Diet Doctor Podcast #26 — Ignacio Cuaranta, MD

Diet Doctor Podcast #26 — Ignacio Cuaranta, MD

August 19, 2019 5 By William Morgan


Welcome back to the Diet Doctor podcast
with Dr. Bret Scher.
Today my guest is Dr. Ignacio Cuaranta,
he’s a psychiatrist from Argentina
who is sort of leading the field along
with Dr. Georgia Ede
and a few just very select psychiatrists
who are using low-carb ketogenic nutrition
and overall lifestyle interventions
to help their patients with mental disorders
and psychiatric diseases.
And as we talk about this in this interview
psychiatric diseases aren’t all that different
from body diseases if you want to call it,
a lot of it has the same the same baseline
the same cause of disorder
and the same potential treatment
much of which needs to focus on lifestyle.
So I really enjoyed this perspective
and I think you’ll get that from his approach
and also how we sort of leading the way
in Argentina.
This movement isn’t quite as big in Argentina
as it is in the United States and in Europe.
So he’s sort of blazing the path there
which I really appreciate.
Also this sort of ties in a little bit with the how
DietDoctor launched their Spanish website.
I wish I could’ve done this interview
in Spanish
but my Spanish is not good enough at all.
But it’s reaching out to a whole new
market, a whole different world,
this is truly a global event.
So if you want to hear more about this and
read the show notes go to DietDoctor.com.
Otherwise I hope you enjoy this interview
with Dr. Ignacio Cuaranta.
Dr. Ignacio Cuaranta, thank you so much
for joining me on the DietDoctor podcast.
Thank you for having me, Bret.
Yeah, it’s my pleasure.
Now you came all the way from Argentina
here in Florida
for the Low-carb USA conference
where you are giving two talks really.
You are giving one in English and then one–
they’re having a special day
specifically all in Spanish.
And you’re giving a talk there as well.
Exactly, two talks, they’re going to be
about the same but in both languages
in order to reach more people and be able
to join more people into this world.
DietDoctor has recently launched their
Spanish version of their website as well,
so when we were speaking last night and
your dad was there,
he asked if this interview is going to be
in English or Spanish
and I said I wish I could do
an interview in Spanish
but it would’ve been
a very short interview if it was.
So I thank you for taking the time
to join us today.
So you are a psychiatrist based in Argentina
and now you are part
of the whole low-carb movement
as treating your patients with nutrition
for their psychiatric disorders.
So let’s rewind for a second,
go back to your training
as you were learning
to become a psychiatrist.
Was there any discussion about nutrition
in any of that training?
There was no discussion whatsoever
and this is one of the things
that really launched me into doing
the investigations myself.
Actually one of my core beliefs is that
we study function, we study dysfunction,
we study anatomy,
we study lesions, injuries,
but there’s no mention whatsoever to how
our brain is functioning, what fuel is using…
Does it have available fuel?
Does it not?
Is it permanent fuel
or is it transient?
So that really is what moves me
into studying this.
My take on psychiatry is,
from what I have learned in medical school,
was that it really was focused
on drug treatment for chemical imbalances
and that was really about it.
And let’s face it,
the drugs that are used in psychiatry
have some pretty significant side effects.
So it’s a huge field that even if you can’t get
people off all their medications
to control their psychiatric disease,
if you can reduce the medications,
you could have a huge impact in terms
of daily function and how people feel, right?
Well that’s absolutely right.
In fact I’m going to have a big mention of
what you’ve just said in the presentations
because current practice of psychiatry
is excessively pharmaceutical-centric,
it has an excessive pharmaceutical-centric
view
and it disregards many other things
we could be doing for our patients.
And if you only have one tool,
that’s the tool you’re going to use
and really in terms of side effects
that’s one of the things that pharmaceutical
companies haven’t been able to reduce much.
And when that in fact happened,
when there’s a drug
that doesn’t have many side effects,
they are usually not as effective.
And let’s talk for instance SSRIs
that are one of the most available drugs
that are used in depression and anxiety,
in obsessive-compulsive disorders,
in psychotic disorders,
for many, many functions,
they have a plethora of side effects
and adverse effects
that are very hard to counteract,
and those are drugs that are often
very hard to take away from patients.
And I think that these strategies
that I’m using in my clinical practice
can have a huge impact in reducing doses
or
even avoiding to prescribe a drug altogether.
Yeah, great point.
And it’s interesting to think
about the scope of the problem
because we talk so much about our obesity
epidemic and our diabetes epidemic
and the epidemic of chronic diseases
that have plagued America and Europe
and the world really,
but when you talk about psychiatric disease
it seems like it’s fairly similar.
I mean there are estimates
that a third of all people
will have some mental health condition
during their lifetime.
