Diet Doctor Podcast #22 — Dr. Georgia Ede

Diet Doctor Podcast #22 — Dr. Georgia Ede

August 3, 2019 29 By William Morgan


Welcome to the Diet Doctor podcast with
Dr. Bret Sher.
Today, I’m joined by Dr. Georgia Ede.
Georgia is a trained psychiatrist and
has worked as a general psychiatrist for years.
But through her own personal challenges
and finding nutrition as a treatment for her,
she started to use it with her patients
and she’s got a fantastic story
about how she sort of progressed
from Harvard to Smith College
and now to sort of nutritional consulting.
Her challenges along the way
and her successes along the way
and how she’s reframed how she thinks
about treating psychiatric diseases.
But she’s not just an expert
in psychiatric diseases,
she is a breath of fresh air
in terms of how she helps us understand
nutritional research and nutritional news.
And the forces behind it and how we can
incorporate that into our lives
and understand the complexities of it.
So, we talk quite a bit about that
in this interview,
so hopefully you’ll walk away from this
interview with some specific suggestions
of how to see nutritional news and also
how to think about psychiatric conditions.
It’s not so different
from the rest of our body
and how insulin resistance, pre-diabetes,
how it plays a role in our bodies
and in our minds.
So, I hope you really enjoy this interview
with Dr. Georgia Ede
and if you want to see the transcripts,
you can find those on dietdoctor.com,
as well as the rest
of our previous podcast episodes.
All right, thank you very much
and enjoy this episode.
Dr. Georgia Ede, thank you so much
for joining me on the Diet Doctor podcast.
Thank you for inviting me.
Well, it’s a pleasure to have you on
because you represent this world
that seems so different
than the rest of the low-carb world.
It really shouldn’t be right?
It’s the world of the brain,
the world of psychiatry,
the world of how we think
and mental disorders.
But, in reality, it’s not
that much different, is it?
The brain is part of the body.
Most studies do agree with that.
Interesting way you put it.
So, you are trained as a psychiatrist,
which means you are trained to prescribe
medications for psychiatric diseases.
Just as a quick recap,
was there any discussion of nutritional
therapies in your psychiatry training?
No.
Psychiatry residency training, four years,
not a word about nutrition in four years.
All right, and then you went on
to work at Harvard as a psychiatrist.
And I’ve heard your story many times
and it’s an amazing story
how through your own health challenges,
you came to find a low-carb way of living,
which really reversed
your own health challenges
and then you decided maybe
I can apply this to my patients as well.
And what did you initially see when you
started to apply nutritional therapies
to your patients
seeing you for mental disorders?
I think the most predictable thing
I’ve seen in the beginning
and all the way through
is two things… usually improve.
One is anxiety levels tend to come down.
And another is that people
who tend to overeat or binge eat
or even people with bulimia who meet
diagnostic criteria for bulimia,
which is not just binging
but also purging
the low carbohydrate diet
can be very, very effective
for controlling urges to binge
because it so nicely regulates
appetites and cravings.
Well, that’s interesting because we
frequently hear when people say
who should not go on a low-carb diet
or a restrictive “diet”,
frequently the topic
of eating disorders comes up.
But here you’re saying it’s potentially useful,
specifically in eating disorders.
Yes, with the caveat that we want
to be careful about anorexia.
So, the eating disorder anorexia was good
for most people with anorexia,
but not all of them are underweight,
and most people with anorexia are very,
very afraid to eat fat,
and so if you recommend a low-carb diet
for someone with anorexia,
I mean, obviously you wouldn’t do that
to help them lose weight
because that’s not a goal.
But let’s say you were thinking maybe
a low-carb diet, a more nutrient dense diet,
a higher calorie diet would help them
resolve the actual thinking
that goes behind anorexia,
the disordered thinking.
The problem with that approach
is that what can happen
is that the person may of course
not be willing to increase their fat intake.
So, now you’ve taken away
another macronutrient
and now there’s very little
left for them to eat.
So, in approaching anorexia,
it has to be done very, very carefully
and in fact I’ve never yet had that experience
of working with somebody with anorexia
and applying a low carbohydrate diet.
It would have to be very carefully done
and on a team.
Right, right.
So important to differentiate
when people talk about eating disorders,
it’s not just one thing,
there are different areas there.
But again, no matter what,
when you’re starting nutritional therapy
to treat any psychiatric condition,
it seems like probably not the best thing
to do on your own
and start trying
to wean off your medication.
It’s best to do it under clinical supervision
and expert guidance.
That’s absolutely right,
that’s a really good point,
because low carbohydrate diets
are very safe options for most people.
But if you are taking a psychiatric
medication or really any medication,
but a psychiatric medication in particular,
when you’re starting a low-carb diet,
especially the first few days,
it’s a very powerful metabolic intervention.
And therefore, your body chemistry changes
very quickly in very positive healthy ways.
But that can have an effect
on your medication levels
and so, if you’re taking a medication
where levels are important like lithium,
a mood stabilizer or Depakote,
another mood stabilizer,
then it’s very important to work closely with
somebody who knows what they’re doing
to help monitor those levels
and regulate them.
