Thread by @LindaWhaley

At #LowCarbSeattle! so far it is meet & greet and check out the vendors. Saw @DaveKeto and @siobhan_huggins in the crowd. Mona, the #LowCarbUSA gal that registered me was totally helpful with some accessibility issues I was having.

Had some tech issues with my Kindle/Bluetooth keyboard setup. Note to self - practice with new equip more before trying out at a conference! My Anke charger is AWESOME though!!! @AnkerOfficial

@AnkerOfficial If you are here and want to say hi - I am the gal at the back of the room just as you come in the door. Totally looking forward to the great speakers! I am going to try to tweet throughout the day. We'll see how that goes. I'll be taking lots of notes too.

Speakers today are RAven Bonnar-Pizzorno, MS, RD, CD on eating disorders; Megan Ramos on IF; Gary Taubes on the Quality of Calories; and Ann Childers, MD on Nutrition, Metabolism, & Mental Health.

Getting ready to get started soon. The place is filling up. I saw Low Carb Wines sampling out in the expo. I need to check them out!

Here we go! We have some folks from Argentina, UK, Hawaii ;-) Doug Reynolds is doing the intro. He is one of the guys who started @lowcarbusa

Lowcarbusa.org has a list of keto/LC docs who are friendly to the KETO/LC diets. They have resources such as technical papers, articles, and websites listed on their website. They just listed Clinical Guideliines on the website based on input for Adele Hite's input.

@Lowcarbusa wants to start local groups to support communities. They have a closed group for medical practitioners. They have joined with the Noakes foundation to include information in their database of docs that have certification through the Noakes foundation.

Doug Reynolds is sharing such a heartbreaking story of his Mom who is having memory issues. He is working so hard at promoting this way of eating in the hopes that people like his mother and other's with different health issues might find help for their conditions.

Raven Bonnar-Pizzorno MS, RD, CD of Eating REcovery Center of Washington is up. She will be talking about eating disorders. She has composite profiles of her patients to discuss eating disorders and how to diagnosis them.

Case 1 involved an underweight patient with low daily intake of food, and laxative use. With dx and discussion with the patient, they find she does not follow guidelines, so the concern is anorexia nervosa. 1-2% of women, .1-2% of men. AN is similar to the body hibernating.

Many negative effects on the body including osteopenia or osteoporosis. Folks can feel better with changing diet to recover, but may not continue with steps to recover.

Ideal body weight discussion. Medical instability discussion of vital signs to watch for. Do watch the video on this when it is posted for all the details. She is covering a lot of details.

Technical difficulties.Tweets on Bulimia disappeared. Now discussing "Diabulimia' & moving onto Orthorexia Nervosa - attempts to eat healthy taken to an extreme that they end up malnourished. Involves compulsion component. Watch this video for all the variety of eating disorders.

Switching to how eating disorders develop. 50-80% reasons for anorexia or bulimia are genetic. Other things like mental illness, anxiety, stress, and even activities like dieting.

Discussion involving thought processes people with eating disorders have, and how to talk to them in a beneficial way, validating instead of judging. Denial can be a problem in people with eating disorders.

Discussion now on healthy eating and how to reinforce healthy eating for recovery. She has several slides on screening tools and DSM criteria for different disorders. Also resources on starting the conversation. This has been a very informative presentation.

@DaveKeto @siobhan_huggins @lowcarbusa @LCPamDevine @DougieReynolds here’s the first tweet in the thread I am writing on the first day of #LowCarbSeattle

Now up @meganjramos is up on Intermittent Fasting and Lean muscle mass. She is a partner in Intensive Dietary Management with @drjasonfung . IDMprogram.com This is a great website with lots of great info.

First a background of how she and Dr. Fung came to understanding how fasting was beneficial for health. (Exciting news - she mentions a book on women and fasting due next year!) Fasting and eating disorders are different. History of fasting covered and now how fasting works.

Study - Compare intermittent alternate daily fasting & calorie restriction. IF better for preservation of lean mass.
How? GNG starts about 24hrs after last meal. Fasting = drop in insulin. Human Growth Hormone increases with fasting. Technical difficulties with slides.

Taking questions while getting slides fixed. T2D - GNG might take longer. Q on Autophagy - dairy, protein inhibit autophagy. @DaveKeto jumped into ask about Lean Mass, but @meganjramos says she'll be talking about him soon. :-)

Q - extended fasting does not cause reduction in BMR? Megan says there is a drop, but not as much as calorie restriction.

@DaveKeto is back and asking about new fasting dieters mistakes. Megan says butter coffee people, low sodium, and keeping your fasting days free of foods.

@siobhan_huggins mentions can have GNG from FA backbone. SLides working again - YAY! Fasting & Feasting cycle being discussed.

