Carole Freeman:
Nice, nice. It looks like it’s warm there, you got your windows open.

Marylou Hopkins:
Actually, it’s nice and cool. So yeah, pretty little fall weather today, it was great.

Carole Freeman:
Oh I was going to say, you guys probably get actual real fall, right?

Marylou Hopkins:
Yes, it’s my favorite time of the year.

Carole Freeman:
Oh, me too normally but I just moved to Phoenix, Arizona, three months ago and it’s still 105 today, so.

Marylou Hopkins:
I saw that, good luck with that. Tell me about that next year.

Carole Freeman:
Fall here means it’s 10 degrees cooler than it was a month ago.

Marylou Hopkins:
Wow.

Carole Freeman:
Instead of 120, it’s only 110, that’s what I’m discovering.

Marylou Hopkins:
I’m looking for a place where you can have fall all year.

Carole Freeman:
Oh, does that exist? I don’t know.

Marylou Hopkins:
Maybe north, [crosstalk 00:01:26]-

Carole Freeman:
[crosstalk 00:01:26] maybe.

Marylou Hopkins:
… cold.

Carole Freeman:
Maybe Seattle but you still get three months of amazing summer up there, so.

Marylou Hopkins:
Right.

Carole Freeman:
All right, well Marylou, let’s talk about your back stories. We’re waiting for some people to join us and I do have a question sent in from Karen. She’s not able to be here today but I’ve got some questions for you from her, but let me just throw out the caveat. Okay? So Marylou is a real life nurse, she’s not going to be able to give any of you specific recommendations or diagnosis or anything like that. She’s going to be able to share information, answer questions, but just keep that in mind and that she won’t be able to actually solve your specific health problems. That’s… health concerns, that’s just a legal, ethical, and licensure thing so we don’t want to get her in trouble and make her lose what she’s able to do. So we will phrase things in ways that are general information and that’s what she’s able to provide for us here.

Carole Freeman:
So Marylou, how did you… tell us your back story. I know you sent in a really great… it was like a chapter in a book of where you’ve been. It’s all fascinating, so I want to hear it all.

Marylou Hopkins:
So I came to keto actually from bariatric surgery. So I was a bariatric surgery nurse and every year I keep forgetting what year it is, and especially this year. So I think it was about 14 or 15 years ago, I began my nursing career in bariatric surgery. I spent four years there and it was an amazing experience. Honestly, something that I really am very grateful for when I do what I do now because as the job that I did bariatric surgery, I would follow patients through their entire experience. One of the reasons I started looking for another job was because as I’m sure many are aware, anybody that knows anybody that’s had bariatric surgery, it’s wonderful, it’s an amazing tool, however, it’s a tool and it has to be utilized.

Marylou Hopkins:
So after a few years of following patients that would have the surgery, lose weight, do amazing, then you would start to see this regain and it’s very disheartening. I am a nurse and I’m a practice what I preach nurse, which every one of my patient hears but it was very hard for me because I was doing the same thing they were doing. I was eating small meals, I was doing the protein shakes, and I myself couldn’t lose weight, if anything I was actually gaining weight at the time. Then I started looking for another job and found that I really did like bariatrics and I was actually going to go into another bariatric surgery practice.

Marylou Hopkins:
Then I met this crazy cardiologist. Absolutely insane, I thought the day I met him because here I come from this background of calories in versus calories out, and portions and exercise. This guy tells me he wants to treat his patient’s symptoms with changing their foods first. I remember when he handed me this little paleo sheet he gave people and it said you give up your bread. After the interview I went to my kids and my kids were like, “So, what’d you think?” I’m like, “That guy’s crazy. I’m not giving up my bread.” However, with that information I started to get into this and look at all the information he had given me.

Marylou Hopkins:
Of course, Eric Westman I came across and I was blown away. It almost a sealed deal as soon as I started hearing what they were saying because it all made sense because my bariatric surgery patients have this great tool, they lose the weight, and the correlation between the two was just phenomenal. What’s the one thing they should not have? Most of the time can’t because they can’t tolerate it? It’s sugar. So wow, wait, all of my bariatric surgery patients were not having sugar and then when they did start to add sugar back because that tool was not as effective the longer you use it, they’d start to regain weight.

Marylou Hopkins:
So I decided to jump on board with this crazy guy and start a program. We started our program at a cardiology practice out in Manassas, Nokesville area, or Gainesville. When we started this, Dr. Eric Thorn, the one I work with, he said he wanted to mimic a program like Dr. Westman’s. So what did I do? I rolled out to Duke, his little lifestyle clinic, and I actually reached out to him a couple of times and ended up studying with him, had a phenomenal experience in his clinic. It was just mind blowing, brought all of the information that he had back to our practice. We formulated a program that is very similar to his, with the exception of, it’s a nurse, physician type program. So I do all of the coaching, I do all of the teaching, and he does all of the doctor stuff. Then, so we’ve been doing this now for nine years. So I haven’t had a piece of bread in nine years, guys. I’m alive and well.

Carole Freeman:
Oh my god, that’s amazing. You’ve been changing lives, how does that feel to have that much impact? Do you know the stats, the numbers of people that have been through your clinic and what kind of impact that’s had?

