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Interviewee Bio :

Dr. Jeffry N. Gerber, MD, FAAFP is a board-certified family physician and owner of South Suburban Family Medicine in Littleton, Colorado, where he is known as “Denver’s Diet Doctor”. He has been providing personalized healthcare to the local community since 1993 and continues that tradition with an emphasis on longevity, wellness, and prevention.

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Transcript:

Carole Freeman:

Hello, and welcome, everyone. We’re live here in the keto chat crew or keto chat group, keto lifestyle crew, keto chat episode, all that stuff. Anyways, I’m Carole Freeman. It says it on the screen. You should know that. And today, our very special guest is Dr. Jeffry Gerber, all the way from Denver, Colorado. Welcome.

Dr. Jeffry Gerber:

Hi, Carole, and everyone listening.

Carole Freeman:

Those of you that don’t know, Dr. Gerber is co-author of Eat Rich Live Long, one of my top… Really, this is my favorite keto book and I recommend it non-stop. He’s also Denver’s Diet Doctor. And so, welcome, Dr. Gerber.

Dr. Jeffry Gerber:

Yeah. Thanks again, Carole. We’re just doing this in between patients today. I still see patients and enjoy it, after 30 years, still going strong.

Carole Freeman:

Oh my gosh, that’s excellent. So, how long have you been doing low-carb yourself, and then how long with your patients?

Dr. Jeffry Gerber:

Yeah. It goes back about 20 years. And we were traditionally trained as a family doctor, not really getting much nutrition advice. But I honestly grew up in a family that we had weight issues, health issues, and as a result became interested in diet and nutrition. And about 20 years back I was challenged to lose 40 pounds. There were other family members, and we approached low-carb.

Dr. Jeffry Gerber:

And I had lost weight without much difficulty. And I had other patients who had success. And back then, I was a little skeptical thinking that their hearts were going to explode from changing their diet in this way. But lo and behold, we followed metabolic markers. And for myself and for my patients, the metabolic markers actually went in the right direction.

Dr. Jeffry Gerber:

And we’ve been sharing our knowledge with patients, with other healthcare professionals through the book. We also run medical nutrition conferences for healthcare professionals and the general public. So, it’s been a joy.

Carole Freeman:

Oh, I love that you shared, that you went into it really skeptical. That’s probably the biggest challenge a lot of my clients have, is that their doctor hates keto. Their doctor thinks it’s going to kill them. Their doctor thinks that they should go plant-based. So, I know we’ve

got a couple people watching too. So, if anybody has any questions for Dr. Gerber, please ask them. But I know that my clients, that’s one of the things that they were most looking forward to coming on or having you on, was that, how do I approach my doctor when they’re not a fan of low-carb or they haven’t experienced it? What are some tips that you have about how somebody might go about, like working with their doctor when they’re not experienced with low-carb or keto?

Dr. Jeffry Gerber:

Well, firstly, the low-carb approach is really in part in the guidelines. In fact, the American Diabetes Association recognizes low-carb diets as a valid approach to patients that are type two diabetics. So, that’s information for you right there. The heart associations do recognize that sugar is a problem in terms of cardiovascular disease and excess of carbohydrate intake.

Dr. Jeffry Gerber:

So firstly, there’s lots of evidence that has been mounting over the decades that continue to support the low-carb approach. And there’s probably a hundred papers now that support the low-carb approach.

Dr. Jeffry Gerber:

And the other aspect that you can share with healthcare professionals is that, we try to look for common themes that other healthcare professionals can accept. And so of late, we’d like to call it a low-carb Mediterranean diet, because everyone seems to think that a Mediterranean diet is a healthy approach. Although, it’s really ill-defined, but it gets your foot in the door.