The Association of psychiatric diagnoses
with reduced mortality
and substance abuse problems
and decreased quality of life.
I mean it’s rampant
and I don’t think it gets the same attention
as you can say the other problems,
the diabetes, the body problems
rather than the brain problems.
Do you think that
that’s an accurate statement?
That it’s sort of been not given
the attention it deserves?
That’s absolutely an accurate statement
and in fact psychiatric conditions
tend to go underreported.
They tend to thus go underdiagnosed,
undertreated, thus “chronify”.
So even when they are properly diagnosed
psychiatric medications oftentimes
make matters worse.
They make a bad problem worse,
because most of them have–
one of the most side effect
that we see is weight gain.
There is an average of between 2 kg
and 17 kg of weight gain
over the course of treatment
and that’s about I think between
4 and 30 pounds of weight gain on average
and this severely increases mortality
among psychiatric patients
and psychiatric drugs are dose-dependent
and so if you have a severe condition
you will probably need higher doses
thus increasing mortality
and highly reducing the quality of life
and expectation to get better,
it really highly limits recovery expectations
in this group of patients.
And yeah, it is an accurate statement,
of course.
So that’s pretty troubling
and there’s a stigma associated with it;
nobody wants to be thought of as crazy
or having a mental condition
when really it’s just another health problem
but yet somehow it’s got the stigma with it.
But even in patients that maybe
don’t make the cut to be diagnosed
with let’s say major depressive disorder
or an anxiety disorder,
they may have insomnia,
they might be overweight,
feeling really… with low self-esteem,
feeling very sad,
having very low levels of energy,
having very low levels of motivation,
high compulsivity
and all those really make your life
very miserable
because it’s like a vicious cycle;
it’s very hard to get away from it.
And it’s hard to make taking care
of yourself a priority
when you feel that way – so the rest
of your health is going to suffer too.
You’re not going to exercise,
you’re not going to eat well,
you’re not going to take care of yourself
so really is sort of a domino effect, isn’t it?
It is a domino effect
and it is a vicious cycle
because most of the those patients,
what really troubles me,
is that most of them are probably doing
very well in other aspects of their lives
but they’ve tried many times to lose weight,
to get ahead on their health
and they are following the usual guidelines,
what the standard of care proposes,
and they are doing it
following the guidelines perfectly
and they don’t get better.
So after a while they get frustrated
and they’re probably going
to drop out any type of treatment.
It is a vicious cycle
that really troubles me.
We focus so much on what people
should eat,
how they should exercise,
how they should sleep
and we don’t think enough
of what’s going on in their brain
and how they’re feeling
and how they’re responding to things
and that’s like you said – they may not meet
the diagnosis of a major depressive disorder
but how they’re thinking and
what’s happening in the brain function
definitely impacts their health regardless.
So walk us through this – so you went
through your training,
you learned to become a psychiatrist,
you started your practice…
how did you take the path less traveled,
how did you differ from everybody else
and start to think, let’s look at how nutrition
actually affects the function of the brain
and see if that’s going to help people…
How did you make that transition?
Well, let me rewind a little bit.
Let us go back to the year 2005.
I was in my last year of med school
and with a friend, we traveled to Michigan
and had an experience
at the Beaumont Hospital
and then I there decided to do
my experience at the weight control center
where they prepare patients
for bariatric interventions
with a kind of a classical approach
but it was with meal replacement packets
and with controlled calories,
but there was a high-protein diet.
They got a lot better and then they
prepared them for the bariatric surgery.
So, it is kind of like
a 14 to 15-year route for me
and when the time came to decide
what specialty I’d like to go in,
I was between psychiatry
and endocrinology.
Psychiatry kind of like suited me
a lot more than endocrinology
because there were other aspects
that I didn’t really care for
and really, psychiatry,
I have a passion for it, you know.
Really, when I study this type of topics,
I get really invested in,
and so I decided to go into psychiatry.
But you know, inside of me,
nutrition was always–
and obesity was always
a very important topic for me.
So, I kept studying it.
Even for myself, for my own health,
you know, it’s something that doctors
sometimes… we will put aside
and doctors ourselves
are very unhealthy people
and that’s kind of like a pretty strong
statement, you know.
And so, I did my residency in psychiatry
where I did, you know,
I focused on all of the psychiatric
large topics but nothing about nutrition.
And, so, after, it was about 2013,
I came across the paleo diet,
I started doing it myself.
And then on year 2004,
I travelled to France,
I did a 3-month rotation
at a psychiatric hospital there in Paris
and I kept studying and studying.
When I came back
my girlfriend got pregnant
and she was–
my daughter was born in December 2015.
So, I started studying ways
to minimalize things in my house.
