Dr. Leslyn Keith:
That’s good enough. I have a secondary title to it, but it’s too long, so what you said is good.
Carole Freeman:
Good. Good. Good. Well, and this is interesting topic because I definitely have some of my ladies that have lipedema. It’s a small percentage, but as I was reading your book, I was like, “No, everyone needs to know this.” Even if you do not have lipedema, you have a lymphatic system, and you need to know about what we’re going to talk about, so please don’t tune out. You need this information. Like, “I learned so much, and I’m so excited.” Dr. Keith, can you tell us a little bit more? I wasn’t quite sure from reading your book. Are you an internist or a… What type of medicine do you practice?
Dr. Leslyn Keith:
No, I am… Actually, I have a clinical doctorate in occupational therapy, so I’m an occupational therapist, and I specialize in treating lymphatic and fat disorders. That includes lipedema, which is a fat disorder, but also lymphedema, which is a disorder that you can sometimes get after cancer treatment. You’ve had lymph nodes removed. You’ve had radiation therapy. Your lymphatic system becomes damaged, and then you can get swelling in the area that you were treated in for your cancer. Those are probably the two most common things that I treat.
Dr. Leslyn Keith:
I really got into keto, because more and more of my patients that were coming to me for lymphedema or lipedema were overweight or obese or even morbidly obese, and it seemed to really make their swelling worse. I was really trying to figure out a way to help them lose weight in a healthy way, because we know there’s lots of unhealthy ways out there to lose weight, but the ultimate goal was to help them manage their lymphatic or fat disorder better. I pursued my doctorate in occupational therapy, just so I could run a study.
Dr. Leslyn Keith:
You need a university backing in order to run a good study, and so I wanted to specifically see if we adopted a ketogenic diet for people who had a lymphatic or fat disorder, would it make their condition less severe? Would they lose weight, and then would they not have as much of a problem? I did that study, and out of that, I wrote the book that you talked about. What is even more interesting is that I was finding out as I was using it with my patients, and I did the study and everything, it really was independent of weight loss that the lymphatic system seemed to function better.
Dr. Leslyn Keith:
I still did my first book that you’re talking about because we got 67% of American adults are suffering from overweight and obesity. Keto was just something that was going to help with that pervasive issue, but I think that it’s even more than that. It seems that keto is actually a fantastic way of eating if you have a lymphatic system, because it makes your lymphatic system healthier. Guess what, everybody has a lymphatic system, so-
Carole Freeman:
Spoiler alert, we all have lymphatic-
Dr. Leslyn Keith:
Yes. I know. That told me that a second book was needed, so that’s what I’m working on, and hope to have it out this fall. That one is… It’s called the Lymphatic Code, because we need something that guides us to the best lifestyle that we can have so that we have a healthy lymphatic system, because it’s involved in everything. Let me tell you the lymphatic system is completely ignored. I mean, have you ever talked about it before? Have you ever even thought about it before? Doctors don’t think about it. It’s an ignored system.
Dr. Leslyn Keith:
I don’t know why particularly, but it seems that it’s because your lymphatic’s fluid, the lymph fluid is clear. It’s invisible, and so it’s just not even thought of really, but it’s so important.
Carole Freeman:
I thought the same thing. I went to school to get two degrees in nutrition, and each time, I had to take the anatomy and physiology class. Well, the first time I took it, I was just blown away to even find out that we had a lymphatic system. Let’s start there. Let’s just talk about… Let’s set the stage. Most people watching have no medical background or training, so let’s… What is this magical lymphatic system basics for people?
Dr. Leslyn Keith:
Your lymphatic system is it’s that clear fluid that when your heart sends the blood all the way to the tissues, and you’re nourishing the tissues and sending oxygen and nutrients and all this stuff sending out to your tissues. Now, all of that now has to be the water and the excess nutrients and the cell debris and toxins and various stuff has to be evacuated, because you can’t leave all this extra fluid in the tissues. Your lymphatic system evacuates that. What’s interesting is that we used to think that most of the fluid got reabsorbed into the venous side, so your arteries would push it out in the tissues, and then most of it would be reabsorbed in the venous side.
Dr. Leslyn Keith:
Only an inconsequential amount, whatever was leftover that couldn’t be reabsorbed in the venous side, the lymphatics would pick up. But in 2010, there was some exciting research that was done by [inaudible 00:06:23]. They published their paper in 2010. They said, “No, actually, 100% of the fluid in the tissues must be evacuated by the lymphatic system.” Do you see how now all of a sudden, this is really an important system? If you aren’t evacuating that stuff, then you get swelling and all kinds of dysfunction happening in your tissues, so you need to have it evacuated.
Dr. Leslyn Keith:
If your lymphatic system is not working so good, or you’ve impacted it by poor diet, then we’re going to get illness. The other thing is… Lymphatic system is hugely involved in water balance. It is also one of the main components of your immune system. Right now, we’re looking at… We have a pandemic that was going on, and you need to have a robust immune system to help you against any kind of pathogen or anything that’s going on with that. Your lymphatic system is what delivers the immune cells to the tissues, and it also is going to evacuate the pathogens. Then every time it comes to a lymph node, we know about those in our neck. Those become swollen when you have a sore throat or something like that.
Dr. Leslyn Keith:
Every time it goes to a lymph node, you have about 600 of them in your body. In those lymph nodes, they are chopping up, killing all the bad toxins and stuff like that. It moves on and it goes to another lymph node, it happens again, and so your lymphatic system is huge for your immune system. We need to keep that lymphatic system healthy for that as well. Then another important function of the lymphatic system, which really comes into play for a ketogenic diet, is your lymphatic system in your gut. That is what’s responsible for mobilizing fat.
Dr. Leslyn Keith:
You eat fat, and it is mobilized through the lymphatic system from the intestines and brought into the blood. That is… I mean, fat is so important that we have a system just for moving along, so your lymphatic system is hugely important in your health. What I have been discovering through self experimentation, reading all these different research articles, stuff like that, unfortunately, most done on mice, but it seems like fat fuels the lymphatics. When we deny ourselves of eating healthy fats, we are actually impairing the function of our lymphatic system, and what have we been told to eat for the last 50 years?
Carole Freeman:
Not fat. Not fat. Not salt. Not meat. Just eat some grass.
Dr. Leslyn Keith:
Right. Grow a couple extra stomachs so you can digest that grass, right?
Carole Freeman:
Right. In summary… Well, I can see we’ve got some people watching too, so go ahead and give us a comment, so we know you’re here, and love to have interaction here. In summary, the lymphatic system is responsible for a lot more than you ever thought. It’s a system vessels and lymph nodes. I thought that maybe one of the reasons that it just was ignored was because there’s no heart that drives the fluid, right, so there [crosstalk 00:09:49]. I hadn’t thought about it either, but because the fluid is clear that they weren’t noticing it so much too.