Dr. Jeffry Gerber:

And to us, what does that mean? It’s really a Mediterranean diet, a whole food diet that is low-carb. So, that really defines a meat and vegetable based diet. So, it’s a variety of meats, chicken, fish, pork, red meat. It can be shellfish. It can be lean cuts. It can be fatty cuts, and healthy, natural fats, which include olive oil, avocado oil, which are the mono and saturated fats, but also the saturated fats, including butter, coconut oil, and yes, animal fat. And so, we add healthy salads, non starchy vegetables. And that really defines a low-carb Mediterranean diet. So, these are some of the things that we share with our patients, that they can take back to their healthcare professionals.

Carole Freeman:

Oh, I love that. That’s a foot in the door, a low-carb Mediterranean diet. That should get some more acceptance then. All right. So, let’s talk a little bit about your book right now. So seriously, like this is my number one favorite keto book that I recommend.

Carole Freeman:

So, and the reason I really like this is because, I always tell people it’s in three sections. So, the first part is, let’s understand how we got to fear fat in the first place. And it’s a very easy to understand, first through the book for anybody, even if you don’t have any medical

background. The second, third, goes in deeper. And then of course, you’ve got to throw in some recipes because every keto book has to have some recipes in there.

Carole Freeman:

And one of the things that is great about this is that this is a fit for everybody, because it doesn’t say everyone needs to be keto. It actually has recommendations for how to tell what level of carbohydrates may be best for you. Can you talk a little bit more about how do you look at that, and what do you recommend as far as how do people know how extreme of carb restriction they should be looking at?

Dr. Jeffry Gerber:

Well, Carole, I’m so glad you are taking it in that direction. I’ll talk about that in a minute, because it’s really critical. But yes, I co-authored the book with Ivor Cummins, and he’s a chemical engineer that uses his problem solving skills to address health-related issues. And I was more of a consultant to Ivor. He wrote the book. But all of the clinical and the practical information comes from the things that we do with our patients in the office. And Ivor talks more about the technical aspects.

Dr. Jeffry Gerber:

And the book is really for everyone. And as you said, it’s simply written and there’s a lot of practical information in there. But then you can take the deeper dive in the third section, in particular, if you have an interest in looking more into cardiovascular disease, the heart calcium score, which we think is a wonderful test to assess risk, rather than just looking at cholesterol profiles. You can dive into diabetes and a more nuanced information is in there.

Dr. Jeffry Gerber:

But most important in the practical section, as you alluded to, is that the low-carb, high fat ketogenic diet is not for everyone. And it depends where you are in the insulin spectrum. And a lot of people in the low-carb community, just assume if you’re not at your ideal body weight, that you have some degree of insulin resistance or you’re pre-diabetic, or diabetic, on this one side.

Dr. Jeffry Gerber:

But we have patients in particular women, it discriminates, unfortunately, that they’re not at their ideal body weight. And then you measure the metabolic markers and they seem to be metabolically healthy, as far as we can tell, in terms of looking at insulin resistance, pre-diabetes, inflammatory markers, lipid ratios. There may be some other subtle things going on with those particular patients, but we call them the insulin sensitive ones.

Dr. Jeffry Gerber:

And so, you can put these patients, these individuals on a low-carb, high-fat diet, and yes, it will control appetite rapidly, and they may lose a few pounds. But often they get frustrated because they hit a plateau or the weight starts to come back up.

Dr. Jeffry Gerber:

And so, the point I’d like to make is with both of these groups, the insulin sensitive and the insulin resistant, the goal is to find a macro nutrient mix that controls appetite, so you’re not as hungry and you eat less. And so, it turns out with the insulin resistant patients, the low-carb, high fat diet really does the trick because it regulates blood sugar and it controls appetite. But on these insulin sensitive individuals the way to control appetite, the macronutrients vary a little bit.

Dr. Jeffry Gerber:

And so, we tell everybody down the road that the goal is to fill with fat. So, you don’t want to gorge with fat. You want to fill with fat, maybe eat a little bit more protein. And on these insulin sensitive individuals, a little more carb might be fine. So, actually a little potato, a little fruit, for insulin sensitive individuals.