It was pretty, you know, kind of like a,
you know, a different path.
But I came across the intermittent fasting
through a minimalist site.
Oh, interesting.
So, there ain’t more minimalism
than, you know, intermittent fasting.
So, not from a health perspective?
Let’s try this, you don’t have to worry about
what you’re having for breakfast,
you don’t have to cook, you don’t have to–
That was my first contact
with intermittent fasting.
Yeah.
So, I read Brad Pilon’s Eat Stop Eat,
that was kind of like a seminal book
in intermittent fasting,
I read it overnight and the other day
was my first 24-hour fast, you know.
I just drove into it.
I felt so great that I started studying,
studying, studying
and I came across Dr. Jason Fung’s work
and I started studying intermittent fasting
in a more scientific way,
trying to see what there was available
in terms of studying and in terms of effects.
And lo and behold I wrote to him and I got
to be able to travel to Toronto in Canada
and did an experience at the Intensive
Dietary Management in 2017 April.
It was on.
I lost, like, myself, like 14 kilos
and people was asking me,
“What are you doing?”, you know, like–
So, did you go there as a patient
of Jason of Dr. Fung’s
or you went as a practitioner
to learn and–?
I learned and observed first and then
with an affiliate of an observation program.
I had been studying for like over
two years at the time, a year and a half,
so I kind of like reinforced
a lot of the concepts that I had studied,
and I started implementing.
And the other side of the story is that, as
the head of the mood disorders department
at the neurological clinic in Rosario,
one of the main clinics in Rosario,
with a lot of patients coming in
all of the time,
all of the patients came in to me
for the psychiatric assessment.
So I started seeing this very frequent pattern
of metabolic disorders among patients.
I started seeing all of these
compulsivity trades,
all of this deterioration
in the quality of life
and I started asking more
about nutritional aspects.
So, you know, as a surprise
came that they were–
most of them were following
the standard diet, you know,
with high carbohydrate ingestion
without affecting their sleep patterns,
you know, with sedentary lifestyles.
So, I started you know, with some patients
that were suitable,
and I have a very strong
patient-to-doctor relationship
that is a very important aspect
of my practice.
I started implementing intermittent fasting
and they started getting a lot better
but in a matter of days,
in a matter of weeks,
I was able to start getting people
off medication or de-titrating medication,
lowering doses, you know,
they started getting more energy levels,
start feeling better,
start telling more people.
So, this is how it started.
Now, you started
with intermittent fasting.
Was there a low-carb approach as well?
Because something that I’ve found is–
well, the clients that I work with–
intermittent fasting is so much easier when
you are eating a low carb, high fat diet
and it can actually be fairly challenging
for a number of people
if they’re still following a high carb diet.
So, did you have to change the way
they were eating first
to then impose intermittent fasting?
Or did you start with the fasting?
Well, actually, myself,
I was doing paleo as I told you before,
I was doing paleo before, and then my–
over my paleo diet I added, you know,
the intermittent fasting protocols.
Among my patients, what I find is that
a 16:8 protocol or a 14:10 for women,
but more around 16-hour fast overnight,
it is a pretty accessible initial strategy.
It helps them a lot to gain perspective,
take
a little distance from what they are doing,
being able to give more thought
to their decisions
and having to make fewer choices
during the day.
Because if you start eating
a low carbohydrate diet,
a secondary effect is that you starve,
you know, reducing your appetite,
reducing your carb cravings
and reducing your high compulsivity.
So, actually my first approach is about
implementing intermittent fasting
but right now I do it as a combination.
I also talk with my patients to reduce,
in the first place, sugar or highly limit sugar
or try to tell them
to avoid sugar altogether,
but I am flexible in regards
to health and goals, you know.
I try to be coherent with what the chief
complaint of the patient is and their goals,
and so I try to tell them, okay you’re going
to have and see a lot of better results
if you do this synergistic strategy.
Not one or the other, just to lose weight
or be in good shape for the summer.
My goal with my patients is quality of life,
that’s what I always talk with them.
Now, that doesn’t seem like
a tremendous intervention, you know.
it’s basically skipping breakfast to start.
And you’re seeing benefits with whatever
psychiatric condition they started with,
just that small intervention
and you’re seeing benefits right away?
-Absolutely.
-That’s fantastic.
And there is an adjuvant–
and you know that there is more
than an adjuvant, an adjacent effect.
When they do more intervention.
Okay, they skip breakfast
and go straight to lunch, you know.
Your breakfast will be your lunch time.
And they start feeling better already
and so, they get excited
and they get motivated
and say, “What else can I do?”
Right.
So, it’s not only you
that is motivated to do
whatever you think
that your patients should be doing,
but they start asking and exploring –
and I always stimulate that in my patients.