I do have a free article on Psychology Today,
Ketogenic Diets and Psychiatric Medications,
to help guide clinicians as well as patients
through that process, give them some tips.
Very interesting, okay.
Now, getting back to your path through
this maze of nutrition for psychiatric health.
So, you’re at Harvard and you start
instituting nutritional recommendations
to help treat your patients seeking care
for psychiatric diagnoses.
And, from what I’ve heard,
I guess you could say the institution
wasn’t so favorable about that.
Well, at first, they were, you know.
So, I was there for seven years
and for the first six or so years
they were very supportive
of my incorporating nutrition into my work.
And many students, particularly graduate
students and some of the faculty patients
were very interested
and motivated to change their diet.
But then, there was a change in leadership
after that sixth year
and the new director came on and–
she’s no longer there–
but the new director came on and said,
we don’t want you to do this anymore,
this is beyond the scope
of psychiatric practice.
And I was forced to stop
and that’s one of the reasons that I left.
Yeah, and hearing it now sounds
is short-sighted to say that nutrition has,
basically nutrition has no role
in the treatment of psychiatric diseases.
Well, I don’t know
if that was her thinking,
she at least thought psychiatrists shouldn’t
be involved in giving nutritional advice.
And you know, to be fair, psychiatrists
don’t have any training in nutrition,
we would have to seek it out ourselves,
and so I guess there’s some logic there
but it was unfortunate.
Right, that makes sense.
What authority do you have
to recommend nutritional therapies?
Well, exactly.
Well, what authority
does anybody have though,
because who’s trained in nutritional
therapies for psychiatric diseases?
Not many people.
No MDs are trained in nutrition
and therefore no MD should be giving
nutrition advice.
I don’t understand how that works.
Okay, so then you transition
from Harvard over to Smith College.
And here’s where I think
the story gets even more interesting.
Because it’s already very interesting,
but even more interesting,
because now you’re in an environment
where people have not so much control
over their food.
They’re living in dormitories.
Health and nutrition is not on the forefront
of most college people’s mind.
It’s an all-women’s college
and a fairly liberal college
where I would imagine a vegetarian bias
was probably fairly present when you got there.
Mm-hmm.
Tell me about your years there and
your struggles, the challenges you found
and some of the successes you saw
in working with that type of population.
Yeah, it really was challenging.
First of all, I loved working with students
at Smith and you’re right.
You know, most of the students that I saw,
their physical health
wasn’t necessarily their top priority.
Their mental health of course was,
and that’s why they were coming in.
But you know, I asked every single student–
this was part of my intake interview–
every student I met with the same question,
“Do you eat a special diet of any kind?”
And I documented what their answer was
and there was actually a very high percentage,
if I remember correctly,
about 8% of my students ate a vegan diet.
And an even higher percentage
a vegetarian diet.
And, for the most part,
not even for health reasons actually
but for compassionate reasons.
And so, you know, because of
the treatment of animals and so forth.
And you know, that’s an emotional
argument that’s very hard,
very hard to respond to, and I didn’t try
because I think it’s a valid point.
But when it came to their mental health,
it was my job as an educated–
as their doctor
and as an educated person in nutrition
to explain to them either that they would
need to very carefully supplement their diet,
which I didn’t meet a single person
on a vegan diet
who was supplementing properly.
Or that they might want to consider
including some animal foods in their diet,
even if it was you know, shellfish.
So, you know that was my approach
but of course, that was unsuccessful.
In five years, I was unable to convince
any of my students
to incorporate any animal foods
into their diet.
-Really?
-Yeah.
That’s very interesting.
And did you see a lack of progress that was
sort of very frustrating to you
in terms of how they were doing?
Well, you know, that’s a hard question
because almost all of my students
were struggling,
almost all of them were struggling
with mental health problems
and you know, the nutritional quality
of a diet
is not just about whether or not
a person eats animal foods,
it’s about how much junk food
they’re eating primarily.
And the vast majority of my students
were eating a lot of processed food.
So, whether you eat plants
or animals or both,
that’s the main thing that’s going to be
interrupting normal brain chemistry.
And that was really the thing
that I was up against.
That was the hardest thing
to work with students around.
So, traditional teaching in medical school
and psychiatric residency
or an internal residency, is depression,
it has to do with serotonin,
it has to do with dopamine
or norepinephrine.
It’s just a chemical imbalance
that it’s sort of hardwired
and therefore, the only real treatment is drugs
that will counteract those chemical imbalances.
I mean, it almost sounds crazy for me
to say those words,
but that’s sort of what we’re taught.
Speak to that for a minute.
Well, there is a lot of truth in that, so yes,
there are neurotransmitter imbalances
and this has been well documented.
Actually the most popular anti-depressant
medication, the so-called SSRIs,
the serotonin reuptake inhibitors
like Prozac and Zoloft and Celexa,
those medications are designed
to increase the activity of the
neurotransmitter serotonin in the brain,
which some people associate
with happiness.
