levels and your total cholesterol will go up now the way I discuss that is look the liver makes cholesterol we absorb some cholesterol from our our bloodstream and the liver makes it a lot there's an HMG Co reductase pathway controlled by a funny little hormone called insulin um that cuz One path paway goes down cholesterol under insulin the other pathway goes toward ketones controlled by glucagon same pathway a little Branch but um if you believe that cholesterol causes um cardiovascular disease then that means that God or nature depending on which way you lean put a kill switch in our liver so it said okay at the age of 50 I'm going to switch this Dar thing on and you're going to die because you've lived too long or maybe God in nature evolutionarily has put that in there because is necessary for the most important asset that human beings have some of us don't have one but our brains and and so it it just when you step back from the science and this is my real listen I'm a scientist I love the data but it's it's been so bastardized and manipulated to separate out the truth from from these polar opposite opinions is a problem but if you just logical about this it makes all the sense in the world yeah no absolutely and um that that um brings you to to a point I was going to make as well which is people say that well you look at familial hypercholesteremia these people have high D LDL and they get higher rates of cardiovascular mortality rate which when you separate out the data uh they're actually more likely to have genetic differences in clotting and so some of them have a higher rate of clotting disorders and you separate those out and the ones that have the clotting disorder are the ones that have higher rates of cardiovascular mortality and the ones that just have the higher quote unquote higher LDL they they have the exact same risk profile as the rest of um the rest of the world so that's interesting but what's even more interesting that people aren't necessarily thinking about is that the first death from myocardial infarction reported in the literature on autopsy in America was in 1912 and basically didn't believe the guy it took about 10 years before they started seeing enough of these cases showing up that people started saying okay look there's like a new disease on town on the on the horizon and then 10 years years after that it was a number one killer in America but then before that there was there were basically no reports I I mentioned this to someone and they came up with this extremely obscure reference to a a a conference in Europe in the late 1700s where they s talk about oh look there might have been this thrombus in the coronary artery it's like thank you for proving my point you know this was this was something that people could see they were doing autopsies they were paying attention so they weren't missing it so they found this one and there wasn't another one for 140 years so the exact same amount of people have familiar hyp cholesterolemia as a percentage of the population during the 1800s the century the 1800s when there wasn't a single case reported in the literature so what happened then why weren't these people just dropping dead and like you say why would nature or God put in a kill switch why would we make a chemical in our body at a physiological state that is damaging us that is designed to damage us that does that doesn't meet for competition in the while and they say well people died in their 30s no they didn't uh that's average life expectancy from birth and um one of the arguments that the vegans will make is that yes we've been eating meat for millions of years but people you know all they had to do is get to reproductive age and then they could just die it's like who's raising the kids like I'm G to flip something in if you look at uh some of the narrative a guy like Steven Kain who's an Alzheimer's researcher in sherber Canada he's done a brilliant evolutionary paper that says that we are human because we ate meat because we I mean that's what this thing needs and there's inadequate meat and vegetables so uh you know the The evolutionary Story the biology the physiology doesn't support the plant-based narrative in fact we've moved away from plants our GI trct uh the way we function because we're not grazes anymore in order to get low yield uh high volume food in we are um uh much which is what a cow eats a cow eats a massive amount of food which has a low nutritional yield and their bodies are physiologically adapted to that we are a high yield concentrated Eater of enzymatic digestion um which favors eating in a brief burst and then um going a longer period of time doing what humans do without food so we're able to store it we're able to enzymatically break it down so the again if you look at physiology as opposed to epidemiology epidemiology is observations and associations physiology is how the body works and if you look at it cleanly without you know uh background belief systems in place it's very very obvious how the Body Works uh and you're absolutely right that those diseases didn't exist we were dying at that time of things that happened to us now and we've done a brilliant job as humans of solving most of the things that happen to us um however what we haven't yet solved is what we do to ourselves and that's the space I work in um and that's a different space because if you get an infection all you have to do is show up and I can can put you on an antibiotic to try to heal that infection if you get a gallbladder attack I you come in all you have to do show up and I as the surgeon will take care of that and we've got great equipment now whereas people were dying of appendicitis 100 years ago now it's very rare that that happens so we've solved those issues and those are issues that you show up in the healthare system takes care of you with what we're talking about the Health Care system is completely unable to do anything for you there's no pill that can stop you from smoking there's no pill that can stop you from putting M&M's and and um what I call Crystal Meth in your mouth that is a youth thing no nobody there's nothing that stops somebody from drinking alcohol AA is there to rebuild you afterwards but that is a CH and Healthcare is not is not capable currently the way we're educated the we taught to be paternalistic in our therapy of patients we do not have the capacity to help people to help themselves even Psychiatry and psychology is about medications for the most part the therapy part is of value but more and more it's about drugs not about helping people to do the rolling up their sleeves and doing the hard lifting of changing who they are and again that is what we focus on in our practice we we look at this as a substance abuse problem not a nutrition problem as a form of dysfunctional emotion management where you've shifted away an alcoholic is somebody who shifted away from primarily drinking for the hydration value of water toward using a drug a highly endorphin activating drug as a source of emotion management and when an alcoholic says oh my God I need a drink it's not because they're dehydrated it's because they're having an emotional moment and they've created a lifestyle where they've always got access to that alcohol in a very very similar way because of ubiquitous access certainly here in the US and I think in everywhere else in the world we have shifted at a very Primal level from a from an infant level possibly even in utro away from primarily eating food for the nutritional value toward primarily eating and drinking in a pattern in a substance that has no or very minor nutritional value but has huge endorphin activation value and it's it's so darn effective why the hell do I need anything else and that's my personal story and the story of all our patients is that the fatter we get the less we're able to do anything the sicker we get the less we're able to do anything what what's left over is our Crystal habit and it becomes uh uh it defines who we are as a human being you know you don't drink alcohol you are an alcoholic you don't just smoke you are a smoker you are a crackhead you are a heroin addict you are a gambler you are a sex perver um it that narrative defines who we are because it's fundamental to how we manage our days all the time and if you've never been fat if you've never been diabetic type two diabetic if you've never had this as a problem it's difficult to gain that Insight um but that addiction is what I call it it defines who we are and in the eating space it's carbohydrates as the drug but everybody has a ritual you know when a smoker it's not just having a cigarette it's the whole ritual of smoking and it's carbohydrates it's the little snack thing where you go and Scurry away and grab that you get that ice cream out of the fridge being there done that and then the other one is binge eating disorder and that is something that even a guy like you may be a victim of and we see that in even our lean mass hyperresponders where binge eating oh you can eat as much as you want to because of availability uh this is the first time ever as a species we've had tsunami like availability of food we we could most of us live our lives within 50 yards of an abundance of food we don't we are not suffering from a lack of food despite the fact that a lot lot of people are starving on this Earth um but that abundance has resulted in overeating both by frequency as well as by quantity even for people who are carnivals and that upsets the system so each one of those things is part of this you know if you think about it do you have children uh no not yet not yet okay so I've got a couple of kids and you know you can imagine this when you take a baby and you put the baby on the breast hormonally the baby determines how much it's going to drink there are certain hormones in the gut gp1 peptide y yast Statin that send a signal back to that baby's brain based on saturated fat milk is the only substance on a carnivore diet that is dominant in saturated fat