Study for yourself, have an exploratory
and growth mindset,
try to be progressively incorporating,
you know, better aspects
of to improve your quality of life.
So, I try not to be dogmatic or rigid
in my interventions because, you know,
when you are in the clinical practice,
face-to-face with patients,
you have to be more flexible,
you have to be able to talk with different
personality traits, different goals,
different activity levels,
different ages, genders
and all of the different types
of patients that we see.
Yeah, well, let’s get
into the physiology of this a little bit.
Because when we’re talking about diabetes,
when we’re talking about obesity,
it makes sense why intermittent fasting,
why a low-carb lifestyle,
why those have a direct
and very meaningful impact.
Why does it help psychiatric conditions?
Why does it help depression
and schizophrenia and anxiety
and what is the connection there?
Well, actually, there are different
explanations for different conditions.
I believe that in anxiety and compulsivity,
avoiding the sugars highs and lows
with their compensatory mechanism
by stimulating the secretion of cortisol,
inflammatory cytokines, adrenaline,
that you know, puts you
in a very vulnerable place, you know,
when you are all the time provoking
that kind of response in your body.
In depression lowering
the stress levels altogether,
being able, especially in the atypical
depression, where it’s more,
it has more of an overlap
with metabolic inflammatory conditions,
it’s highly linked to hyperinsulinemia
and the inability of the brain
to use glucose as fuel.
And that’s why it’s also linked
to type 3 diabetes or dementia.
It is my hypothesis that it’s not only
affecting memory and concentration,
but it’s also affecting behavior,
it’s also affecting mood.
I mean, how would you behave
if your brain was not able to use
the main fuel that your body is using?
If you have already fixed your metabolism
to use glucose as energy
and your brain is not able to use it
efficiently, how are you going to be?
Are you going to be tranquil?
Easy?
Are you going to be calm or are you going
to be excited, desperate, irritable?
I mean, it makes a lot of sense for me
and this is what I am seeing in the practice,
in my everyday practice.
So it’s not that you have to wait until
someone is 60 or 70 to make an intervention,
but my proposal is that we should be
training metabolic flexibility
at an early age, you know.
Even though you’re not
perennially in ketosis
but you can you know, be in the outskirts
of ketosis daily, doing some types of fasting,
training the fasting ability,
and being able to use both types of fuel.
Some patients that’s more in the psychotic
side like schizophrenia,
there’s studies,
very old studies
linking gluten, you know,
gluten sensitivity to schizophrenia.
I recently had the opportunity
to talk with
a patient that was having hallucinations
and really persecutory ideas
since she was a child,
since after some
traumatic event at 5 or 6 years old
and she was 34
with continuous hallucinations.
And after she read
Dr. David Perlmutter’s Grain Brain,
she dropped gluten and started doing
a ketogenic diet in January,
and two or three weeks after that,
all the hallucinations were gone.
And those are pretty, you know, strong
N=1s and experiences and observations,
and this is one of the limitations
because we try hard in psychiatry
to get people to do
these types of investigations.
So, what we are seeing at the office
is very important
because I don’t think we should disregard
the results that people are seeing,
so that sometimes many people
are starting to lose weight,
but they see secondary effects,
“secondary effects” on mood conditions,
they start feeling better,
they start seeing more mental clarity,
thus, making better decisions
if you are able to make.
In fact, we are the results of the decisions
we take moment to moment to moment.
If you start taking better decisions
for yourself,
that’s better outcomes to be expected.
Yeah, that’s a pretty dramatic example
that you gave
and similar to the example that Dr. Westman
published almost ten years ago now.
Of the woman who had schizophrenia
her entire life since she was 6 years old
and in her 70s I think it was,
when Dr. Westman started treating her,
she started a ketogenic diet and, again,
within days, her hallucinations stopped
and she was able
to come off her medications.
And these dramatic case reports
definitely have something behind them.
But therein lies part of the problem
because right now, we’re in a world
of anecdotal experience and case reports
and not clinical trials
and large bodies of clinical research,
so it might be a little challenging
to say, yes, this works,
yes, this should be recommended,
because what do we have to back it up?
How would you respond
when someone asks you that?
Well, actually, that’s a great question
because I am addressing
at my presentation on Sunday,
what we should expect and what
we should not expect from ketosis
and what I like to call
the pathways into ketosis.
It is not the ketogenic diet
or intermittent fasting,
or paleo or banting
or low carbohydrate diets,
but it is what you gain from those strategies
and what works for you.
And I think we should not see ketosis
or the ketogenic diets or ketogenic pathways
as, you know, the panacea,
as you know, the end of it all.
And the solution for everything
is not the panacea for psychiatric conditions
and it’s not the panacea for major depressive
disorders, schizofrenia,
bipolar disorders, severe anxiety disorders.