And so, that theory about
a serotonin deficit being a cause,
a root cause of depression
is very, very weak.
When you look at the best-done studies
about these types of antidepressants,
the SSRIs, they can help
about 50% of people
but in the fine print what you find out
is that is only 10% more than placebo.
Oh, boy.
And there are many other reasons why
the serotonin deficit theory doesn’t hold up.
But there’s a little bit of truth in it
and there’s actually a little bit of truth
to the dopamine excess theory of schizophrenia.
And there is this new theory,
relatively new theory
which maybe your listeners
haven’t heard about.
There’s a neurotransmitter
called glutamate,
which is kind of the brain’s gas pedal.
And that neurotransmitter
is found widespread throughout the brain
where serotonin and dopamine
are found in certain places.
And glutamate, the brain’s gas pedal
is balanced
by another equally widespread
neurotransmitter called GABA.
And so those two,
the balance between those two,
help your brain decide how active your
brain is, the activity level of your brain.
There is a lot of strong evidence
coming out now
that imbalances in the glutamate system
are driving a lot of cases of depression
and psychosis and even bipolar disorder.
So, yes, there are neurotransmitter
imbalances but what is causing them?
That’s what we always want to ask.
Okay, you can add a medication
to try to address the neurotransmitter imbalance
but that’s not going to get
to the root of the problem.
It’s not that you have
a medication deficiency.
What’s wrong? Why are your
neurotransmitters imbalanced?
So, I could go into lots of biochemistry
if you want, but I will just state one thing–
and you can ask me more if you’d like–
is that if you eat refined carbohydrates
and seed oils,
those cause inflammation
and oxidation and those turn on–
those shift your chemistry particularly
on a particular pathway
away from serotonin towards dopamine
and further more you can get up
to 100 times your normal glutamate level.
Wow.
Just by eating the wrong foods,
primarily processed foods,
particularly refined carbohydrates.
If you want to unbalance your neurotransmitters,
that’s the best way to do it.
That’s impressive, over a hundred-fold
just by eating the refined foods.
That’s pretty impressive.
So, then is that how a low-carb diet works?
Simply by avoiding the refined
carbohydrates and the vegetable oils?
Because that would just be
to, you know, higher carb diets,
I guess a cleaner carb version
would work equally as well.
So, is there a need to differentiate
between the two
or do you think they can be equally
effective in the right setting?
Well, any change you make in the right
direction is going to be a good one
so, I think start wherever you can and
then make further changes as you go along,
especially if you’re not seeing
the results you want.
I think a low carbohydrate diet
is a very, very healthy diet for the brain
because when you eat a low-carb diet,
you may or may not go into ketosis,
but even if you don’t go into ketosis,
you have lowered,
you’ve taken a lot of pressure off your brain
to process all that excess sugar.
Yeah.
That’s a great point, so do ketones matter?
You know, they matter for a lot of things
but do they matter
for trying to treat depression
or to treat schizophrenia or treat anxiety?
Do the ketone bodies actually matter or is it
the reduction of the glucose and the insulin?
Do we know the answer
to that question even?
Well, theoretically, I could give you
all kinds of theories about this,
but we have very little clinical, documented,
published clinical evidence on this.
I can tell you my clinical experience
and the experience of several other
psychiatrists who are working in this field
is that for some people it does matter,
for others it doesn’t.
Okay.
The diagnoses that get thrown around
and lumped together frequently
under psychiatric disorders
are depression,
bipolar, schizophrenia, anxiety, ADD.
Do you sort of see them as fairly similar in
terms of their response to carbohydrates
and the restriction of carbohydrates,
or is there a little variation in them?
There’s a lot of variation
because, you know,
it’s not all about carbohydrates,
it’s not all about metabolism,
although I think that takes care
of a lot of what we’re trying to do
in terms of address underlying causes.
But there are also things
like food sensitivities.
And in particular, with ADHD, there’s really
nicely documented studies–
none of them done in the United States and
all of them done in the past 20 or 30 years–
where if you take children with ADHD
and you put them on a very simple diet
where you eliminate all of the potential
common allergens
and things like most of the processed food
and you just put them on, you know, meat
and poultry and rice and vegetables,
you get a two thirds to three quarters
response rate, you know, kids improving
and many of them no longer meeting criteria
for ADHD after just two or three weeks.
Wow, that’s remarkable.
And that’s not a low carbohydrate diet.
All right, that’s good to know.
So, there’s the treatment
of “psychiatric diseases”,
where people are deemed
to have a problem.
And then there’s this sort of I guess
I’d call it emerging society
or emerging population of people
who just want better brain function,
they want to be more alert,
better cognition.
And, you know,
ketosis has been promoted for that
and some people are using Ritalin for that
or nicotine patches for that.
Did you have experience with that?
Would people come in to you for that
and wanting their Ritalin?
Oh, yes.
So, as a college psychiatrist specializing
in college mental health,
every day more than once a day.
Students coming in and saying,
“I can’t concentrate, I can’t get my work done,
my memory isn’t as good
as it used to be in high school.”
And most of these students were earnest,
not all of them but most of them.