Dr. Leslyn Keith:
You bring up an interesting point, Carol. As I was writing my second book, The Lymphatic Code, I’m looking at what’s the evolution? How did we end up with the lymphatic system? There are some actually animals that still have little limp hearts, little things that help it pump along.
Carole Freeman:
How adorable.
Dr. Leslyn Keith:
Yes, it’s very, very cute, but what we still have… Humans have probably been most developed lymphatic system of any animal, but we still have in the vessels, the major lymphatic vessels between valves. There is actually smooth muscle on the larger vessels that contract, and so it has this rhythmic pumping, these little lymph hearts that actually, that’s what’s leftover with the lymph hearts that can pump to the next section, the next part of the vessel to move that fluid along. Guess what? One of the things that increases that contraction of the lymph vessels is when you eat fat.
Carole Freeman:
Oh, interesting. How fun. How fun.
Dr. Leslyn Keith:
Actually, they found, and this is again on mice, but high fructose diet slowed down lymph vessel contraction. Eating fat, and specifically, they test this with olive oil, when they fed them olive oil, increased lymphatic vessel contraction. I really think that the lymphatic system is fueled on fat, and we cannot deny our lymphatic system its fat.
Carole Freeman:
Well, it’s interesting. The more we study this, the more we find that more parts of our body are actually fueled by fats, or our enterocytes, the lining of our intestines are fueled by fat as well, so we get to just… 50 years of nutrition information, we’re just turning it on its head right now, and now we have to tell everybody the opposite of what we told them back in the ’80s.
Dr. Leslyn Keith:
We just need to remember what we used to do, because we used to know how to eat. We just have to go back to what our grandparents were doing. They used to know how to eat.
Carole Freeman:
I use that example with a lot of my clients. It’s like, we don’t need snacks, right? How many of us grew up being told, “No, you can’t have a snack. You’re going to ruin dinner?” We didn’t need to eat all day long. We weren’t allowed to eat all day long. You eat three meals. Sometimes you skipped breakfast, you were fine. Often during the summer, I just remember that you ate breakfast, and then you just played all day long, and you’re too busy to even… You’re hungry, but you’re like, “I want to keep playing. I’ll just go home for dinner.” Even as kids, we ate two meals a day usually so…
Dr. Leslyn Keith:
Exactly. Exactly. Yes. Yes. I wanted to… Because you brought up Alzheimer’s, there’s been actually some fantastic research done on the lymphatic system and brain health, because we used to think that the brain didn’t have a lymphatic system, and it actually is. We now know that there’s actually lymphatics that go to the eye. The body part that we’re thinking now that doesn’t have lymphatic system is… Now I can’t even think of it. Oh, cartilage. The cartilage doesn’t have its own lymphatics.
Dr. Leslyn Keith:
But for the brain, specifically, what happens is that when you sleep, the brain actually shrinks a little bit to allow better space, and then the lymphatics of the brain use that time to clear out the toxins, the junk that’s collected during the day, that seemed to increase your likelihood of getting Alzheimer’s. Good sleep means that that brain shrinks. We have more space. The lymphatics clear that out, and so they have noticed a very high correlation with people who had for years prior to their diagnosis of Alzheimer’s, they had a sleep disorder. They were not getting good sleep, so you have to have that nice deep sleep for a certain amount of time every night so that your brain can get cleaned up by your lymphatic system.
Carole Freeman:
Wow. I just love the more we study and know about the body, the more everything is connected. When I was in school, they were just starting to understand that previous, it was vitamin D was just needed for bone mineralization. Then when I was in school, it was like, “Oh, wait a minute, it turns out almost every cell in the body has a vitamin D receptor on it, so it does more than we thought.” Now, it’s being recognized for its role in our immune system, but it’s needed for everything-
Dr. Leslyn Keith:
Right. Yes.
Carole Freeman:
… so side note of the vitamin D too. Dr. Keith, this is a little fun fact about my family totally. I just wanted to share this with you because I was reading your book about all the different lymph disorders. My cousin, he was born about six weeks premature, and he ended up having both lymphangioma and hemangioma. As a little baby and kid, he had so many surgeries. The lymphangioma, for people that don’t know, was just an overgrowth. He had so many lymph nodes that were growing in his neck area that it was clogging off, he couldn’t breathe, and so he had to have all those excessive ones removed, and then at the same time was developing hemangioma which basically was the overgrowth of blood vessels.
Carole Freeman:
They grew so many in his neck and his tongue that he had to have a tongue reduction surgery, because that also was just clogging. Apparently, I don’t remember which one of those but having both of those is so rare, and they don’t have a very good prognosis. He’s now in his 30s. Actually, I think he’s… Oh, wait, I’m sorry, I think he’s almost 40 now. He’s doing great. It’s a miracle he’s alive and hasn’t had any flare ups in a long time, but used to have some really big problems with that as a child.
Carole Freeman:
I’m excited to let him know that for the health of his lymphs, he needs more fat too.
Dr. Leslyn Keith:
Yes, but he’s gotta cut those carbs because one thing that I’m seeing just reading through the literature is that carbohydrates are inflammatory to the lymphatic system. Actually, it costs more water retention, slow down the lymph vessel contraction, so they can’t transport extra fluid that you have in your tissues by eating carbs, so you gotta eliminate those carbs, and then give your lymphatic system that nice fuel of good healthy fats to help keep it healthy. Interestingly, another condition that you can get, another lymphatic condition is chylous ascites and chylothorax.
Dr. Leslyn Keith:
That’s your gut lymphatics that transport the fat, and if there is an injury to it, if you’re born with the malformation of those, you’re going to get just the huge buildup of lymph in your abdominal cavity. Typically, because MCT seem to avoid… They don’t travel through the lymphatic system. They say, “Okay, well let’s not burn these intestinal lymphatics by… We’re only going to eat MCT fats and no other fats.” Then they won’t have as much to carry. This is only done on a single case study, but what happened on this person is that they went on MCT-only diet, and all of a sudden, when they tested the lymphatics, the contents of his lymph fluid in the intestinal lymphatics, it was full of MCT oil.
Dr. Leslyn Keith:
It was full of medium chain triglyceride fats, because it needed… I surmise, it needed fat, and if you’re not giving it any other fat, it said, “Okay, we’ll take the one we usually don’t use, and we’ll put that in there.” Normally, the MCT is bypass lymphatics. They just go straight to the liver via the portal vein. That’s why it’s a really fast energy type of fat, but the lymphatic said, “We need something. We need some kind of fat,” and so it co opted a fat that it normally doesn’t use.
