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Carole:                  Welcome, everyone, to another episode of Keto Chat. I am your host, Carole Freeman. I’m the creator of the Fast-Track to Keto Success Program and certified nutritionist and clinical hypnotherapist. I am honored and privileged to be here today bringing you Dr. Keoni. Oh my god. I totally screwed up Dr. Keoni Teta. Oh my gosh, [crosstalk 00:00:33]. I can’t very …

Dr. Keoni:            Very good.

Carole:                  Dr. Koeni. How about that? We have connected, both graduates of Bastry University. You’re over on the other coast for me. Where are you at right now?

Dr. Keoni:            North Carolina, Winston-Salem.

Carole:                  All the way in the East Coast here. You guys are starting to get your heat, right?

Dr. Keoni:            Yeah. Today was hot. Yes.

Carole:                  Dr. Koeni, can you share with us how did you get on the track that you’re on? Actually, I want to start out. I forgot. I get so excited to talk to you I forgot to read your bio. Let me share with everyone who you are. Then, we’ll dive into how you got to be where you are. Koeni is a naturopathic physician and acupuncturist practicing at the Metabolic Effect Clinic in Winston-Salem, North Carolina. He received his undergraduate degrees from North Carolina State University in chemical engineering and biochemistry and his graduate degree from North Carolina A&T University in environmental engineering.

He attended medical school at Bastyr University. His passion is in the study and practice of exercise nutrition, bone health, and longevity. He is a contributing writer for natural triad magazine in the Townsend Letter for doctors and patients. Along with his brother, Jade, he’s a founder of the Online Health and Wellness Company Metabolic Effect and author of the books, The Metabolic Effect Diet and Lose Weight Here. He’s also a contributing author in the text book of Natural Medicine Fourth Edition. Welcome, Dr. Koeni, after I totally screw up your name. Thank you. I’m glad you’re here.

Dr. Keoni:            Thank you.

Carole:                  Your background is very different for a medicine. Biochemistry, it definitely sounds like you’ve got an interest in systems. I’m just going to guess that you really love figuring out how the body works. Is that what …

Dr. Keoni:            Yes, indeed. I guess my history with working with people trying to lose weight goes way back to my personal training days. For years, I believed because it was ingrained in my head about the eat less exercise more mantra and that’s the way I helped people get weight off. It worked at least in short term, but in the long term, what happens is they rebound. They rebound and go over and beyond because the body just does not want to be in another state of stress like that of eating less and exercising more. That’s a lot of stress now.

What happens is it affects your weight thermostat. Over the years, I’ve learned that and seen that. That’s why you will rarely ever see pictures of the people on that show, The Biggest Loser, because they end up being the biggest gainer so two years or two years out. The research shows that that people that go on diets eventually will gain all their weight back. The more they go on diets, the more they will gain their weight back. That’s my passion.

As far as fat loss goes with longevity, I’ve come to the point where, yes, if you can get the excess visceral fat off somebody, not necessarily a subcutaneous fat off somebody, you can make them healthy and help them live a higher-quality life. But I also do believe very strongly that people who cannot drop that weight can make themselves very healthy also even though they’d be considered or have a high BMI or high fat percentage which I’ve seen in my clinic many times. Losing weight should not be the end-all be-all. It should be about making the person healthier in whatever way we can. That’s in a nutshell what I do at my clinic.

Carole:                  That’s fantastic. I love that. There is so much misunderstanding about visceral fat and the subcutaneous fat because people are conditioned to think like if you can see somebody’s fat, that means they’re automatically healthy. If somebody doesn’t fat, then they’re healthy. I was just having this discussion this morning on a call with my clients. A lot of times, they’re telling me like, “Well, my husband can eat whatever he wants. He doesn’t have a weight problem.” I was like, “I would probably guess a 90% chance that he’s not as healthy as he thinks he is even though he doesn’t have that external fat that we can see.”

Dr. Keoni:            Right. I’d even go the other way. There are skinny people in our society who are obese. Sarcopenic obesity is a real thing. You also see that too. Measuring people by the way they look or how society measures them is not a true measure of health. Somebody who’s overweight does not necessarily mean they’re unhealthy.

Carole:                  I’m guessing you’ve got lab markers you’re looking at. What are things that you look at to know whether somebody is actually healthy or not independent of what they weigh?

Dr. Keoni:            That’s a great question. In our clinic, the test that I run across the board for everybody, just to get a baseline and some of them are diagnostic, but I don’t run them to diagnose them. If some comes up, I will definitely tell them, but the main test I run is a hemoglobin a1c. Most diabetics know what that one is. That’s a measure of your blood sugar or average blood sugar over the last three or four months. If you get a hemoglobin a1c of five, your blood sugar is going to be about 90 or so once you get up to around six year at 120 or 130.

What I want to do is I don’t want them just in the reference range. I want them to be optimal. An optimal hemoglobin a1c for me for my client that I like them to work towards is less than five without hypoglycemic symptoms. The next test I run is called a cardiac CRP or C-reactive protein or a high sensitivity C-reactive protein. That is one of my favorite inflammatory markers. People with excess visceral fat in their body will tend to have an elevation of that. It’s also a great marker of future heart attack risk. I’ve put more weight in that test than I would into blood lipids. The optimal level is [inaudible 00:06:47] for that. Most Americans are about two to three.