And I believed them and stimulants really
do help most of those people very quickly.
They often have side effects,
you can develop tolerance,
you can even develop a certain type
of psychological dependence on them.
But by and large, they can be very helpful.
The problem is again,
they’re not addressing the root cause.
And so, you know, long term,
you’re just going to take that medication
for the rest of your life
and again, they come with side effects.
What happens mostly
with these stimulants
is that you get kind
of these peaks and valleys in your attention
and so, you get hyper focused
and then you’ll crash.
So, and there are other side effects
that happen as well but, you know,
again what’s causing it, why can’t you
concentrate, that’s what I’m interested in.
So, you’re not sleeping well,
you’re not managing your stress well
and you’re eating too much junk food
because you don’t have the time
to prepare you own meals
and think about the quality of your food
and you know, I mean those have to be
the top three in most college kids right.
Absolutely.
They’re not getting enough sleep,
they’re eating the wrong food,
they’re under a tremendous
amount of stress.
Okay, so well then after your time
at Smith, you’ve made another transition,
so tell us about your latest adventure
and what you’ve transitioned into.
Yeah, so I made a very difficult decision
to leave Smith at the end of Spring last year,
so I guess it was May or June.
And the reason I did that–
there were many reasons–
but the primary reason was that the nutrition
work that I was so passionate about,
the writing and speaking
and studying nutrition, the advocacy work,
it just became very time consuming
and I loved doing it
and it was like I had two full time jobs
and so I had to make a decision.
And, you know it was very difficult
as you mentioned, sort of eluded to before,
it’s hard to do really good nutrition work
on a college campus.
The environment really works against you.
Not just against me,
but against the students’ best efforts as well.
Students are required to eat in dining halls,
there’s not even a whole-foods dining hall
let alone a low carb dining hall.
There are vegan dining halls
and there are gluten free dining halls
and kosher dining halls,
but there’s no,
not even a whole foods dining hall
if students want to improve
the quality of their diet.
So, now what I’m doing
is a mixture of things.
More writing and–
so more writing, more speaking,
I’ve started an online consultation service
for people who are interested in talking
to me about diet and mental health
and any other aspect that they’re–
nutrition that they’re interested in.
And I’m working on a book
about nutrition and mental health,
many other little projects on the horizon
but I’m really enjoying it so far.
Well, that’s great because it shows
you’re sort of two hats,
you’re multifaceted because you are
an expert in psychiatric diseases
and treating them both
with medications and with nutrition.
But you’re also an expert in evaluating
nutritional science
and evaluating nutritional reports
and I think that’s where
you’ve also shown your expertise
and where people really look
to your writings for guidance.
And part of that is represented in the talk
you gave here at the conference
at Low Carb Denver
about the EAT-Lancet report.
So, this has been a huge topic in the news
over the past I guess month or so.
So, give us a 30 second snippet
of what the EAT-Lancet report is
and then we’ll go
into your analysis a little bit deeper.
Sure.
The EAT-Lancet report was published in January
in a very prestigious medical journal.
It was commissioned by Lancet
and it was written by 37 researchers,
headed by a Harvard nutrition professor,
Dr. Walter Willett,
who is arguably the most influential
nutrition researcher in the world.
And basically, what it is, is a document
that lays out the argument for a very low
meat or perhaps even zero animal food diet
in order to improve our health–
they claim to save a million lives per year–
and to protect the planet.
And the way this was publicized was that
there was a science/evidence-based report
on how meat is deleterious
for our health and for the planet.
Exactly.
And are the claims
backed by the information in the report?
Why, they are not.
And we laugh but we see this time
and time again, you know,
that the media overplays the results
of a study or, you know,
the social media just takes a snippet
of something and then runs with it.
But this was a bit different because this was
actually promoted by the people writing it,
by the authors as being sort of
the be-all, end-all conclusive report.
And that’s a little frustrating
if the science doesn’t back it up,
so give us a couple of examples
of where you see the science
falling short to back up that claim.
Yeah, so there are many examples
but I guess what I would say
is that when they use the word “Science”,
“scientific evidence”
that’s where I would take issue
because the report relied very heavily–
not exclusively– but very heavily
on a certain kind of nutritional study
called an epidemiological study.
Professor Willett
is a nutrition epidemiologist.
He is actually considered to have invented
this methodology as it applies to nutrition
and so, he obviously believes
in the power of these studies,
but most of the studies used to back up
the anti-meat claims
are epidemiological studies
and these are not nutrition experiments.
These are questionnaire-based guesses
about food and health
that then need to be tested
in clinical trials
but unfortunately, they’re usually
doubted as fact and published in headlines
and written into our guidelines
before they’re even put to clinical trials.
And when they are put
to clinical trials
more than 80% of the time those guesses
about food and health were wrong.
So, you’d be better off flipping a coin.
So, that’s my main issue
with the type of evidence they used.
They did use other evidence
but whenever it contradicted their low
meat/no meat plan, they dismissed it.
Yeah, so you used a couple of examples,
I mean eggs being a big one,
poultry being another one.