Marylou Hopkins:
It’s phenomenal. One of the things that I respect most about Westman is his statement that people ask him all the time, “What’s your success rate?” It’s 100% when you do it. That means a lot, and the impact when I started nursing, I really didn’t know. I actually was not even considering this. I can tell you today, it would be very… I don’t know that I can ever leave it. I actually got an opportunity to work with and study with Jackie Eberstein. That was my… that’s my whole idol, oh my gosh, because [inaudible 00:08:16] we are doing this and what you experience. Again, it’s been nine years that we’ve been doing this. You’ve seen that trend of products on the market and availability for just easier meals. You’ve seen that come up over the last nine years. Right?

Carole Freeman:
Yeah.

Marylou Hopkins:
[crosstalk 00:08:34] years ago, it was hard and you didn’t have all those options. Can you imagine back in 1976, when Jackie is coaching these people? So it was phenomenal, it was a great opportunity. Yeah, I don’t think I see myself ever doing anything else besides this. I love it.

Carole Freeman:
Well, so I know who Jackie is but for those who don’t know that name. Can you tell us why you were so excited to train with her?

Marylou Hopkins:
[crosstalk 00:09:04], I usually open with that, Jackie Eberstein. Jackie Eberstein is the only nurse that worked in Dr. Atkins clinic. She was the one that actually helped train Eric Westman back in ’90 something. She’s phenomenal. You know these people when you talk to a coach, you know they’re a coach because you can hear the things that they’re experiencing, that the clients go through. You figure out ways to adjust everyone’s foods to where it works for them.

Carole Freeman:
Yeah, that’s one of the keys, is there’s no one size fits all.

Marylou Hopkins:
No, no two people are different even when they eat the exact same thing, yes.

Carole Freeman:
Isn’t that crazy? That’s so weird, yeah.

Marylou Hopkins:
It is, and actually I will tell you. That’s one of my fun things is when I have patients that are husband and wife or a couple, and they’re in our area. We’ll have some that are, I’m in a cardiology practice. So some of our range is higher and so I’ll have people that are retired. They literally eat together every day the same thing and they don’t have the same results. So that’s one of those moments where I’m like, hey, now you guys get to see the truth.

Carole Freeman:
Yeah, well and a lot of times they think, oh, it’s not fair, men lose weight so much faster, but I’ve seen the reverse where the wife is losing weight really fast and the man’s the one with the stubborn metabolism, so.

Marylou Hopkins:
Right, so I think that’s one of the biggest things that I push especially when in my class is, please remember that no two people are the same. Just because it works for someone else does not mean that it will work for you and vice versa. It doesn’t work for someone else, it doesn’t mean that it won’t work for you.

Carole Freeman:
Yes, excellent. Oh, let’s see. Oh, if I may share a little fun tidbit of my education. So I did my undergrad and graduate both in nutrition. There was one of our professors taught an elective class in weight loss, how to lose weight and all the different methodologies and the biochemistry and all that kind of stuff, but of course… so this was in ’07 through 2012, not a class talking about low carb as an option. She just, one of the classes one day said that yeah, she talks about bariatric surgery in her class and she had this upside down funnel or something she taught, basically you try everything first and every diet first and weight loss surgery is the last resort. She said that it’s really, really, really effective, but the statistics show that within two years, people start to gain the weight back.

Carole Freeman:
I was just like, what? Most people don’t know that, and I just thought that was absurd. I said, “Why do they put people through all of that risk of surgery and all of that work?” She says, “Well, for those two years, the improvement of their life, it’s thought to be that that’s worth it for two years of improvement of life.” I was like, wow, I wish there was something different back then I didn’t know any different, so. So that’s a little dirty little secret of it, is that-

Marylou Hopkins:
Well, so… and I’m sorry to throw in bariatric surgery, but it is really… it’s heart wrenching. I didn’t say this earlier but the reason I started to look for another job was because it was so hard for me to be the nurse that I am and be able to help them. When you would go and say, “Why are they regaining weight?” Whether that’s the nutritionist or the surgeon, it was always, they’re eating more and exercising too little. I’m like, you don’t understand. I know these people, they’re not doing that.

Marylou Hopkins:
So then on the other side of it, my poor patients would come to me and they’d be devastated. Like, I’ve done everything. Look, I did this and I did great and now it’s not working. So, and I did the same thing. I didn’t know, this was what I did, this is what I was taught. One of the other things that drives me nuts is how many people will recommend bariatric surgery over the keto diet.

Carole Freeman:
Because it’s safer, right?

Marylou Hopkins:
Are you kidding? It’s mind blowing, but it’s the times. We have to remember that all of medicine, we are taught a certain way, we learn a certain way, and it’s hard to break those things because when you break them you’re going against everything you’ve learned and everything you’ve been told.

Marylou Hopkins:
So I am very grateful for Eric Thorn because he did break the mold and he [crosstalk 00:14:15] with 12 other cardiologists, all of them trusted him enough to send their patients to him. Then they get to start seeing. I have seen over time, I’ve had many, many physicians that are, no way, no way, no way. Then all of a sudden their patient comes in, and I have one of my favorites, she was a hardcore vegetarian. Hated ringing for everything that I recommended, maybe not. This is my opinion, but my favorite part is, do you know that she actually started handing out Dr. Westman’s material to her patients? Now, she is still a hardcore vegetarian and is very like, oh you should exercise. But she knows that it works and she knows enough to be able to give it to her patients as a recommendation to make some changes. I think that’s phenomenal, that’s where we start. That’s how it reaches everyone, so.

Carole Freeman:
Yeah, oh I love it, love. We’re changing one person at a time and then there’s a tipping point of enough people, their doctor sees it, and then we get to change one doctor at a time. We’ve got a lot of work to do.

