#64 Jessica Turton Returns


Originally published at: https://ketowomanpodcast.com/jessica-turton-returns-transcript/

This transcript is brought to you thanks to the hard work of Karen Jones.

Welcome back, Jessica to the Keto Woman podcast. It's lovely to see you again. How are you doing?

Thanks for having me for a second time. I've been thinking about coming back on because there's so many things I'd like to talk about. So, I'm so glad you've had me on

Exactly, it's a pleasure to see you. And as you said you're back. You were on, I looked it up, you were on episode 35 back in June and you told us all about you and your story and what you're doing and you teased us a little bit with the Type 1 research that you're doing and you promised to come back and talk about that and all the other things you've been getting up with. I've seen pictures you've been putting on social media. You've been really busy on the lecture circuit this year as well, I think.

Yeah. Yeah. Well there was that recent series in Australia where we had Steve Phinney come over and Jake Kushner and a lot of other amazing speakers and they spoke in Sydney and then they spoke in the Gold Coast as well, and I was able to go to both of those. And, I was so lucky to be able to take Steve Phinney and Jake Kushner out for lunch in Sydney.


I know! I was super star struck and then they're just so down to earth and I just got that sort of out of the way. But it was just lovely. We went to the 360 Bar and Restaurant. Have you been to Sydney? It's in the center point tower.

No, never been that far. The furthest around the world I've got to is Thailand and Hong Kong, that sort of area. So no, never got that far.

Well, when you come to Sydney, I'll take you there because it is beautiful. You just look around all of the city, and it was a perfect place for them to go because they wanted to sightsee but it was raining. So I'm like, okay, well this will do. So yeah, it's been fantastic and I've obviously been lucky enough to be able to speak at some of those events as well. 

Actually, when I was at the Gold Coast, I spoke about my personal story with distorted eating, which we spoke about on the podcast last time. So that was really good to actually get that out there into the conference space and get that out there to the doctors and other health professionals. A lot of individuals and the patients, they know all that happens because they're the ones who live and experience that sort of disordered eating or negative relationship with food. 

But I think a lot of health professionals are blinded to that or they just don't see it or they don't think about it. So, I was really happy that they asked me to come along and speak about that at the Gold Coast. So, I'm sure that'll be on YouTube eventually. And apart from that, I've been really busy stuck into the PHD this year, so I'm sure we'll get into more about that. But it's a busy time, but it's all very fantastic.

Oh, great. It's nice, isn't it? When you're busy doing something you love it, it doesn't feel, doesn't feel arduous in the same way.

Yeah. Well I mean there are parts of a PHD that are kind of like "what am I doing", that are lonely and tedious. But I'm almost out the other end of that section now. And you're right, If I wasn't super passionate about this, I don't think I could be doing it. So yeah, I feel lucky.

It's pretty full on, isn't it? I mean I know to a certain extent you can pace your own PHD, can't you? You can decide how long it takes you to complete it

Potentially. So, the minimum amount of time is three years. And then I think you can do up to, I don't know what the maximum amount of time is, but generally they don't want you to go for longer than four years. Right. And it's usually your supervisor who doesn't want you to go longer than four years because they want to get on to the next thing. And if you're going for longer than that, it either means you've been too slow and you haven't been dedicating time to it, or something went wrong or you're doing too much for your thesis. So any of those things could be applicable if you're going for longer than three years or four years even. 

But my PhD is a continuation of my Master’s work, so it is on low carbohydrate diets for Type 1 Diabetes.  I can't remember if we spoke about that at all last time, I would've said that. I know we touched on it. Okay, cool. So, yeah, in my master's degree for dietetics, I did a systematic review looking at all the available literature on low carbohydrate diets for Type 1 Diabetes. And you know, we found what we expected, which is that there's hardly anything out there. That's the whole reason we did the review because we knew that the evidence was scarce, but we thought, “Well, you know these people out there living with Type 1, and it's essentially a disease of carbohydrate intolerance, so we need to figure out which level of carbohydrate is appropriate for these people. We can't just keep reverting back to the national dietary guidelines to give advice to people with Type 1 Diabetes”.

We have to make a change, and that's going to take years, but we need to do that systematic review so other researchers go “Wow, this is an area we need to investigate”. And so we pulled together all the studies we could find. The studies we did find, though they weren't large randomized control trials, they were decent studies and they all show that low carbohydrate diets had a positive effect on Type 1 Diabetes clinical outcomes in at least one of the outcomes - an HbA1c reduction or reduction in insulin or a reduction in severe hypoglycemic events, or just average glucose levels. So, if it was a reduction in any of those outcomes, then we classified it as effective and so the research was promising and that's what we saw. But certainly the biggest conclusion of our systematic review was that more research needs to be done. And so that's why my PhD is delving into this same exact topic and we planned to do a couple of primary clinical trials where we are investigating a specific low carbohydrate diet protocol for people with Type 1. So, I'm in the very early stages of my PHD, but those are the things that are to come over the next few years.

Wow, fantastic. It seems to be something that I've often seen the arguments against using a low carb diet for Type 2/Type 1, and I've seen infographics and all sorts of things which basically say it's a great way of eating for both, but quite often people who are familiar with Type 1s, maybe Type 1s themselves or have friends or relatives who are Type 1s, say "Oh but hold on, you know you can't treat them in the same way" and "you have to have carbohydrates and you have to have this minimum amount". And they quite often quote something that's quite high. And it to me that logic doesn't work. 