I mean, they would cite evidence
to their credit,
they would cite evidence that’s not been shown
to be harmful in most populations.
So, eggs being a big one.
Their only caveat was in diabetics
where you could say they cherry-picked
one study and they ignored others.
But they did say there is other evidence
showing up to you eating one egg a day
was not harmful to your overall health.
But then the recommendation
was to eat one egg a week, right.
So, how do they go from acknowledging
the evidence that it’s not harmful
to then making
such a low recommendation?
It doesn’t even fit.
It does not fit and it’s just
a really good example of bias.
How can you in the same breath,
say all of these studies show
that this was perfectly fine
but we’re going to recommend
a lot less than that?
Right.
And then there was this other conflict
about is this about health
or is this about the environment?
And it certainly seemed
like they were saying both,
that this is what’s necessary to sustain
health and sustain the environment.
But then yet now there’s this quote
from the scientific lead I guess,
saying that it was never
about the environment.
Do you know about that?
Because I find that more confusing.
I do.
So, the report is 47 pages long,
only 11 pages are dedicated to nutrition
and then the rest is dedicated t
o environmental impact,
so if they’re saying that it wasn’t about
the environment then that doesn’t square.
But you know, what happened was–
you know, I’m not qualified
to talk about sustainability,
it’s a very, very complicated topic
so I reached out to other people
who might know something
and I reached out
to people with different biases.
And what they pointed out to me…
one particularly Dr. Frank Mitloehner
from UC Davis…
He pointed me to the table
in the sustainability section of the report
that was trying to show that eating
less meat or perhaps no meat
would be better for the planet.
And they looked
at all these environmental outcomes.
The only – and these
are estimated projection
because we don’t know
what would happen of course,
these are models,
again these are sort of guesses.
And so, they were guessing
if they did everything just right
and you ate this different diet,
that greenhouse gases would go down.
And then all of the other things–
they looked at water quality
and pollution and things like that–
nothing else changed
when you lowered your meat intake.
But greenhouse gases seemed to go down.
And we want that right?
That’s good.
So, when Dr. Mitloehner wrote
to the scientific director from Lancet
and said he was taking issue
with the way the calculation had been done
and he wanted to know
what model they were using
because he wasn’t sure if it was correct.
And instead of answering him,
they wrote back and said,
well, we didn’t base our dietary
recommendations on sustainability,
this is completely
about nutrition and health.
So, that was concerning.
That is concerning.
And gosh, I mean, I don’t want to fall
into just everything is biased
and they just had a mission
from the beginning
and they were you know,
they were just trying to confound people
and confuse people into believing.
But it seems
like that was a big part of their mission
and I wish it wasn’t
but it’s hard to find the other side of this.
It is hard and it’s probably
because they’re not transparent.
So, I have a bias, you have a bias,
we all, you know, all of us
as human beings are biased.
There’s nothing wrong with that
and you know, you actually can’t avoid it.
But you should be aware of it
and you should be transparent about it
because that way,
people know where you’re coming from.
So, if you are Dr. Walter Willett
and you say,
all right, I’m not comfortable
with the idea of eating animals,
I don’t eat animals myself–
I mean, I don’t know if this is true of him,
I’m just saying hypothetically–
if this were the case, couldn’t he say well,
you know this is what I believe best.
This is what I worry about,
I’m worried about how animals are treated,
I don’t personally believe
that it’s good for us to treat animals.
I worry about, you know,
how they might be affecting our health
even though I can’t, even though
I’m finding lots of evidence of the contrary.
Wrestle with it openly.
And you know, I think the emotional
argument is a valid one.
So, I don’t know why they feel the need
to at least seemingly hide
behind nutrition science
when there really isn’t
any nutrition science there.
Yeah, that’s the most troubling part
of this whole thing,
it’s displaying something as factual,
displaying something as conclusive
when really, it’s anything but–
And that confuses a lot of people,
I’m sure you’ve seen this.
I’ve seen some people
who just come to you like desperate
and I’m so confused because I’ve seen
so many contradictory things
and this is part of the reason for that.
This is overstating the quality of evidence
or the certainty of evidence.
Yeah, when you were mentioning
that the media plays a role in this
and I agree that they do,
because often, they’ll just repeat the headline
or the press release
that the author or that the journal
have given to them.
But and certainly,
how would they do it all–?
I mean, it takes so long to read, it took me
a week to read the 11 pages–
a full week, full time, a full week’s work
to read those 11 pages
and to try to understand
what the arguments were.
No journalist has that kind of time
or the ability to do that.
And if you were still practicing
in full time psychiatry,
there’s no way you would have had time
to do that.
So we’re lucky to have you,
that you were able to do it.
Well, it was fun.
You have a twisted sense of fun then.
I do, I need to get out more.
So, what would you recommend
to people?
I mean, what can we do
now that this is out there
and it sort of has this steam behind it?
But yet, what can we do to help ourselves
interpret what it means
and kind of help counteract it?
That’s the million-dollar question.
I really don’t know.
I’m not somebody who knows
a lot about politics or power
or how financial power works.