Marylou Hopkins:
Fantastic, I love it, I love it.

Carole Freeman:
Oh, I can see, so we’ve got Leticia watching, and I can see we’ve got one other person. So whoever’s here, just type in the comments, let us know you’re here. I can’t see who it is until you actually make a comment. Also, if you’ve got any questions for Maryanne. I know somebody just joined us, so this is Maryanne, sorry Marylou. Marylou-

Marylou Hopkins:
[crosstalk 00:15:55].

Carole Freeman:
… cardiology nurse that specializes in keto coaching and keto transformations with cardiology. Now is it specific cardiology patients or are you just getting everyone that needs weight loss? Most of them happen to have cardiology support issues, right?

Marylou Hopkins:
Right, so we do. We have a great deal. We don’t take anyone under 18 just because of the cardiology practice and their guidelines. We don’t have any pediatric cardiologists. Then hello, then we have so across the board, my patients don’t have to come in because they have a cardiology problem. Now that our program is established, if they just need to lose weight, they can come in. They have a consult with the physician, and then they followup with me. Then I run it from there. Then we do labs, depending on the patient, every three to six months to a year. Then they do their coaching, it’s all patient driven.

Marylou Hopkins:
So what your stats are, well, unfortunately I have people… I’m not even kidding when I say, so we’ve been doing this nine years. I still see patients that I saw nine years ago but the frequency is different. So they struggle or they’re doing great and I don’t see them and then they start to struggle and then they come in.

Carole Freeman:
Yeah, okay, we’ve got some questions starting to come in. I know, so Penny, I’ll let you share your back story a little bit if you want, otherwise I won’t expose. I know we’ve got interview videos with Penny though, so I’ll just let her decide what she wants to share right here with everyone, but. So she’s… let’s see, let’s get into the… So your office, the fact that you have a cardiologist and a keto nurse together. It seems like the penultimate heaven for people. So this is probably one of the top worries that everyone I work with either before they start keto, and or across as they start going into it, even though every number improves except sometimes that one pesky one. Everyone’s freaked out and worried. One of the questions I had come in, actually let me get that up and I’ll give you the gist of it too. So we’ll talk about that.

Carole Freeman:
So let’s transition to just talking about, what about this high fat [inaudible 00:18:32]-

Marylou Hopkins:
Shoot.

Carole Freeman:
So I tried to get her before numbers. Again, this is going to be just general information. This is not going to be any specific recommendations of what Karen should do but just a general question that Karen had.

Carole Freeman:
So she didn’t have her before numbers and she’s changed doctors. So she lives between two different states and so her before numbers she doesn’t know. She started keto and the doctor… where’s my page out here? The doctor was concerned, so even though… okay, so her triglycerides are 43, her HDL is 109, her cholesterol to HDL ratio is 2.5. Okay, so she says, “I’m not worried about those,” but her total cholesterol is 276, her LDL is 158. Again, so the doctor put her on pravastatin because the number was too high. Again, I don’t even know what the numbers were before. I don’t even know that this doctor does, but he’s going based on this.

Carole Freeman:
So let’s see if we can frame this in a general way of like-

Marylou Hopkins:
I can’t pretend you just asked me that. So what I think I’ll do is, I’m going to treat you like you’re the patient and you just asked me the question.

Marylou Hopkins:
I think the first part of that, right before you started talking about the numbers it broke up a little bit but what I’m going to say to you is what I would say to my patient. Okay? Because I have this happen all the time and when they come in they’ll say, “Oh my gosh, I got my labs done. Look at this.” So when you said, so first off, triglycerides are, what did you say? 43?

Carole Freeman:
43, yeah.

Marylou Hopkins:
Was that before or after the addition?

Carole Freeman:
This is after keto.

Marylou Hopkins:
No, addition of statin?

Carole Freeman:
Oh, yeah, see that’s a good question. I think this is after the statin, yeah. Yeah-

Marylou Hopkins:
[crosstalk 00:20:45].

Carole Freeman:
Let’s see. I didn’t get the date when that started, so correct.

Marylou Hopkins:
It’s okay, it’s okay. So I’m just framing everything. All right, so this is what I would say. I would say to you, listen, first off, your triglycerides are amazing. Okay? What’s crazy is, is if you think about this, Carole, and I don’t know how much experience you’ve had with this, but the American standard for a healthy triglyceride is 150. She has 43. Triglycerides, when I see them, are a direct reflection most often, not all the time. Nothing is ever 100%, most of the time your triglycerides are going to be a reflection of your sugars. Okay?

Marylou Hopkins:
Now, on the other side of that, what number did you say the HDL was? 100 and what?

Carole Freeman:
109.

Marylou Hopkins:
Okay, I think she wins for the highest HDL I’ve seen. Now, that is a lot coming from somebody that’s been working in cardiology for nine years and doing this. Very, very high HDL. Your HDL is there to clean up your LDL, so you have a super high HDL, you have a high LDL, you just said your ratio super small, she’s cleaning up all of her LDL, or you. That’s right.

Carole Freeman:
Me.

Marylou Hopkins:
So anyway, so that little cholesterol thing, I would not even blink at. Now, was the question something about the statin or was it just-

Carole Freeman:
Well yeah, she’s worried that the total and the LDL are too high. We’ve talked about this a lot, but you understand how you often have to say things 10 or 17 times before it sinks in. Not that because people aren’t intelligent, it’s just that when-

Marylou Hopkins:
[crosstalk 00:22:44].