I would have thought having the carbohydrates lower is the best possible thing because it's all about trying to keep that insulin as stable as possible. And I know you're not producing any insulin at all when you're a Type 1, you have to be putting in, but surely the least you need to be injecting the better. Can you just maybe address that a bit and get rid of or debunk some of the myths that are out there. Because I'm sure you know very well how to contradict some of those.

Well exactly what you're saying is the rationale for why we want to do this type of research, why we even looked into it in the first place. You would think logically that if you reduce your carbohydrate, then you can reduce the requirements for insulin so you don't have to have excessive insulin injections, and then you can expect more stable glucose levels

Because, of course, there are problems aren't there. There are problems associated with injecting insulin and presumably the more and more you use it, there are side effects to that.

Yes. So that's a big thing that we're learning. Before the discovery of insulin, which was in the early 1900s, they were managing Diabetes with a low carbohydrate diet, and it had to be very, very low, basically it was almost no carbohydrates with periods of fasting. That's how they extended the lives of people with Diabetes because otherwise they would have died in a few days, and they extended their lives from a few days to a few months or a few years. They obviously weren't going to live full lives without insulin, but it was the best they could do at the time. And then when insulin was discovered, it was an amazing discovery, we can be so grateful for that discovery and the use of exogenous insulin when it came into the medical system.  

And so, the treatment for Type 1 Diabetes changed significantly. And then the sort of understanding that came from there was that “Well, you know, Type 1s or people with Type 1 already live with this difficult thing” or I guess their life is so tough that why would we then go and put them on a restrictive diet, like a low carbohydrate diet. You know they already have to go through so much, let them eat what everyone else eats. And so that started being the thought process. And particularly, I know that's how dieticians are taught, we don't want to put them on any restrictive diet because that's unfair to them when they've already got this unfair condition. So that’s the way that they manage it basically, well we know they're going to eat a diet just like everybody else because that's what we want them to eat, so then we have to give them a set amount of insulin. That's how it came into practice that we need to have carbohydrate regularly. We need to have the insulin regularly which can be an okay way of doing it. 

I know a lot of people out there can manage their Type 1 Diabetes with more moderate levels of carbs or even slightly higher levels of carbs, but it's not easy. And it depends what sort of health outcome you as the individual want do you want those really, really stable blood glucose levels so you can really minimize any risk of disease?  If you do, then maybe you will need to have or find those other approaches, and find those other interventions like a low carb or a ketogenic diet. But the individual needs to be aware of the different interventions out there as opposed to just some random dietician coming to them in hospital when they're diagnosed and saying “you must eat x amount of carbs this many times a day and if you don't, you're at risk of having a Hypo, you could die”, because that's what they're doing in the hospitals at the moment.  

I've seen it and you know, I wasn't impressed at all. I was actually very frightened by the way that it was all going on so happy and bubbly, like there was no issue.  Just dosing all of these people, and very young people as well, up on all these carbohydrates when that could lead to really negative consequences and potentially a really low quality of life if they're unable to manage their Type 1 Diabetes. I guess, the thing we should say as well, is that a low carbohydrate diet for Type 1 isn't necessarily evidenced based practice yet but neither is a high carbohydrate diet. 

So there hasn't been adequate evidence to support a high carbohydrate diet in the practice of Type 1, but people are doing it anyway and that's the best practice guidelines at the moment. And you have to sit back and you have to go “Why, why, why are we just reverting to the guidelines for this population?” So that's really the crux of my PHD. I'm asking why.

Yeah, amazing. It's that fear factor. And that's the thing I've seen cited often “You know, you don't understand, we have to predict, protect against hypos because they can kill us”. And you can hear that the fear, and very understandably because it must be something probably most of them have experienced, and it must be terrifying. And, but, but again, with my logic, it seems that that you can predict much more what those peaks and troughs are going to be with the blood sugar when your carbohydrates are down. It seems to me that they get more wildly erratic when you throw the carbs in and it’s less predictable. Presumably the thing that would help most is predicting much more accurately how much insulin you're going to need.

Yeah. Well, Dr. Richard Bernstein says that big inputs lead to big mistakes and small inputs lead to small mistakes, the input being the carbohydrate amounts and the mistake being the mistake in calculating insulin. So, you're exactly right in what you're saying there are, at least that's what we would expect. And we have seen that in those few trials that are looking into low carbohydrate diets for Type 1. The other thing I want to highlight that people don't talk about a lot in the “Type 1 Space” is that it's really, really hard to estimate or calculate the amount of carbohydrates in food. So, even if you say, “Okay, well, I am eating two pieces of bread and I know exactly how many carbohydrates are in there.  All is well, I'll give my insulin”. 

The nutrition label on that bread is not accurate, it's an estimate. And then if you go to something like an apple for example, well how ripe is that apple, what's the exact size, how many bites did you take? How much did you leave leftover in the end, did you eat the skin, did you not, what type of apple, what season was it grown? All of those things affect the carbohydrate content. So even though we go onto Google and we search the carbohydrate content in apples, that is just a big estimate. And as you can imagine, the more people are eating carbohydrates when they have Type 1 and the more they have to figure out how much insulin to take, the more risk there is for error.

Because that's the variable isn't it? That must be the biggest macro that you're using to calculate how much insulin you need to compensate.

Yeah. Some people will also calculate insulin requirements based on fiber intake and protein intake, but then starch can also delay the release of glucose into the blood so it can change your insulin requirements. Again, that is more related to the timing of the insulin dosages and so on. So, I mean it's so difficult.