and that saturated fat is a singularly molecule back to the brain that says dude you've had enough some days you eat a lot some days you eat a little bit but um the baby isn't in charge of how much it gets and it'll always get enough however when you bottle feed a baby you can take the same breast milk and now the mother by some pre-identified calculated volume has decided the pediatrician said this is how much your baby needs and if you're a good mom come hell high water you plugging that baby in and that baby's going to get that amount whether it's too much or too little so already we override at a fundamental young young age we override intestinal hormonal sign signaling that feedback relationship and everything the human body's homeostatic which means it's got a a push and a pull a feedback system we override that feedback system where the brain or the mother tells the gut how much it's going to get deal with it rather than the gut telling the brain how much it needed it so binge eating disorder is what I call that or Rottweiler syndrome we eat like Rottweilers having breakfast um that is as much part of carbohydrate addiction or The Addictive element because oh my God I'm stuffed you're hurting yourself for that bizarre pleasure on the back end and when we tell our carnivals you can eat as much as you want to you're fine and yeah you're lean you're skinny because you're not adding fat you're not I mean you're eating fat but you're not creating a huge amount of fat it still disrupts the hormonal pathway in the body it overwhelms the system so uh uh those are the three elements and if we understand those three elements we get rid of the carbohydrates um we don't snack because we we are are tidal in terms of living on shorelines evolving on shorelines we're very tidle in our eating and we don't binge eat or if we do binge we go a long time without eating um those are the three healthiest Dynamics it's not just what we're eating it's the pattern as well yeah nice and so when you have someone in with with addictive eating with disordered eating or just they just like eating carbs and just had trouble with diets how do you how do you approach that if someone's been struggling with this for years how do how do you address that aspect of it well the the SEO concept is so heavily entrenched what SEO calories in calories out Gary T has written a lot about that but it's so heavily entrenched and everybody has tried diets and here's the problem with the diet they all do well you can't go on the Oreo cookie the cookie diet the Oreo diet it it you can go on any darwn diet and initially you do well because of caloric restriction so you lose weight you get a little bit better doesn't matter what the diet is and that's part of the confusion um but eventually under emotional unexpected emotional distress you go back to eating the old way you it's I call that a relapse that's addiction method nomenclature but um so that's why diets don't work they always work you can go vegan you can go car anything works for weight loss and the evidence is there but the sustainability is because at the root of your who you are for your existence you still function emotionally based upon putting stuff in your mouth for emotional relief for endorphin relief so we are defined by that and the first part is to help people who are naive to that concept to understand that this is a substance abuse problem not a calorie problem and once they start to without changing once they start to understand their own pattern look at how often you're putting calories in your mouth look how often your mind goes toward eating look how look how much you put on your plate and how fearful you are for example Americans going to Europe and you go to a fancy restaurant happens to me how pissed off I get that they put this little kitties portion you know done by an interior decorator on a plate no that's how much we should be eating we shouldn't be eating a super sized Big Mac every day or three four five times a day so you look at your snacking Behavior you look at your quantity and you have the Insight wow I never understood this but now I understand and if you ask yourself why am I eating right now why am I eating why am I hungry okay we're not hungry because of nutritional deficit hunger for us has become a word we use that's equivalent to oh my God I need a cigarette or oh I need a drink hunger is an expression of emotional need you know I'll give you an example you've probably done an extended fast in your life what happened to hunger what happened to hunger after a day or two non-existent goes away so if hunger was driven by nutritional deficit surely the longer you didn't eat the more hungry should get and yet it disappears because we got more than enough inside of us the first thing that really goes south is vitamin C and that happens at about 8 to 12 weeks of not eating so the the entire narrative the body is so super stocked with food it's not a hunger issue it's not a nutrient issue and yet what's the narrative in the literature oh you must take this to be super healthy you must take this you got to take these supplements you got to eat this amount of protein well you are not me I can't tell you how much protein to eat or me how much protein to eat because it's different our needs are different and if we eat the same amount we have to process it differently and it causes harm even if it's protein and fat so we have to understand unique individual biology and that's the challenge is how do we help those people to have insight into their addiction and then formulate we have to do two things after that then formulate a diet that is uniquely appropriate to them and you know this in healthcare uh Anthony more and more because of guidelines and best practice is we've created a box and every patient has to plug into the same box and that's so F we are Unique Individuals and what happened to the old family doctor that would come to your house know your first name know the name of your special toy know you as a unique individual we don't do that so if we say oh you got to eat five grams of protein per pound or per kilo every day who knows I'm not Shawn Baker I love Shan tobits but I'm not him I don't work out 36 hours a day day I don't need to eat three cows a day okay and I sh is phenomenal in our space but that's not me so but but I can look at your blood work and tell you how much you do need if you're eating too much or too little I can look at your blood work and tell you where you currently are I don't know exactly what the amount is but I can tell you increase your fat decrease your protein whatever it may be I can give you that narrative but we box everybody into the same box and we've got to treat people as individuals and so we want to shift them to a way of eating that is suitable for them and quite frankly because I work across the world I don't care if you're more vegetarian like a lot of the the religious Indians who all a lot of them have type two diabetes how do we stay within their vegetarian diet and still get them to get rid of the white food how white what I mean by white is starches and that kind of thing uh and be more green vegetarians than white vegetarians but more importantly we also when you remove carbohydrates from their diet you leave them at a massive emotion management deficit and we then have to find a replacement and yes physical activity is one source of that but it is not the unique Source if you are more a thespian if you're more a musician if uh you are more spiritual if you're more a people person Embrace that as your source of emotion management that you're leaning on spirituality and prayer rather than carbohydrates that you're leaning on exercise that you're leaning on human connection that you're leaning on some creative art playing the piano whatever it is that becomes your Fortress of Solitude the place you go for emotional restitution but if you don't do that changing what you eat is unsustainable because life when life throws you curve balls you go straight back to your safe haven which is the fridge in the pantry and everybody does that 85% of bariatric surgeries fail for that reason ketogenic diets fail for that reason or they get stranded the sustainability depends on a transfer of your primary source of emotion the f I know I'm talking a lot but the the narrative that I use is the suitcase thing if somebody's going on a vacation they pack into that suitcase what defines who they are the alcoholic's going to put a bottle of whiskey in there smoker going to put a carton of cigarettes in there you're going to put your uh your cleats and your gym pants and your running shorts in there or whatever your weight stuff the golfer is going to put some golfing stuff and the fat person's going to slide some snacks in there you watch fat people on a plane and they've always got their little bag of snacks in case they're going to die of anorexia while they're flying so we are defined by what we packed in the suitcase and what I tell people it's February now today a patient coming to my office is probably going to put the snacks in the bag what are you going to put in your suitcase in December what are you going to put in your suitcase a year from now in other words what defines you and changing your Fortress of Solitude that place you go for emotional emancipation is is fundamental to sustainability and that that is what we focus on as much as the dietary element in our office yeah very good well that's um I think that that's very important I mean I I see this all the time with patients you know that they'll they'll get onto a diet plan 44 otherwise and they'll they'll get very good success with that and then some will just feel so good that they transfer that into other things they get other Hobbies they working out and they're really excited with their new life then others can't others uh do exactly as you say they they hit an emotional hangup there's some sort of issue with the family there's some something that happens at work and they're