Carole Freeman:
… 50 years of something being told that it’s bad for you, it’s hard to unlearn that but she’s also saying that the doctor thinks she needs to eat less red meat, eat more fish, and eat more berries, and eat more fruit.

Marylou Hopkins:
Okay, we’ll talk to that doctor later, but-

Carole Freeman:
And-

Marylou Hopkins:
… how I would respond to this in that, because guess what? Even in the same practice I still get pushback sometimes and it’s fine, I get it. First and foremost, she needs to do whatever she feels, you feel, Carole, whatever you feel is best for you. One of the hard things and when you said people, you have to say it 17 times. You have to say it 17 times because it’s freaking scary. You have grown up your entire life hearing all of this bad stuff, now all of a sudden you’re trying to get healthy and you have this LDL that’s ridiculously high. Honestly, she probably does eat a ton of red meat because that HDL, when I see a lot of red meat eaters, those will jump up too. It’s fine, but again, it’s a good one.

Marylou Hopkins:
The LDL is so stinking tricky because I have not been able to pinpoint anything. It almost seems as if it is more a personal, hereditary DNA type thing. My mother’s LDL, I think it’s 222. I was like, listen lady, you don’t need a statin because her HDL is super high, but then when she goes off and she’s not eating well, I’m like, hey, get on a statin. That’s your choice, go for it, but that’s my mother. I also know her, okay?

Marylou Hopkins:
The other thing that you could potentially do if you have a cholesterol panel like that, get an NMR. Those are detailed breakdown of your cholesterol particle sizes. So basic terms, your LDL can be super large, and actually, Eric has a wonderful description of that and he talks about marbles going into a funnel and if they’re a bunch of little hard marbles, then it gets stuck but if they’re not, then potentially they can make their way through. So that’s what an LDL is, because as those particles, the LDL particles enlarge, that total LDL goes up really high. Okay? When it does, that does not necessarily mean that there’s all those particles. Potentially, that just means the particle size has grown so it increases that number. You cannot get that unless you get a lipoprotein NMR, is what it’s called. Again, it’s just a breakdown of everything.

Marylou Hopkins:
So, perfect example. Mother, her particle size was huge. Actually, I had an incident with her where she has lost about 60 pounds, maybe even more, in a matter of about six months. She went to her doctor elated because all he wanted to do was have her get bariatric surgery because she needed to lose weight. Okay? She goes in, getting ready like, I can’t wait to see what he says. He’s going to be so proud of me. The only thing he says to her is, “Why are you not on a statin?” She said, “What?” He said, “Why are you not on a statin?” It was because her total cholesterol and her LDL were high. Now, the whole conversation was that she didn’t… she was back and forth and with Dr. Thorn, she was working with him, if she wanted a statin she could’ve absolutely had it, but then she had the NMR and it was large and fluffy. So her choice and decision was to not take the statin.

Marylou Hopkins:
So after her appointment, after he is talking about the cholesterol, she actually… he ended the appointment with that. He says, “If you’re not going to take a statin, I’m going to put in here that you are going against medical advice,” and that was it. So the appointment was over, she calls crying hysterically. He never mentioned her weight loss.

Marylou Hopkins:
So I’ve heard you say something about that one number, and that’s actually very true. Think about her A1C, her cholesterol, her C reactive protein. All of those things in combination, that’s what’s important, and how she feels and what she’s most comfortable with. But just remember, if you feel like that the total cholesterol is too high and taking a statin is fine, go for it, man. There’s nothing wrong, if you have problems, then you go back and revisit it.

Carole Freeman:
So can you give us some insights into why is it that cardiologists especially, a lot of doctors in general, but why is it cardiologists get so fixated on the LDL? No matter all the other numbers get better, every other number you can test gets better, why do they get so worried about that one number?

Marylou Hopkins:
How we started the conversation. They’re trained that way, so this is ingrained. [inaudible 00:28:13]. How many times do you say that? I say it all the time, but it’s ingrained. That’s what they know, and the other thing to consider is, again, totally personal, not professional opinion, but I want to know what’s going to happen in 20 years to our lab values. Okay? Because they’re going to have to change because if people are getting healthier but these weird numbers that we’ve been seeing over the last 45, 50 years of us eating bad food, right?

Carole Freeman:
Mm-hmm (affirmative).

Marylou Hopkins:
We’re eating bad food, then they tell us these are our healthy numbers. Well, what’s going to happen in 20 years when a lot more people are eating this way and realizing that it’s healthier? It potentially could adjust those lab values. So I think, I mean seriously, you look at even fasting glucose, cholesterol, what else do I see that changes funky? Because they’re not having the swings of the sugars, they’re not having things that are drawing them up and down. Our triglycerides, honest, unless you have a medical condition that causes those triglycerides to go up independent of your foods, a lot of times triglycerides shouldn’t be above 80. [crosstalk 00:29:40]. Right? That’s almost half of what the recommended is. So I think that will happen down the road, but just remember, this is what they know, this is how they’ve been taught. This is across the board, and they have to protect themselves too.

Marylou Hopkins:
The other thing I want to mention actually very important right now in this whole conversation is that after that incident with my mother, one of the things… I mean, of course I’m livid, okay? My mom’s kicking butt here and she looks great and she walks out of her doctor’s office crying, I’m so angry. So the one thing I do want to mention is is that they are held to a standard too. So there is a lot behind the scenes where if your cholesterol, Carole, is 250, and that doctor does not say, “Hey, you have to go on a statin,” it could be medical malpractice. So you have to be careful when you get into medicine, but always remember you’re your own advocate. So you are your driver, this is your body. Okay? So if you have the ability to change your foods for forever and it works for you, great, but the other piece is, how many times your little upside down funnel, pyramid, so [crosstalk 00:31:12] things and nothing works.