I was going to say it just a nightmare thing to have to try and calculate all the time.

That's the thing - even when we find strategies that are shown to be more effective, it's never going to mean that managing Type 1 Diabetes is easy, it's always going to be such a difficult condition to manage. And all those people out there that I see on social media that are absolutely killing it with Type 1 Diabetes and they're sharing all their progress online, all their ups and downs?  I think that sort of social media support is incredible for Type 1 Diabetes because I know a lot of people can feel quite alone. And I think partly it’s because there is so little evidence on appropriate dietary management of Type 1 Diabetes that the health professionals actually don't even want to see people with Type 1 Diabetes or they just want to send them to somebody else, or they just want to wrap up the conversation.  

I mean we do have the health professionals out there, but do we actually have those health professionals that really know what they're doing when it comes to Type 1? I think there's only a handful of them. So I really just hope that with the research that we're doing, we can spark the interest of more researchers to investigate this as well. Because it's just my study on its own, we need way more than that. Yes, we'll be able to more securely and efficiently answer the question “Are low carbohydrate diets effective for Type 1 Diabetes?”. But we're going to need more for the guidelines to change and for those standard practice recommendations to change.

Yes. And I think also that groundswell of what the public are doing, as you mentioned social media groups like the Facebook Group Type 1 Grit. they are doing amazing, amazing things in helping push and encourage that research, aren't they? As well as just the day to day familiarity with talking to other people who are going through a similar experience to you. I mean that really helps when you're making any kind of change or dealing with anything.  To talk to somebody who's going through the exact same thing is so helpful isn't it?

Yeah, definitely. And that kind of brings us to what I'm doing at the moment, which is trying to figure out the features of an effective low carbohydrate diet. I could do this for any dietary intervention. I imagine they've done it for plain old weight loss guides - what features of those diets are the most effective. But you bring up a specific feature there which is group support or group sessions. 

We could have two low carbohydrate diets that are exactly the same level of carbohydrate but one of the interventions will use something like group support and the other one doesn't. And the one that doesn't may not be effective whatsoever then people will be signing it going “Look, low carbohydrate diets suck. They don't work”. But was it just because the intervention was no good?  Whereas the other intervention using more rich methods and methods that are really supporting the individuals is helping them stay compliant to their diet. 

I think a big part of staying compliant as you say, is that support, the peer support, whether it be other people going through the same thing or just regular sessions with the health professional. And then also education, I would expect that the more education someone gets behind why they're making these changes in their diet, why is it carbohydrate they're reducing, why is it fat or protein that they're increasing and which types of fats and why are those types of fats healthy? 

All of these really deep questions are so important for the person that's going to hopefully sustain that lifestyle long term.

Yes, absolutely. It's certainly been something that's helped me immensely making changes. The difference with the weight loss surgery I had the first time where there was just no support whatsoever and the second time finding the online groups and just getting that peer support, it made a vast difference and that's actually how I got into low carb and Keto in the first place. It had a very important impact, it's really, really important.

Yeah, I think it's interesting you say that because the low carb Keto space has a very strong community behind it. I haven't necessarily delved into or looked for Vegan communities or whatever, I'm sure they're strong as well. But I know in the low carbohydrate community we put on these regular conferences, like what we were speaking about at the beginning, and we have so many podcasts like this one that is spreading the education and spreading the knowledge. I haven't ever seen a low-fat conference going on with heaps of people that are attending for 10 hours on a Saturday out of choice.

I don't think it would be as much fun.

No, I just, I wonder if they could even provide the rationale and the logic and the education for those other diets. Maybe that's why they're not holding full day events for them! But I think that is a huge reason people have found low carb or Keto or Paleo or whatever, because the rationale and the logic makes sense. Receiving that rationale and logic and knowledge is very crucial.

Yes. And I'm sure I'm biased, but it does just seem to be a really nice community. You know, all the people I've met, when I met people at Ketofest this year, they just seem to be a really lovely bunch of people

And I think they're all empowered, aren't they? Everyone has that sense of positivity about them. You know, even people that haven't even, like you say, Ketofest -I went to the Ketofest in Canberra, in Australia in September - and I met quite a few people that hadn't actually started a ketogenic diet. They didn't know what it was before the conference, they had actually come with a friend or a family member, and even they were so empowered by the message and the community and the education and the cooking and the fun that was going on that day that they brought the same energy as everyone else was buzzing on. 

Everyone was just bringing each other up. I think in a world where we are absolutely plagued by these epidemics of obesity and Diabetes and heart disease and cancer, where for the last 20, 30 years, we haven't really gotten better, we've just been getting worse, and we haven't had the tools to deal with those diseases, and now finally having something which makes sense that we can apply and we can enjoy that is just huge. And it's no wonder people are buzzing from ear to ear at these events and there's hundreds of podcasts talking about these sort of dietary tools. So, yeah, I think it's a fantastic movement to be a part of.

It's actually, and I think you mentioned that buzzing I think, then the whole thing is, people feel good eating this way so they're naturally predisposed to be being in a good mood. I mean, I can just imagine being at a low calorie, low fat conference so you know, I'm going to be grumpy walking in, so it's going to be very difficult to feel upbeat.