sort of they're back into Christmas I mean every everyone seems to struggle with that um and so uh it's I think that's very important to address that as well so that's a very good good point that you make um because it has to be sustainable I mean this is I I try to get that across to my patients as well that you have to think of this this not this is not a diet a diet is temporary you know anyone can starve themselves into a smaller dress size that's not hard but you know eventually you're going to get to a point where you're not you're getting diminishing returns you hate your life you don't want to do this anymore and you and you go away from it so you need to do something this is like this is what I want to do for the rest of my life and um and and addressing that emotional aspect of it because uh I I mean I haven't really even thought about it I don't think most people have thought about in that that sense that this is this is an addiction certainly people do have addictions and and the carb cravings and the carb addicts and things like that so of have that concept but you know really understanding that to that degree that this is this is more to do with an addictive response to eating rather than just they don't know what to eat I think it's a dysfunctional emotional management system I mean if you look at you um there's probably a day that doesn't go by where you don't do something Physically Active either intentionally or vicariously but if you broke both your arms and both your legs what would happen and you know where do you go because you're you're defined both visually as well as mentally by your physical activity which is wonderful um but the challenge is if if that is a unique thing if that's and you don't you've got a variety of different things like these podcasts and things and your your your interest in the metabolic space but if that is a singular issue and you lose it where do you go and uh a lot of people who change their eating pattern do a drug trans because what also we have to change is our methodology of emotion management substance abuse is what it's about upfront instant gratification where you get a shortlived massive benefit when you eat that tub of ice cream when you drink that bottle of whiskey when you have that cigarette massive short-term benefit enjoyment and that's the problem it's it's wonderful but on the back end there's a lot of harm negativity and guilt whereas if you go to the gym you have to put time and effort into the gym and the reward is on on the back end when you walk out and some people really struggle with backend relief or backend emotional restitution and because they're wired toward instant gratification and that's that is a a fundamental change in how as a family you're raised how you function as a family there are families that are raised in um for toward instant gratification their families that are raised toward an effort-based emotion management system and it's defined often before we're bornn you know if if your mother is stressed while she's pregnant she goes for a long walk or she listens to music that's imprinted on that baby if your mother is pregnant and she's eating gummy bears and and ice cream all day long that is hormonally imprinted on that baby so this is so much deeper than just changing what you're eating and I think we've always as well certainly in the in the last couple of centuries we had Prohibition in the US for a reason because alcohol was a problem we went through big tobacco now we're into the carbohydrate era but we're also into the fental opioids we're into vaping there are and and we're also certainly into the pornographic era where you know I mean it's a multi-billion dollar industry it's not magic that nobody watches the stuff so all of those things are parts of dysfunctional emotion management or sometimes functional emotion management but when it becomes unique and excessive that defines addiction addiction is not about the substance or um the behavior it's about our relationship with it it's about how we use it excessively and it's that chronic excessive use that's the problem and that's an important concept because in our space we sometimes demonize carbohydrates carbohydrates aren't the problem we exist as a species because of carbohydrates survival during lean times we're we're we're designed to do that however when you're Rel relationship with carbohydrates becomes excessive that's when the problem happens and that's more up here than down here yeah yeah definitely well and that's the thing you know I mean I have I don't eat plants but um you know I understand that that that confers a survival advantage and then you you know when you're in this when a lion runs out of meat that it doesn't have any alternatives it it dies it gets meat or it dies and we we had the ability to eat other sorts of things and that's conf that would certainly confirm a survival advantage and we've become very dominant we've gone over every continent in the world um but um yeah like you say it can become too much of a of a problem it's um uh you know it's an evolutionary trap right we get this we get this sort of responsibility with like things like fructose is very sweet we recognize this is safe and oh you can have that get quick hit that energy that's really good well normally you're only seeing this for two weeks out of the year in the summer when the fruits ripe and there's barely any of it there now and uh and so you have that oh go get this this is safe but now we have extremely sweet fruits we have refined sugars and then chemicals that mimic that sweet flavor and that hits that an evolutionary trap which is it it it hits on that that physiological pathway that says this is safe eat this and we just over consume over consume over consume as well so we get into that um to that rabbit hole as well where you just you're just in this sort of addictive State and uh and and have difficulty digging your way out of it right you're absolutely right and you know let me put this into perspective uh I'm also carnivore but we didn't start there uh and I I would tell you that it's not a it's a difficult place to start when you've been on a standard Western diet um it's a difficult place to start it's jumping into the pool in the deep end before you can swim but it's an ideal way to navigate toward this it's just simpler and easier but I I'm going to tell you this you're not going to like what I'm about to say number one I don't think carnivore is necessary um it is more convenient it isn't better I've got people that are as healthy as omnivores as they are as carnivores but in my life I got pissed off about throwing dead vegetables out at the end of the month or the end of the week but and my dog won't eat a leftover salad but he'll eat leftover steak so we're carnivore as a matter of convenience and you are also a carnivore because you live in an era of meat abundance if I dropped you on an island and you had nothing the survival type mentality there's no way you would remain carnivore because it's about survival carnivore is a luxury that we have because of the abundance and easy access to meet and uh and I love it I mean listen I'm not I'm not negating the space but sometimes and I I've got to be cautious about myself because I can show you my fridge right now it is there just Meat and Fish in there and it's like you know it so yes that defines who I am but I've got to be cautious when I'm talking to my patients that I don't want to create them in my mold and I don't set a vegan standard for them because setting that standard for them is is no different so we've got to put this into perspective that yes this is the ideal diet for us because we have access because we have ease of access um and certainly our bodies work the best it's the most anti-inflammatory diet but it is not not the only diet that makes you healthy and I think the the important thing you know nobody tells an alcoholic what they should drink don't drink alcohol it doesn't matter what you do drink there's better and worse but nobody tells them what they should drink but we love to tell other humans what they should eat and the objective for me is to get people to get rid of the carbohydrates and the snacking if they have a health issue and you know we were talking before this started about Isabella Cooper's paper and there so many wonderful things about it but she eventually looked at a group of young women who had been in fat adapted ketosis for a protracted period of time I think the the the youngest one was four years into fat adapted ketosis which is a a decent length of time some of them up to 20 years and while there were some carnivores in the group there were others who were not and their biology their blood work was identical because they were in a state of fat adapted ketosis and what was interesting for me is is that 50 to that that all of these women did eat carbohydrates now none of them were addicts so in my case I I I won't allow myself to do that you know fact I've chosen not to do it's not allow I've chosen not to do that because I can't trust myself there's no way I can eat one Oreo cookie Nick Noritz um it's just not going to happen Nick is a good friend of mine and i' I've known him for a long time but uh we do that with some of our folks but you put an Oreo cookie in front of me that's like putting a small bag of ha in front of a a guy that's been clean for a long time it it's not about the Oreo cookie it's about the permission I grant myself and the addiction space to go down the road if you haven't suffered like like I have in that regard most people don't understand that and that's why they say have one don't have a lot just not possible um be that as it may those women who had I mean exceptional the the ideal ketogenic biology by a ton of testing the majority of them ate some carbohydrates and I'm not advocating for that for my patients because addiction is treated through abstinence but um and you can't abstain from food but you can't abstain from carbohydrates