Marylou Hopkins:
So when you’re in medicine and you say, “Hey, I want you to go out…” it’s getting too hot there isn’t it? Your 110 degrees, but say, “I want you to go and I want you to change your foods. I want you to lose 10 pounds and come back and see me.” So this person goes out, they change their foods, they don’t lose 10 pounds and they come back and everything is still crud. What do you think the physician feels like? They didn’t do it.

Carole Freeman:
Right, they blame the patient. It must be, because that’s all they’ve learned is that, well, if your cholesterol is high it’s because you eat too much red meat, you don’t eat fruits and vegetables, you don’t exercise. You must eat fast food [inaudible 00:31:57] time.

Marylou Hopkins:
You see what I’m saying? So it’s all of these. It’s what I tell people all the time about just in general about changing your foods. There’s a whole line, there’s a lot of things that intertwine into everything we’re dealing with. So as long as you’re open minded and you’re patient and you have a good relationship with your physician, so that’s the other one now. When you back up, having a physician that is… what’s the good word that I want to… is, I don’t even know what the word… I’m so sorry. So is willing, is willing to hear you and willing to follow you closely even if you’re not making the changes they want you to make or whatever. That’s key, it’s really… which is honestly half the reason we’re so busy. You got this guy here, works with you, figures things out. He doesn’t not prescribe statins at all. He will absolutely say it, but if the patient says, “Hey, I want to change something, can we try this or can we try that?” 100%, you see what I’m saying?

Carole Freeman:
Mm-hmm (affirmative).

Marylou Hopkins:
I don’t know how to read the comments, by the way.

Carole Freeman:
Oh yeah, I don’t think you can. I don’t know that you can see them or not. Only when I put them on the screen. So I’ll catch up with those in a minute. So basically, to recap and summarize, it’s very complex. Doctors, keep in mind that cardiologists aren’t trained in nutrition at all, so the recommendations of eat less red meat, more fish, more vegetables and fruit, that’s just stuff that they’ve heard. It’s not their training.

Marylou Hopkins:
They’ve learned, that they’ve been taught, remember?

Carole Freeman:
Yeah.

Marylou Hopkins:
Not heard but it’s taught, it’s ingrained.

Carole Freeman:
Yeah, yeah. They are also trained that if that LDL number is a certain thing, you have to prescribe a statin or you could lose your license. Also, you won’t get paid by insurance, that’s a whole other thing. Your insurance rate payment also is dependent on whether you’re following standard of care, which is prescribing medication. So they have to do these things. So they’re not trained to look at the whole picture, they’re trained to look at just each individual thing in isolation. So there’s a lot of reasons that they recommend this, and it’s not that they’re bad or doing wrong thing, they’re following what they’re supposed to do.

Carole Freeman:
So how then, how does a person go about… I mean, this person’s trained, they can prescribe medication, they can do surgery a lot of times. How can we as a lay person feel comfortable at all in knowing, well, if all that stuff we’ve been told isn’t true, how do I know? Where do I go to get information so I can empower myself? Can Cassie is asking, for example, she’s asking for books or websites that we could possibly [crosstalk 00:34:52].

Marylou Hopkins:
Actually, I feel terribly unprepared. I can send you a link, it should be on Adapt. So on the Adapt issue, so Eric is on there, Eric Thorn.

Carole Freeman:
Let me find it.

Marylou Hopkins:
He actually has a… was it on that, or maybe they was a Facebook… there was a Facebook video. I’m not exactly sure, but he has a video that he talks about how to talk about this with your physician.

Carole Freeman:
Okay.

Marylou Hopkins:
Perfect.

Carole Freeman:
The Adapt your Life, or what’s the-

Marylou Hopkins:
Yeah, Adapt your Life. Right, and then-

Carole Freeman:
Okay, I’ll see if [crosstalk 00:35:32]-

Marylou Hopkins:
… [crosstalk 00:35:33] Eric Thorn and if it doesn’t, Carole, I will send you the link when we’re done.

Carole Freeman:
Okay, cool.

Marylou Hopkins:
But so the, okay, easy overview. You go in, you talk to your physician, you explain to them, this is what I’m doing. You also have to be prepared for them not to accept it. Okay? If they don’t accept it, you can be grateful, thank you for your time, it’s okay, and you can leave. Then you’d have to figure out something else. Now, having said that, you know there is a ton more physicians now than there were even five years ago. Okay? You’re just fine. Actually, one of the greatest websites that I use all the time, Low Carb USA. Okay? You go in there, they have physicians listed. Now, I will tell you that going in there, it’s a little weird because sometimes they’re not really low carb, keto, but it’s fine. They’re in there, that means they’re going to hear you, it’s about medication adjustment.

Marylou Hopkins:
Now with telemedicine, I’m just kidding. There might be more opportunity to find a physician that will follow your numbers. They have Virta, but I think Virta’s more towards diabetes, but [crosstalk 00:36:59] thing where they actually work specifically with your physician. Then I will tell you, we have people that travel. They come in and they’ll meet with him and they do a class and leave, and then they’ll come back if they need. So there’s lots of ways, but you want to be comfortable and you want to know that your physician is hearing you, and if they don’t, it might be time to find a new one.