But it is and it could be a great
co-adjuvant tool to implement,
for any psychiatrist or for any clinician
or someone working at a primary care
and being able to intervene
and do prevention.
I mean, how unsafe could it be
to prescribe to your patients
that they eat real food,
that they stop snacking all the time,
that they start to talk with them
about prioritizing sleep patterns,
that they implement any type of stress
management, you know, strategy.
Those are very safe interventions,
and we have a lot of evidence to say
that those are safe interventions.
So, what I am proposing is not an excuse
to irresponsively dropping medications
if you are under treatment,
but it is a proposal to widen our views
about what we are doing with our patients.
Because especially under severe conditions
because of what I told before
in regards to dependence,
the dose dependence of the effects
of psychiatric medications,
we could really reduce and improve
their metabolic profiles
even if we are prescribing medications.
And there are also studies regarding
the 16:8 protocol
and joining, you know,
giving the time of the medication
at the time of the meal, of meals
and, you know, that is a kind
of intermittent fasting protocol.
And it really reduces the metabolic
derangement of the medications,
especially of the anti-psychotic
that are very, very tough on insulin levels.
Yeah, so, it’s an interesting point
you bring up
about how deep you need to go into
lifestyle treatment
to have a meaningful effect
because there’s always this question,
do you have to be in ketosis
to get the effect,
is it something about the keones,
the metabolic shift,
or is a low-carb healthy lifestyle
with time restricted eating?
So, is that enough to see meaningful change?
And that’s also what makes it difficult
to study from a scientific standpoint
because where do you draw the line?
Because there are lots of these studies
that show low-carb diets don’t work
and then they define low-carb diets
at 45% carbohydrates.
And so, it all depends
on how you define it.
So, I think that would make it challenging
from a psychiatric perspective
but what I’m hearing from you
is you don’t think it’s necessarily ketosis.
So, we hear lots of things about how
ketones are beneficial for the brain,
whether it’s in Alzheimer’s disease
or a traumatic brain injury
and people talking about
how to use exogenous ketones
to boost the beta hydroxybutyrate level
to get a bigger effect
and bigger penetration into the neurons.
And there’s studies that ketones
decrease oxidation of neurons,
there’s studies that it increases
mitochondrial function in the brain.
So, from your perspective though,
is there something beneficial
about ketones and ketosis
that you think would be helpful
for psychiatric patients
above and beyond just
healthy lifestyle and low-carb?
Well, there has actually been studies
that show that actually being in ketosis
and their brain running primarily
on ketones and beta hydroxybutyrate
helps to establish
a more homeostatic state on the brain.
It avoids what I like to call
a more stoic fuel
because it avoids this external dependence
on constant inputs of energy.
So, I think it’s a lot about the energy
availability and the energy quality
because ketones don’t only provide
for very large deposits of energy
that are very reliable, predictable,
thus providing for a brain state
in which you have energy predictability,
that’s fundamental.
And then you have neurotrophism that is
linked to a higher production of BDNF –
brain drive neurotrophic factor.
It strengthens synaptic signaling,
helps provide a more physiological
environment for the brain.
I am a really big fan of Dr. Cunnane’s work
about brain evolution.
He’s working also, you know, he’s doing
a lot of work in relation to dementia.
And really, this is not about surviving,
this is about thriving.
And what I like to tell, you know,
I am focused on prevention
and I would like people to know
about these types of strategies
to start exploring themselves
and don’t wait until they start getting
severe symptoms to start implementing,
because it might be too late and it might
not gain functions, lost functions back.
Because
when we’re talking about the brain,
it’s really an energy hawk and
it needs a constant fuel flow,
and ketones provide that.
I mean, especially in patients
where they are insulin resistant.
I love Dr. Naiman’s meme,
it’s the dam concept.
I don’t know if you are familiar with it.
No tell me about it.
Hyper insulinemic state, it works like a–
it operates like a dam holding
on your energy stores.
So, if you are in a constant
hyper insulinemic state,
you will be preventing
or impeding those energy stores to flow.
And if you start through fasting
and low carbohydrate diet,
you can start lowering
that hyperinsulinemia,
providing this ever-increasing
amount of fuel flow.
And this is what I see
in the clinical practice
because in one week, two weeks,
and three weeks
after implementing,
a well-formulated ketogenic diet
and intermittent fasting protocols,
patients do start to wake up, do start to feel
a lot more focused, more stable,
they really reduce cravings
and they start feeling more energetic.
One of the main chief complaints
that the patients have at the office when
they come
is low energy levels, low initiative.