but for those folks for healthy biology they did eat some and again that's that's a bit of a conflict with with part of the narrative now there were carnivores in that group but um but it didn't it didn't make them more or less healthy that's that's the point I'm making and we do what we do it's the REM it's the remove removal of certain things behaviorally that's more important than absolutely what we do eat um and they were fairly clean eaters as well but I that's an important concept and it's a difficult concept because I know I'm going to get poked in the eye by a lot of people but um orthorexia is a word that people should look up and orthorexia is this obsession with quality of food and we see that it's similar not it's not anorexia but it's in the same vein and we have people that won't put pepper on a steak or you know I'm I'm drinking black coffee here oh no but that's a plant okay you put pepper on your steak that's a plant when I eat shrimp I melt butter and I put some garlic in there does that make me a not carnivore yes it does technically but but how do we you know these these evangelicals along the the oh you must do this that is as much a pathology for me as just living your life in the space of what you do um and it's important to understand that because especially as practitioners when we tell people when people come to us for advice we've got to meet them where they are not where we would have them I don't want you to do what I do but I'd like you to be as healthy as you can possibly be and let's figure out for you what that means and as a practitioner that's a difficult thing to do you know um um you were a Neurosurgical resident am I right m and you operate on brains to cure tumors and to fix epilepsy and other things but every time you operate on the human brain you destroy it yeah you do and you know that's part of the you're destroying something to make it better so part of the part of the issue here is we're all going to die you just don't want to die by what you eat yeah so again that was a an odd example but but you understand where I'm coming from with that yeah definitely yeah I mean the the thing is I I do you stay pretty pretty strict on it because if I put pepper on a steak I I feel like crap you know I do I do feel different and so you know the reason I do it is not um you know just it is convenient it's very simple I don't even use salt anymore just that's how my taste preference run now um but I conceptually did this at first because I you know I was told how toxic plants were like right I'm not going to eat those I did use spices back then I'd use salt and pepper and things like that there's a seasoning a Greek season called Cavenders that I grew up with loved it put that on everything um I tried that now and I felt like crap and so I was like damn it all right well I can't do that and so so for me that's what I do but I always tell people like look if you if you feel fine with that stuff and and that's something that can help you stick on it you can use spices go for it you know you can always try coming off it for a few weeks and see how you feel and if you feel that that you feel better without it you know then that then that's great I do feel better without it um i' I've always I think I think that is very important from an inflammatory perspective so that is slightly different to and I I agree with you that that is a very clean way of doing things and it works for you but I'd Rather somebody have a cup of coffee or put pepper on their steak then relapse back to a tub of ice cream oh yeah and it's the it's the bandwidth so you know you didn't St there you evolve to that and it may be over time I may evolve to that um but it's a it's a stepwise progression and it really is more about what happens here now for my my inflammatory bowel disease patients my alitis is my Crohn's disease patients who have who are heavily triggered by anything plant related for them absolutely are if they're capable of doing it that's the ideal anti-inflammatory gut diet um so all of those things do matter in terms of where you position yourself but I think the consensus is that chronic excessive carbohydrate consumption is the problem and by the way if you don't eat carbohydrates you're not going to get a lot of seed oils in um and you know the the six Omega fatty acids are as important as the threes but the ratio is important and um so all of those things are are part of the narrative and I don't want to be nitpicky about stuff I think where you are a lot of my patients are but the question I then have for you is what is your hemoglobin A1c what's your triglycerides what is your average blood sugar run and that's something we that I mentioned to you that we see a lot of I've got plenty of patients that are in the same category as you that are lean mass hyperresponders very high LDL very high cholesterol which I have no issue with but then what we start seeing is we start to see their triglyceride number come up a little bit why they're only eating meat um and these are just like you uh the only difference is I P push salt pretty hard um uh salt is important for all mammals so I'm a promoter of salt uh and if you look at all animal species and all of the more carnivore leaning first world people salt was always a very important thing that they chased so that's the one thing that I would disagree with you in terms of your now it works for you that was just for me so exactly right exactly I always tell people salt to taste you know Salt's fine just salt to taste and my now if I put any salt on a STI it tastes way too salty so and again that's the one place where I I push the salt narrative especially in the absence of carbohydrates that's neither here nor there but because our body is very very good at preserving sodium chloride it's I mean your sodium goes out of whack by Five Points your brain is imploding uh Central pontine myolysis which you might know of uh is when your sodium drops below 30 uh we'll see that so the body is very preservationism how however um from what was I what was I talking about was it the inflammatory stuff the inflammatory gut stuff yeah oh no no no we were talking about the um what happens on a pure carnivore diet is that insulin is not triggered and insulin is a very misunderstood hormone insulin is not responsible insulin is not responsible and a healthy person for the regulation of blood sugar glucagon is so if you're not eating carbohydrates in your body all of your sugar has to come from glucagon not from insulin yes insulin facilitates the entry into certain cells not all cells like your muscle cells but at a very very low level but glucagon is the dominant hormone that regulates how much sugar there is in your body and insulin is uh really just there in a small amount and one of the things that I've discovered and Ben bitman has done the same thing in the laboratory um is that we believed and my friend Tim noes taught me this is that um and it's an observational thing is that um as your blood sugar Rises the sugar triggers the release of insulin so even if you eat meat and glucagon releases sugar into your liver you should see a rise in insulin and that's false you don't the primary trigger and it it it's conceptually understandable the primary trigger of insulin yes blood sugar triggers it a slight amount if you remember remember the old penny farthing bicycle had the little wheel on the back and the big wheel on the on on the front that's kind of how insulin release Works where elevations in blood sugar will cause a minor rise in insulin but inadequate whereas the if you think about it why should insulin be released it should be released when we eat and if we have some carbohydrate in our diet there are hormones in the gut particularly a hormone that everybody knows called gp1 uh right now gp1 is a hormone gets released by the upper gut that primarily does two things it triggers insulin release and it shuts down glucagon which is kind of what you want so because insulin is there it's an anabolic hormone together with thyroid testosterone and human growth hormone that results in the storage the the manipulation the rebuilding and the storage of product nobody absorbs food into their bloodstream we absorb amino acids we absorb glucose we AB absorb monog uh uh uh uh um mono elements of everything um whether it's the lipids whether it's the amino acids whether it's the sugars the gut breaks it down and under the influence of insin we rebuild and store that we where in the in the fat cells we turning sugar into fat Dan over lipogenesis same thing in the liver but in order to release insulin we need to trigger glp1 and fat and protein does not trigger glp one uh we know that so we get a non-insulin response and the issue with insulin is that insulin is there for protein synthesis in insulin regulates cholesterol synthesis um insulin regulates steroid hormone synthesis uh insulin reg regulates um cell replication especially at the mitochondria level so through through uh receptors uh surface receptors so insulin is a primary quarterback regulatory hormone and when we test our Pure carnivores our um uh lean mass Hypes carnivores they behave almost like a type 1 diabetic when you give them a load of carbohydrate they're so unfamiliar with it that their insulin curve is flat and their sugar curve goes up and stays up for a very very long time and we call that insulin suppression and the which is fine I don't have a problem with the glucose management because you're not eating it but the problem is that you don't have insulin adequately available once or twice a day in that dial pattern to perform all of its other functions and how do we know that's happening cuz when we do blood work we start to see triglycerides go up well triglycerides are exclusively produced by the liver when it's converting excess sugar to fat that's why your triglyceride level is such an important monitor for me of blood sugar it's not a it's not a cause but it's a marker of elevated blood sugar and if you're