There are other people
who do understand those things
or even the legalities in politics of this.
I really focus so much on the science
that it’s really hard for me
to even ask those questions.
But what I do notice is that this effort
to reduce or eliminate animal foods
from the diet of everyone living
on the planet is very well funded
and very well organized and very powerful.
And so, you know, it has the potential
to affect everybody’s food choices,
how much food costs,
what foods are available.
If they’re successful,
this could have major consequences for us.
For everyone, whether you eat plants
or animals or both.
And so, I do think that people
who care about nutrition science,
not just low-carb people because
this isn’t about low-carb and high carb,
this is about public health
and this is about social justice.
And so, if you care about this,
we need to find a way to organize better,
join forces with other communities,
not just the low-carb community but other
communities which are interested in health,
and find a way to send a more cohesive
message
and spread more information
and sort of at least be able
to lay out arguments to the contrary
so that people can see both sides of it
and decide for themselves.
Yeah. That’s a good point.
And you know, you hinted on this,
I meant to bring this up.
The point about nutritional completeness.
So, we need to organize better like
you were saying and not just low-carb.
I think that message is so important.
But one of the messages can be
“what diet is more complete?”
and “is this a complete diet
that we can all thrive on?”
And the answer there is no, I mean,
it’s a really incomplete diet, isn’t it.
By their own admission,
and repeatedly throughout these 11 pages
and I would encourage people
who are curious to just read them.
But repeatedly throughout the report
they acknowledge that the diet
that they’re recommending,
is between–
let’s say, let’s give an example.
Seven grams of red meat per day,
which is a quarter of an ounce.
Quarter of an ounce.
That’s the size of the top of your thumb.
Or less than that.
So, you could have up to two–
you could have up to a whole thumb’s worth
or you could have no thumbs at all…
worth of red meat.
So, you know, that diet
that they’re recommending…
I lost my train of thought on the–
I forgot the question Bret,
because I was so excited
about describing this piece of meat.
It was about the completeness
of the diet.
Oh yes.
It was a good description about the piece
of meat though, you can picture that.
So they repeatedly acknowledge
for pregnant women, for infants,
for growing children, for the malnourished,
for the impoverished, for teenage girls,
that this diet– for aging adults
who are losing muscle mass,
all of these people – that the diet,
even their middle diet
with the not zero meat but a little meat is
nutritionally inadequate and inappropriate.
And that you need to take
not just B12 supplements
but other supplements on top of that
like iron and B2 and perhaps Omega 3.
And so, by their own admission,
their diet is insufficient
and then of course
there’s insulin resistance,
which in the United States and
this is around the world in many places as well
only one in eight of us
are metabolically healthy now.
So, the Lancet diet recommends
a very high carbohydrate diet
with on average 330 g
of carbohydrate per day.
Wow.
And for somebody with insulin resistance,
that’s going to be a dangerous diet.
So, this diet really isn’t appropriate
for anyone I can think of.
So, it would be the 12 % of the population
that’s metabolically healthy
but who is not an elderly adult or who is not
pregnant or who is not a teenager,
who is not growing, nobody who wants
to grow or be healthy essentially.
That’s right and for those people
that you mentioned,
that very small slice of the population,
even they would have to take supplements,
particularly a B12 supplement.
And that’s a choice
that you can make if you wish to.
But you should know that first of all, there
are other supplements you’d need to take.
They really downplay
the nutritional deficiencies
but you should know that’s, in my opinion
based on everything that I have read,
a vegan diet is not a healthier diet.
Simply removing the animal foods
from your diet, there’s no proof,
there’s no evidence that only removing
the animal foods from your diet
will get you healthier in any way.
And what we know is that
when you remove all the animal foods
and you remove all of the processed foods,
then you get a little bit healthier.
Right, that’s a very important point
because people will cite evidence
saying going on a vegan diet or vegetarian
diet is proven to be beneficial for our health.
But that’s the caveat.
You’re not just removing the meat.
You’re also removing the processed food,
the junk food the refined sugars.
Hard to argue with that.
But the question of if you’re just
removing meat that’s unanswered.
It’s never been tested, so we have
absolutely no idea what happens
if you simply take whatever diet
you’re eating now
and just remove
the animal foods from it.
We have no idea if you would see
any health benefits whatsoever.
Well, it’s certainly disturbing to see
the way things are promoted
with the lack of scientific security behind it,
or scientific certainty I should say behind it.
Well, on that depressing topic,
let’s transition to another exciting topic –
Alzheimer’s disease
and dementia, all right.
So, the baby boomers are aging.
They happen to be a higher percentage
of overweight and insulin resistant baby boomers
and there is this fear that Alzheimer’s
disease is going to skyrocket
and it is a devastating disease not just
for the person affected but the loved ones,
the caretakers, the family and of course,
economically.
So, it’s a brain disease.
You are an expert in brain diseases.
What do you see as again
a kind of root cause,
common theme with Alzheimer’s disease
and a way to potentially attack it?
So, you know, we were talking before
about psychiatric disorders
and low carbohydrate diets.
We have very little evidence there.