Then, the next test I run after that is fasting insulin. Now, now insulin is a great marker. What insulin is, it’s actually a growth promoter. A lot of bodybuilders will actually use insulin to help them build muscle because it helps them put on weight, helps them put on muscle. It’s a locking and storing type hormone. If you’re working out a lot like a bodybuilder, you can use it to put on muscle. You can also use it to cycle your carbs to help you with that if you’re working out a lot.

But what it does from a health perspective is the higher it is, the higher at-risk you are for promoting fertile ground for the growth of cancer. Also, the higher it is, the higher risk you have for blood pressure. A high blood pressure creates all kinds of problems. The optimal level you want with insulin is less than three, in my opinion. That’s optimal. Most people run between like 5 and 12 with a fasting insulin, but it’s really interesting because the levels and range go from three all the way up until 25 on an actual doctor’s lab. That’s number three.

Then, number four, I like to run a homocysteine test. I consider that another anti-inflammatory test, but it’s beyond that because it also tells you a little bit about your B vitamin status. I really like it because it also tells you how well or optimal your biochemical processes are working and how well you are methylated. A lot of your biochemical processes require methyl groups to run optimally. For example, if you have a tumor suppressor gene that’s not methylated appropriately, that’s a problem. Homocysteine gives you an indirect measure of health status. Also, most people know about homocysteine as having a relationship with future heart attack risk too or a future cardiovascular event.

Then, the last one that I really like to run is vitamin D. Any conventional doc will know what all those are. They won’t necessarily run it on people that are not diabetic or have cardiovascular disease, but I recommend all my patients run it because it’s a way to optimize your health. Once you get the baseline, then you work to do things to optimize it.

Carole:                  Well, okay. I wanted to ask too about back as your days of personal trainer when you were a staunch promoter like everyone was of just eat less and exercise more. When you would see people gain the weight back, did you fall into that traditional mindset of like, well, they just got lazy. They stopped working out. It’s their fault. Is that how you thought before?

Dr. Keoni:            Absolutely. Here is my thing. I would consider it a big regret with what personal trainers do, nutritionists, physicians that are still in that mindset. Anybody who re still putting people like I was telling you before on an eat-less-exercise-more regimen and tell them that’s the way to lose weight, I think at this point is unethical. The research doesn’t support. In fact, there’s tons of research out there that shows that it does just the opposite. It causes weight gain.

But we have is we’ve all been brainwashed with that. Not only we’ve been brainwashed with that. We think the only ways to go to lose weight and to be healthy is to eat less and exercise more. All it does is it puts your body into thinking that it’s starving. Then, your body becomes more efficient at storing fat over time. You will become heavier. You’ll have more fat storage. Then, what do we do? What do most people do? We think, well, my client, they’re just not good enough. We tell ourselves that, the people that are on that, “I’m not good enough. I don’t have the willpower to do it.”

Really, what it is evolution has primed our bodies to get as many calories as we can and to do with the least amount of exertion that we can. That’s what evolution has done for us. That’s why we’re here, but now in these days, we have sugar on every corner. It doesn’t work so well. Most of us are gaining weight. An interesting fact is this weight gain phenomenon, we’re not just seeing it in humans. We’re seeing in our pets. We’re even seeing it in lab animals. Look how crazy that is. Those are controlled environments. We’re even seeing it in wild animals. That goes into a whole another thing why this weight gain phenomenon is going on because, then, there’s other things that that probably can be out there causing it like environmental toxicants maybe part of the role.

But getting back to your question, if I had a regret in life with the thousands of clients I’ve seen, I want to say, “Look. I’m sorry to each one of you because I’ve put you on an exercise-more-eat-less type thing. All I did was make your body more efficient at gaining fat. That’s what I was taught.” Everybody was. Everybody was saying that, and people are still saying that. It’s a big problem. One of the biggest causes of weight gain in our society is just that going on the stereotypical diet eat-less-exercise-more.

Carole:                  That’s exactly what I came out of school believing and promoting in my own practice as a nutritionist was don’t go on diets. It’s just going to make you gain more weight in the long-term. Just love yourself the way that you are. Eat mindfully. Eat intuitively. Don’t label foods as good or bad. Just eat joyously. I would eat a piece of chocolate cake enjoying every single bite with no guilt and all the while continuing to gain weight and be in denial that I was getting more and more unhealthy. What’s the option? Do we just all get fat and sicker or is there hope for [crosstalk 00:12:54]?

Dr. Keoni:            Yes. There is hope. Let me get a little bit into that, but it’s very interesting. Here’s where the whole lies. You can think about it as two toggles between two ways of eating talking specifically about diet and exercise. There’s two ways to lose weight which is when we’re talking purely of taking in calories and burning calories. There’s two ways. The first way is eat less exercise less. That’s what our great-grandparents did. What I mean by eat less and exercise less, I’m not talking … Our great-grandparents didn’t necessarily exercise. We’re talking about the turn of the 20th century, by end of the 19th century. What they did was they stayed active. They were active. What we find throughout the passing decades going way back that we’re getting more and more sedentary in our lifestyle. Eat less exercise less is one way to help. Then, the other way is to eat more and exercise more.