Dr. Leslyn Keith:
Give your lymphatic system the fat that it needs, and it needs… Usually, it’s going to just have those long chain triglycerides that are going to be carried through the lymphatics, and so feed your lymphatics. Give it fat.
Carole Freeman:
Give it what it wants. Give it what it wants.
Dr. Leslyn Keith:
Yes.
Carole Freeman:
Excellent. Let’s talk now about this lymphedema, which I know… I don’t know if you have a sense of the prevalence of that, but I can guess that it’s probably just been getting worse over the last 50 years that we’ve been starving our lymphatic system of the proper types of fat. Can you share a little bit more about what that is, how somebody know if they have that?
Dr. Leslyn Keith:
Right. Lymphedema is when your lymphatic system is either impaired from birth, so like your cousin had a lymphatic system impairment. It’s impaired from birth, or it has suffered some kind of injury during your life. The most common injury that it gets because the lymphatic impairments from birth are very, very rare, so the ones that you most commonly get an injury to your lymphatic system is cancer treatments. You have lymph nodes removed. For instance, if you have breast cancer, and you had the lymph nodes under your arm removed, because that’s where the cancer usually goes from the breast, and then they radiate that breast area and under your arm, so that further damages the lymphatic system, then it has difficulty evacuating that amount of fluid, the normal amount of fluid from the region, and so you have very regional lymphatic.
Dr. Leslyn Keith:
The lymph nodes under the arm would just serve that half of the trunk, that breast, front and back, that area of the trunk, front and back, and that arm. Typically, a woman who had breast cancer treatment, she would get swelling either in her breast unless she had a mastectomy, and or her arm. That might be something you commonly see. Any cancer you have, for instance, if you have prostate cancer, and they removed nodes in the lower trunk, your legs could swell, because that’s the nodes that take care of the fluid coming out of the legs. It depends where you were treated, and then that part of your body can swell.
Dr. Leslyn Keith:
Also, in tropical and subtropical regions, there is a problem with a parasite, the filaretic parasite, that invades the lymphatic system, and gives you repeated infections and causes scar tissue, and then they don’t have proper access to health care. You see this what is called elephantiasis, so gargantuan limbs in those areas. We just don’t see that so much in the U.S., but really, in tropical regions of the world, you will see a lot of people who are suffering from that condition. But now, quickly becoming the much more common reason for impairment to your lymphatic system is obesity.
Dr. Leslyn Keith:
I was seeing more and more people coming to my clinic that just because they were obese, their lymphatic system was becoming impaired and not able to evacuate the lymphatic load to the lower body, and so they would start first by getting some foot and ankle swelling, and then it gradually would work up higher and higher in their body. They would come in. They would have treatment, which involves some massage and compression bandaging, some exercises to help pump the fluid out, but we can only do so much. If they still are overburdened by their weight, by their obesity, by their poor diet which is also affecting the lymphatic system, then you can only achieve so much with trying to get that fluid out and try to stay ahead of it.
Dr. Leslyn Keith:
I think now the biggest problem is obesity, and that’s what the lymphatic therapists are seeing in their clinics. I would ask them. Go to a conference. What percentage of your patients do you think are there because they are obese, that they have swelling in their legs because they’re obese? I was hearing numbers of 80% of all their patients. It wasn’t because of breast cancer. It wasn’t because they had a genetic disturbance and were born with lymphedema. It was because they were obese.
Dr. Leslyn Keith:
That’s really what spurred me is that we have to do something about this. We have to be able to help people help themselves to take care, so they don’t need me. I’d be happy to do something else. I don’t need to treat lymphedema. If there’s no one out there that has the problem, I would rather the people didn’t need me, right?
Carole Freeman:
You could do other occupational therapy things.
Dr. Leslyn Keith:
That’s right. That’s right. Then let’s compare that to lipedema. The words are very similar for people listening. One is lymphedema. It has a f sound in it, and then the other was just lipedema, which if you’re seeing the words, basically, the first part of the lymph one is about the lymph system, and then the lipedema is about the lipid system, which in the, whatever, the science world, instead of saying fats, we call it lipids. That’s where the lipedema is an issue with the fat system in the body.
Dr. Leslyn Keith:
Tell us about lipedema.
Carole Freeman:
That’s a good point you bring out, Carole, because it is… What we’re seeing is that the lymphedema is a problem with the lymphatics that also can develop problems with fat, because a swollen arm for breast cancer treatment, the longer you have that stagnant fluid in there, it actually causes fat to proliferate. She will not have any other fat in the rest of her body, but she will have a lot of fat in her arm. Lipedema, on the other hand, is a fat disorder that ends up having a problem with the lymphatics because of all the excess of fat. What happens in lipedema is it is a curious distribution of fat from the waist to the ankles, where if you see a woman with lipedema, she looks like she has two different bodies.
Carole Freeman:
She has a normal size, often a normal size, body from the waist up, and then you have sometimes a very huge shelf at the hips and going down to the ankles, and then little tiny feet. A lot of times, the feet are not affected. Sometimes, the upper arms can be affected, and so you would see this normal shaped body in the trunk, but the upper arms are very, very large, and then that large lower body, but it’s not just this mal distribution of fat. It’s pathologic fat, because it is very, very painful for a lot of women with lipedema, that just on very light touch, they’re hypersensitive, and it’s very, very painful.
Carole Freeman:
They bruise very easily. Sometimes they have no idea that they don’t even remember any trauma, and a bruise shows up in that area in the lower body that’s affected by lipedema. They have all these things that go along with that maldistribution, because it’s not… If you just have a pear-shaped obesity, that is not necessarily lipedema. When you have this, the fat pathology along with it, then that’s when we start diagnosing it as lipedema, and it originally diagnosed that there was such a lymphatic involvement, that at the end of the day, there would be all this water retention, and then overnight, it would go down.
Carole Freeman:
It seemed like you have four or five pounds weight change during the course of the day, so they felt that there was an edema portion to it. The more we study, we’re not sure is that edema, or that swelling portion, is it because now the lymphatics have been damaged and they’re actually getting lymphedema on top of the lipedema, or is that part of the syndrome that were… We don’t know for sure. But one problem that women with lipedema have is one, they don’t even know about it. They don’t know that this is a condition. They think they just have obesity, but the other thing is the doctors don’t know about it.