Imagine how many tea breaks you would need! You would need a break every two hours so people could go and have something to eat because they'd be lagging and low energy. And I actually thought about this the other night, I thought at the next low carb conference I really want to do a behind the scenes thing, like a video series or something, because I think capturing that energy is the most amazing thing and it would be a really good way to get other people on board I think as well. Because something that I'm really interested in doing is spreading this dietary information that I am lucky enough to have with people who don't have it or they just haven't had the access to it. 

I always think back to my dad's story, for example, where my dad ended up having a heart attack and was diagnosed with Type 2 Diabetes. But in the years leading up to that event, he was going to the doctor and he was trying to get some answers and he was trying to do something. He was always going on some sort of diet or doing more exercise or whatever it was, trying weight loss pills. He knew he had to lose weight and improve his health, but no one could help him do that, and I just feel that that's an all too common problem. 

We have all these people out there who are wanting to do something and that are trying, but all the strategies they've been given are ineffective or they haven't worked for them or they've done them in the past and it's not working now. And a lot of these people, when you tell them about this new strategy, this alternative, well, it's not a new strategy but it's an alternative strategy to what they've been doing.  

So, let's say for example, it is a reduced carbohydrate, high fat diet, and it works for them and they can sustain it, and they get the education behind it. Then they are just so grateful and they just think “Where have you been all my life?”! And that is just the critical thing, it's not that low carb hasn't been here, it's all of a sudden new, it's that people just aren't being told that it's there, they aren't being offered it as a strategy. And whether or not people decide to use it forever or not, at least give them that dietary tool and at least offer it to them and let them know that it is there. 

And I think that's how we tie it back to Type 1, I think that's important for them as well. You know, we can say to them “Okay, well this is a high carbohydrate diet, this is a moderate carbohydrate diet, this is a low carbohydrate diet. This is what we know about them. This is what your management's going to look like on each diet. What would you like to do?”. If that's how they treated people with Type 1, then I feel like that would already be better.

Yes, absolutely. And I do love that sense of empowerment. That's part of what is so uplifting isn't it? And I can see, especially in the in the Type 1 community when you feel you've lost that, you feel disempowered because you've got this thing going on that is really difficult to control. If you can be offered a strategy that potentially can really help you with that and that sense of empowerment and feeling that it's your managing it rather than the other way around, I can see that being a huge relief.

Yeah. You're in the driver's seat. And I think the other thing too is a lot of health is an investigation. So a lot of people, I mean I work as a dietician in private practice as well, and a lot of people want a yes or no answer. So, for example, they come in, they want to lose weight and then they'll say “Okay, with these strategies we’ve spoken about today, am I going to lose two kilos a week for the next 10 weeks?”, or whatever it is. And I just think “Well, we don't even know if you're going to lose one kilo. We have to just try this, give it our all, and if it doesn't work, that's okay because at least we've tried it and then we'll try something else or we'll tweak it”. 

And we are constantly investigating, and we are constantly individualizing until we find something that does work, and I think that is lacking a little bit in the standard healthcare system. People always like a good one size fits all - if you want to lose weight, this is the diet use, if you've got Type 1 Diabetes, this is the diet you use, if you've got IBD (inflammatory bowel disease) this is the Diet you use. 

I think we need to kind of step back a little bit and we need to break diets down into strategies. So, if we broke the low carb, high fat diet down into strategies, one of the strategies might just be to reduce your intake of processed foods. And that's one strategy and we haven't even spoken about carbohydrate. The person or the individual will go off and they'll do that, maybe they'll do that for a couple of months and maybe that's all they do, maybe they will see some positive health improvements, maybe they won't. 

But then they've mastered that one strategy and it's now become a habit, and we haven't labeled it with anything, we haven't called it Keto, we haven't called it low carb, we haven't called it Paleo, but we've made an improvement. And then the next one might be, okay, well let's think about reducing your carbohydrate intake, let's just cut it down by half, or let's just get rid of the carbs at one meal of the day, or something like that. And maybe that's what they then try on next, and they do that for a while. 

I think that layering of strategies is going to be far more effective than just saying, okay, well here's the Keto Diet, or here's the Paleo Diet, or here's the Vegan Diet.  It’s a “Which one do you want to do?” kind of thing. I think we do need to get everyone involved really, particularly the person that's actually going to go away and do the diet. They need to create their own diet using these different strategies that the health professional offers them, and we're seeing a lot of that actually. What we're seeing more of in the scientific literature is where studies will investigate more personalized approaches. 

So, for example, I'm doing a systematic review at the moment, I'm looking at all low carbohydrate diet interventions for Type 2 Diabetes and that's going to help me build a protocol for my Type 1 Diabetes research. But basically there are some studies out there that will just say, okay, well our dietary intervention is just 75 grams of carbohydrate per day for every single participant no matter what. Full Stop. And there's no individualization, there's no flexibility, there's no changing of that carbohydrate description after a few weeks or anything like that. Whereas there's other studies that will base the carbohydrate prescription on the individual's progress. 

So, for example, we can take the recent study by Steve Phinney and Sarah Halberg, the Virta Health study where they didn't just say “Okay, well here's a set carbohydrate prescription of 30 grams”. They actually sort of started between this range of 20 to 50 grams, but then individualized everybody's carbohydrate prescription based on whether or not they could get those therapeutic levels of ketones, and then other studies have done the same thing based on glucose levels as opposed to ketones. 