Dr. Jeffry Gerber:

And the point there is that, I’m saying that the calories and the quantity of the food at the end of the day, it does matter. But you have to understand, and this is really important, that we’re not telling people to eat less and exercise more. It’s not about calories in, calories out. This isn’t an approach where it’s mindful living. And we’re trying to find an approach to diet and lifestyle that controls appetite and living healthy, getting proper sleep, eating less frequently if you’re not hungry. So, mindful living rather than depriving yourself. But at the end of the day, the hormones matter and the calories, and the quantity of the food, all matters. So, you have to bring it all together.

Dr. Jeffry Gerber:

Now, one more point, Carole. And sorry for going on. For the insulin sensitive individuals, we refer to this diet, which again is low-carb Mediterranean. It’s a version of a protein sparing modified fast. And really, that’s been around for a long time. But again, you’re just backing off on fat calories a little bit. It’s still a higher in fat diet. And you’re increasing protein, and perhaps increasing carb for these insulin sensitive individuals. And so, that hopefully describes the difference.

Carole Freeman:

That’s nice. And I just love that you’re looking at individual bio-individuality, there’s no one size fits all diet that everyone should be on and fixes everything. So, you’re actually looking at these people as a whole human, and a lot of different factors as to what actually is going to be a sustainable lifestyle for them. That’s great.

Carole Freeman:

Okay. Pennie, is the one that I was thinking of. So, she says that her doctor is, she just recently changed physicians and he is not on board with keto. He’s concerned about her cholesterol. Pennie, can you tell more. And also, caveat here, Dr. Gerber cannot give specific medical advice to anyone here, because unless he’s your doctor. So, we’ll talk in generalities. But high HDL and a high LDL, Pennie, what’s your… High LDL, I know is not even that high though for her.

Dr. Jeffry Gerber:

Yeah. I think I understand the question. I love how it pops up on screen. It’s beautiful how you have that formatted.

Carole Freeman:

StreamYard is the app we’re using to stream. Yeah.

Dr. Jeffry Gerber:

Yeah. So, penny, this is very typical when you go on a low-carb, high-fat ketogenic diet, that we see the LDL go up and the HDL go up. And typically, triglycerides go down. Now, the ratio, I don’t know if you’re talking about the triglyceride to HDL ratio. Generally, we like that to be under two. So, if that’s what you’re talking about, that looks really favorable.

Dr. Jeffry Gerber:

And so, traditionally doctors are focused on looking at LDL as the singular measure of health. And again, it’s unfortunate over a half a century that has been the focus on health, therefore the dietary recommendation to do everything to lower LDL cholesterol, such as a low fat, low calorie diet. And this is where we’re trying to teach healthcare professionals to take off the blinders, and to understand that the LDL cholesterol is just one parameter.

Dr. Jeffry Gerber:

And when we say we’re looking at metabolic health, we’re looking at inflammatory markers, we’re looking for insulin resistance. And we also measure the heart calcium score, which is direct visualization of the disease process. It’s a CAT scan of the heart, uses a tiny bit of radiation, and you can see calcium or plaque in the arteries itself. And it gives you some historical data as to what’s going on.

Dr. Jeffry Gerber:

Now, if you’ve recently changed your diet, your LDL went up well, or you can track it with metabolic markers. They tell you what’s going on at the present time. But you can also do serial calcium scores down the road. But getting back to the specifics on this, so we see the cholesterol going up in a healthy way, where… Go ahead.

Carole Freeman:

Let me show you. So, here’s her numbers. This what her doctor thinks is high LDL. So, I’m laughing to myself here that her LDL is only 124.

Dr. Jeffry Gerber:

Yeah. So, they want to see LDL under a hundred, but even by mainstream standards, I think most would pass on that. Especially when you look, you have a very high HDL, you have a very low triglyceride. So, I don’t really know what the fuss would be there.

Carole Freeman:

Yeah. Do you think that sometimes it’s just, even when markers look really good, people in general and physicians have a bias, they just think, well, it’s healthy, so it could be better. Do you think that maybe?