Carole Freeman:
If they happen to find out about it, as you did, Carole, when you met [inaudible 00:27:43], they’ll go to their doctor and say, “Hey, I think I have lipedema,” and the doctor says, “I never heard of that. That’s nothing,” but what these women have found is that they will go on a strict calorie restricted, low fat diet, eating 500 calories a day, and they’ll become emaciated in their trunk, and nothing will happen to their lower body. The same thing happens when they have bariatric surgery. They’ll have a gastric bypass, and they will lose weight only on the upper body, and nothing happens to the lower body.
Carole Freeman:
They feel like, “Okay, I’ve just got bad genes, and I don’t have good willpower. This is my lot in life,” but really, it is not their fault. We think we’re theorizing now that this way we’ve been eating for 50 years of high carb, low fat, exacerbates with edema. Yes, you probably have bad genes, and or there’s hormonal involvement, and then you put on top of that a high carb diet, then it really exacerbates, and a lot of women end up living a miserable life with a lot of pain and ever increasing size of their lower body and a lot of social embarrassment.
Carole Freeman:
They feel judged, and people are blaming them for their lifestyle, like they brought that on themselves, and it’s not their fault.
Dr. Leslyn Keith:
Especially if they’ve tried all these diets, and their body’s only like, “Nope, we’re not going to let you lose the weight where you don’t need to lose the weight, or where you don’t want to lose any more weight.” Oh my gosh. I ran into… Maybe you know her as well, so Jillian [inaudible 00:29:40].
Carole Freeman:
Yes.
Dr. Leslyn Keith:
I met her in keto conferences years ago, became good friends with her, and so she shared with me… I remember overhearing her talk about… or she would share with me how she lost the most the higher fat intake she would consume. At that time, it was a curiosity. After reading your book, it’s like, “Oh, it’s making more sense,” because this fat distribution error is so intertwined with the lymphatic system, and the lymphatic system isn’t working correctly, isn’t healthy, the tissues aren’t healthy because they aren’t getting the fat they need, then the… You’ve talked about this a little bit more about how integrated those are, right?
Dr. Leslyn Keith:
When one part’s unhealthy, they put more fat there to help fuel the lymphatic system, so it’s this never ending snowball effect of that. It sounds like not only keto, but perhaps even higher fat keto, then maybe a lot of people can do well with maybe optimal for are people with lymphedema and or lipedema. Before we go there about more about what dietary interventions you found work really well, so can you share more about then how is it that the lymphatic system and the health of one affects the other, the lipid system?
Carole Freeman:
That’s excellent, excellent point, Carole. Another reason why I believe the lymphatic system is fueled on fat is that question of a woman has breast cancer related lymphedema. She has her arms really swollen. It’s been sitting there a long time, and now, it’s accumulated but it’s mostly fat. It’s not so much fluid, but there’s a lot of fat in that arm. What some researchers in Australia found out, Natasha Harvey and others, was that there is lipolysis with an acute infection, so we break down fat when we have an acute situation. We have an infection.
Carole Freeman:
We break down fat, I believe, because it’s fueling the lymphatic system, which is our immune system to help us fight that infection. But when we have chronic inflammation as lymphedema is, we chronically have this buildup of fluid in the arm, and so it’s chronically inflamed. I believe the lymphatic system is saying, “Hey, I have a long-term thing, I’m going to have to battle. I need fuel. Let’s put fat here so that I have the energy to battle that long-term situation.” We gradually get more and more fat buildup in that area.
Carole Freeman:
Natasha Harvey and others in Australia found that when we look, historically, at where the lymph nodes beds are in our body, typically, they’re lying in a bed of fat. When your doctor goes in to remove lymph nodes under your arm, he has to dig around in there to find the ones that are lit up with the blue dye that’s for the [inaudible 00:32:55] biopsy, or finding the ones that the cancer could be draining into. It’s digging around in that fat pad to pull out that lymph node that we need to remove. Natasha and others surmised that it’s lying in that fat pad, because that’s the fuel for it. That’s the fuel that it needs.
Carole Freeman:
Again, on animal studies, what they did was they take an animal that was not obese, and they would excise the fat that was around those lymph nodes. Then they would also just… If they had some excess fat elsewhere on their body, in their belly or whatever, they would excise that fat. Well, guess what, the fat that grew back the fastest was the fat around the lymph nodes. The body said, “Hey, we need that fat there. We don’t have to have the fat elsewhere,” but if those two sites were removed, it would grow first back around the lymph nodes to make sure that it had that fuel.
Carole Freeman:
Now, you look at lipedema, and there is some theory that actually women with lipedema prehistorically, those were the women that were able to survive famine, and reproduce and be able to care for their young because they were able to store fat in a metabolically safe place that wasn’t around their belly. These women with lipedema have a very narrow waist typically. If they don’t also have obesity, that waist can be very narrow. They were storing it around their hips and butt and thighs, and so that was a safe place to store fat, so in the time of famine, they had fuel. They could have breast milk, and they could reproduce and care for their young.
Carole Freeman:
Then the problem happened when that woman now is living in modern times, and we are told to eat low fat, high carb, that distribution of way of storing fat, which was an advantage evolutionarily now becomes pathological, because it’s becoming so excessive that it becomes pathological. Then you get the pain and the bruising and the edema and everything that goes along with it, and your body says, “Whoa, this is a style of storing fat that’s going to keep this body alive, so if you go on to starvation, I’m going to keep that body there.”
Carole Freeman:
If I eat only 500 calories a day of low fat, I’m going to keep that body on the lower body, and so we think that women actually with lipedema may have insulin resistant fat tissue, not necessarily be insulin resistant or diabetic systemically, but-
Dr. Leslyn Keith:
I was going to ask about that.
Carole Freeman:
It might be just that just the adipose tissue is insulin resistant, because this was solicited advantage. The body does sees no reason to let go of that fat unless that person is going to be near death from starvation, “Oh, okay, now, we’ll use it, but otherwise, let’s save it because we might be in a long-term famine here, and so let’s save this here.” This is something we just don’t know. This is a theory that we’re looking at that we would like to test clinically, and why we think maybe one reason why a ketogenic diet works for someone with lipedema, that they actually start losing that lower body fat, because when you feed your body fat, it’s telling your body, “Life is good. Food is plentiful. I can let some of the stored fat go because there’s no famine going on here.”
Carole Freeman:
It’s very, very interesting. I think we’re going to learn more, the more we try this out. People like Jillian have been experimenting with it, and sharing her story that she lost an incredible amount of lower body fat, because she went keto, and she actually did an interesting carnivore experience experiment with Dave Feldman. Those two worked on it together for her to do specifically a certain ratio of protein and fat and carnivore. It was for a short period of time, but it really showed us that maybe for women with lipedema, we have to get that insulin so low in order to allow this lower body fat to be released.