not eating carbohydrates for the most most people have high triglycerides it comes from chronic excessive carbohydrate consumption and the first step of protection is the liver turning that into fat so your vld goes up and then the liver is shipping that fat to the to the fat cells for storage so traffic is liver to fat cells instead of fat cells back to liver for ketogenesis under the influence of glucagon um and then what what so what happens is that you eat a lot of protein and the pro the excess protein nobody knows how much nobody can tell me how much okay it's always excess and it should be slightly excessive on a carnivore diet because you want some of that sugar but now now if you're eating it excessively that extra sugar is having to be turned into triglycerides and the sugar is spilled over into the bloodstream and we see a slight rise in Sugar so my good friend Paul Mason says that your A1C goes up because red cells are healthier and they live longer that may be true but why are your triglycerides going up why is your A1C going up why are all the glycemic markers going up and that's because of lack of insulin and under those circumstances we need to trigger in my well the question then is is that healthy or unhealthy they Feldman has shown that those elevated lipids don't affect the bloodstream but the question that we have and Ben bman has done the same thing with cells is is it important to have that fluctuation in insulin or is it okay to have a flat line of insulin and given the other causes of it you can go to I I know it's not the great source but if anybody just goes to Wikipedia and looks function looks at functions of insulin there's over a hundred functions of insulin that don't involve sugar m okay it's a regulatory hormone and so what happens with those other functions over time what happens to our aging what happens in our brain uh so we use certain products to trigger um an insulin release once or twice a day so my son who's three years old he's a little guy he's been a carnivore since before he was a sperm in an egg okay um in other words my wife and I were carnivore at conception and he's been that throughout um and I'd say 95% Carnival because he eats a little bit the the the few things that we do um however he gets a bottle of raw milk or whole milk with heavy cream twice a day why because milk has glucose and galactose in it no fructose and it isn't there it's got a lot of sat in fact milk is the only Carnival product that that is dominant in saturated fat all the others are actually dominant in poly UNS saturated fat which most people don't understand but that milk that little bit of glucose and galactose triggers enough of of an insulin response that he's getting that insulin for his growth twice a day and you know when we measure this he was at his pediatrician last I just tell an anecdote because I know I'm narrativ I'm talking a lot here um he was at the pediatrician's office a little while ago for a a preschool well check and this this kid is robust he's he looks a bit like you he's got a lot of muscles he's blonde but he's got a lot of Muses just beautiful to see and it's strong uh be that as it may he was at the pediatrician they did a urine check on him and he came back three plus ketones and they hit the Panic Button he's got diabetes he's a type one diabetic and my wife just smiled at him and he came back and in US numbers his um they then did a blood stick on him and they checked his blood sugar and his blood glucose was 92 now 92 in the US is absolutely fine I want that to be under 95 in the morning but when my wife told me about oh my goodness that's high why is his blood sugar so high 92 is high for him and the reason was about an hour ago hour before he had his bottle of milk so uh you know 92 was his high he normally lives in the 60s and 70s for his blood sugar but he's always in ketosis but we give him that milk for that for that dial rise and in some of my um insulin suppressed patients we've seen over the course of several months that they've been able to correct that by introducing a small amount of uh some form of carbohydrate into their diet and that again follows very similarly to Isabella's patients who typically do eat some carbohydrate and she in that study has demonstrated their their blood work is about as healthy as possible because they're triggering insulin you know I'm not a and I'll throw this out there I'm absolutely in my space not a fan of Paul saladino who promotes a lot of carbohydrate okay because Paul's out on the he's surfing all day long I mean he's he's out there surfing his he's utilizing that carbohydrate he's way over the top on that but there are a few times in some of our athletes who are pure carnivores where the benefit of a little bit of carbohydrate to trigger insulin is a value uh now the flip side of that it's one last anecdote there's a guy called Ian Lake I don't know if you know Ian lake is no I think but if you haven't had Ian Lake on you definitely need to Ian lake is a GP in the UK wonderful guy brilliant brilliant guy and Ian lake is an ultra distance athlete okay so Marathon for him is a training run and is also a lifelong type 1 diabetic and just a brilliant man I've known y for a long time um just a great great guy very humble man but I did something called the 05100 and 05 100 what does that mean because diabetics have to eat carbohydrates and they have to snack on carbohydrates and you have to have 75 grams that's the and he's been carnivore for a very long time okay now he doesn't cast a shadow he's so lean he's a very lean guy Guy and um I'm ultra distance runner in the in the uh just exceptional category so what he did to prove this is he and a buddy of his both type one endurance athletes said we are not going to eat anything no calories now you know he's literally skinny although he's got adequate fat he's got no visible fat zero calories for five days and during that time they're going to run 20 miles every day mhm and he looked at his insulin numbers and his insulin requirement went way way way down I think it was like 3 or point4 units so he required very very little insulin he still required insulin however and he was running in ketosis he did absolutely fine nothing happened nothing happened he ran his races fine he felt brilliant and you know you run 20 miles the next day you're lying with your legs up on the couch with ice packs they ran this every day for 5 days and it was just a brilliant experiment that he talks about um so yes there's variations to this but he is a type 1 diabetic who can regulate his blood sugar with insulin we can't you and I cannot do that we rely on our pancreas to do that and we rely on gut hormones to trigger the pancreas to release that insulin so I don't know what that means I don't there's not enough data certainly even in my own practice where we've seen this several thousand times I mean I've got a lot of patients um however I don't know whether or not that is harmful I don't like the numbers when I see them on my patients when I see that elevated triglyceride when I see that A1C going up my target is 5'2 when I see those things happening I don't like the numbers but I don't know if they mean anything biologically and if you look at most of the cultures out there that are primarily that we admire that are primarily Carnival the Messiah milk is a part of their diet so I I just I'm raising that more as a question it's stuff that I've seen in my practice and when people do do that over time they tend to get a little bit better I don't know what your thought and I spoke a long time I don't know what your thoughts on that are well yeah no it's interesting you know I I do wonder you know when when we think about things about about optimy about how we're designed you know I always think back to like when we're in the ice shelves with the ice ages and things like that or the Inuit when they're just up in the in the Arctic Circle and what they had access to at the time and you know how would how would they sort of you know go around that you know and what and what that would mean for them for their health one thing I remember talking to Ben bman I wonder if this is the same uh scenario that you're talking about he said that that some people have said that being on a ketogenic diet in ketosis for a long time it actually causes insulin resistance because they give them glucose tolerance tests and they don't respond appropriately but he said that after a few days then they do start appro responding appropriately and what he told me at the time was that when you're eating carbohydrates regularly you'll pre-make insulin and have it just ready to go and so then you eat the carbohydrates and it releases on the go and so you you can adjust more quickly um whereas when you're not using it you don't premake it anymore and then after a couple days of this you you start preak it again is that is that something different than what you're talking about or is that is the only word I object to there is the word resistance insulin resistance is a receptor problem that is where the receptors are phosphorilated they're blocked so you produce enough insulin but the insulin is not having an effect on a cellular level and you need Super outed doses this is insulin suppression ex Ben's exactly right and it's exactly the same point is that our cells the pancreatic cells the beta cells are still functional but they're just sitting there saying hey you don't need me right now they they're chilling out on the beach um and and not not engaged or involved at any significant level of course there's low levels of insulin but when you measure insulin and I actually measure C peptide on everybody those levels are in the 0. 