Carole Freeman:
So this is Penny’s question in a nutshell, yeah. How does a layman argue with a cardiologist? Well, there’s a strategy to it, she just went through that.

Marylou Hopkins:
Get me in there, I’m just kidding.

Carole Freeman:
Yeah.

Marylou Hopkins:
But so you don’t argue, I think that’s number one. Don’t argue. You don’t have to argue, there is no argument there. You’re going to do whatever you need to do that’s best for you. You go in, and like I say, you can… now, I’ll tell you in nine years, we have had a million people bring in tons and tons and tons of stuff to Dr. Thorn and be like, “Here you go.” He’s like, “Yeah, I know.” Okay, now you take that to somebody else who knows. They might not be able to go through it or they might not understand it, but you just… I would say number one, don’t stress too much. If the physician is willing to follow you, okay, and be able to make recommendations, they don’t have to believe it because guess what? You’re going to show them. You’re going to be their first case. Next thing you know, maybe they’ll be recommending to everyone else, all of the rest of their patients, but don’t stress if you have a hard time.

Marylou Hopkins:
If this is like my mother, that was her lifelong freaking physician. She was devastated but then she got over it, she found another physician, worked with them, he still pushed bariatric surgery which really pissed me off, but it’s fine. So but you got to understand where these people are coming from. Also know that just I’m sorry, I push it a lot but please be your own advocate if you know something works for you, if you feel good and if you’re seeing on those numbers everywhere, labs and scale and fat mass and all of that, come one. That’s way healthier.

Carole Freeman:
Oh, I’m going to add some interjections more about the LDL because I know that that’s the one that the person who wrote in the question is like, my doctor’s freaked out about this one number but this is also something doctors aren’t trained in. Again, they’re trained like, if this number is this, then equals that, which is medication. Then they have to offer it, again, okay. So but when I was in school we were looking at research that showed total cholesterol and LDL rates, and associations with heart attacks and stroke, which is really what people are worried about, right?

Marylou Hopkins:
Right.

Carole Freeman:
That’s what we’re worried about, we’re worried that our cholesterol is going to cause us to die of a heart attack or stroke or have one.

Carole Freeman:
So we were in class and she’s going over the bell curve and so the bell curve looked like this. So the total number was like this and the higher it got, the lower the risk it was. So they picked an arbitrary number in the middle that happened to be at that time 200. Just drew a line, they just picked a number, a nice, round number. It didn’t correlate with the worst outcomes, it was just that it was an even number. So I raised my hand in class and I was that person, that I was always like, “Wait, this doesn’t make any sense.” There’s a higher risk… the risk doesn’t get worse until you get out to 400, why did they pick it? Actually at 220 was lower than it was at 200. So I said why? They said, the teacher was like… this was professors at a prestigious university. This is just because this is how we’re taught. So people that aren’t questioners like me, the professor said, “Well, it was just a nice, round number, it’s easy to teach that to people that way.” It didn’t correlate with risk, it was just a number. So if you weren’t paying attention in class and nobody asked that question when you were in class, you’re going to miss that. Okay?

Carole Freeman:
The other thing to know and I don’t know if cardiologists are taught this or not, but that LDL number does not correlate… this is building on what I just said. That LDL number does not correlate with how many heart attacks you have or how many strokes, or if you die of a heart attack. It’s not-

Marylou Hopkins:
Actually-

Carole Freeman:
[crosstalk 00:41:52] really high. So I interviewed a lady earlier today to work with and she two years ago had a heart attack. She said that her doctor was, oh, wow, that’s puzzling because her cholesterol numbers were perfect beforehand, perfect. So then they had to come up with an excuse of why it was and they said, “Well, you have some sleep apnea so that’s probably what caused it.”

Carole Freeman:
So, I’ll just [crosstalk 00:42:21]-

Marylou Hopkins:
[crosstalk 00:42:22], okay, wait a minute.

Carole Freeman:
[crosstalk 00:42:24] statin now because even though her cholesterol’s normal, they’re worried about her. Well, but I mean, that’s a whole other case, but.

Marylou Hopkins:
Right, so all of that is fine. Honestly, one of the things that people miss all the time is your A1C.

Carole Freeman:
Yeah, her blood glucose, she’s pre diabetic, and I’m her A1C yeah. So I talked a little bit about that. The bigger correlation.

Marylou Hopkins:
Exactly. The heart and A1C are hugely correlated and nobody ever talks about it.

Carole Freeman:
Insulin as well, which is this… my client that’s written in with the question, worried about the LDL, I’ve had her tracking her insulin number and it’s come down. She’s at I think about a six or a seven, which is doing really well.

Marylou Hopkins:
Oh, that’s great.

Carole Freeman:
Yeah, but-

Marylou Hopkins:
Remember something else, Carole. For real, as far as since we’re talking about labs is, everybody is different. Everybody varies, so when you get these things if you can, take a step back and look at the overview. For the person that didn’t have their labs prior, who knows? Maybe their LDL was already high and then they changed their foods and their fat helped it to increase but in a good way. Or the A1C, man, like I say, or your insulin or your C reactive protein, you’re talking about inflammation markers there. Just because somebody’s CRP is high, that doesn’t mean it’s dangerous. It’s something we watch, something that-

Carole Freeman:
[crosstalk 00:44:10].