Dr. Jeffry Gerber:

Yeah, or they have a bias that low-carb is unhealthy.

Carole Freeman:

Right, right, right. That’s what I meant. Yeah, sorry.

Dr. Jeffry Gerber:

Yeah. They have a bias that low-carb is unhealthy. And yeah, there is a bias there. And so, this is where we tell the patients to say, “I’m doing a low-carb Mediterranean diet and look at my numbers, they look real, pretty, they look good.” So, it might be her LDL went up a little bit.

Dr. Jeffry Gerber:

But so the point is though, Dave Feldman through the Cholesterol Code has done a lot of research on these LDL hyper responders. And he wants to actually do more research with these particular patients. But what we see is that a diabetic, for instance, that goes on a low-carb, high fat diet. And I don’t know if Pennie, was diabetic or pre-diabetic. But all the metabolic markers improve, triglycerides go down, HDL goes up, inflammatory markers improve, insulin gets better. We do two hour glucose tolerance tests by the way, where we measure glucose and insulin. A1C is improved. And the only number that goes up is the LDL cholesterol. And again, that’s just one metabolic marker of health. And so, from our perspective, we see a patient like that doing everything right, and they’re losing weight. So, this is the conundrum, and this is where we’re trying to help our healthcare professionals and our patients to understand what’s going on.

Carole Freeman:

Pennie has lost what? Over 200 pounds, I think so. And she’s maintaining her weight loss for a long time.

Dr. Jeffry Gerber:

Yeah. That is great. That’s great way to go.

Carole Freeman:

She’s worked very hard in following a low-carb ketogenic lifestyle. She has through trial and error, she has found that she does feel a lot better doing a higher protein, lower fattish approach. So, that’s something that we found for her that she just feels the best too.

Dr. Jeffry Gerber:

Was she diabetic by any chance? Pre-Diabetic? You don’t know.

Carole Freeman:

She’s lost over 300 pounds. Here we go. Correction, she’s lost over 300 pounds.

Dr. Jeffry Gerber:

Pennie, that’s tremendous.

Carole Freeman:

Yeah. Pennie, I don’t know if before we were working together, were you ever diabetic or pre-diabetic? Let us know there. So, she’s had tremendous [inaudible 00:18:04].

Dr. Jeffry Gerber:

What I might say is, how the diet looks now is different than when Pennie started. And so, naturally, if you lose weight, there’s less of you and you’re just not hungry, and you don’t eat as much, or you eat less frequently. So, it’s just a natural progression. But if you haven’t reached a goal or you’re hitting the plateau, then you have to think about the things that we were discussing earlier, that you just want to eat enough fat to fill, and so forth.

Carole Freeman:

Yeah. Not diabetic. So, she’s [crosstalk 00:18:45]. Yeah.

Dr. Jeffry Gerber:

Yeah. So, this is an example of someone that was not necessarily full-blown diabetic, maybe not even measured for pre-diabetes or insulin resistance, but did have success. An if we query Pennie, she would probably say that she’s doing a lot of the things that I’ve been talking about, anyway.

Carole Freeman:

Yes. I know she is. Yes.

Dr. Jeffry Gerber:

Yeah. That’s your plant, Carole.

Carole Freeman:

My plant, yeah. Oh no, well, the people that we’ll be watching live are going to be my current clients.

Dr. Jeffry Gerber:

Excellent.

Carole Freeman:

So, when we put this out on the YouTubes later, we could have, who knows how many people watching there. So yeah, we get the special as a bonus for my clients, they get to watch live, and then we’ll share it out more for other people too. So, all right.

Carole Freeman:

So Pennie, other questions you’ve got for Dr. Gerber. So, perhaps talking with your doctor about following a low-carb Mediterranean diet may make them feel a little more comfortable. But I also know from talking to Pennie, yesterday, that her doctor just in

general thinks that plant-based is best. And so, I don’t know that even saying a low-carb Mediterranean would make her doctor happy right now. But yeah, she’s saying that the low-carb Mediterranean, I think that may make him feel a little more comfortable.