5.6.7 range um early morning fasted which is very low for the dawn effect it's equivalent or getting equivalent to a type 1 diabetic who cannot produce insulin and some of my autoimmune diabetics kind of live in that territory and they need they need injectable insulin because their sugars are running high so yes that's exactly the same thing but I've coed the term insulin suppression as opposed to insulin resistance because the insulin levels are suppressed because they don't need to be elevated and my concern and my theoretical question is what about the other functions of insulin and I said Paul Mason has has talked about the same thing um but Paul has explained the elevation in A1C based on longevity and health of red cells but which is fine that may be true but I can't explain the triglycerides and the elevation bu bu by the way is our marker B creatin and uric acid are the three markers I use to determine adequacy of protein consumption and if your bu is super high that means bu is the way you break protein down so why bu that measures nitrogen in the bloodstream and if you look at carbohydrates and fat they're made of carbon hydrogen and oxygen so we can breathe that out um whereas protein is carbon hydrogen oxygen and nitrogen and we can measure how much nitrogen is being released but peed out by measuring The Bu blood UA nitrogen uh that we pee out to determine how much protein we're turning into sugar which is the way we metabolize protein um in the liver and even the muscle cells creatinine creatinine creatine and uh and bu and uric acid are the three waste protein or are the three protein products and if your bu is substantially elevated on a carnivore diet it means that your your body is struggling to manage the over consumption of that protein because it's having to turn extra protein into energy but it's a futile cycle because if and that happens on people that are on a lean mass diet so by the way um Anthony the the first experiment we did when we saw this is we followed uh um non and Maria Em's idea of um protein sparing okay so these guys are eating lean protein because if it was true that elevated sugar triggers insulin release then by eating excessive amounts of lean protein getting that extran protein turned into sugar which does happen we can measure that then we should see an equal response of insulin and we didn't that the problem was that their blood sugars went through the roof and their insulin stayed low and they were miserable they were hungry all the time they were miserable you ask any carnivore that is on a lean protein diet it sucks okay so when we add added the fat back and they all did this automatically that's where it was okay so the point is we proved with that experiment human experiment that lean protein and causing elevation of blood sugar does not cause a release of insulin and for those folks that bu were through the roof and by the way their cholesterols and their uh um and their LDL went through the roof as well because insulin regulates cholesterol production so if you're not if you're not if you and and here's the par is that if you are not regulating insulin a cholesterol production in the liver under the influence of insulin Ur in ketosis which is a glucagon phenomenon but insulin also blocks the absorption of cholesterol from the gut so the lean mass hyperresponders their high cholesterol is absorbed cholesterol because of a lack of insulin and that's where Nick Noritz when he says oh eat Oreo cookies and I've got Nick's blood work I've worked with him for a long time uh he's absolutely right when you eat Oreo cookies you bring those numbers down why because you're triggering insulin and that blocks the absorption of fat and uh uh and your cholesterol and your LDL comes down yes that's true we do that in our carnivores using milk products again if they if they want to stay carnivore and just that little bit of gluc of galactose and glucose is adequate not a huge amount to be to make carbohydrates a substrate but enough to trigger gp1 so yeah I mean we we see this I don't know what it means but I've coined the term insulin suppression to distinguish itself from insulin sensitivity where you're getting appropriate Rises of insulin and Insulin suppr insulin resistance which the majority of people have which is hyperinsulinemia and receptor problem but it is an important concept and um we can measure bu and look at in our Carnival to say are we a little bit over the top and um that's how we regulate it but fat is so so important as a uh a substrate for energy in our carnivals and we see some some carnivores who are a little afraid of fat because their LDL their cholesterol is high and you're going to have a heart attack in about 10 minutes even though your CAC score is zero um that they're afraid to eat adequate fat and then we start to see these numbers go up as well so it's an interesting it's a detailed discussion in the carnivore space but I don't know what it means I'm a little worried about it but we see it all the time yeah well as far as my numbers mine mine have still been okay um my patients so far have have still been um quite good I have seen fluctuations in HB andc I have seen fluctuations in triglycerides especially I mean I've even seen people that were on I mean not even long-term carnivore but short-term carnivore that uh had low HDL and high triglycerides and it was it was very strange but at least in that individual he had an extremely high stress uh job and projects and things going on and that seemed to affect his his numbers and he even had pattern B lipid profile to his his LDL even though he was just just eating meat and um shouldn't have been shouldn't have been damaging his LDL in any any from carbohydrates anyone from hypoglycemia um and when he was able to get out of that job and into a new situation then his numbers started sort of coming on um but that's that's very interesting it's something I'll keep an eye out for as well I haven't seen that as as much though look at the bu I I typically run my athletes toward a bu of 18 to 22 to my non-athletes around 18 I I don't know if the if the numbers are the same in Australia but yeah what's interesting is you you're absolutely correct that it's not cortisol cortisol is your anti- adrenaline hormone it's trying to put out the fire everyone cortisol cor cortisol is irrelevant to me what's relevant to me is adrenaline and when you're stressed out David Diamond who's an adrenaline specialist uh even though he's very big in the lipid space his day job as he'll tell you David is a brilliant guy but his day job is to look at stress response and he will tell you that when adrenaline surges and is up all the time because we're stressed out um adrenaline overrides both insulin and glucagon it's your fright andlight hormone and it overrides the release of sugar um and uh so we get this massive sugar response then cortisol afterwards puts out the adrenaline fire so we measure cortisol it's elevated but the problem is not cortisol the problem is adrenaline just an important concept and yes you're right stress will do that you know when when I'm I'm not super fit but when I'm on a long run and I hit that wall my blood sugar start going up through the roof why because it's a central Governor Theory from Tim no say that my brain is starting to need more energy it's not my muscles and my brain is sending a signal to my liver to say hey dude give me something and the the ketones aren't quite adequate enough so my brain my my liver is releasing sugar even though um I'm carnivore it has enough sugar to be able to release that Sean Aker sees the same thing when he's rowing he sees his blood sugars going up but then they come down very quickly so that is still an adequate insulin response but for some of our folks our uh Ultra Pure carnivores they'll do that and they will see their blood sugar go up on a craft level and stay up for a long time and that's why the A1C goes up and remember A1C is a measure of your average blood sugar and we know that average blood sugar is the cause of vascular inflammation so all of those things are th this is just open for the debate I'm not right or wrong or healthy or unhealthy but what I'm saying is we need to monitor our blood work and that is what we do piles and piles and piles of every patient that comes in regularly gets that followed um so I don't know what the right approach is I'm a little worried about the numbers in these patients they seem to do very well when they either add some carbohydrate or add um some dairy products back into their diet um and again Dairy is probably the single most nutritious food we can eat Ian remember this no mammal exists without dairy so for those that shun it you shun it if you don't like it if you're still overweight like myself and you're trying to manage weight because I'm at the I mean I literally walk past the donut I gain five pounds so if some of my folks are underweight and they're trying to gain um some are managing it at the upper level um so I don't do liquid Dairy I do some heavy cream but um the and then the other reason is if you've got a pro a milk protein allergy not a a galactose glucose or lactose allergy that's not an allergy that's an intolerance that's just an enzyme deficiency and it's a created enzyme deficiency you can recruit those enzymes so I I'm Dairy is an important component but it doesn't have to be um some of our folks our athletes will use some like ukan a starch um what's the Zack bidder uses that mhm um there are a few other folks out there that will will add some in uh in Lake doesn't but he's got insulin in a needle or a pump M so you know that those are and he has to use insulin he has to use insulin so all of these things we're at the high end of stuff but all of this stuff is important I think our fear of carbohydrates Isabella's paper has shown that we don't need to fear carbohydrates because these women all ate a little bit but their blood withth was pristine Yeah well yeah I mean I I certainly do feel better um as an athlete you know when I when I came off of that I I've miles better and um you even now you know well past my my playing days I I feel much better and I feel very very good um uh but that's interesting I I do want to know um or just see get your thoughts on this you know when you when you