Marylou Hopkins:
Right? It’s another marker of another thing where if you can put everything together, it might make more sense. But you can’t freak out about a change in one or even two or three numbers. Depending on the direction that they go, if you have somebody that is familiar with this regarding labs, you go in and they’ll be like, oh it’s fine.

Carole Freeman:
Yeah, so Penny shared a little bit more about her history. So she had lap band in ’09. Then she had lots of problems, we’re getting the pieces here.

Marylou Hopkins:
Sorry, Penny. I know the problems you have.

Carole Freeman:
Then she had it drained, regained 50 pounds, and then she turned to keto and she’s been doing really great but her cardiologist frowns on it because her LDL… let me… is high but HDL is higher. She sent me another here that says HDL is higher. So she’s saying she needs to argue with her doc now. So we talked a little bit about, you don’t need to argue.

Marylou Hopkins:
No arguing, it’s a smile and wave, like okay, oh is that how you feel? Thank you very much, and then you go look for another one. It blows my mind. We got back to the bariatric surgery and she had a lap band, right?

Carole Freeman:
Mm-hmm (affirmative).

Marylou Hopkins:
What is lap band? It’s literally squeezing to where you can’t swallow things. Come on, man. [crosstalk 00:45:46] foods, had a lot of lap band patients that I will have them take their fluid out and jump on… and then it was… I don’t know if they still do lap bands today, but that was a rough one. But she’s come back down, she’s doing good, and all her problem right now is the fact that her LDL is high. Again, I would tell her, get a lipoprotein NMR. Okay? But she also has to get it because a lot of times they won’t order it unless they read them. So you want to have a doctor that will do it. Then you just call around, a lot of them do but call around and see. It’s just a blood draw, no big deal, but it’ll just break down that cholesterol for her and give her some peace of mind.

Marylou Hopkins:
Now, if that whole makeup is all jacked, well, then maybe going on a statin is an option for her. As long as she doesn’t have side effects, again, her choice. What makes her feel most safe? As long as she’s not having negative side effects, okay, but it’s up to every individual patient. I never push on either side, ever.

Carole Freeman:
I had another questions. What was it?

Marylou Hopkins:
I know, [inaudible 00:47:14].

Carole Freeman:
We got all the ones of the people that were watching here. Yeah, I don’t know, maybe it’ll come back here.

Marylou Hopkins:
So I see Kathy asked about resources [inaudible 00:47:30]. So the number one out there is obviously going to be the Big Fat Surprise. I do love that.

Carole Freeman:
I see she just has a new cover on it, so.

Marylou Hopkins:
She what?

Carole Freeman:
It’s been updated with a new cover.

Marylou Hopkins:
Oh, how exciting, but she’s great at that. The other one is Sugar, the Bitter Truth. No, yes. No, yes. Sugar, the Bitter Truth, is that the one that came out two years ago from… oh my goodness, why am I blanking?

Carole Freeman:
Taubes?

Marylou Hopkins:
Yes, Gary Taubes.

Carole Freeman:
[crosstalk 00:48:08] The Case Against Sugar.

Marylou Hopkins:
The Case Against Sugar, thank you. I’m sorry, they all get mushed together, but The Case Against Sugar, I’ve been doing this for how long. When I came out and I read it, I was just like, oh my… I can’t-

Carole Freeman:
Yeah, right?

Marylou Hopkins:
Because it’s like, one of the ones you get all heightened about was the darn sugar that they soaked the tobacco in sugar. I was like… because-

Carole Freeman:
Inhaled sugar. How much worse is that for your lungs? Yeah.

Marylou Hopkins:
Right? So anyway, those are two great resources. The Big Fat Surprise I love because she does go through the whole timeline and where the fat fairy came from. Then backs it up and talks more about how today we deal with it, but then again, the sugar wine was mind blowing because it just drives me crazy. It always-

Carole Freeman:
Do you-

Marylou Hopkins:
It’s hard to control when you get a little passionate about things.

Carole Freeman:
Have you read the Cholesterol Myth? I can’t remember the author of that one.

Marylou Hopkins:
I have not, is it a good one?

Carole Freeman:
Yes, where he breaks down that LDL isn’t associated with risk and on and one. Case Against Sugar, the other one, or have you ready Eat Rich, Live Long?

Marylou Hopkins:
I mean, I have it. I haven’t read it front to back. I’m really bad about that, so.

Carole Freeman:
That one, I also really liked because they do a condensed version of why we were told fat was bad for us. Then their favorite test… this is the question coming back to me now, is the CAC, the calcium arterial scan. Are you a fan of that? How does that compare to NMR?

Marylou Hopkins:
So in our practice, there are patients that get it done. I don’t have a ton of information on as far as what… how do I say this not medically speaking. Does that make sense? So I don’t want to overstep here but we do have times where people will have crazy cholesterol, they get a calcium score to look a little more at where they’re at. Usually calcium scores aren’t covered, so it’s not something they order all the time, but I can promise you in our area they’ll have sales on it. It’s so weird, like it’s Macy’s.

Carole Freeman:
Oh, [inaudible 00:50:44].

Marylou Hopkins:
It’s Macy’s. Hey, we’re having a sale today on our calcium scores, sign up now. So they do that in most areas, and yeah, you shouldn’t spend more than $100 on it but it’s a good test to have. Now, do you have some crazy cholesterol? You have a calcium score and it’s high? It sways your own decision of what you need but you have a crazy cholesterol, large particles, and then a calcium score that’s zero. Well, then guess what? You may be okay, but again, just remember this isn’t medical advice. It’s something you have to talk to your doctor about but we definitely do that.