Carole Freeman:
I would just say to your viewers that you may not know for sure that you have lipedema, but if you have lower body fat, and you have been doing keto very strictly and you’re at a standstill, try going carnivore and just having protein and fat, and see if you get some movement again. It’s not like you have to eat that way the rest of your life, but 30 days of carnivore and then regular keto, and then several months later, do another 30 days of carnivore. That may be what you need.
Dr. Leslyn Keith:
Well, I’m so excited that you brought up that insulin resistant fat tissue down there, because I actually had a theory about that just helping the clients that I have been doing. My six-year anniversary of keto is coming up in let’s say about a week. I don’t know when you’re watching this in the future, but at the time of this recording is about a week away. For about five and a half years, I’ve been helping a lot of different women with this. I’ve seen that there are some people that at the very beginning of starting a keto diet, that they’ll have more swelling on their lower legs, and some of them do have lipedema already, and some of them don’t.
Dr. Leslyn Keith:
I’ve seen this pattern, and basically what I’ve had to help them through that time, because it’s always been kind of a temporary thing is that encouraging them to look up… If they can go get at the time, they could go and leave the house and get lymphatic massage, or sharing videos with them about how to do that for themselves. Perhaps we do the reverse wall set where you put your legs up there, and just helping them with getting that fluid back. I had a sense that it was because their lymphatic system just wasn’t healthy enough to start this new fat transport that it had to do that had been starved up for so long.
Dr. Leslyn Keith:
It just wasn’t quite healthy enough to get all that fluid to come back, and so it was a temporary thing. The other thing was also making sure that they’re having regular bowel movements because nothing backs up your fluid issue more than not having regular bowel movements. That was all the things that I had to work with, and then also, I found that for my… I’m really big on optimizing salt intake for my ladies as well. I found that that same group tended to be a little more salt sensitive as well, whereas everyone else needs a lot, and then that’s where I thought like, “Oh, so what if…”
Dr. Leslyn Keith:
They still need this all except that that area of their body is more insulin resistant, and so it’s actually… While the rest of it’s flushing the fluid out, because there, the insulin is still too high to flush the fluid out, it’s holding on to more of the salt. You’re confirming just the patterns and theories that I had thought was going on. I’m excited that they do maybe tissue samples to check the insulin levels in the fat or something or…
Carole Freeman:
You know what, and there was an interesting study done out of I believe it was Vanderbilt in Tennessee. They were looking at women with lipedema, and they were looking at the sodium content in the lipedema fat. They did find that women with lipedema had a higher level of sodium content compared to normal controls or women who had simply had obesity and did not have lipedema. There is that higher sodium content. Now, what is the reason, and what is that sodium doing? That’s what we don’t know, and the authors of the study said, “We are in no way saying that women should cut down their sodium intake because of this, because it actually might be…”
Carole Freeman:
I mean, your body doesn’t do things just to screw things up, right? It’s trying to figure out how to be healthy. One thing that sodium, especially in that subcutaneous tissue, it’s used to fight infection, and so are women with lipedema, is it an inflammatory condition, and is your body drawing sodium to that area because it’s being used to fight an inflammation? Well, now we have sodium in the area. Is it causing a retention of fluid? There’s always a secondary thing that happens to do the primary thing you’re trying to fix, but now something secondary happens.
Carole Freeman:
I do not believe that just because you have lymphedema or even lymphedema, you should not be decreasing your sodium intake, especially if you are going keto, because we know we lose a lot of sodium, and the dangers of low sodium are way worse than the dangers of high sodium.
Dr. Leslyn Keith:
Yes.
Carole Freeman:
I do not recommend my patients. If they are doing keto, you actually need to add salt to your diet, and this is very hard for a lot of people. It’s hard for them to add fat as it is to add salt. They’re afraid of it.
Dr. Leslyn Keith:
I think it’s so interesting, because every day I’m having salt coaching with my clients, right? Thankfully, there’s this book so I can recommend The Salt Fix to every single person, and it’s not even a keto book, so I can help at least allay their fears, because that’s another one of the things [crosstalk 00:43:10].
Carole Freeman:
I got my copy too. I got my coffee too. Here we are. Here it is.
Dr. Leslyn Keith:
We have book twins. It’s going to allay their fears a little bit, but it’s actually sad that we’ve been conditioned to fear salt, right? I use the analogy like… They’re really hesitant when I’m like, “You’re constipated. We need to add more salt.” They’re like, “Oh, I don’t know.” I’m like, “But if I told you you needed more calcium, you’d be like, “Oh, how many pills a day should I take?” If I said more is good, “Let me get some more.” Nobody’s afraid of getting too much calcium, but salt, we’ve been trained that that’s a dangerous thing.
Dr. Leslyn Keith:
I said, “They’re things our body needs. They’re both just minerals.” Unfortunately, one of them has been demonized, and we’re afraid of it, and the other one’s been glorified. I don’t know if we can prove which one was more important, but I think salt’s more important mostly because everybody’s under eating it.
Carole Freeman:
It seems to be that we need a lot more salt than we needed calcium. Calcium is one of those trace minerals. It’s definitely essential, but we don’t need as much as we need of salt. I mean, I try to have at least a teaspoon a day. I think this is… You have to tell me your tricks on how you get people over that fear. A lot of times, what I tell people is that, “Hey, if you’re feeling super fatigue, so tired, can’t even lift your arms, have a headache, irritable, take a little bit of salt, maybe just a half teaspoon. Put it in some water. Stir it up, drink it down, and then 15 minutes if you don’t feel better, then that wasn’t the issue but you probably will feel better in 15 minutes.”
Carole Freeman:
Now, of course, this is always done with your physicians, because we do have people that have salt sensitivities and stuff like That. I definitely do not want to go outside of their recommendations by their doctor, but this is something that they can discuss with their physician. If that is okay with their physician, this is a very easy fix.
Dr. Leslyn Keith:
I do. Just like Dr. Keith said, check with your doctor. Make sure you’re working with your qualified health care professional on your optimal salt amount. What I do for my clients is we quizzes on our coaching calls when somebody is having an issue. I find that the number one sign, though, that they’re not getting enough is constipation, and when they get the salt right, then they don’t have constipation issues. That’s the number one. Headaches, muscle cramps are the… Typically, those are going to be the most…
Dr. Leslyn Keith:
That’s probably not enough salt if you’re having those, but also cravings, fatigue, excessive appetite, lightheaded dizziness. There’s another one recently too now that I’m just… What was the other one that recently we’re like, “Oh yeah, and that one too?” It’ll come to me in a little bit, but… Everybody figures out their own way, so what I do with my clients is they start with a minimum of one teaspoon extra per day on top of what’s in their food, and then we increase from there based on symptoms only. Thankfully, there’s more information coming out recently.