@siobhan_huggins @meganjramos says they don't have any patients that have had to have loose skin surgery from weightloss. Losing protein that makes up excess skin is taken care of with IF.

@siobhan_huggins @meganjramos Case - post menopausal woman - alternates 16-24 IF, weight trains, totally dedicated to her diet. She had a DEXA scan - over 4 months she gained some lean mass. Other patients didn't gain lean mass. Conundrum.

@DaveKeto says carbing up makes his LM go up. Turns out DEXA looks at organ mass, and counts that as lean mass. Fatty organs can make the LM number increase. This is a DEXA limitation. Rec checking 6months and not more frequent. Show of hands - about 80% here fast.

36-42 hours best for older women to fast.
MG citrate, salt, tea, broth, or coffee allowed during fast. IDMP now will be TheFastingMethod.com

Q&A
- Need to be in fed state 3-5 days before a lipid panel.
- For fatigue, sodium (takes about 2 weeks for improvement, MG (might try topical applications if having trouble with levels), Fat levels - for some patients 1-2TBSP of MCT oil to get through short term.

- Sustainability for patients 93% who started in 2012 still with IDPM, 80% compliance rate. Flexibility of fasting big driver.
- Athletic performance and IF, IDPM works with pro athletes mostly off season.

- LC/KETO gave patients opportunity to make bad decisions, but fasting is easier to tidy up diet.
- Pro athletes encouraged to break fast after workout, Megan will fast & workout. Hydration earlier (water and electrolytes) 1hr before and also after workout.

- salt intake depends on individual, ramp up slowly to let people adapt. Missed amounts.
- 36-42 generally needed before seeing results for their patients who are generally sick.
- Q fasting & bloodwork - Answer patient to not fast 3-5 days, but do need 12-14hr pretest

- IF longer hours plus LC or Keto women see reduction in C section scars due to autophagy.
- Can use DEXA to see level of bodyfat to decide how much fasting is needed and also how to tweak diet.

- Scales that measure body fat too sensitive to confounders (water, lotions)
- Time to start fasts? most start after dinner
- find strategies (set timer) to remind for salt & hydration.
- IDMP sees BP go down with salt

I missed the answer to @DaveKeto 's question about Dawn Phenomenon and if it is affected by GNG. Can you or @meganjramos put the answer here?

@DaveKeto @meganjramos - Tumeric, cinnamon, herbs ok on fasting, ask folks to skip supplement if they can on fast days(though MG is ok)

Q&A done - a great talk and Q&A. Thank you, @meganjramos

@DaveKeto @meganjramos @garytaubes is up. He will be speaking on the quality of calories.
State of affairs - 1998-2002. about a dozen md's talking LC/Keto. Science learns from observation. If eating so called healthy & getting T2D then in a position to learn. Gary calls this the conversion experience.

@DaveKeto @meganjramos @garytaubes 2019 - 3,715 LCHF Canadian Women's Physicians network. This is good. Mentions WW article asking if Keto is affecting their bottom line. One the other side other articles attack Keto.

@DaveKeto @meganjramos @garytaubes Energy balance wrong way to think. You get fat shaming regarding willpower from energy balance. So solution is eating healthy, right? Obese eat what healthy eat only less? No. We've eaten with lean people diet advice, but it doesn't work.

@DaveKeto @meganjramos @garytaubes But we ate like lean people and gained weight, so there must be something different about some people. Obese people are physiologically different. Conversion experience is finding ways to put their condition into remission (IR, T2D).

@DaveKeto @meganjramos @garytaubes Adipose Tissue remains IR after lean mass becomes IS. If in ketosis you are below insulin threshold to allow the AT to release fat from stores. It is a fat balance thing not energy balance. Bottom line for weight loss need to get under the Insulin threshold.

@DaveKeto @meganjramos @garytaubes "When you change the physiology you change the cravings." @garytaubes now craves butter and bacon.

@DaveKeto @meganjramos @garytaubes Q&A with @garytaubes
- Scientific method not being adhered? Gary says how do we know we aren't quacks & cult members? :-) We either are or the community can't work with true science. He thinks the change will come from the front line docs who are helping T2D.
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@DaveKeto @meganjramos @garytaubes - Scientific methods standards may have been lowered in some instances because of cost of experiments.
- Unsure of state of genetics and obesity and what to think of that work but wants to learn more.
- You store the fat you eat, it's possible to starve your body of fat.

@DaveKeto @meganjramos @garytaubes - Combining a lot of N=1 could have some benefits of understanding, but limited and would need to follow well, but may not convince everyone.
- Veg oils need to be tested with a clinical trial and not to be suggested because of a hypothesis.

@DaveKeto @meganjramos @garytaubes - Tipping point for LC diet? Might be getting close, but there is a big pushback happening.