think about just the the animal kingdom you know mammals in G you know mammals in general like you said all the depend on milk and we drink drink their mother's milk and then they're weaned onto their mother's food and then they eat their mother's food for the rest of their life and then they wean their children onto the same thing so given that that process you know we see that in the animal kingdom with mammals and presumably we would have the same Dynamic you know with our species and you with Inuit and ice ages and things like that it was presumably going from milk onto meat why do you think that that that is causing a problem with the insulin suppression and like you say you don't know if it's a problem or not but it seems to be like there might be some woring markers there why do you why do you think that is and is does it happen to everybody or is it just a few people and it might might be able to explain that for some individuals as opposed to the entire population I I think first of all there's no first world population because they're they're they're living in a world of food scarcity that is 100% carnivore even the Inuit are carnivore when they have to be but they will still scavenge berries and that kind of so there's a small element maybe a 5 or 10% fraction of their diet that is not pure carnivore so I you know I think that even the Messiah the Bushmen where I come from which I got to know very well they're scavengers they'll eat whatever they can because it's about survival as opposed to us living in a world of abundance so I I think there is a we point to them a lot we like to use those but the reality is even if you look at those studies um Iva Cummings did a great uh video a little while ago on the the group of Physicians that in 1912 from Canada went up and lived with the Inuit came back to balmont hospital they only did that for a year and then reverted back to adding some carbohydrate back um but they were fine for that year and they they studied the Inuit in Winter and in summer uh and they were eating a small amount but mostly blubber and fat and they also 50% of their diet by Gram was fat so they they were eating even more fat than we eat however we do see this in everybody that's been fastidiously carnivore long enough most of my people that claim to be carnivore actually are not pure carnivore like myself that's why I'm saying I'm carnivore based because I don't want to be put in the same space as people who don't eat garlic pepper and coffee um so and I'm I'm totally comfortable with that so that's piece of it but the the absolute uh carnivores over time we do see those elements rise up just a little bit now my Baseline for A1C is 5.2 um 18 to 22 on the bu um my trigly I want below 75 these are all US units HDL I want above 75 so when you're off those metrics um that tells me something is leaning in slightly the wrong direction uh and and I don't know I don't know what the ramifications are my issue is more with insulin than with diet and I want that insulin it's an important hormone uh in what we do now if you look at milk products there are things in milk that we don't even know what the hell they do it's the only place that we get galactose M it's the only place where we get odd-numbered fatty acids C15 what what does c-15 do we don't even know but it's not there by mistake so and yes we we use it when we're young and then we move on uh to other foods from that diet but here's an interesting concept if you look at cows there're two types of cows and so most mammals will produce milk female mammals will produce milk when they short after giving birth for a period of time and then they stop producing milk cows have been bred into two separate groups based on what they do with the energy that they eat meat cows turn that uh that energy that they're consuming and they're not eating protein or a lot of protein but they're turning that into meat and fat and if if you look at these animals they're massive they're they look like you and sha Baker okay on the other hand if you look at a Jersey cow jerseys produce massive amounts of milk they skinny bony runts with these massive ERS and all of their energy is going in them and pouring out through their milk so what is beef on a beef cow is milk on a milk cow think about that so what that cow uses to to make muscles is what we drink when we drink that milk it's just they've been they've been bred to those two Divergent species but they're eating exactly the same thing one is converting it to muscle the other one is converting it to milk but it's what's in that milk is still that energy waste product so again I these are just quirky little things that happen in my head in the middle of the night but uh I I I'm not a like milk thing I'm more looking at the insulin side of things and if you look at the MS milk and sour milk is a daily part of their diet um they have cows for a reason they herders for a reason um so those are all things that we need to be aware of and not too fastidious of I don't want to harp too much on the milk but I do think that this Bears recognition and observation what are we going to do with it I'm not sure I'm not sure what it means long term we just haven't I've only recently in the last five to seven years recognized this phenomenon same thing with Ben and probably the two of us more so than anything else me on the clinical side then with cells are the people that are really talking about so more and more all I'm asking for people to do is to be aware of the concept I don't know if it's right wrong healthy or unhealthy but at least be aware of it and check it out even in someone like yourself and again I don't know what to do with it but when we look at these numbers on the insulin on the insulin resistance side we're afraid of them and that's what we're trying to correct when we're taking standard American diet people and putting them on a ketogenic diet we're trying to correct those numbers so in then those numbers are a problem now we see the same numbers in our carnivores and we say oh Kumbaya it's fine it may be but I'm not sure because the numbers are not that different yeah it'll be interesting I mean that's the whole thing is you know we we haven't we're just coming back to this we're just coming back to a natural way of eating and so by the time we've been able to have these sophisticated tests and studies and look at things at a molecular level and a at a at a biochemical level you know we have we've been doing something else we've been eating carbs and a whole bunch of other stuff so it's it's a burgeon field and it would be very interesting uh to see what happens you know so far I mean I don't I don't commonly check my Bloods it's more for other people's interest than mine I just figure I'm I'm I'm eating what I'm designed to eat my body's going to do what it's designed to do uh but when I've checked my blood they've all been quite good and I actually but you got to look at what quite good is uh in terms of that block because if you look at if I look at a insulin suppressed patient and an insulin resistant patient the only major difference is one has a super low insulin and C peptide the other one has a very high insulin and C peptide M that's the difference MH um but but not uncommonly the other metrics their protein numbers their lipid numbers are not dissimilar and again it's I don't know what to make of it um because we assume that carnivore is super healthy and I I I'm following the same lifestyle uh with with minor exceptions so yes personally I believe in that my patients do best on it I not negating the results I just want to make sure that Ultra longterm it is good the best we have of the Bellmont studies um the Belmont Hospital studies which is one year we have Isabella Cooper studies but they included carbohydrates in their diet so they don't really technically count so the point is we don't have studies Dave Feldman studies two years but not everybody was a pure carnivore is lmhr study so we don't have a long-term 5-year trajectory on my diabetics type 1 and type twos I got fiveyear data I've got fiveyear data that puts their a1c's at 52 53 54 I just presented a 1093 type 1 diabetics that we've managed to an A1C 5.3 or 5.4 yeah results that you just don't see anywhere else so and that's fiveyear data which means this wasn't just they did it for a few months these numbers were measured at five years out which means it's now a lifestyle it's a way of life we don't have that for our carnivores but I see carnivals as individual entities that are 3 5 10 20 years in MH and that's where we've seen these observations so I'm just articulating observation I they're about as healthy as you can be zero CAC scores all the metrics that we look at are great but these numbers are off and I don't know what they mean yeah interesting well I'm yeah not off yet anyway so I wonder if it's um yeah I wonder what's going on there as far as the triglycerides and things like that my my HDL is quite high so I I'll put it in context so I say you know that that my my Bloods have been been pretty good uh I say pretty good but what I mean by that is when I have a friend here's endocrinologist and functional medicine doctor and he was got interested in carnivore D wanted to know more about it because he said well you look like you're in good shape but have you ever gotten your Bloods done let's check under the hood and so we did this comprehensive blood test on me and he ended up converting to carnivore and started promoting this to his patients about five years ago four years ago uh because he looked at my Bloods and he said that if you took a 100 th he'd been doing this for 40 years and he said if you took 100,000 people that my age off the street that my blood would be number one without a shadow of a doubt and so he's just like okay I want to know more and so we started getting into more detail about it I I don't dispute that I you know again I chosen just as a clinician yeah I don't want to be have cognitive dissonance uh and I agree