Dr. Leslyn Keith:
It’s in your book, and Dr. Finney mentions it as well, whereas, we look at people’s salt intake, and historically, not keto, but just people in general that are consuming between four to six grams of salt a day are the healthiest. They have the lowest cardiovascular issues. I typically have people do a half a teaspoon per dose, because that’s about how much bowel tolerance is for most people. If they take it with food, they can do a lot more, so they typically can do one whole teaspoon, which is almost about two grams of sodium per meal with their meals.
Dr. Leslyn Keith:
We brainstorm different ways, so put it literally in a little shot glass, and take it that way, or put it in a taller glass with a squeeze of lime or lemon. Usually, that tastes a lot better. Heat up the water. Use with bone broth, so warm bone broth. You can put a lot more salt in there, and people really like that. Other ones my clients have figured out is that if you put it with a little bit of sparkling water like LaCroix. Now, it’s going to fizz like crazy when you first pour it in, so do it really slowly, but they like that as well. Just the citric acid or the acid in there complements that, again, with a little lime or lemon wedge.
Dr. Leslyn Keith:
I had one client that she found that she liked to take half of a tomato, so she save all of her carbs for her evening meal. She would do half a tomato, and put an entire teaspoon of salt on that, and eat it like that. That was her way. LMNT, the supplement that’s out on the market now is also really popular. I don’t know if you’re familiar with that, the drinklmnt.com, the little individual salt packets. They have a bunch of different flavors that are really delicious. They put a little bit of citric acid in with the salt, and then most of them have a little bit of stevia and then some other flavor in them.
Dr. Leslyn Keith:
They’re like the best tasting Gatorade that doesn’t have any corn syrup in it out there. They’re individual little packets. Each packet has one gram of salt. That’s another one that most people really, really enjoy and won’t fight you on. For me, it’s a combination of just allaying their fears that it’s not bad. I know that you think we’ve been trained to fear it, but it’s not. The other thing that I’ll tell them as well… I know in your book, you talked about how the body’s greatest store of sodium is in the lymph system, which I didn’t know. That was fascinating.
Dr. Leslyn Keith:
The other thing that I’ll say, and now I want to back check this because I always told them that our backup storage of salt is in our bones, because all of our minerals are in our bones. What I learned in school is that in order to keep our blood balance of all of our electrolytes, we’re constantly breaking down bone, and remineralizing it. The problem with breaking down bone to get salt is you can’t just pick the salt out and leave all the other minerals. This is actually my personal theory of why we have such an epidemic of osteoporosis is a combination of low fat eating and low salt makes our bones just get picked to death over our life, and not get remineralized.
Dr. Leslyn Keith:
We need fat soluble vitamins in order to mineralize our bones, and we need of salt to get that in there. What I will do is I’ll paint the picture. It’s like, “Okay, you can…” Maybe it’s annoying you’re having a headache, and you can’t go number two. Those are annoyances, but if I explain how, if you’re not going to eat enough salt, guess what your body’s going to do? It’s going to go pick out the salt out of your bones, and you’re going to just lead yourself to osteoporosis. Then they go, “I don’t want that.” That’s a scary thing to them, whereas having a headache and not pooping is just an annoyance.
Dr. Leslyn Keith:
That’s one of the other things that I’ll do is to just to get them on board with like, “This is a serious long term thing if you’re not willing to consume enough salt for your body to be healthy.” That will often get them to go, “Okay. Okay. Okay, this is serious. I’ll increase it.”
Carole Freeman:
Yes, and how does that work into the whole… The good thing that we’re looking for, the better imaging for heart disease is a calcium artery, the coronary artery calcium score, and then there is some question about, “Are we drawing calcium out of our bones, and is it getting deposited in the heart where it’s causing harm, because your body is trying to fix some other deficiency?” Like you’re saying, if we were to eat more salt, can we decrease that problem of calcium getting deposited in those coronary arteries?
Carole Freeman:
That’s way out of my area of expertise, but like you were saying, that everything works together, and we can’t just deal with one little part of our body. It has permutations to everything else. It’s going to affect everything else. That’s what makes it so interesting.
Dr. Leslyn Keith:
It’s so true. It’s like, just because we don’t understand why the body is doing that doesn’t mean that there’s a really good reason for doing that.
Carole Freeman:
Right. Exactly. Can we talk more… Let me look at my notes to make sure, because I had so many things I wrote down out about your book. We talked about that. In your book, you’re talking too bout so the excessive fat can lead to elevated c-reactive protein, which promotes inflammation in general, which then promotes more fat, so it’s this vicious cycle here. It also suppresses anti inflammatory agents. I found, for me personally, just going keto within the first two weeks… I don’t know how much of my backstory you know, but I was in a really bad car accident, and my inflammation that my naturopath checked at that point was over seven.
Carole Freeman:
Within two weeks, it dropped down to two something. It’s a 60% or 70% decline in just two weeks. I know that just keto in general helps bring that down. Do you have a sense then of for some of your ladies with the chronic lipedema, they may have an elevated c-reactive protein longer than maybe somebody who doesn’t, is that what you’re seeing or…
Dr. Leslyn Keith:
I will say two things about that. One, you were talking about when we have excessive adipose tissue, we suppress some of the anti-inflammatory agents like adiponectin. Adiponectin really suppresses inflammation. I mean, sometimes we need inflammation. It’s part of healing, so we have to have this balance of inflammatory versus anti-inflammatory agents. But when you’re suppressing the anti-inflammatory agents, the inflammation wins, and it becomes not just acute. It becomes chronic, which then becomes bad. It also happens that adiponectin… This is a anti-inflammatory hormone submitted by fat tissue.
Dr. Leslyn Keith:
When we have too much fat, we suppress that, and adiponectin increases the healthiness of the lymphatic system, and actually is used to make the vessel walls. If you have leaky lymphatic vessels, you’re leaking the fluid out. It’s not transporting it, so we need to have less adipose tissue, so we have this healthy anti-inflammatory agent that is helping with all kinds of stuff, including the lymphatic vessel health. Then what we’re seeing was women with lipedema, yes, I do believe that they have probably started out with an increased CRP, but we are seeing with women with lipedema when they go keto, and not just partway, but full-on to keto, within two weeks, their pain diminishes drastically.