Marylou Hopkins:
But the only other side to that is that you do one now and then you do one in a year. Make sure they’re okay and just watch them, but absolutely. A calcium score would be beneficial.

Carole Freeman:
In Eat Rich, Live Long, they actually give some recommendations about if your score was in this range, here’s when you should get another one. So I like that too, so they break it down. [crosstalk 00:51:55].

Marylou Hopkins:
Perfect.

Carole Freeman:
So basically, you’re overall summary is, one number doesn’t mean much of anything, we need to look at the big picture, we need multiple pieces of information to know if you’re healthy or not. So for example, if somebody weighs 200 pounds, do we know if they’re healthy or not? They could be six seven, they might be too skinny, they might be overweight. So just one number doesn’t mean anything. Let’s say if it’s 70 degrees out, does that mean it’s hot or cold? Well, it depends on if you’re in the antarctic or if you’re in Arizona. [crosstalk 00:52:26]-

Marylou Hopkins:
Or Virginia.

Carole Freeman:
… more information, yeah, yes. What’s the humidity, how many clothing are you wearing, right? Because if you have three coats on and it’s 70 that’s going to be too hot. So we need more information, so.

Marylou Hopkins:
I love that analogy, Carole. I really like that.

Carole Freeman:
Excellent, well it looks like it’s almost time to wrap this up, Marylou. Is there anything else that you want to add or share? Any other tips of wisdom or experience, nine years of doing this?

Marylou Hopkins:
Well, okay. You want to hear my favorite one?

Carole Freeman:
Yes.

Marylou Hopkins:
Okay, you guys are all going to hate me for this. So the one thing I would tell… so I hear people all the time, that’s their question. What’s the one thing you see is the biggest… I don’t know, thing that messes everybody up, is nuts, guys. Any kind of nuts, every kind of nut, and every nut flour, stay as far away from them as you can. I heard your girl last time said, don’t do net carbs. That’s 1,000%, but the nuts thing, it’s a hard one because it’s on every website if you are struggling with your weight and you are eating nuts, cut them out and tell me how you feel.

Carole Freeman:
Yes, that’s one of my starter rules, is I have everybody cut out all nuts of all kinds because for most people, one is never enough. I love that you include the nut flours as well, because even though we’ve got so many wonderful options for keto foods now, we’re going a little bit too far into the dessert-y territory and nobody needs to eat an entire piece of some carb-y dessert that’s made 100% from almond flour because that’s the equivalent of a pound of nuts that they’re eating in that one thing, so.

Marylou Hopkins:
It’s crazy, right?

Carole Freeman:
Yeah.

Marylou Hopkins:
For me, like I say over the last nine years of coaching patients, the response that we have towards any kind of the nut family is so strong that I can detect it when they come in. They’ll walk in and I’ll be like, they’ll start talking and I wait a few minutes. Then I’m like, “Hey, you eat any nuts?” I’m not kidding when I say that it would be more than 75% of the time they’re like, “Oh yeah, huh.” [crosstalk 00:54:57]-

Carole Freeman:
Because they’re high in protein and they’re good fats so they must be fine.

Marylou Hopkins:
Absolutely, exactly. So stay away from the nuts and nut flours, how about that?

Carole Freeman:
Yeah, that’s great.

Marylou Hopkins:
One day my cookbook will come out, but it might be after I die, I don’t know. I haven’t gotten around to making it, so. It’s fine.

Carole Freeman:
I’m in the same boat. Oh my gosh, thank you so much for being here.

Marylou Hopkins:
[crosstalk 00:55:23].

Carole Freeman:
So how do people on the East Coast come and find you, or are you guys doing telemedicine, or?

Marylou Hopkins:
So, I don’t know state wise, I think they’re a little different right now but we are at Virginia Hospital Center. Oh, I guess I didn’t say that either but. We’re at Virginia Hospital Center, it’s Dr. Eric Thorn. VirginiaHospitalCenter.com is our website, you can look that up. Then, and if they just need a physician to see them, for that they don’t have to do my program. Okay? So we have a lot of keto people that need their labs, they want to be followed. They’ll come and just see him. He knows what’s going on and he can adjust things for them.

Carole Freeman:
So take a vacation out there, you guys. Go see the wonderful, perfect fall out where Marylou is and if you need a cardiologist oversee your healthcare.

Marylou Hopkins:
There you go.

Carole Freeman:
Who is keto friendly. You don’t have to do any arguing at all. You can do some high fives.

Marylou Hopkins:
Well, quarantine fives.

Carole Freeman:
Oh okay, yes, yes. Plastic gloves through a plexiglass shield high fives. Oh my gosh, this has been so fun. Thank you so much for answering-

Marylou Hopkins:
[crosstalk 00:56:39] too long.

Carole Freeman:
No, this is perfect, this is perfect. So yeah, thank you so much. We’re going to wrap this up. Thanks for all your questions, thank you Marylou, for being here. We’ll wrap this up for today. This has been so fun, this has been great. Indulgence in top and top… talk about topics that I love to rant about. We got a lot of work to do in the world still.

Marylou Hopkins:
Well, we’re here. We got this.

Carole Freeman:
Yeah, yeah.

Marylou Hopkins:
[crosstalk 00:57:07] by the way, you’re amazing.

Carole Freeman:
Oh, thank you so much. Thanks for taking the time. I know you have a super busy schedule, so I really appreciate it.

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