I really like that because I think that that says “Okay, well, yeah, we may have to go really low carb at the beginning to help you sort of get to where you need to be”. But based on your progress towards your goals, whether it's glycemic control, whether it's weight reduction, whether it's high levels of Ketones, whatever, we can actually be flexible in how much carbs you have, how much fat you have, how much protein you have. And again, as we were saying before, it puts the individual back in the driver's seat and, if they want to reach those goals, it's their health and if they want to reach those goals, they have the power and capacity to do that.

Oh, I can't agree with that enough. I know it's one of the things I just bang on about all the time about making this work for you, not the other way around. It's not you who's got to find a way to fit with some prescriptive version of the Keto Diet that you've been told. You know exactly what your macros should be for the day, exactly what you should and exactly what you shouldn't be eating. And there is a lot of virtue in taking some kind of plan just to get started because you know there's so much information out there and it's very difficult to know what's going to suit you until you try something. 

So, you've got to really take some kind of plan to get yourself going and get into the swing of it. But I really encourage people to find what works for them. I think it's so important and that's part of the whole empowering side of it is that there will be a version that is perfect for you. It might be super low carb, it might be that you're on the higher and you found that works for you. Carb ups might work for you. Carb ups might be the worst possible thing you could do. More protein, less fat, more fat, less protein. There are so many variables that there is going to be a perfect set up just for you.

I agree with that too, and your own health goals are going to change throughout life as well and your metabolic health is going to change, which means your diet can change as well potentially. And I think of using myself as an example. When I first went from being overweight and having a problem with binge eating and the loss of control, then moving over to a low carbohydrate, high fat diet where I was able to eat a lot of fat and keep my glucose stable and not have any binges. 

When I first moved over to that space, if I were to have something that was carbohydrate dense, that would just be very, very negative for me, that would cause me to get those feelings that I was going to binge, I'd get anxious, I wouldn't feel good, and I'd potentially be at risk of losing control and all of that.  And that was at the beginning of my journey with low carb, high fat eating. But now it's been many years since then and I can have some more carbohydrate on occasion. 

It's Christmas time at the moment, and the other night we had a Christmas party and I had a dessert. It was actually a really beautiful mango Mousse, you know? No, it wasn't Keto. It was made with sugar. It had a lot of mangoes in it, and it's not something I eat every day. It was something that I was doing because it was Christmas and I made that conscious decision I was going to have some and I felt really, really good after.  I didn't get those feelings like I was going to lose control or I was getting anxious or anything like that. And that's because now I'm at a different stage of my health journey where my whole metabolic system and my mental health is so different to what it was five years ago. So my diet can be different to reflect that as well. And I think that a lot of people would find that they also had their own similar experiences, but maybe with different examples.

Yes, exactly. And yes, it just depends, doesn't it? I mean, I did, I did a similar thing on my birthday and I didn't even eat the whole dessert. It was actually a bit too sweet, but, I had some of it, and I actually woke up feeling awful and it reminded me how eating that kind of food can make me feel. And I felt miserable that day, that depression, it's sort of come in full force and I thought, oh, this is not nice feeling like this. So, I've made a real conscious decision. It's going to be easier this year. I'm on my own at Christmas and really, I've just got too much to do to spend days feeling like that. So I've made a conscious decision not to have any of those foods.

And I went to a Christmas party. Oh. And I was very lucky, actually, the guy who'd done it, and he'd done all the cooking, and there were so many Keto things on that table of food. It was fantastic. Yes, there were crackers and carby type things, but there was a lovely plate of chopped vegetables that we could use for the dips and the things that the dips were - there was a lovely chicken pate, there were some fatty type dips- and it was actually perfectly easy to stay completely compliant.  I had a nice time, had a couple of glasses of wine and didn't feel awful the next day.

That's wonderful. And that sounds like an amazing little Christmas space there. That's a good point as well what you say because a lot of people will say “Can I go out and have Chinese or can I have rice?”.  They're always wanting to go and have something that they used to have and they used to enjoy. And sometimes the answer should just be, well, if you really want to do it, just think about what it's going to mean for your metabolism and what it's going to mean for the progress towards your goals. So, for example, if your goal is to lose weight and you want to go out and have some Chinese with fried chicken and fried rice or something like that, then maybe your progress towards losing weight is going to be slightly slower. But as long as you're aware of that, that's okay.

And so some people will then go “Oh yeah, well no, I don't want to do that”. And when they relate it back to them and what they want, it's not like I'm not sitting here going “Yes, you can. No, you can't” for any benefit of my own, it's all for the individual. And when they just reframe it like that and they say “Oh, it is actually my choice. The more I do things like that, like have something that's carbohydrate dense or something that I know is going to spike my insulin levels, the slower it's going to take me to lose weight and I don't want that to happen”. 

Alternatively, people might be okay with slow progress and they want to make things a bit more flexible. And a lot of people, just like what you say happened to you, will go and have something that they've cut out of their diet for a while and when they put it back in, they're just like “Whoa, I don't feel good eating that food because all of a sudden that metabolism has stopped because the insulin has spiked and the body has to rely on glucose until we can get back into that fat burning state and inflammation levels are higher and there's a lot of other things going on”. But of course, you're going to feel different. 

Your whole body is using a different fuel source that it doesn't like anymore. And so even that can actually be a positive thing for people because then they say “Well, I don't want to do that again. You know, I tried the chocolate cake and I don't want to go back”. So that's a really important part in people's journeys as well because then it comes again, back to what you said- I'm making the conscious decision this Christmas where it's technically the hardest time of year for everybody to stay “healthy” and you're doing it easy because you know that you don't want to feel bad and you don't want to feel sluggish and you want to feel good and you want to celebrate this season. And I think that's what we should all be striving for.