Let’s think about Michael Phelps, the Olympic swimmer. When he’s in training, he’s eating about 7000 calories per day. If I put him on an eat-less-exercise-more type of thing for him to go do his Olympics, he would fail miserably. I don’t care how great he is. He cannot sustain himself on a diet like that. He’d lose muscle and, over time, he’d start putting on fat. People can think in their lifestyles like when the holiday season comes around, instead of waiting till January 1st, I know I’m going to be eating more. Well, why don’t I just make sure I’m moving more to during that day? That’s when I want to get my Fitbit out or whatever and walk more. That’s what I want to do my intense workouts.

Then, there under stressful times of the week where you can’t get to the gym or you have to take care of your kids or you have a lot of stuff where you just can’t work out instead of sitting at your desk all day maybe stand or maybe get up and move. Do what you can. Park at the end of the parking lot of a food store. Those are two ways to help yourself because really what we’re ultimately doing, this is what I tell my clients is what we want to do is we want to make your hunger centers in your brain resisted to gaining weight. That is an ultimate thing we want to do. That’s where obesity starts or weight gain starts. All starts in your head. That’s what your hunger centers are.

By staying active whether you exercise consistently or move a lot what that makes is that makes your weight thermostat more resistant to weight gain. People who are constantly moving and doing something during the day, they just are not as prone to that decades 10-pound weight gain. They’re at a new weight thermostat every decade and you keep gaining and gaining. It just does not happen as readily to them. That’s one way to do it just thinking about diet and exercise alone, but there’s a lot of other ways to do it that we can certainly do it. I’m really into … We can talk about it later now, but I’m really into environmental food chews and knowing how did people realize what other things that we do mindlessly also. Do you want to talk about that now?

Carole:                  Yeah. Let’s about what are keys to sustainable fat loss.

Dr. Keoni:            This is a big key then. This is a big key in my clients. People really need to think about what their food environment is like. Let me give you an example. Some really incredible books out there, one is called Mindless Eating by Brian Wansink and the other one is called Slim by Design by Brian Wansink. He’s a PhD at a Cornell University. He’s a nutritionist. But what he did was he went into thousands of American homes all over the country. What he want to do is he wanted to compare normal weight people compared with two people to have a weight problem. What he found was the people who tend to have a weight problem tend to leave food on the counter.

For example, and he even got specific about it. He even said, “Somebody puts soda on the counter. “You look at soda. Compare it to somebody who’s normal weight that overweight person or that person who does that is going to be about 29 pounds overweight by leaving sod out on the counter. One of my weight-loss mantras or techniques I use for my people because they could just say it in their head is at a sight, at a mind, at a reach, at a stomach.

What I mean by that? At a site, at a mind, at a reach, at a stomach. What I mean by that is if you’re leaving food on the counter and you come in and constantly see it unconsciously, that’s getting your cephalic insulin rise going seeing it. It’s going to make you want to eat. You start losing willpower. Well, you’ve already lost it from a hard day’s work. You come in. You’re going to want to snack that. He looked at a number of foods. He looked at diet soda. Diet soda 21 pounds overweight compared to somebody who doesn’t leave it out on the counter. Crackers, I think was 9 pounds overweight. Cereal, I think, was 24 pounds overweight if you store the food.

Just storing the food away where you can’t see it is a trick that everybody can do that will help them tremendously. You went even further. When you open your cabinets and the first thing you see are your comfort foods or junk food, for me, of my one comfort foods is chocolate and chips. If I have chips in the house, and I go into my cabinet and it’s on that shelf at eye level, I will go through that bag of chips in probably a couple days. If I put it on the top shelf hidden behind something, I know it’s there consciously, but if I put it up there, I’m going to go through it in about two weeks ,maybe a month. Sometimes I’ll even forget about it.

If we think about how our brain works and from an evolutionary perspective, we want to consume as many calories putting the least amount of energy into it. You want to make it difficult in your food environment for you to obtain your comfort foods or junk foods. It doesn’t mean you can’t have that or it shouldn’t be there, but again if you make sure that every time you get junk food, you’re going to be a lot less likely to eat it if you have to get your car to go get it than if it’s in your house somewhere. You’re going to a lot less likely to eat it if you have to reach up as opposed to just going in there and opening your cabinets at eye level or refrigerator.

Carole:                  I use that strategy also to advantage with my client. I teach them to make all their keto-friendly foods fast and easy as well. I want those to be the easiest ones for them to grab. Even going so far as buying pre-sliced cheese, sliced meats and things like that. Even hard-boiled eggs that are pretty hard-boiled just if that’s easier to get and grab, then like you said, the chips that are on the back of the cupboard because their husband or wife or kids have to have those foods now still, then that’s going to make it more sustainable for them because that’s easier to do than the other.

Dr. Keoni:            Yeah. That’s right. Here’s another fascinating thing about these studies. Him and his colleagues even went into restaurants. You went into buffets. He wanted to see how people are that are overweight, what do they do mindlessly compared to people that lead up buffets that are underweight or normal weight, I say, not underweight.

What he found was people who go to the buffet especially if they’re overweight, they go straight to the buffet, they usually pick up the largest plate and they go down the line. Whatever they find appealing on their plate, they tend to choose fatty, salty, sugary stuff like we all do, but they tend to choose a lot of that. They’ll fill that plate up.