Dr. Jeffry Gerber:

Yeah. So, you can also approach it from a low-carb vegetarian approach. Plant-based it really just the new term, perhaps it’s more palatable rather than saying vegetarian. But I think you have to ease your way into it. And we don’t want the people to be at the doctor’s throat with this extreme dietary approach because it really isn’t.

Carole Freeman:

Mm-hmm (affirmative). Right, right. The preconceived notions of what a low-carb diet is for a lot of people, it can be plant-based, if you’re eating a certain percentage. And also, that’s such a nebulous term. Right? So, plant-based, what percentage of your diet or calories need to come from plants for you to be plant-based?

Dr. Jeffry Gerber:

Right. Exactly.

Carole Freeman:

So, let’s go back to, when you did your own experiment, you saw the results and that started to influence the work that you were doing with your patients at your clinic. Can you share some of your favorites stories of transformation of people you’ve worked with over the years?

Dr. Jeffry Gerber:

Sure. And it varies across the board, that we have patients that will lose 20 pounds, a hundred pounds, 200 pounds. And I have a database. Although it’s important to understand, I don’t have a research type of setting in my office. It’s just simply clinical. But we try to keep it a database.

Dr. Jeffry Gerber:

And one patient, this reminds me early on, he’s been a patient for probably 25 years. And he’s diabetic and overweight, when we first met him. And he didn’t have a heart attack, but he was having, I think it was anginal symptoms. And then he ended up going to the cardiologist. And whether or not you agree that the patient got stents with non-MI disease, that there’s some controversy about stents in patients that just have stable angina or unstable angina. Well, he got a stent and he was fine. But we also noted that he was a diabetic. And we ended up early on placing him on a low-carb diet. And I think he had lost like 50 or 60 pounds. And we got his diet under control without medication. And he’s still a patient of ours for 25 years. And knock on wood, he hasn’t had any cardiovascular events.

Dr. Jeffry Gerber:

And we see these stories over and over again. And we see a lot of patients that come in precisely with this concern about going on a low-carb diet and then their LDL cholesterol

went up. And is this placing them at risk or not? And so, we have these discussions with our patients each and every day.

Carole Freeman:

Yeah. And like you said earlier, you’re looking at the whole picture and all their metabolic markers, and making that decision individually with each person.

Dr. Jeffry Gerber:

Yeah, absolutely. And the beauty of what we do is that we really blend traditional medicine with the nutritional approach. And we talk about medication. If a patient can comply with lifestyle modification, we get them off medication. If they can’t comply and they’re having a really hard time, well, then we say, okay, well, there’s medication. So, we have that discussion as well. But we certainly prefer getting people off medication and addressing healthy lifestyle and diet.

Carole Freeman:

Pennie, has got another question. Pennie, I’m going to ask for a little more details here. But she’s asking how does support fit into your practice and experience. So, if you’re talking about like, I’m going support or what type of support?

Dr. Jeffry Gerber:

I get the question. So, Pennie, what we’d like to do is empower our patients and to be their personal health coach for them to bring about change. And what’s interesting with our medical practice, we work in the context of health insurance. So, we’re dealing with health and nutrition, and comorbidities. So, in a sense, we’re not a weight loss clinic, where we have nutritionists that you meet with once a week. We’re actually the nutritionists.

Dr. Jeffry Gerber:

It’s actually somewhat unfortunate within the health insurance model, we can’t even get paid to have nutritionists in our office. The criteria for nutritionists to be paid by commercial health insurance is they have to have end stage renal disease, end stage heart failure, before they’ll even consider reimbursing a nutritionist. It’s an end game type of approach. It’s terrible. So, we’re the nutritionist. And my staff are somewhat trained, so we’re always available to help answer questions. And we see patients back on a regular basis. We have support group once a month, although because of the pandemic we’ve put that on hold.

Dr. Jeffry Gerber:

So, I think it’s very important question that you’re asking. And so, really empowering our patients to make change is important, and it’s something we do each and every day with them.