Exactly. I think it can be a very useful learning experience. And I always say to people, if they've, slipped up and fallen face first into the chocolate cake spontaneously or people who are actually considering it for a particular event or something and asking advice what they should do. I know I say, “Really, please, whatever you do, don't pile on the guilt and beat yourself up about it. Don't go down that route because that is just going to waste your time. Just be mindful of it. Be mindful of the experience and approach it as something that you're going to learn from.  And be very mindful in the moment.  I was mindful in the moment of eating that dessert and thinking, wow, this is actually really sweet.

So you were saying about something people often want to try again, something that they used to really enjoy, if they're really mindful in the moment of having that thing again, 9 times out of 10 they'll probably realize actually they don't enjoy it as much now as they used to. They've had it up on the pedestal all this time for something they've been diligently avoiding. Now it's in front of them and they're eating it, it doesn't taste as good as it used to, or perhaps it did and you enjoy and you see what happens as a result of that -you might find that you are metabolically much more flexible and you deal with it fine and you decide it's something you’re going to do every now and then. Or you wake up like I did feeling awful and think "That's a really good reminder of why I've been avoiding this kind of thing because I just, I just don't want to feel bad. Thanks". But either way, whichever way you look at it and whatever the outcome is, it's really valuable to learn from it.

I love that. I think this is such an important conversation because it's basically, 50% of my job as a private practice dietician is trying to help people understand this, that everything is a learning experience and as long as you are mindful about it and you take something away from it and learn from it, then it's always going to be positive. It doesn't matter what your decision is, it's always going to be a positive one. And that's why I think now, I would never be able to go back to the person that I was and make the food choices that I made when I was in the midst of my disordered eating because I'm too mindful now and I learn from every single experience that I have. And I'm still on my health journey. 

There are times where potentially I've over eaten and my stomach is bloated and my pants don't fit me or whatever it is.  But I just go “You know what? I enjoyed that. I'm really full, maybe a bit too much, maybe next time I'll think about not eating so much that my pants won't fit, but it's okay, it’s alright. The food's going to digest, I'll be fine.” You know, just whatever, I get over it. And before when I was in the midst of disordered eating, that sort of feeling where your belly is full and bloated is what gave me the worst panic attacks and the worst anxiety. And so now it's just so different, and being mindful is one of the biggest things that has helped me overcome that I guess, in combination with better nutrition because there is a difference. And you may have had a similar experience, I don't know, but there is a difference from how you feel when you've overeaten a ton of carbohydrate dense foods with how you feel when you've overeaten a ton of low carb, high fat.

Oh, for sure.

It's very different. What, one of them is almost like you're kind of high, when you've eaten a lot of carbohydrates, I guess you've got a lot of glucose in the system and you've got that feeling of being high, the high blood sugars and just unwell in the head and the body and feeling bloated and heavy and all of that. But then when you've eaten or you've overeaten too much high fat, lower carb foods, you do get that fullness. But that's usually just it your mind is still the same and your mood doesn't change necessarily.

That's exactly it. You've literally just eaten too much and it's like you were saying, you have to loosen the belt. Maybe undo your jeans. Yeah, but, but that's it. You don't have all the other things that go with it, like maybe feeling dizzy or sick or all the other things that, like you say, when you start messing around with, with your blood sugar that make you feel, yeah, really not good.

And it also usually means that in the four, five, six hours after you're feeling that way you're not going to eat anything. Whereas, I remember I used to have a binge on 5,000 or 10,000 calories worth of low fat, high carb foods and I'd feel horrendous. But then two hours later I'd be ready to do it all again because I'd be starving hungry. That's another really important message as well. If you’re going to overeat, make it high fat, low carb. 

It could be a helpful strategy for Christmas coming up because we know there's always too much food and it's okay to have days where you've eaten too many calories or something like that. It's okay, we are going to have those days where it's higher calorie because the appetite's high or, or something's going on and then we're hopefully going to be balancing those out naturally with days where we're busier and don't have as much time to eat and we're eating lower calories. 

So, I don't think we need to overcomplicate things, but really having that intuition to be able to say, I'm hungry, I'm going to eat now or I'm full, I'm not going to eat or I'm not hungry I'm not going to eat that, that's really important as well. And that's not something you can necessarily teach yourself either. I think that actually comes through getting your metabolism right, through good nutrition and healthy lifestyle principles as well.

Megan Ramos actually has it as a fantastic strategy for if you're making that conscious decision, to have some of those high carbohydrate things - leave them to the end of the meal. And for me it is usually the dessert. It's relatively easy here in France to make pretty good Keto decisions from the menu, and I can have something like, I had a set menu the other day and the first course was a goat's cheese and ham tart with some pastry and it was very easy for me just to scrape off the ham and the cheese and eat that with the salad and just leave the pastry to one side. That was really easy to do. 

It gets a bit more difficult when it gets to the other end and it's the dessert. But what she says is you fill yourself up on the Keto foods so you don't have much room left. And the example she uses, which has always been something I love too, with a roast dinner, is roasted potatoes, and she could just eat so many of those if she had them at the start of the meal. But by putting them at the end, she can literally only manage one or two. And so you still get to have it if you want to. You might decide by the time you get there you don't, but you can still have it. But you really minimize the impact it has purely by not being able to eat much of it. I love that. I think that's a really a really good tip to, to fill up on the lovely Keto foods first. And so literally not leave much room.