Then, they go to their seat. They tend to sit within 16 feet of the buffet. They tend to face it. This is fascinating stuff where somebody who’s underweight will go to that buffet. They tend to pick up a smaller plate. They’ll scan the buffet before they even go in there. Then, they choose a few foods. They don’t have a whole lot of variety on their plate. Research on variety is fascinating. The more variety you have to choose from, the more you’ll eat. Then, they walk away from the buffet. They tend to sit with their back to it. They’re more than 16 feet away by a window.

If they had the option to use chopsticks, the normal weight people use chopsticks where the overweight people don’t. They tend use fork. It’s just mindless stuff that is fascinating. Also, normal weight people will tend not to do the liquid calories and all the other stuff that me and you, you know about. But the other stuff is very mindless stuff that we don’t think about that plays a huge role in let’s maintain our weight. I tell people, “Think about your food environment in your house and how to set that up to make it more difficult to obtain and get those foods and stuff like that.”

Carole:                  That’s great. Let’s talk about … Oh gosh. So many things we need to talk about. Talk about how you look at cravings, how do you … Imagine. This strategy you’re talking about also reduces cravings, but what other things do you have that …?

Dr. Keoni:            I want to bring up another fascinating study about cravings. This blew me away when I saw. It’s just fascinating to me. This guy is that of what’s-his-name. I think his name is Dr. [Kubiniec 00:22:25]. I don’t know. My friends … I probably ruined his name, but he’s a French guy at [ULaval 00:22:31] University in Canada. What he found was he took two groups of people. He took a group of people that were obese. Then, he took a normal weight group of people. What he did is he had them in laboratory settings. He fed them a bland foods diet. It was like a bland food smoothie. He had the correct number of macronutrients in there. We had all the carbs you want, the fat, the protein, had the micronutrients in there. It just didn’t taste great. It wasn’t like a sugary salty thing.

What he found was the people that were overweight automatically lowered their calories to starvation levels, automatically. They could eat as much as they wanted this stuff, but automatically did it. Guess what? Their body didn’t push back against them. They were satisfied on this diet. They didn’t want to eat anymore whereas the normal weight people still ate their normal caloric load of 2000 calories. That blows me away because that tells me that tasty foods make you overeat, of course. But if you can move people more … How can you use that in real life?

If you can take people and move them more to a Whole Foods diet and get them away from a junk foods diet which tend to be more sugary, salty and fatty, and that type of thing, you’re going to automatically move them to a more bland foods diet. People tend to eat more of a Whole Foods diet automatically tend to eat more of a blander diet. They can regulate their weight better than somebody who eats more of a fast food, junk foods diet. You won’t get the pushback on that.

Now, here’s another fact. Now, the second part of that study was he took another group of people. I’m doing this from memory. See if I get this right, but anyway, the people that were overweight or had a weight issue, he had two groups of them. He had two groups of people that had weight issues. One group, he fed a bland foods diet too. The other group, he just lowered their calories. Let them eat whatever they wanted. The bland food diet group automatically lowered their calories again to like really low levels without any metabolic pushback on their body which fascinates me. They lost weight like you wouldn’t believe.

Then, the people who were put on a low-calorie diet what happened was they were miserable. What happens when your body thinks it’s starving? I mean these people were dreaming of food at night. Their cravings were out of control. When they came off the diet, they rebounded. Their weight set point. They rebounded back and above what they originally had whereas the other people that’s more of a bland foods diet stayed satiated and lost a tremendous amount of weight. That says a lot about cravings. The cravings happen in your brain. Taste, food textures, that all plays a role.

To your clients and to my patients and clients, them saying, “Well, Dr. Teta’s or Carole’s put me on a bland foods diet. That’s awful. “But you really have to think about it as relative to what a junk food diet is.

Carole:                  Yeah. Well, nobody’s going to sign up for bland food diet. That’s not sexy. Nobody’s buying that. I found the ways around that is just creating some other rules and explaining it in a different way. Eat food that doesn’t taste very good. Nobody wants all of that, but I have a starter phase that I have people go through. One of the rules is no sweeteners of any kind, not even any of the keto friendly sugar-free stuff because I tell them that’s working re-setting taste buds which it is because you take a break from that. Then, a little bit of sweet goes a long way. You don’t need nearly as much.

Also, it removes the ability to have that combo of fat and sweet together which automatically it makes us eat more. One of the mistakes I see people trying to do keto on their own is they’re trying to make all these keto desserts and fat bombs and trying to recreate their former high carb life in a keto friendly matter they’re wondering why they’re not losing any weight because they’re still overeating even though they’re following these low-carb plans. That’s one of the ways that I incorporate that is that it does make it more bland to not have sweetness with it, but I don’t tell them they’re going to have a bland diet.

There’s just going to have [crosstalk 00:27:03] have one, but tell it different way. I don’t know. Are you familiar with Dr. [inaudible 00:27:08]?

Dr. Keoni:            Yes.

Carole:                  His whole eating plan is based on that like bland foods approach which works well, but you’ve got to sell it differently.

bread yes it definitely is it definitely has to be sold differently.

Dr. Keoni:            Yes. It definitely has to be sold differently. You are right. When we look at the science on what are the most satiating foods we can go from there to help people move more towards a diet that’s going to help stabilize our weight and want the least satiating food combos is sugar and fat together or carbon and fat together. That does not satiate very well. The most satiating … This fascinates because a lot of people can’t believe this, but the most satiating food that I think that’s been tested is a white baked potato. That that’s most [crosstalk 00:27:58] food.