Dr. Leslyn Keith:
They could be having a level of eight or nine or 10 out of 10 pain, and then when they go with less than two weeks before they’ve even had any fat loss, because that’s what we’ve said is that, “Oh, it’s just because of the excessive fat, and that’s why they have all this pain,” and so when they lose the weight, they won’t have as much pain. Before they’ve had any fat loss, the pain goes down to one or two out of 10. We just had our ketogenic solution for lymphatic and fat disorders symposium. It was held on April 17th virtually, and we had a woman, Teresa, who she has lipedema, and she has obesity, and she was presenting about using a ketogenic diet.
Dr. Leslyn Keith:
She tried every other diet and never got any help, but she thought, “Okay, I’m going to try this one.” She would roll out of bed, and take a whole bunch of Tylenol every morning, and it was a trial of a great deal of pain. One morning, she woke up, rolled out of bed, stood up, started doing her day, and didn’t take any Tylenol, and go, “Wait, something’s wrong here. Am I actually awake?” This was six days of doing keto, and her pain was gone, six days. There is something hugely anti-inflammatory about this way of eating, getting out the carbs, and eating healthy fat.
Dr. Leslyn Keith:
This is the kind of changes that you can make. It is healthy for… I can’t think of any part of our body it’s not healthy for. I would really urge your listeners to consider that if they’re not already doing it. If you are even on the plant-based spectrum of keto, consider adding more animal sources because plants have carbs. You can’t get around it. We love them, but they have a lot of carbs, and so moving more and putting more animal source foods in your diet will be even better for you for every part of your body.
Carole Freeman:
Dr. Keith, have you ever worked with somebody with CRPS, the chronic regional pain syndrome?
Dr. Leslyn Keith:
I have, but my experience with that is prior to doing keto myself and with my patients, but I got to think that it would help with that. If your listeners don’t know about chronic regional pain syndrome, CRPS, it’s kind of does crap, this is-
Carole Freeman:
Crips is the other thing that people don’t like that the acronym is too.
Dr. Leslyn Keith:
[crosstalk 00:56:48] is your nervous system has gone wacko. It is you’ve had some kind of injury, and slammed your finger in the car door or something like that. It was very painful when it happened, and the tissue was damaged and now the tissue was healed, but the wires are still saying that severe pain, severe pain. I mean, it usually have swelling with it, and it is quite a horrible condition. I really got to think that that probably a lot of it is caused from that chronic inflammation that won’t go away. I would love to see a research study on doing that. Yes, have you done it?
Carole Freeman:
Not a research study but a case study. AFter that car accident… I had two aunts that developed it. One has since passed, and another one still living, so I was familiar with what it was. After that car accident that I was in, my legs were smashed up against the dash, and knees to ankles just completely nearly crushed injuries to my legs. As I was developing it, I didn’t want that to be what was happening because I know how disabling it is. The aunt that’s living has had a spinal stimulator implanted in her back to numb her from the waist down is how bad it was.
Carole Freeman:
I didn’t want it to be what was developing but the signs were all there, and you’re right, the pain scale is the worst pain a human can experience. The pain from the original site just begins to spread so it started… It was starting to spread up my legs that the sensitivity, the hypersensitivity, just a brush on the leg is excruciatingly painful. The swelling as well was… I couldn’t stand or even sit with my legs down. It was just… I was going to a pain specialist.
Carole Freeman:
Basically, all they do is refer you to a pain management therapy group because they don’t have anything they can do. I started keto, and the pain went away. I call it the pain is in remission, right? The swelling, the pain, the hypersensitivity, ever, all the symptoms [crosstalk 00:59:09].
Dr. Leslyn Keith:
If you added the carbs back, it would come back.
Carole Freeman:
If I push my luck with carbs, I can feel the legs get tight. The skin gets tight, and just a little more sensitive type of thing that’s like, “It’s still there. It wants to come back.” I went into my pain doc, and I was so excited because I just thought, “Oh, he’s going to just want to know everything possible about this, and we’re going to change the world.” He was big on the plant-based diets and the veganism, and he… I’m, “Oh, what did you do?” I said, “Well…” I called it low carb, because you don’t want to freak him out by saying keto. “Oh, well, that probably has anything to do with it.”
Carole Freeman:
I said, “So, well, what now?” He goes, “Well, you don’t have any pain anymore. What do you want me to do for you?” I said, “Well, aren’t you interested to know what I did? This is remarkable.” He goes, “Oh, well, you probably just didn’t even have CRPS then, because that doesn’t reverse. It’s chronic.”
Dr. Leslyn Keith:
Oh, no. No.
Carole Freeman:
I was like, “Well, what did I have then? I had all of the symptoms of it. They’re very distinctive symptoms that nothing else causes that.” Then he says, “Well, you must have just had a CRPS-like syndrome.” He just made up a term. He made up a new syndrome.
Dr. Leslyn Keith:
It’s like they have… They’re so set in their paradigm that they have gotta make whatever you say fit into that paradigm, but I do believe that the more people that experience that, and they go to that doctor, eventually, he will start to see. You can’t unsee what you’re seeing.
Carole Freeman:
[crosstalk 01:00:51].
Dr. Leslyn Keith:
I did have a patient who participated in my study with… She had lymphedema. She had obesity. She actually had undiagnosed lipedema, and she was doing keto. Her doctor was vegetarian, but he did sign off on her participating in the study. She did all this stuff. Her pain with to zero. She had all this increased energy. The size of her legs went down. Her weight went down. Her body fat went down, and she went back to him and said, “Looks like this is working.” At first, I mean, very, very resistant, but he had to come around because he said, “Well, wait a minute. Let’s check your cholesterol.”
Carole Freeman:
It’s got to be…
Dr. Leslyn Keith:
Let’s do your coronary artery calcium score. Let’s do… What’s the one you test in the carotid artery?
Carole Freeman:
The carotid.
Dr. Leslyn Keith:
He was sure this high-fat animal food diet would be killing it. He did all those tests. I mean, she’s in her 70s, and she had a coronary artery calcium score of zero. She did [inaudible 01:01:57]. The triglycerides were low. The HDL was high. I mean, everything came out perfect. Eventually, he said, “Okay, I guess you could continue with that.” Then I had several more patients who were doing that, and he would sign off on their plan of care. Eventually, if they see it more and more, and they see the evidence that actually this person is showing all the signs of health, that they will be convinced, but it’s a challenge.
Carole Freeman:
It definitely is. I only hope that he sees more. The problem with people with that kind of chronic pain, though, is that they’re on disability. They can’t work. I was at the point of I can’t work. I was getting my food at a food bank. In the fall and winter time, this is why I’m passionate about supporting local food banks for high-protein foods, because it’s extremely difficult. I started this when… I could go to the food bank and get an entire basket full of baked goods for free, and then when I switch to keto, I had to resist all of that, and go out with maybe a third of my basket full of the proper foods.