Seeing that they want to do something
that highly differentiates
from melancholic depression
that they have no motivation
to do anything,
but they know they see their goal,
what they want,
they recognize they have everything
that they want but they don’t have…
they just don’t have the energy
to go with what they want to do.
I think if we can rule out
all of those patients,
we’ll keep other conditions
that probably don’t respond as well
to this type of strategies.
What do you mean that – what kind
of conditions wouldn’t respond as well?
Because they–
if we follow up on the example that I gave
about atypical depression
that is more characterized with a metabolic
overlap
with obesity, leptin resistance,
insulin resistance,
with personal or a family history
of type 2 diabetes
and metabolic inflammatory markers.
We also have typical depression,
which is melancholic
and more related to childhood trauma,
it has a later onset,
it has a different profile
more linked to psychiatric conditions
maybe to schizophrenia running
in the family,
very low appetite levels,
with clinophilia, that is like wanting
to be in bed all the time.
So, those won’t respond as strongly
to nutritional interventions and lifestyle–
Exactly, that’s what I’ve seen
and those are very
hard or tough patients to work with
because there’s no motivation.
They are usually drawn to the consultation
by a family member if they have one
and they are isolated.
It’s a different subtype of depression
and I’m going to talk about that
on Sunday and Monday as well,
kind of like trying to differentiate
what type of patients I propose have
the better outcomes with these strategies.
Yeah, it’s interesting
to sort of draw the correlation
to whether it’s diabetes or obesity that not
everybody’s going to respond the same.
But also, it’s not a cure, right?
We’re not talking about a cure,
we’re talking about either a reversal
of symptoms
or managing disease or reducing
medications just like we can with diabetes,
important for people to understand,
you don’t just start the diet
and stop your medication the next day.
That could have some serious
adverse consequences.
They need to work closely with somebody.
But the problem of course becomes
finding the person to work with,
finding a psychiatrist
or even a primary care doctor
who’s willing to work with them on this.
So, you’re in Argentina.
I don’t know much about
the medical culture there,
but I’d imagine it’s–
you sort of stand out
from the crowd as a rare breed.
Is that the case?
Tell me a little more about that.
Well, I do feel like that.
This is also–
the demand that I have for my services
or what I do in my clinical practice
kind of shows what you just said because
I have high demand right now
and there is a huge subset of patients
that really need these types of strategy.
I work close with the patient.
Because, in addition, obesity and type 2
diabetes tend to mobilize patients
to go to a consultation with a nutritionist,
with one of the mainstream
weight loss professionals.
But they might not,
related to what I said before
in relation to the under-report
of psychiatric conditions,
they might not do a consultation
with a psychiatrist or a psychologist
because the taboo, because of stigma,
because they don’t recognize
or some of the symptoms
are harder to recognize
and they might not even know
that they have depressive symptoms.
They kind of maybe feel that they have
low energy, they are overweight,
it’s all related to that,
and they have a reason to think that.
But the problem is that they go
to the wrong professional
and there is a big “Why”
because there’s– not all of them,
and I’m not saying that everyone
that is not doing what I’m doing is wrong,
I’m far from that, but I really get very mad
when I hear stories from my patients,
there is a high rate of verbal abuse about
professional abuse with obese patients,
and you can see it on live TV,
you can see in the Biggest Loser.
We also have our version
of the Biggest Loser.
It gives me nausea
to watch that program.
Really, you see people suffering,
you see people relapsing all the time,
you see people with probably mental
conditions or psychological traits.
It’s really, you know,
we have a lot of work to do.
And this is part of why I decided to,
kind of like expose myself
and expose what I’m doing in order
to incentivize more psychiatrists
to start prescribing or using
or at least increasing awareness and
observants about this metabolic profile.
Yeah, so you’re really leading the way
for Argentina, it sounds like.
So, what advice would you give somebody
if they want to try getting
on a low-carb/ketogenic diet
and lowering their medications
and their physician just isn’t hearing it?
What kind of advice can you give?
If they are taking medications,
I think we really need to–,
it’s more from our side what we need to do,
we need to really–,
I’m launching online consultation
in order to be able to help patients
so it’s not only in Argentina.
I can include people that probably want
to know how to do it.
But I have to work close
with a local physician,
because if you are taking medication
like you said,
you need to know
personal history, you need to know–
I mean, psychiatric relapse is not a joke
and it’s very important
to be cautious about this.
But I – like I said before – a 16:8-hour
protocol is a safe intervention,
eating real food is a safe intervention.
It’s like, that’s kind of like weird to say.
But improving quality of sleep
is a safe intervention.
So, really, these are very–
even though it may not sound like it–
these are very conservative interventions.
I mean, and I start from there.
I always talk with my patients.
16-hour fast is like an anti-seismic structure,
I do the same gesturing with my patients.