That’s fascinating to me because people are like, “Oh there’s a lot of carbon there.” Yeah, there is, but there’s other aspects of that potato. When you eat wet carbs over dry carbs, it’s much more satiating. When you add fat to that potato or salt that you’re going to eat more of it. When you fry it, you’re going to eat more of it, but a plain white potato is very satiating for people who do not want to go on a low-carb or no carb diet. That’s very satiating. Then, after that, then you think about any combos like protein’s very satiating. Protein pack combos are satiating where you’re eating fiber and water combos are very satiating. Soups and salads before meals can help control that that hunger also.

But here again, it’s like that sweet taste, we have evolved to want that sweet taste. Unfortunately, it’s everywhere around us. When you give that sweet whether it’s in the form of real sweet like glucose or diet sweet as in diet soda sweeteners or whatever, it can bite you in the long run and make you eat more later on. Hence, the studies of leaving diet soda on the counter. There’s no calories in diet sodas, but yet people that drink diet sodas overall based on those studies tend to be overweight. Now, which came first? I’m not sure, but we do know that just the taste of sweet can make you have cravings later on.

Carole:                  Yeah. There is research actually shows that most of the sweeteners that they use in most diet sodas actually cause an insulin response. That makes sense from a hormonal aspect that any time you’re going to get that insulin response, your body is going to be promoting fat storage or at least locking up what it’s already got in there. Speaking of hormones, let’s talk about how the hormones come into play in the fat loss. Moving away from the whole … if it’s just about calories or it’s not about calories and exercising. What’s going on behind the scenes? What the hormone have to do with it?

Dr. Keoni:            Hormones play a big role in it. I used to be that it’s all about the hormones moans. It’s not necessarily all about the hormones. However, they are the things that metabolic messengers that signal your brain about what’s going on in your environment and stuff like that, but I think the hormones to worry about mainly are going to be insulin, cortisol, and leptin. Just real simply insulin is a locking and storm hormone. If you’re eating a high-calorie diet and/or a high-carb diet, those two tend to go hand in hand, but it doesn’t have to be if you’re just eating protein all day, you can still get a big insulin response off protein. Hence, a lot of people doing the keto diet, if they’re you too much protein, they need to lower it, because they’re probably getting some sugar from all the protein if they’re eating too much.

But anyway, insulin is a is a big one. That’s why I test for it. We want your body to be insulin sensitive. As you eat more calories, eat more carbs, you can over time become insulin resistant where your body no longer hears that signal. If it doesn’t hear that signal, then your hunger centers, that signal goes your hunger center, it will disrupt you and make you want to eat more than you normally would.

The other hormone that is a big problem for people is stress hormone. We all deal with stress on a daily basis. The problem is most people don’t have very good healthy ways of managing it so that your body doesn’t perceive your stressors as physiologically damaging to your body. If cortisol stays elevated long, that’s also going to give you a sugar surge from your liver. A lot of people who’ve been eating Atkins or been eating keto and tend to have high insulin levels or whatever, it may just be the stress hormone that’s causing those sugar levels to be up there.

Dieting will actually help elevate cortisol if you’re doing it the wrong way, if you’re doing the eat-less-exercise-more thing. Not only that, when you are eating a high-calorie diet and you have that stress hormones. Stress hormone cortisol causes you to build more visceral fat and more visceral fat. This is where I think a lot of our problems come from, health, but not only the fat gain phenomenon, but also the chronic disease issues that we have. Visceral fat just pumps out inflammatory metabolic [inaudible 00:32:44] non-stop. It just goes non-stop.

It will hit your hunger centers and completely disrupt it so that you’re going to be more likely to eat more. You’re going to sleep less which is going to make you eat more. You’re not going to make very good choices which is going to make you eat more. You’re going to store more visceral fat. You’re going to have more inflammation, but also that fat talking about the third hormone, that fat also will secrete leptin. All your fat cells will secrete a hormone called leptin. That is really the main hormone that will tell your brain to shut off eating.

If you’re constantly putting on fat and you’re constantly getting surges of leptin, you can become leptin-resistant. Then, what happens? All of a sudden that your brain doesn’t hear that signal to stop eating anymore. You’ll keep eating. Those are the main the main hormones without getting too much into the biochemistry. What can you do about that? How do you offset that.? I think one of the biggest ways, and this goes back again to diet and exercise, but do it in a way that is doable for you. I like to make a distinction between exercise and movement because for a lot of people, I think exercise is just another added stress to their life.

It’s like another thing they have to do during their day. If they can only do it for two weeks at a time and then they take three months off because they’re so exhausted, then it’s another stress in your life. The main thing is I want people to do is move. Research shows there’s something out there called NEATs. It’s the acronym for non-exercise activity thermogenesis. That’s all the movement other than exercise that we do during the day. If people just stay active, do other than exercise, where they stand at their desk or they get up and move, they’re doing the dishes, or cleaning the car, they’re cleaning house or they’re running errands or parking at the back of a parking lot before they walk in this new store, what that shows is that will actually help normalize hormones.

They’re actually getting a lot more activity in than somebody who like me on some days will sit at a desk for like eight hours. I work out pretty consistently, but what the research shows somebody like me or somebody who worked out every day, but sits at a desk for seven hours or eight hours a day is more unhealthy than somebody who doesn’t exercise, but just moves mostly whether they’re overweight or not, whether they’re overweight or not.