Carole Freeman:

So, I wonder if the insurance nutrition reimbursement must be state by state. Because I know back in Washington, the nutritionist there could get quite a bit of reimbursement.

But also, I think a lot of that was influenced because there was a lot of Microsoft employees there, and they had pretty significant, they could get like 12 appointments a year with a nutritionist for weight loss or various things. So, maybe in different states, that varies, is that why?

Dr. Jeffry Gerber:

Well, we deal with co-morbidities and that’s how we work with health insurance. And they do recognize obesity codes. And so, they’re included when we deal with patients. Traditionally, the health insurance, again, to their fault, were very skiddish about reimbursing for anything related to obesity. It’s absolutely ludicrous. But for us over our career, we’ve really worked it in, and have created a model for what we believe is the correct delivery of primary care and primary prevention in this way. Yeah.

Carole Freeman:

Pennie loves your personal empowerment term. I’m sure that that’s not common for a lot of medical clinics. So, that’s great.

Dr. Jeffry Gerber:

Nice [crosstalk 00:28:12].

Carole Freeman:

So, what are some of the first steps? So, let’s imagine you’ve got somebody coming to your clinic for the first time, and they’ve never embarked on a low-carb approach. What are some of your initial recommendations of how they can get started?

Dr. Jeffry Gerber:

Yeah. Well, the evaluation is we do a physical history and we look at their dietary approach, their medical problems, medications they’re on or not on. And then we will do basic metabolic markers. And as I get older and crotchety, I have decided that simple is best. And we can get so much information by doing a standard lipid profile, glucose and hemoglobin A1C in a urine in our office. And we have equipment, we get the results in 10 minutes. [crosstalk 00:29:06].

Dr. Jeffry Gerber:

Yeah. And that tells you so much about metabolic health right there. But we take it one step further. We’ll do general blood work that we’ll send out to the lab. But we’ll also include an insulin, a C-peptide, which is a pro insulin measurement. We’ll do CRP sed rate.

Dr. Jeffry Gerber:

And then in certain individuals that we do suspect insulin resistance, we’ll bring them back for the second visit and do the two hour glucose tolerance test with a two hour insulin. And so, the two hour insulin is rather interesting. We see patients that all the numbers I just mentioned are, can be pretty normal, including a fasting insulin and your A1C, and your glucose may not even be that high. But then the two hour insulin, if it’s over 40 micro units, that definitely confirms that you have an insulin problem.

Dr. Jeffry Gerber:

And we’ve seen patients, they’ve set records where we’ve seen the two hour insulin over 500, over 600. And other patients’ stories, very surprising that you look back at their fasting blood work, and you don’t see a whole lot going on.

Dr. Jeffry Gerber:

And what’s interesting is that insulin measurement, the endocrinologists that we sometimes refer patients to, where the patient has seen an endocrinologist is taken back, “Why are you as the family doctor measuring insulin?” Well, we read our book. That’s why we measure insulin.

Dr. Jeffry Gerber:

So, at the second visit, then we see the patient back and we go over the results. We might do a heart calcium scan. And we individualize a dietary and lifestyle approach at that point.

Carole Freeman:

Oh, so that’s really cool. I recommend that people get a fasting insulin. But you’re going a step further with the two hour glucose and insulin tolerance test, because you’re going to see the insulin dysfunction even before it shows up in that fasting insulin. So, that’s really great that you’re able to do that, because that would be another one that [inaudible 00:31:20] clients ask their doctor. The doctor be like, “Why do you need that?”

Dr. Jeffry Gerber:

So, this comes from the work of Dr. Joseph Kraft, who Ivor and I had a chance to meet when he was at the tender age of 95. And he’s since passed, but he actually devoted his career to the insulin assay. And what he really demonstrated is that you can identify an insulin problem, 20 years before the diagnosis of diabetes by simply doing the insulin assay. And so, we’ve learned from that, and we’ve been doing that for years.