This is a anti-seismic structure,
this is where we start from,
we are going to move from this.
But it is a structure that is going
to give you an ability to better management
and to better manage stress in your life,
and it’s very flexible.
So if you wake up one day
and you don’t follow it, not a big problem,
you’ll get back on track the moment after
you did something you weren’t planning to do
or to ate something
you weren’t planning to eat,
you drank something
you weren’t planning to drink.
So, I’m also seeing when you’re lowering
your compulsivity,
I’m also seeing an easier pathway
into reducing addictive behaviors,
being whatever, alcohol, tabacism,
marijuana, cocaine,
I’m seeing, you know if you reduce–
and a stressed brain will look for a relief
and this is where culture comes in,
or your personal history.
Some people rely on food, some people
rely on other types of substances
or binge watching a TV show or Netflix…
and it is one on one work.
I’m hoping that more psychiatrists
and psychologists jump into this, you know,
into this wave and into this movement
because it’s bringing back the customs
that we had 40 to 50 years ago.
Really, and intermittent fasting
is kind of like a cool name
for something we shouldn’t
stopped doing ever.
Right, it should just be normal.
We shouldn’t have names
for not eating that way.
Exactly, Dr. Fung says
in 60s and 80s that was like normal eating.
You know, it’s not like fasting,
it’s not like real fasting.
Right, and you brought up
a good point about addiction
because it’s hard to address all this
if you don’t also address addiction
which frequently can be carbohydrates
and there is some serious debate about
whether it’s a true addiction or not
but, I mean there’s certainly
a subset of people
where it seems like it is a clear addiction
and they need to be treated as such.
So, do you see the same?
I have many patients that had
no problem dropping their smoking addiction,
but they are having huge problems
dropping sugar or grain addiction.
This has to do with…
this substance has
been so ubiquitous
and offered and so socially accepted,
and it also has to do with the advance in the
development and the design of this food
because we have to remember
that most of this food–
I mean, when you are carb-addicted,
it’s not really rice,
it’s not really potatoes you crave,
it’s the processing that adds
the addictive behavior.
And it’s also fructose,
so I’m a big follower
of Dr. Robert Lustig’s work.
And really has helped me a lot,
the approach that he proposes
in The Hacking
of the American Mind, his latest book,
I really love that book.
It really helped me into finding
the way between stress, addiction
and the ways to, you know,
the ways you provide relief.
And also, enhancing– this is very important–
enhancing serotonin pathways.
There are many, many natural ways,
physiological ways,
to enhance your feeling of tranquility.
And it’s not just taking an antidepressant,
and this brings me back
to kind of like a joke that I’m going to tell.
It’s like most patients– well not most,
but frequently I get
at the office, the consultations;
“Doc, I have low serotonin,
I need something to put it up.”
And this is kind of like you know,
this clear example
how this monoaminergic imbalance dogma
has penetrated the population you know.
Someone is like,
I know I have low serotonin,
I have to put it back
and everything will be normal again.
Why don’t we address
what might have happened,
why your serotonin is low
in the first place?
Right, everybody wants a pill
to fix their problem.
Exactly, a quick fix,
or you know, the silver bullet, like–
Right, all right, well, let’s transition
for a second.
I find it strange that a low-carb movement
isn’t bigger in Argentina
because Argentinian beef
is like the best, right?
Tell me about Argentinian beef,
is it really that good?
Well, I have conflict of interest
I have to declare,
because I am always a big proponent
in favor on Argentinian meat
and this why I tell my patients, you know,
we live in the best country,
probably the best country in the world
to follow these types of diets
and sometimes the only intervention
that we need to do is remove the bread,
remove the potato, and just eat the meat,
if you want to eat the meat
and put it some side, some vegetable sides
and have a good olive oil
on your salad, and you’ll be great.
And we have this accessible meat,
especially the meats that I propose
my patients to eat,
that are not the lean cuts, that are probably
more expensive,
but are the cheaper cuts.
That’s what I eat personally myself.
And this is kind of the diet that I follow.
I don’t only intervene with my patients,
I have a lot of friends that I kind of like
supervise their diets
and they come to me and they say,
“What can I do?
I need to do something about my diet.”
So, there I go, you know,
straight to the source
because first of all,
cut this everything out and focus on meat,
kind of like a carnivore transition diet
but not dogmatic.
Not like, I had the lettuce,
no, you ruined your diet,
no, it’s not what I propose.
But it is a great transition
because, they get better, you know.
They start feeling better and it’s like I said
before, they start asking, what else can I do,
what else can I add to my life
in order to improve it.
When you come to the United States
and you taste the meat here,
can you tell a definite difference?
Well, there’s definitely
a difference in the price.