This whole phenomenon, somebody being overweight and being unhealthy is not necessarily true. You can be overweight and be healthy. That’s my main goal with my clients. I just want their health to get better. I do it with those lab markers and some other things. Then, usually that weight will start coming down. They feel more in line to where that willpower battery’s not drained and they’re not snacking. There they’re more mindful of what they’re doing.

Carole:                  Well, that’s a key thing that you said, such a big difference in what most people have heard when they go to the doctor. Most people are told lose the weight and then you’ll get healthier. Lose the weight and then your blood pressure will come down. Lose the weight, and the pain will go away, but it sounds like you agree with my perspective with what I’ve seen is that you start getting them healthier. Then, the weight comes off.

Dr. Keoni:            Right. Yes. Not only that. If you put them on an exercise more eat less type phenomenon which most doctors do because they don’t know any better and I did four years. I was just as guilty that. You’re making them more unhealthy. You’re making them more unhealthy later on. You’re making them efficient at putting on fat. Not only that. This is this is a huge problem especially for young women in our society because I have a number of women who based on societal standards consider themselves overweight, but really aren’t overweight. They’re going on diets or I have overweight teenagers going on diets. That is setting them up for big problems later on. Big problems.

Dieting with people that are normal weight, people that don’t really have a weight issue, but go on a diet anyway, dieting is worse for them than somebody who’s already overweight and going on a diet. If you are underweight or normal weight and go on a diet, that’s a problem. A lot of people do it because a lot of people especially men too, but women are really known for this in our society, based on the magazines and the media, are just not satisfied with the way they look. Everybody can relate to that. Well, I wish I had this or I wish I had that or I wish … Instead of an ab, I wish I had abs, that type of thing. That leads to this whole dieting phenomenon which is problematic later on in life.

Carole:                  Yeah. I run into that as well that there’s people … When I go speak at conferences or something, people would come up to me and they’re like visibly underweight. They’re telling me that, “I tried keto and it didn’t work for me. What was I doing wrong?” Why were you trying a keto diet? What was your goal? Well, because I heard it so good for your health. I want the magic. I want to do that too. It’s like it’s a stressor on the body. Unless you have epilepsy or brain cancer or dementia or some other things, specific thing that you’re treating with it and you’re not overweight, it’s very stressful in the body.

Those people don’t need that extreme medical therapeutic diet to follow. Just cutting up the sugar out of their diet is probably going to be as … Like flour they’re, going to probably get as many health benefits.

Dr. Keoni:            I think you hit it on. I love the ketogenic diet. It is part of my therapeutic order for getting people to get weight off. I do believe I don’t think the science is there yet, but I think with everything we’ve been talking about, I do think the ketogenic diet when you’re on it will make you more resistant for that weight thermostat to go up. It makes you more resistant. The issue, and you’ve probably seen this also with the keto diet, most people are in the almost keto state. That’s why they think it’s so bad.

I think once you get into ketosis, you start feeling a lot better in my experience in my clients. Then, it seems to be easier. Once you’re in that state, now your brain is like, “That stress is almost lifted off of them.” Like being in almost not getting quite the ketosis is problematic because I think it can be a stressor. People don’t test correctly also. They’re not really good about it. They just hear about, oh, I’m just going to eat a high fat diet without really talking to somebody about how to walk you through that and test to make sure you’re really where you are, where you need to be with that.

Carole:                  Yeah. I run into the people that tell me there, “I’m following your keto diet,” or “I’m doing keto-ish,” and put them in what I called a carb no man’s land like [crosstalk 00:39:56] carbs to fuel your body where you need to keep them low enough to get to ketosis, but if you’re in the middle like that’s misery right there because it’s just not enough to fuel you. It’s not low enough to [crosstalk 00:40:05].

Dr. Keoni:            Yeah. It is misery and I just tell people, they really should have some guidance with it and test appropriately to make sure they know what they’re doing if they’re going to go there, but before I even get to my clients on ketosis or even recommend the ketogenic diet, there’s so many other things you can do first. For example, if somebody tends to be anemic, they’re not oxygenating their tissues. They’re not going to be a great fat burner. That needs to be taken care of before you consider ketosis. If you are snoring at night and waking up tired all the time, just getting a CPAP makes your body and more efficient fat burner. It’s like rule out the medical stuff.

Look at the medications you’re on. Last time I looked, I mean I’m just guessing here, but it’s like four out of five medications seemed to promote weight gain or at least don’t allow you to lose weight. It’s like manipulating that. Lowering inflammation, those things can help. Then, when you tried everything, ketosis is one of those things in my … The ketogenic diet is one of those things in my therapeutic order where it’s way before any type of bariatric surgery of course, and it’s way before any pharmaceutical intervention or weight loss drug that should be tried if you’re clearly doing it to help with weight.

Then, once you do it a few times, you become better at it. Then, you can be on your own, but, in general, I just tell people get the guidance, have somebody like yourself or myself to just help you walk you through it so you don’t hit the pitfalls that a lot of people do, a lot of people do.

Carole:                  You’ve mentioned a couple times your therapeutic order. Do you mind sharing what that is ? It sounds like it’s a progression. Is it try this first, and if that doesn’t work, then move on to next thing?