I love that tip as well because again, it's putting the individual back in the driver's seat and letting them make that conscious decision. Yeah. So that's not a bad tip for the festive season coming up. And I think that is partly how I was able to overcome a lot of my binge eating because the urge to want to binge and overeat wasn't something I could just switch off. It took a while for that to settle and for me to have control over that. But, um, the way that I really helped myself get out of that was just by over fatting. So, I want all the time. No, it is like, it is a really important part in some of our journeys. And it was for me, I had to just really go crazy with the butter, the cheese, the cream, which so many people online would be like, oh my God, too many calories, blah, blah blah.

But my initial priority at that time, or my first priority was to stop the binge eating. It wasn't necessarily to lose weight at that point. Um, and so I remember I was really diving into the sort of like fat bomb type recipes, like the Keto ice cream. Um, and they, uh, what are some other things I was doing just like real cheesy sauces and butter sauce on every single thing I was having and just drowning my plate with coconut oil. Um, I remembered that when I was eating dinner. It would just, the whole table would just be covered in oil after because I just have to put on so much. 

So, then I couldn't possibly want to have, a binge on something after. And it really, really worked. I mean, yeah, I was overeating calories, but I was at least, I was doing it in a way that was able to keep my glucose and insulin stable, and then that allowed me to really just break free from the toxic dieting cycle. Um, and that over fatting term, I actually use it for people to help them to get into ketosis as well. If they're trying to get into nutritional ketosis, even if they don't have issues with binge eating, um, but they're chronic calorie restrictors or people that have been avoiding fat for a long time. sometimes the body won't get into that state of nutritional ketosis if it's feeling stressed because you're not giving it up enough calories from fat. 

That's a very common thing for people that are just pro dieters and they're just like, Yep, got this. I can lower the carbs super easy. Yup, I'll have fun. I'll have protein, but just not have enough food or enough energy from fat. They just may never get into ketosis. And then they're sitting in that sort of state where they're not quite burning fat for fuel, but they're not quite burning carbs or giving themselves, enough carbs and they just feel absolutely terrible. 

So we go through our initial stage of over fatting, which a lot of people love and a lot of people are so afraid of as well. Um, but we go through that initial stage of over fatting and the goal isn't in that time to lose a whole bunch of weight. Um, but the goal is to help the body burn fat for fuel and teach it to burn fat for fuel. And then once we've done that, we can go, all right, so now let's tune into those hunger and satiety signals and pull back on the fat or the food if we need to.

It's really difficult isn't it? Because so many people approach it from a weight loss perspective and it's really helpful to switch that perspective, especially initially to an improving your health perspective. Maybe there are no health issues at all and the only thing that you need to do is to lose a bit of weight. But it's, it's pretty rare. There are usually, there are other things that that come with it. And I loved what you were saying that your approach to start with was regaining control with the binge eating and nothing else mattered. Because once you could get a handle on that, then you could start getting everything else to fall into place. If you were overly panicked at that point that everything had gone completely wrong, if you gained a pound or two, there's no way you would have stuck with it. So, I do think it's really important to get your priorities straight.

Yeah. Prioritize your health goals and then prioritize your strategies as well. Especially with the new year approaching, people are wanting to just jump headfirst into these diets that they believe are the perfect diet for a perfect life and perfect health. Um, but it's, it's, you're going to hit a position where you can't execute that diet perfectly, whether it's an event, um, or you go out for dinner or something happens at work and, and do you feel like you need to go get ice cream? Whatever it is, there is going to be something that comes along where you can't execute that diet perfectly. 

And if you have your priorities, where maybe your very top priority is to be gluten free, let's say it should be gluten free because you have an issue with metabolizing gluten for example, then if nothing less, you achieve that number one goal. You stay gluten free. Even if you end up eating sugar or more carbohydrates or damaged fats or whatever it is, as long as you stay gluten free, then it's like, okay, cool. I'm still progressing. I'm in the driver's seat, I'm still in control in control. Oh, you might have a different goal that you've prioritized or whatever it may be. But I think that's important as well, that keeps it unique, that keeps people on path. Because going on and off the “diet” is a part of the Diet.

It's about the process isn't it?

Yeah. There may be some things that are just complete non negotiables for you. Like in that example it was gluten that was a non negotiable and then there's other things that are slightly flexible. But at the end of the day, that's how we create the perfect diet by having those points of flexibility within the diet as well.

Exactly. I think we spoke about being mindful of what you're eating, mindful of how you feel, all those kinds of things. I think it's also really important to be mindful of your personality and what your like in your approach. I find Gretchen Rubin's Four Tendencies fascinating. And knowing yourself is really helpful in knowing what kind of approach is going to work. Some people love rigid guidelines, they find it very easy to adhere to that, and they like accountability, and so following a really strict plan is going to work really well for them. 

Someone like me who has a rebel tendency, strong overlap with questioning tendency, I just push against that the whole time, always pushing against it. So the kind of approach that I was talking about going into the meal and allowing yourself to have something if you want it, not putting down those rigid guidelines "you can't do this" or "you can't do that". As soon as someone tells me what to do, and that includes me, my first instinctive reaction is, "hell no, I'm not going to do that, in fact, what I'm probably going to do is the complete opposite of what you just said". That is my gut instinct reaction to anybody telling me, trying to impose what I should do. Whereas for somebody else, it's going to work really well. So I think it's really important to know yourself and how you react to change.