And also, the types of cuts that we prefer,
and it has to do in the way we handle the–
how they call, when you have the–
-The carcass?
-The carcass, exactly.
It is the way that we eat the carcass
that makes the cuts different
that we have available.
And what about organ meats?
Isn’t that much more prevalent in–?
Much more prevalent
and this is very sad because most of–
I mean, it is gratifying for me
to tell my patients, eat organ meats,
because it’s like kind of like prohibited
by classical nutritionists, you know.
They prohibit organ meats.
And we have “mocheja”,
that would be like thyroids,
would be like adrenals, and I don’t know
which other organ “mocheja” is.
That it’s like gold because it’s pure fat,
it’s very fatty.
And it’s very tasty to prepare too
with butter, garlic,
those are kind of like prohibited
in the usual diets.
And people– this is the sad part–
people remove butter, remove organ meats,
remove all the fatty cuts,
remove olive oil, remove nuts.
It’s like they remove everything
that is healthy
because of this caloric-centric view,
you know, it’s like this eco strategy.
And that’s, okay, you want to reduce
your calories voluntarily,
you will be able to do it maybe for two
weeks, three weeks, but you will relapse.
I mean, it’s like because it’s not what
our bodies and brain expect from your diet.
They start sensing
that is, you know, a shortcut.
So, most of the time, most often
that elicits responses.
And this is important in my practice
to address stress levels.
Because I don’t necessarily suggest
a patient going under severe stress
to do long fasts, but I go easier,
easier with them.
And try to of course reduce stress load,
improve sleep patterns.
I do a lot of emphasis on sleep,
maybe you’ve noticed.
Yeah.
Because I think it’s the first step.
Like, I prioritize sleep and movement.
If they are overweight,
I don’t tell them to run,
I don’t tell them to do CrossFit
or functional training.
Just go for an easy walk, that’s it.
But don’t go chasing calories.
Just think about trying to relieve stress,
try to connect with nature,
don’t take your phone
with you, you know.
I use a lot of–
I talk a lot about technology
addiction in my practice
and this is going to be a–
this is
a very big problem for future generations.
If you don’t address
the technology addiction
that is the most prevalent…
to our cell phones,
and nobody forgets their phone
when they go out their house.
And it’s the first thing we do in the morning,
the last thing we do at night.
And it causes most of chronic
sleep deprivation
and we all know that this increases insulin
resistance you know, and a host of others.
Right, yeah, great point.
And we focus a lot on nutrition,
and it is so important prevalent
but there are all these other factors
that definitely need to be considered,
technology being one of them.
And you brought up
the calorie restriction part
and the last thing someone who’s battling with
depression and medication side effects needs
is to feel constantly hungry and be counting
calories and just have the stress from that.
I mean, hat just seems
like a terrible intervention,
why would we need anybody
to recommend that?
-The worst.
-People do recommend them.
They get better for, you know,
transiently they feel better
because anyone that starts focusing
on something,
they go to a nutritionist,
or a clinic, a medical professional,
a medical professional
that prescribes the psycho strategy.
They might start feeling better
for the first couple of days
because they are doing
something about them, you know,
that makes you them feel good.
It’s also a trap because you eventually
fall down on what you are doing,
and this will be another frustrating event.
So, picking up what I left before–
this is a very important message that I like
to tell in regards to being a psychiatrists
and working with these conditions.
Many patients come in and they say,
I want to lose weight,
and I try to talk to them
about quality of life
and being able to intervene
in other aspects of their life
and this is what I call really prevention
and capitalize all the opportunities
of the contact of a the patient
with a health professional, you know.
Capitalizing each opportunity
because you never know if it is going to be
the last opportunity that the patient has
or the last time he or she
are going to try to get better.
You never know that.
Yeah, very good point.
So, the capitalization of a contact
with the sanitary system.
Yeah, make the most of the intervention
because you never know if you’re going
to get a second chance.
Yeah, well, this has been
a wonderful discussion
and I’m thankful that
there are individuals like you
taking this message into this whole field
of mental and psychiatric conditions
because it’s not that different
but yet for some reason it’s been portrayed
as being so different
so thank you for doing that
and for taking the time to be here.
If our listeners want to learn more
about what you have to say,
where can you direct them to go?
Well, I’m very active on Twitter,
it’s Ignacio, @ignaciocuaranta.
I recently launched my web page in Spanish,
I have to do a lot of modifications,
but I have a guide for intermittent fasting
in Spanish on how to start.
I’m going to put a lot of information
up there, it is ignaciocuaranta.com
and also on Facebook I have a page
that is called Flexibilidad Metabolica,
where I also upload information
or interesting articles
but mostly on those three sites.
Very good, Dr. Ignacio Cuaranta,
thank you so much, it’s been a pleasure.