Dr. Keoni:            Yeah. I can take you through it. Typically, when somebody comes to me for weight loss, you go through their history. What I want to do is I will first look at calories do matter. I want to look at their … If you’re on a ketogenic diet and .. This is the thing I love about a ketogenic diet. It self-regulates calories too. It’s hard to overdo the calories once ketosis, but you can. If you do, you may not lose weight there, but it’s hard because it tricks the brain and then thinking you’re satisfied.

But before they even get there strictly with fat loss, a client coming in for fat loss, I will look at their basal metabolic rate. In general, I will say, “Okay. Your basal metabolic rate is 2000.” Let’s say … I don’t know what we’ll say, we’ll say 2500. I will say that is your upper level caloric load.

Now, I don’t want you to count calories, but that should be your upper level. I don’t want you to go too far below that, but I don’t want you to go too much above that. Then, see how they do with that and see if that’s like too much or if that’s easy for them to do and see if they’re losing weight off of that. If they’re not, then I play with their macros. Again, a lot of this is mix and matching and the main macro I’ll use is I will make sure that they get their protein level up and usually lower their carb level.

Protein, it can be and it depends on the person. It can be protein one gram per pound of bodyweight or one gram per pound of lean mass. It just depends on the person, depends on how active they are. Usually, that will take care of that. Then, you think about that. Somebody who is, I don’t know, getting protein at maybe try to get 100 grams in a day again as your caloric load or we’ll say 200 grams a day for somebody like maybe like 200 grams a day. You’re going to say that that’s going to be 800 calories of protein a day.

Then, from there, then you can adjust the other macros. Everybody’s a little bit different, but protein is key because it’s very satiating for them. Then, the next thing down is, then, we start talking about exercise. We talk about the whole movement versus exercise. What can you do to maintain movement in your life? If you’re really motivated, what can you do to exercise also? But movement is key.

Then, in conjunction with that, we’re doing testing to see what medical conditions may be inhibiting their weight loss. Anemia, can. Sleep apnea definitely will. Then, we look at also their drugs. Then, part out therapeutic order, then we go to sleep. If people aren’t sleeping, what does that cause? It’s going to cause them to overeat. If they don’t sleep well enough, they’re not going to have enough energy in their brain centers or willpower battery to be mindful things. They’re unconsciously going to be slave to food cues and things like that.

One of the big things I found with sleep is getting people to shut off their electronic equipment at night, don’t even get on the screens, do something else. Read, but don’t read on a computer because a lot of people, that can mess them up. We’ll do things their nutraceutical intervention.

Now, let’s say that we’ve done all of that stuff. We got the exercise. We looked at sleep. We looked at mental conditions. We looked at drugs and everything. They’ve given it a good go. Now, I’m going to start talking about the keto diet. Now, I’m going to say, “You know what?” Also, I do think like people who have who have tried every diet out there in the book tend to do best on the keto diet. They tend to do it because they’ve had in their head for years eat-less-exercise-more, and the keto diet throws all that out the window where you’re talking about a high-fat diet.

Once they can get past that, psychologically, do that. We walk them through it. Then, I would go there. Now, usually, that’s the last stage. Most people don’t even get to the keto diet. We’ve taken care of the problems way up here. Way up there, we talked about those food cues too, just so you know. That’s in my therapeutic order also, but usually when they get to the keto diet, that’s usually it.

Now, with that, now I may start talking about nutraceutical intervention. One of my favorite nutraceutical weight loss supplements, and this is going to be … this isn’t sexy, but it’s fiber and also gut health, restoring their gut health. Let’s say we get all that done and they’re still having struggles and issues and they need something to spark the weight loss, off I’m not against weight loss medications, but it is way down on my therapeutic order. For some people, again, you weigh the advantages and disadvantage of the weight gain and what their health is like.

I’m not against … Then, if that doesn’t work or that is not sustainable and those drugs have to be done with a healthy lifestyle, they’re not magic bullets or anything like that, same with all the nutraceuticals and if that doesn’t work, then I will go to bariatric surgery. I will recommend that, but again I’ve rarely gotten there. It’s one of those things where you go from the least invasive approach down to the most invasive approach, and bariatric surgery is usually the most evasive because bariatric surgery, it’s funny and the research has shown certain procedures, they will lower your weight thermostat.

It does have some good results, but the rates of death from the surgery are so high. Most people, if they knew probably, wouldn’t want to do that anyway, but, again, it’s a give or take. Where are the people in their health? That’s the therapeutic order in a nutshell with weight alone, diet and exercise.

Carole:                  Well, I love that you instilled all these other changes and habits and then before they even get there because I think that’s one of the reasons … There’s actually … from the numbers that I’ve looked at two years after any weight loss surgery, most people have gained all the weight back. It only lasts for two years, but it’s because they don’t address the psychological stuff for food cues. They don’t address the lifestyle things that really …

Dr. Keoni:            Yeah. You’re absolutely right. You’re absolutely right. They have to address that stuff or, else, you will gain the weight back no matter what diet you’re on. That speaks to the fact about creating habits. The other thing I tell my patients, a lot of people heard that .. Well, here’s what the research says about habits from what I understand. If you try to take on, if you try to make a healthy change in habits and you take on more than three habits, you’re probably going to fail.