I love that you brought that up because it relates to my own practice, but also to the research as well in low carbohydrate diets. Just as you were saying, I love to find out when I first meet somebody in practice, are they a moderator or are they an abstainer, and actually get them to identify that for the different types foods that we're talking about. So, alcohol is a big one where I like to say to people “Okay, are you a moderator or are you an abstainer?”. And some people will just know straight away “Oh, I'm an abstainer. It's all or nothing. I'm either going to have a bottle of wine a night or I'm going to have nothing”. 

And then they've just created their own strategy for them, when they are ready to look at alcohol as a strategy, then they can go “Okay, Yep, I know it's just all or nothing for me and I'm just going to completely get rid of it”. Alternatively, they may be someone who's just doing four glasses of wine a night and that's something that they want to prioritize as on improving. And so they say “You know what, I'm a moderator. I can bring it down to two glasses of wine a night and I can have an alcohol free night on the weekend”. And for them that's okay. 

And by having that sort of approach, they're more likely to go off and actually do that because if we didn't find out if there are moderators are abstainers and we just said “Okay, now you've got to cut that wine back to, just having it three nights a week, two glasses of wine, whatever the guidelines are for alcohol intake. But if they're an abstainer that makes no sense to them, they can't, they'll try and have one or two glasses and it will just lead to the whole bottle or more of the wine. 

But if they actually were able to recognize that they were abstainer and actually just say “You know what, if I'm going to be improving my alcohol intake, I've just got to get rid of it and that's what's going to work for me”. It might be hard at the beginning, but really it's going to be better for them in the long run, and it's a decision that they've made. And the way this ties into the low carb literature is that we have this massive issue in nutrition science, and it’s not just on low carbohydrate diets, it’s an issue of compliance and noncompliance. 

So, we could have this great big study and we have 150 people and we put them on a diet, let's say it's the Mediterranean Diet, and we might have 80% of those people that just don't do what the prescribed diet was. So, it might be to eat x amount of fish per week, it might be to have 40% carbohydrate, it might be to have low fat, whatever. But if the Diet doesn't work for that particular person or they don't make sense of it or the way it's delivered to them is wrong, then they may just not do it. They might not do what they were told, they may do a completely different diet or something. Then we are trying to make conclusions based on the prescription as opposed to "what did they actually end up eating?". So a lot of nutrition research makes its conclusions based on the prescribed diet whereas some will factor in compliance and ask "Okay, well what did they actually eat?" and not go on to analyze the results according to what they actually ate. 

Everything's always about the prescribed diet. And I mean, I don't know if there's one way that's better than the other, but I think what we should be doing is going "well how can we improve compliance?". I think that is the thing we should be looking at in the nutrition research and little things like what we're talking about today like individualizing it to the person, bringing in the behavioral strategies, having flexible prescriptions as opposed to a one size fits all. Those things could be the things that help us improve compliance. 

And maybe this extends to other diets as well. So maybe it's not just the low carb diet where we can improve compliance but others. So then it comes back to that question while if you want to do a different diet, if you want to do a vegetarian diet or a low fat diet or whatever, we can help you do it. So there are people out there that want to do those other forms of the diets and that's okay. We've got to think of these strategies to actually help people stay compliant - finding out their personality type and finding out their social history. Can they cook? Who do they live with? What is their job like? Are they under pressure and under stress? Do they get sunlight? All of these things make a difference to people's diets and which diet they should be recommended as well.

Exactly. It's so variable and asking those questions of the participant, finding out why things didn't work well for them can be so useful. I think this has been a fantastic conversation and I think very timely in the new year – like you mentioned before about people often set themselves up with all these goals that are quite often unachievable in the New Year. So, really getting to grips with understanding yourself and what might work for you might be the best goal you can have to start with. Maybe you could give us a top tip to kick off the New Year with.

I'm glad you asked that because I was just about to say my top tip before you asked and then I would've had to come up with another one! So my tip today is to really know your “Why” every time you make a decision.  Let's say for example, it's the New Year and you want to do this low carbohydrate, high fat diet thing. Cool. No worries. Just know why you're doing it. 

Every strategy you implement, whether it be reducing processed foods, whether it be increasing your fish intake, whether it be choosing wild caught, whatever it is, always know your “Why”.  Come back to that reason why you as the individual are making that choice. Because all too often I see people just looking up what they should be doing online, seeing what other people are doing and going “Oh, I have to do that. That person is doing a 24 hour fast, now I have to do it”, and that's not the case. 

Not everybody needs to fast, not everybody needs to do Keto, not everybody needs to do to all these things that we're seeing online. So really saying, “Well, why am I doing those things?', and if I have a valid reason as to why and I think that strategy is going to work for me, then I'll do it and that's fine. So that's probably the most common word that comes out of my math in clinical practice is "Why". Why do you want to do that? Because all the time people are printing things off the Internet and saying, "Well, my friend is doing this, should I be doing a five day fast?" and all of that. And everything's got a potential benefit to it. And it's that investigation, if you want to try something, okay, let's try it, but we need to know why you're trying it and not just because so and so online is doing it.

Perfect. Well thank you so much. It's been wonderful catching up with you. I've really enjoyed it.

It's been great. And we were having a few issues with this recording because the cicadas at my place were so loud, so I'm glad that they have been nice to us tonight and really shut up in Australia. There's always these problems with the noisy wildlife, so we've been lucky tonight.

Well thank you and I, and I hope it's a fantastic year, for you. 

Same to you.