It’s emerging about insulin resistance
and psychiatric disorders
but when it comes to Alzheimer’s disease,
we have multiple lines of high quality
mature scientific evidence,
all pointing in the direction
of insulin resistance
being not just associated with Alzheimer’s,
an innocent bystander,
but also being a driving force
behind most cases of Alzheimer’s disease.
This is, most brain experts now
agree on this point.
Now, what level of evidence is that?
Because it’s hard to do
a randomized control trial, right.
So, that’s the highest level of evidence.
I guess it’s not quite to that degree,
so what do you think
what level of evidence supports it?
Right, so we’re not talking
about epidemiology,
we’re talking about mechanistic studies,
we’re talking about imaging studies,
we’re talking about clinical studies;
humans, animals, mechanistic studies,
basic science experiments.
Every kind of evidence, every type
of evidence that you can have
that isn’t a randomized clinical trial
is there.
And it’s not– you wouldn’t want to point
any one of these types of lines of evidence
because all of them point
in the same direction
and they’re all very strong types of–
the study results are all very strong.
Then you have a good case.
And it has started
to be tested in clinical trials.
We have a few studies that have come out
showing that if you eat a low-carb diet,
even if you have early Alzheimer’s disease,
you can start to see little changes
in cognitive functions.
And there are a lot more studies to come,
it’s an really active area of research.
But it really makes sense because
Alzheimer’s disease is basically–
the brain is dying and
it’s a metabolic disorder,
the brain’s not getting enough energy.
It’s an energy crisis.
So, the funny thing about it is that yes,
the brain needs sugar
and even if you’ve got a lot of sugar,
if you’ve got high blood sugar,
that’s all going to–
sugar has no problem going into the brain.
It flows in, no questions asked.
If your blood sugar is 400, you have plenty
of blood sugar, nothing’s going to stop that.
The problem is that if you have
insulin resistance of the body,
you will also have it
at the blood-brain barrier.
And then the insulin won’t be able
to cross into the brain.
And you need insulin to process glucose
and turn it into energy.
So, the brain is suffering
from an energy deficit.
An energy deficit
despite the sub streak for the energy,
the glucose being prevalent everywhere.
Exactly.
It’s flooded with glucose
and yet it’s still starving to death.
So that’s the thing
that people don’t understand.
They think the brain needs sugar,
well yes, the brain needs some sugar,
but you know, getting it up there
isn’t all that needs to happen.
Right, and yet, there have been
hundreds of millions of Alzheimer’s drugs
and medications but none of them
looking at insulin resistance.
Do you see the tide starting to change?
Do you think there’s going
to start to be a shift?
There have been actually some studies.
As soon as scientists
in the communities have noticed
this connection between insulin resistance
and Alzheimer’s,
the first thing most of them did was to think,
oh, we need a drug for that.
So, they started to test
insulin resistance medications
that can lower insulin resistance.
And so, some of them have worked
and some of them have not.
This is very, very early but there are actually
studies out here looking at this.
But what I would argue now and again
is why don’t you in the first place
rather than use a drug?
Why don’t you lower these insulin levels
naturally by changing your diet?
Right.
Just makes so much sense doesn’t it?
It just makes so much sense.
Now, would you recommend that someone
has to be on a ketogenic diet
to prevent Alzheimer’s
or to treat Alzheimer’s
or again just getting off of
the high carbohydrate, low glycemic index,
refined sugars is enough
to make an improvement?
How do we know when we’re getting
a benefit and how much effort is needed?
We don’t know.
It’s a really good question.
So, it really is a matter of degree
or how insulin resistant you are.
I mean, this is my hypothesis.
I want to make clear that this
is my hypothesis, this is not fact.
I don’t know for sure.
But what I see when I follow the trends
of other diseases
as we look at sugar metabolism
and ketosis
is that the more insulin resistant you are,
the more strict you’re likely
going to be.
And so, it’s not a one size fits all.
But if you have pre-Alzheimer’s
which is mild cognitive impairment
or early Alzheimer’s, chances are–
and you can get tested to find out
because not everybody with Alzheimer’s
has insulin resistance, just 80% of them do.
Only 80%.
If you have resistance
it’s probably pretty significant.
And you know, you can start
wherever you can.
If you can do ketosis, do it.
If you need to work your way down to that
and see a little – you know,
I think everyone is a little bit different
but I think that it’s really important
to make the changes that you’re capable
of making because it really can hurt.
I think that’s refreshing to hear
the way you explain things
because you admit when you know
what you know
and you admit you don’t know
what you don’t know
and you admit where you’re not an expert
and where you need to rely on others.
And it’s refreshing to hear that because
especially something like the EAT-Lancet
or you know, other people who sort of
espouse about a lot of different topics
where maybe they’re not an expert
or are saying things
with the certainty that doesn’t exist,
so it’s refreshing to hear
that acknowledgement
about what you know
and what you don’t know.
There’s a lot I don’t know.
Humility is a good thing, I think.
Oh, yeah.
It’s fun to let people learning though,
it’s the, you know one of the things I love
about it is there’s so much more to learn.