Good talk. Thank you, @garytaubes !

@DaveKeto @meganjramos @garytaubes @AnnChildersMD is now up. She will be talking about Nutrition, Metabolism, & Mental Health.
We aren't suited for an industrial diet. Her opinion. 1. We are carnivores, dental health is key for diet, we need to avoid refined carbs.

She used to train dogs. Wolves have beautiful teeth on their normal diet. Humans too in some instances like the Samoans before the industrial diet came to them. 1977 US diet encouraged 55-60g carbs <30% fat, and decrease chol to 300mg/day.

Ann is convinced there is a link between mental illness and diet. Our GI systems are different than other species we share common traits with. We eat meat but need to break down plants in multiple ways to get the nutrition out of them. Evolution adapted our bodies to hunt.

Added Sugar is an acellular carb. The cell walls have been removed in processing. Stealth sugar is sugar that is broken down from other things like rice, wheat, potatoes, etc.

Dental health affects body health. Fermentable Carbs lead to dental disease. We need to figure out the right diet for dental health.

Mental health and food - acellular carbs (cakes, candy, bread, etc) cause more problems. Reaction to plasma GLU similar to plasma cocaine.

Cortisol as a reaction to stress affects mood. Skim milk and corn to fatten pigs same as SAD.

Ann did n=1 with Dexcom Glu monitor to test different foods. Some surprises when fat was a component, but did have reactions to carbs and felt hangry with one food trial.

Found a study showing people more "in a bad mood" with hyperglycemia. Another study showing Hypoglycemia can affect mood. Shows a slide from hypoglycemia.org showing symptoms of hypoglycemia.

CGM can't show insulin. OGTT + Insulin gives more info.

Sleep apnea indicates metabolic problems and can affect health and weight.

De-sugar the brain. We need fat for our brain.

Q - is Keto a mood stabilizer? Don't know. Maybe.

Women's health important for pregnancy, and other family food choices too.

Nice talk. Now Q&A

- She has talked to dentists and it has rippled into their communities. She is open to working with dentists.
- Ann has treated children and written a chapter on child issues & LC diet.
- last 5 years of practice has been rewarding to treat patients the way she wants.

- Really thinks there is no coincidence when folks do better with Keto.
- Ann has no experience with Keto & schizophrenia. Gluten might be a factor, unsure. The study is too young.

This was a great talk. Thank you @AnnChildersMD !

@AnnChildersMD Next up is Carol Freeman who will be talking about "The keys to sustainable Keto: addressing the psychology of cravings, appetite, and habit change."

@AnnChildersMD Been interested in diet and the brain for 20 years. She has a Bastyr degree in Nutrition, and a degree in Psychology and another degree - sorry missed it.

Diets don't work. She had a car accident and her injuries lead her to try Keto and worried Diets Don't Work.

It worked! Her brain injury and other issues got better and lost 60 pounds. Other people come to Keto in other ways such as seeing a friend lose weight on Keto. Then Q's start with plateaus, cheating on the diet, etc. It comes down to cravings from the brain and society signals.

The Tl;dr - dopamine causes cravings. The brain uses dopamine. It connects emotions to food. Times and places can make connections to food too.

Raccoon story. You need to be here. :-)

Cravings are like raccoons. When you give into the craving you are rewarding the craving.

You need to get away from the food cues. Figure out what makes you think food and avoid that. Avoid recipes to avoid stimulating cravings & appetite. Skip the places you ate a lot (theaters, etc.) No sweets. Raccoons like sweets. After 3 days you'll do better.

No sweeteners if having problems with cravings. Protein is good to help with cravings. 80-100g roughly a day.

Salt. Likes @drjamesdinic "The Salt Fix" book.

Pavlovian cues make us think food.

Liquid meals don't take care of satiety.

Fat & sugar together = craving.

@drjamesdinic Higher content sugar hybrid foods these days.

Keto lets us have the best foods with the most nutrient dense foods.

Limit nuts.

Sat Fats are good.

Habits can be good or bad. Keto habits should be easy to be successful.

@drjamesdinic Mentioned Amy Cuddy 2012 TED Talk for Power Pose to lower cortisol.

Other suggestions involve using your brain for happy thoughts to deal with stress.

Likes the book Atomic Habits by James Clear for learning new habits.

Lots of good new habit suggestion. Watch the video.

@drjamesdinic @carolefreeman ketocarole.com for more info on Carole. She is on IG & has a FB group too. This was a talk chock full of good info and ideas to deal with cravings and food cues.

Thank you, Carole!!!

@drjamesdinic @carolefreeman This was the last presentation for the day. It was a great first day of #LowCarbSeattle and I am totally looking forward to Day 2.

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