Carole Freeman:

Oh, I love that. Now, I want to come out and see you out there. So, I know that people that have been following low-carb ketogenic diet for a while, they don’t do very well on the two hour glucose test. Right? Because they’re not really tolerant anymore. But will their insulin be normal?

Dr. Jeffry Gerber:

Yeah. So, that’s a great question, Carole. So, we really reserve doing the glucose tolerance test in patients that are low-carb naive.

Carole Freeman:

Okay.

Dr. Jeffry Gerber:

Because once you’re on a low-carb diet, there’s something called physiologic insulin resistance that can skew the results. Now, we see a lot of data geeks and biohackers that come into our office, and they’re on a low-carb diet. And they insist on doing a two hour glucose with insulin. And so, what we do with those patients is we say, “Okay, I understand you’re data geek. So, what we’re going to do is have you load up with carbohydrates. You have to eat 150 grams a day for maybe seven to 10 days. And then we bring you back. And then we do the glucose tolerance test. And that’ll give us more of a baseline result.” But it’s really an important test to do in patients that are low-carb naive.

Carole Freeman:

Okay. What do you see is one of the biggest mistakes of people trying to adopt a low-carb lifestyle?

Dr. Jeffry Gerber:

I mentioned it before, I think the biggest mistake is this idea that you can just gorge on fat, that calories don’t matter. And over the years, that frustrates me. And so, the message is clear that eat enough fat to fill. If you’re not hungry, eat less frequently. Again, you shouldn’t force, intermittent fasting is what we’re referring to. So, yeah, that’s kind of the main theme. And you have success, if you’ve paid attention to that.

Carole Freeman:

Yeah. I love that message is starting to come out more and more that, maybe three, four years ago, that was the theme was like, you got to get your fat in. You got to have all these fat bombs. You got to drink fatty coffee. And it turns out that may actually not be very healthy either, as well as not being necessary or good for results too.

Dr. Jeffry Gerber:

Carole, I’ve learned a lot along the way.

Carole Freeman:

I think we all have. Yeah. Well, and I don’t know if you saw this or not, but a friend of mine was on a podcast interview, Mike Berta, where he’d already lost quite a bit of weight on low-carb. He was in maintenance mode. He lost about 80 pounds. And when you look at him, you’d think like, “Oh, this guy had never had a weight problem his whole life.” And so, then he tried the 90% fat ketogenic approach for his N-of-1 experiment just to see what happened. So, he’s a patient of Dr. Ted Naiman. And he shared this openly. So, he went in and got his blood drawn after he did this 90% fat ketogenic experiment. And his triglycerides were 1500. And Dr. Naiman said, “Abort, abort, this experiment.”

Carole Freeman:

And so, I’m thinking and wondering why, when we try to apply this medical therapeutic diet that was applied to little kids with epilepsy a hundred years ago at 90% fat, like perhaps that extreme level of high-fat, especially when applied to people that are just trying to get metabolically healthy, may actually be part of why we can see in literature that there are some complications of a really high fat ketogenic diet.

Dr. Jeffry Gerber:

Well, that’s actually unusual. So, we have patients that have familial hypercholesterolemia, they have lipid disorders. And that can include very high triglyceride. And it’s interesting, you put them on a high-fat diet, it seems to be kind of counterintuitive or a paradox. But we do see the triglycerides come down.

Carole Freeman:

Yeah.

Dr. Jeffry Gerber:

And that’s just really unusual. And so, what we see is that the high fat, low-carb helps to push the fat energy into the cells where it’s needed for energy rather to have it stuck or circulating in the blood vessel, where you can measure the high triglyceride. So, I’d like to hear a little bit more about that patient. And hopefully, the triglycerides came down, whatever the intervention was.

Carole Freeman:

Well, they were. And his moderate fat, high-fat ketogenic lifestyle that he lost the weight with, his triglycerides did come down to normal. It was when he was at a lean body mass that he tried this 90% fat experiment that that’s when the triglycerides bumped way up. So, it might’ve been that extra fat trafficking at that level for him, it showed that that was not the way to continue his lifestyle for a 90% fat [inaudible 00:37:42].