Every day there’s something new
and I can discover.
Well, we’ve walked through
a number of brain-related conditions
and then quality of science
related conditions,
which both I would definitely
consider you an expert on.
So, what’s next for you? What else
do you think needs exploring here?
Well, actually
what I’m learning about now,
I just spoke yesterday at the world’s
first carnivore conference
and so I spoke about the potential for–
well why might carnivore diets
be good for the brain.
We hear anecdotes all the time.
People say that their long-standing illness
of whatever type
mysteriously disappeared
on a carnivore diet or significantly improved.
And so, you know the question is–
if we believe these people – why would that be?
Why would that be?
There’s a lot of things
and I’m looking into that.
Well I had Amber O’Hearn on the podcast
and she gave a wonderful discussion
about the carnivore diet.
So, what are some of your theories?
What are you playing with
at the moment for why it would work?
Yeah, so my talk yesterday
was exploring all of these things
but as I was preparing for it,
I realized how much I didn’t know.
You know, there are
so many other things I’d like to learn.
But what I presented yesterday
was sort of the–
there are three underlying reasons
for pretty much any illness, right.
Their toxicity, deficiency
and what I call metabolic mayhem right.
And so pretty much every disease
can be boiled down to one of those three
or all three.
And so, if you’re eating only meat,
what you’re doing is you’re eating a food
that contains every nutrient
that we need in its proper form.
Without any anti-nutrients, all–
many plants contain substances
which interfere with our ability
to use nutrients
and all plants are missing
certain essential nutrients.
There is no such thing
as a complete plant food
that gives you all the nutrients
that you need.
So, you’re getting all the nutrients you need
and you’re not getting any anti-nutrients
so that’s good.
So, nutritionally you’re good.
But you’re also reducing drastically
the number of toxins in your diet
because plants defend themselves
using chemical weapons.
Those are natural toxins.
I want to make this clear.
We have evolved mechanisms to deal
with those toxins in many cases–
not all, in many cases.
And so, it’s not as though you know,
everyone’s going to die if they eat plants.
But for so many of us we have sustained
damage in our gut or immune system over time,
from who knows what environmental insults,
toxins, pesticides, antibiotics, drugs,
who knows what things
are in the environment?
And we’ve lost our ability
to manage those toxins
because in most cases, we’ve evolved
to either not absorb them in the first place
or rapidly detoxify and eliminate them
very, very quickly.
So, if that’s not, if you’re not able
to do that, those toxins get in
and there are some
really powerful toxins in plants
that can penetrate
the blood-brain barrier.
And then, the third is what we’ve been
talking about; this metabolic mayhem.
So, if you eat an all meat diet,
you’re not eating–
you’re eating very, very little carbohydrate
if you’re eating an all meat diet.
And so of course, that really,
has been shown by many of us
including the wonderful Dave Feldman,
in meticulous experiments,
and I’ve done this myself,
blood sugar is stone cold flat and nice
and low,
you know 60s, 70s, 80s
on a low-carb – on a carnivorous diet,
which actually was not the case
for me on a ketogenic diet.
Interesting.
So, it’s very good for when you’ve got
fluctuating blood sugar and insulin.
Yeah. So, it suggests though that there
could be a damage process in the gut
that could heal and then potentially we will
be able to tolerate plants in the future.
Potentially.
I think that’s something
I’d be interested in seeing
as this sort of carnivore community grows
and if some people try to go back
to a keto diet or you know, lower carb
but still with plants
if they do better on it.
Exactly.
I wish– if you ever find out how to do that,
you know, to improve my metabolism
and my health
so that I can expand my diet,
please let me know.
Yeah. And I mean, it’s limiting.
It can be very socially limiting
and difficult in certain situations
but still perfectly doable because there’s
a growing number of people doing it.
Yeah. And you would ask what’s next
and so, intellectually
it’s an area of interest for me.
I’m learning more about
the biochemistry of the brain
and the endocannabinoid system and just
things like that, just my own interest.
But I don’t know if you know about this
but there’s going to be the first ever
low-carb conference in Asia next month
in Indonesia in Jakarta.
Oh, right.
So, I’ll be there,
Dr Westman will be there,
Gary Fettke will be there in Tasmania.
And then in Switzerland,
there will be a conference,
a keto live conference
in Bergün Switzerland
and Dr. Thomas Seyfried will be there,
Ivor Cummins will be there.
Many, many people,
so it will be wonderful.
This low-carb science community
is really growing
and the message is spreading
to more and more places around the world
and more and more people are learning
about it as an option,
so I think it’s great.
I like how you said that “as an option”.
It doesn’t mean
it’s right for everybody.
But certainly be a potential tool
in the toolbox
doesn’t mean it’s right for everybody.
Well, I really appreciate your approach and
the way you see things and explain things.
So, thank you for all you’re doing
and thank you for all your work
and thank you for continuing to try
and learn more
and sort of be better
and help educate the rest of us.
Thanks for a great conversation
and your excellent questions.
All right, Dr. Georgia Ede
from diagnosisdiet.com.
Thank you.