Carole Freeman:
It is a big challenge, because the doctors think it doesn’t do anything. A different diet doesn’t change anything. Anyways, we’ve totally got on a tangent here [inaudible 01:03:22] passioante about helping-
Dr. Leslyn Keith:
I know [crosstalk 01:03:24]. CRPS does have that swelling component. I imagine not only do your pain go away, but the swelling went away.
Carole Freeman:
Exactly. Let’s see. Let me look at my notes for your book. I think that covers all the things there. Anything else that you want our viewers to know about the connection… No. No. No. There was one other one I wanted to ask about too then. As far as implementation of a keto diet with people specifically with lower body swelling, which we’ll say is very likely probably due to not as optimally healthy lymphatic system, this is where everybody can get on board here. But even lipedema and lymphedema, do they do better with a much higher version of fat than keto with some other people? Is that something you’ve seen, or it vary from person to person or…
Dr. Leslyn Keith:
This is just my opinion, but just as working with people in this for over the last 10 years or so that it actually has to do with your metabolic health. For instance, I had a patient who was not obese, but she had a swollen leg because of her ovarian cancer treatment, but she was very, very physically active. She cycled. She swam. She hiked. She did all this stuff. She decided to go keto. She actually did not go keto. She just went low carb. She lost fat in her leg, and the swelling was easier to manage. She lost maybe, I don’t know, five to eight pounds, but mostly, she lost fat in her leg, and it just made that easier to manage, but she was not metabolically deranged.
Dr. Leslyn Keith:
Now, if you have abdominal obesity, you probably have… Well, if you have abdominal obesity and high triglycerides and hypertension, that cluster of things to say you have metabolic syndrome, you may need actually lower carb than the other person. Just by going low carb, you probably will have a beneficial effect on your lymphatics, but to really achieve really good health and good lymphatic health, you might have to go even lower and really get your insulin levels really low. That’s the person that I really encourage them to try to get more animal source foods in their diet, and not have so many of the plant sources, and trying to…
Dr. Leslyn Keith:
You probably do this with a lot of your clients, Carole, is figuring out. Just because the food is keto, maybe it’s not good for you. Maybe you don’t do so good with nightshades. Maybe your inflammation and your swelling increases when you have nightshades which are eggplant and peppers and stuff like that, which usually in a low carb and sometimes even on a ketogenic diet, those foods are fine, but maybe not for you, or cruciferous vegetables, maybe the broccoli and cauliflower are inflammatory for you, so experimenting and figuring out that.
Dr. Leslyn Keith:
I do think it is very individual, but the main thing is are you metabolically healthy, or do you have some metabolic damage? Then that determines how strict or how low you need to go with your carb intake.
Carole Freeman:
So not so much varying percentage of fat intake or total fat, more just lower in carbs, more…
Dr. Leslyn Keith:
We’re learning more and more about the fat intake, because when we first started doing this with women with lipedema, that we were going off of what they did for epilepsy. It was very, very high fat intake. What some people like Dr. Eric Westman and others were doing in the obesity field is that they were finding that let’s let the body fat be the fat part of our diet, and maybe not eat so much fat. 80% to 88% of the women with lipedema also have obesity, and so we’ve started modifying that recommendation saying, “Just eat fat to satiation, but you don’t have to say 80% of your calories are going to be fat.”
Dr. Leslyn Keith:
Maybe for you, you don’t need that much fat, because now we can also work on the obesity at the same time that we’re working on with lipedema. But if you have someone like Jillian, who I would not say she’s obese, she has just lipedema fat on her lower body, maybe she doesn’t need 80% of her calories to be fat. It’s a very complex question that I think we don’t know for sure exactly how to answer yet.
Carole Freeman:
Yes. Well, thank you so much. Anything else you were hoping I would ask about or anything else that you feel like you’d like our viewers to know?
Dr. Leslyn Keith:
I would just say that it takes a lot of self-experimentation and figuring out what is going to be… How do you feel the healthiest, and how does your body respond to various foods? I would say that there’s probably very, very, very, very few people that need to have carbs. If you decide to go zero carb, that is probably going to be fine, and all of the rest of it is negotiation. How much can I tolerate? Because I really like X plant food that has carbs, can I do that and still feel good, still be healthy? Again, with the consultation with your healthcare provider, making sure because I don’t know what medical conditions you have and things that you’re working with.
Dr. Leslyn Keith:
We need to make sure that this is safe for you, but there are very, very few people that need carbs. There are no essential carbs. It is not bad to eliminate them all as long as you’re doing this with your health care provider, and then seeing what your body can tolerate if you really, really want to have some of those carbs.
Carole Freeman:
You mentioned the nightshades crucifers. Oxalates is the other one that can cause [crosstalk 01:10:16] issues too.
Dr. Leslyn Keith:
Huge one. I know [crosstalk 01:10:17]. I mean, I cut out almonds a long time ago because I was doing a whole bunch with almond flour, and got a kidney stone. It only took one for me to say, “I don’t want to ever have almonds again.”
Carole Freeman:
Too much of those keto-baked goods, and it gives me a stomachache. I think that’s also what’s happening for me too, so I minimize that, too. Well, thank you so much for being here. Dr. Keith, how can people get in touch if they want to know more about your work, your support?
Dr. Leslyn Keith:
You can contact me with two email addresses. You can use either leslynkeithot, for occupational therapist, @gmail.com. If you specifically have questions about lipedema, and you want help with that, you can get me at leslyn@lipedemaproject.org. Check out our website at lipedemaproject.org as well as my website, leslynkeith.com. Tons of information in both of those locations. I’m always happy to… I mean, I could talk about this stuff all day, so feel free to email me. I always love to talk with people, and share information.
Carole Freeman:
That’s great. We’re going to link all that in the show notes down below as well, too. Thank you so much for being here. Everyone, give her a round of applause for being here. Thank you so much for taking time out of your busy schedule to share, and thanks for helping getting the word out about how do we get this population healthy that we’ve got to turn the ship around 180 degrees from where we’ve been. Thank you so much for the work you do.
Dr. Leslyn Keith:
Thank you, Carole. Thank you for everything you do too.
Carole Freeman:
Oh, my pleasure. That’s why I’m here. Thanks, everyone. I hope you enjoyed the show. Give us a thumbs up. Subscribe if you’re on YouTube there. Subscribe so you get notifications of all the new episodes that are coming out, and we’ll see you next time. Bye.
Dr. Leslyn Keith:
Bye-bye.