Dr. Jeffry Gerber:

Good for him it came down. But it just reminds me of this aspect that what we’re trying to do for weight issues is to mobilize stored fat. So, we want to mobilize the stored fat, where the energy is predominantly stored, and get that out of the fat cells. And so, it’s a balance between the dietary fat coming in and the fat that stored. And so, if you lower down the dietary fat, then you tap into the fat stores in a sense, and then the energy becomes available.

Dr. Jeffry Gerber:

But if you’re diabetic, this energy here in the fat stores is trapped because of high insulin levels. And that’s where you can eat a lot of high-fat initially. And again, it seems like a paradox, but that high-fat diet mobilizes the fat stores. And then, you see the fat energy it gets released, it gets distributed throughout the body, stored in the lipoprotein. But then eventually the insulin resistance gets better. And then you have to back down the dietary fat long-term.

Carole Freeman:

I’ve got one more question for you about the prevalence of people that look lean and healthy but actually have metabolic, I guess, well, maybe it could be metabolic syndrome. They’re just don’t have the obesity. But like pre-diabetes. So, I have a lot of my ladies that, “Oh, my husband, he can eat whatever he wants and he never gains an ounce.” But I always caution them that those people are the ones that are at danger of developing undiagnosed

diabetes. So, and I know a lot of these people fly under the radar because their doctor is not checking them for diabetes because they look lean. But in your clinical experience, do you have a sense of what percentage of those people that look lean, that can eat whatever they want, they eat a lot of junk and sugar all day long, that actually are at risk of developing complications or metabolic dysfunction?

Dr. Jeffry Gerber:

Sure. Well, I would say in general, two thirds of the population have some degree of metabolic syndrome, whether they’re at their ideal body weight or are not at their ideal body weight. And so, you’re referring to patients that are TOFI, so they’re thin on the outside, fat on the inside. We have an expression for that. And we typically see a large Asian population that fit into that category. And we see that each and every day. And you think they’re healthy, and then you measure their metabolic markers, and they are pre-diabetic or overtly diabetic. And so, because of what we do, we screen for this, and very early on, we can say, “Hey, there’s an issue.” And again, we can pick up the problem sometimes 20 years ahead. So, it’s important to screen for these individuals that are thin on the outside, fat on the inside, meaning that they’re metabolically unhealthy.

Carole Freeman:

Yeah. Yeah. That’s great. Well, let’s wrap this up now. Anything else that you were hoping I would ask about or that important information that you’d like to get out there to the world as we continue to work on changing the health of this planet?

Dr. Jeffry Gerber:

Yeah. Well, we still enjoy family medicine. We’re in the trenches and hope to continue doing that for a while. And also, spreading the message with our patients, with healthcare professionals and in the writings. And we had to put a hold on our conference for 2021, because there’s so much uncertainty because of the pandemic. But we keep our fingers crossed that we can have an in-person conference in 2022. As you know, you’ve attended our conferences, and it’s just much more rewarding to do it in-person.

Carole Freeman:

Yeah. Oh, I miss it so much. That’s the last time I saw you, was in, right before things got bad this year. So, and you’re right, the online conferences are just nothing like the in-person experience of getting to meet everybody and connect with other people that are following this low-carb Mediterranean lifestyle. So, well, thank you so much for taking the time, Dr. Gerber. We appreciate all that you’ve shared and for being here. And thank you for taking the time to be here for us.

Dr. Jeffry Gerber:

All the best, Carole, and also to your clients. Stay healthy.

Carole Freeman:

Excellent. How can people follow you? What’s your website they can connect with you?

Dr. Jeffry Gerber:

So, two websites, Denver’s Diet Doctor, or Low Carb Conferences.

Carole Freeman:

Excellent. Excellent. And we’ll have those linked in the show notes below too. So, thank you so much. Thanks for everybody for watching. That’s all for now. We’ll see you next time. Bye.

 

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