so htl is an interesting number htl gets produced by the liver between meals when you are burning fat when you're in ketosis so when you eat the first thing you do when you eat even if you're eating pure carnivore is you get it you should get some insulin T3 testosterone human growth hormone those are your anabolic hormones going up and they reduce ketones they don't negate them so because you're in storage mode um and you don't produce HDL by the liver because the liver is turning those elements into other products because all the traffic except for the fat goes through the portal vein to the liver the only thing that bypasses the liver is the fat then there's a period of time after a meal after you've stored that meal and remember when you eat it doesn't just last for an hour or two you eat a big meal that can last 4 6 8 12 hours the reason we do early morning fasted blood work is to see what that person ate the night before and are they still in storage mode that's what the dawn effect is it's still early morning storage phase plus an override of adrenaline but then they go into early glucagon which is the glucoses phase of utilization where the liver is releasing that extra stored sugar into the bloodstream and if you're using that Sugar then you don't have to convert the excess to triglycerides that's our carnivors that are exercising a lot and that's probably why your numbers are better than some of these other folks although a lot of these guys are exercise guys then once you've depleted the liver not to zero but you've used up that excess stored glycogen you then flip into under the influence of glucagon as your insulin level comes down you flip into fat utilization that is where you're releasing fat with low insulin you're releasing fat from your fat stores coming back to the liver and that's the traffic you want you want fat fat cells back to liver rather than liver to fat cells when you reverse that traffic under the influence of elevated gluon and low insulin that is when the liver produces HDL and so HDL is a marker of fat utilization phase and HDL then ducks with LDL and transforms LDL Scavenging cholesterol scavaging certain molecules from that and bringing it back to the liver so understanding lipid biology and everyone's so fixated on LDL and cholesterol they don't understand vldl which is vldl gets produced by the liver to transport triglycerides that come from sugar out to fat cells and vldl ducks with fat cells releases the triglycerides and the cholesterol into the fat cells breaks off and we call that LDL goes through IDL and LDL but LDL is a byproduct of dldl that gets made by the liver so again it's it's unless you understand that TR so I can look at vldl to tell me about lipid traffic LDL doesn't give me that information because your LDL can be big fluffy if you are releasing fat fat from the fat cells or small tight if it's a if you're vldl dominant so it's either a waste product or a transport molecule uh and again we can get into lipid biology quite easily and we measure those things but I'm more because you cannot have um small dense LDL and a low vldl okay that's the type B pattern the vldl is always low when you've got the high the big fluffy Tri LDL except in some of these carnivores and that's the challenge is that they're dealing with excess protein rather than and and that's causing the problem and I don't know it's if it's causing harm but they're having to store excess protein where do you store excess protein there is no store for protein you have to convert it to sugar and you either use it as energy or you store some as fat and that's what's happening in these carnivals so do you think it's a product of eating like too high protein versus fat then yeah or even though they lean so they have to that's the problem and that is where we work with fat fat protein ratio and we also use insulin to trigger that stor storage so you know again it's it's because if you think about it when your insulin levels are slightly elevated you block fat utilization okay um so so you're not get so but if your insulin levels are super low you're releasing fat in the face of trying to deal with this extra food you've just eaten so you got this Paradox you've got fat being released from your fat cells for utilization while you're trying to deal with the meal you've just eaten okay in the same way when insulin glucagon is broken in the insulin insulin resistant patients their blood sugars may be high but because of insulin resistance they can't get sugar into their cells so the cells are depleted of energy and the liver then releases extra sugar into the bloodstream despite hypoglycemia because the cells themselves are deficient in energy and that's what we call paradoxic hypoglycemia and it's where both glucagon and Insulin are elevated I measure glucon in all my patients so I know what these numbers are doing yeah and I know my Carnival is their glucagon levels are elevated mhm so you know this is you don't see this unless you look for it yeah yeah and I'm not saying it's pathologic but I understanding the traffic is important for me and that's kind of my intellectualization of it yeah and by the way be corrected by eating a little bit of carbohydrate yeah no that makes sense it's um well maybe that's why I haven't had too much of an issue I I I I do make sure I get a lot of fat I try to I'm very fat dominant and what I eat um I me the sort of the um you know the uh Sophia Clemens side of things where I'm trying to get you know upwards of you know one to two grams of fat to one gram of protein which I think is is you know evolutionarily from a you know probably consistent when we're hunting meapa you know the bigger animals have a higher proportion of fat uh to body to to body way and we were going after macadons and I mean there's evidence going back a million years that we were doing Mammoth drops and dropping these things over Cliffs and then presumably having food for the whole year similar to the Plains Indians but let me let me stop you for a second that's also a little bit of a false narrative if you ever hunted deer and game is very lean even the big animals are fairly lean but all the fat is sitting viscerally and if you watch a lion eating prey the first thing it Go does is opens the belly and eats the eats the fat in the gut um if we are eating pure muscles of wild game we don't get adequate fat but in farm raised or or even if it's grass-fed beef that kind of thing they're much fat fatter so yes the fat is important if you look at the esimo the in it's that Belmont study 50 plus% by Gram was fat now if you're an 8020 by calorie you still under the 50 gram Mark yeah um so or or or under the 5050 gram so what you're eating is more fat than most people that I know in the carnival space are eating MH okay their protein fat ratio is not quite as high as so again that's commendable and probably the right thing to do yeah well I certainly feel better on it and I and I always try to tell people that um you know fat has been wrongly vilified and also we have a limited capacity to absorb fat you know we have bile and that helps absorb fat there's there's a very small percentage of fat that gets absorbed without bile and otherwise it's it's sort of an overflow valve so it's like you go remember bile is bile itself is a cholesterol the B myself c k that's a cholesterol not a cholesterol but that is a kyom micron is a lipid molecule and and we don't you again this is the cognitive dissidence of this absolute paranoid fear of lipids uh you're right fat is essential to without fat we die yeah without protein we die without carbohydrates we we are very healthy yeah Anthony listen I'm I'm very far behind on a on a patient I this is you know again I it's stuff that I see in the trenches that isn't spoken about it's not me being judgmental or not about good or bad I follow the lifestyle myself it's just I have an open mind to to look at stuff that I see and question it well I think I think that's I think that's commendable and I think it's very important to do that because you know like I said we're we're we're still sort of we we've only had the tools to look at things in such depth very recently and so it behooves us to do that now even though we're in in a new space that we think is more uh biologically appropriate so I I I'm really uh uh grateful that you shared that with us and I'm really looking forward to you know more information that you can bring out in the in the coming years as well um so thank you for that um Rob can you tell us I know you have to go can you tell us where we have where we can find you and follow you and people can go and and see more of your stuff yeah I'm in clinical practice in I'm actually in Idaho right now in Idaho and Florida I shuffle between the two which is odd this is my my place of Zen in Idaho but um I can be found if anywhere in the world and we've got a lot of Australian patients um if you WhatsApp or text 561- 5170 642 you can set up a consultation we do it by Zoom or by phone by WhatsApp anywhere in the world if you want to see some of my content and it's more on the addiction side but everything we've talked about is out there I have a little YouTube channel not nearly as as big as yours but it's called carb addiction Doc and we're on YouTube Instagram and other social medias great well I'll put all that in the in the links below and um as well as the phone number and so people can can hopefully get a hold of you there uh Rob thank you so much for coming on it's been an absolute pleasure I'm really glad that we got to to finally meet and speak I really appreciate that you know what I tell everybody is I don't care if you agree with disagree with me if I've made you think I've done my job yeah well that's the whole point is having discussions and and thinking about things differently because the old ways have not worked and so we have to try something new absolutely absolutely great well thank you so much and thank you everyone for watching and we'll see you next time