If you take on one thing that you know you can do, you can make a habit out of it where it becomes unconscious after a while. You don’t have to think about it. If you’re a soda drinker and you can make that change not drinking soda, the minimum is going to take for you to make that change is 21 days, three weeks, to where it’s becomes mindless, but most people, it takes close to a year to create a habit. That’s what the research shows. I think sometimes people take on too much.

If we can make one small change, and, now, we’re talking about health and not necessarily talking about weight, I’m talking about I want you to be healthy and if you can make that change, your [inaudible 00:49:42] being healthy and I can show you objective measures that you are, that way, it will come off. But creating smart habits is really key for a lot of people. Part of those small habits is your food environment knowing what it is and no one had to change it.

Carole:                  I want to ask … Going back to the hormones, let’s talk about middle-aged women and their hormonal challenges I’ve noticed with all the people that I’ve worked with, there’s several things that contribute to how easy or how hard it is for somebody to lose weight. People have this fantasy that a keto diet, I’m going to lose 30 pounds overnight. Then, when they don’t get that kind of results, then they go, “I must be doing wrong or won’t go work for me.”

I found one of the many factors that slows things down is that the older women are, the harder it is for them to lose weight easily. I’m attributing that to our hormones. How do you support that? How do you evaluate that?

Dr. Keoni:            Yeah. Unfortunately, women do tend have a little bit more difficult time losing weight than men, but as we age, there is such thing called age-related weight gain. We all have that, but to become resistant to that where it’s not a big problem, again and it helps your weight thermostat become resistant to weight gain is I really want the older, we get the more important I think it is to do resistance training.

That’s one thing because I think it will help bounce your hormones. Women know. Yes. Estrogen is one of those hormones that that helps give women that hourglass shape, gives them the female form. When you go low on that, you’re more prone to gain weight. However, with appropriate sleep and lifestyle changes, with the exercise, the resistance training, that can help tremendously to get them back online.

Now, again, it’s part of my therapeutic order. If women are going through menopause and they’re just having a horrible time with it and they’re not sleeping and they’re having hot flashes and you tried everything like I just finished a study with acupuncture and hot flashes which is really, really good, but let’s say, you even try to acupuncture and it didn’t help take your hot flashes away, I’m not against hormone replacement therapy if that would help.

But again, there’s so many things that you can do with diet alone and exercise. Carbohydrates, when we talk about hormones and the therapeutic order with hormones, the biggest ones that we’ll look at no matter what age you are across the board are going to be insulin, leptin, cortisol first. Estrogen and progesterone do play a role in that, but at first, you get those in order first. Then, you can adjust the estrogen and progesterone levels to help a woman maintain weight, but again for me to sit here and say, “Are there really good studies out there,” to say, well, if we give you estrogen and we give you progesterone, are you going to be normal weight. No. We don’t really have those studies.

But what we do know is women who are on bioidentical hormones, many of them will feel better on them which can roll into helping them not be so prone to negative food cues, help them exercise and just help them feel better about themselves and the same goes for men too. There are some men out there where being on testosterone can help, but again, there’s a lot of natural things you want to do beforehand. Resistance training helps elevate testosterone in men. Resistance training in women helps optimize sex hormones in women.

When I see people like all they’re doing is running, I want to change that around. It’s not that I’m against running or going out. If you like that, that’s great, but I wanted to be done in such a way that it’s not an added stress to the body. I want it to be more anabolic in nature than more catabolic in nature, but with metabolic effect, we have a whole program on that stuff. There are certain supplements that can help and all that, but, really, it’s about, okay, what is the lifestyle stuff that we can do that can help you.

There’s the other thing I also tell [crosstalk 00:54:03] women because a lot of women have it in their head that they’ll never get their 30-year-old or 20-year-old body back. That’s false. That’s false. I know. I know a lot of genetics play a role now, but I’ve had plenty of women middle-aged who still have that hourglass figure and the same with men where they can lose that gut. Yes, with age, your body doesn’t work as efficiently in all areas. That is also with the maintaining your lean mass, but it can be done.

Really, it’s about if I can optimize their health, guess what, hormones will start coming back into balance. Yeah. Maybe, if I can make sure your adrenals are not stressed where they can take over your ovaries or get them on board a little bit more, that’s going to help. If you’re living a stressful life and you’re having terrible hot flashes, if we can help your adrenals and get them back online, you may not need to go on hormones and stuff like that.

Carole:                  Yeah. Nice. Another thing I wanted to ask you about them is detoxification in weight loss. That’s probably a complex topic. We can talk for an hour on that or …

Dr. Keoni:            Yeah. Maybe we could talk forever. In a nutshell, I’ll tell people this. I just tell that getting the excess weight off, especially visceral fat is a form of detox. The two, I think, go hand-in-hand. If you are trying to get weight off of you, in essence, you’re also going to detox also. Going to detox. However, I will say this. Most people think of detox is as, okay, I need to take a pill or a drink a magic potion or greens drink or whatever. Then, I’ll detox. But the best way to detox is through avoidance. What I mean by that is it can be as simple as making sure you open the windows in your house. It can be as simple as making sure that you change the air filters in your home.

It’s as simple as making sure that you’re not drinking out of hot plastic or microwave and in plastic. I know a lot of people probably heard this, but the research is there. There’s associations of these chemicals will inhibit fat loss. The more you can avoid these chemicals, the more your body is going to be better able to drop weight. This speaks to the fact of some of these very high fat diets like a ketogenic diet, yes, it is better. This may be splitting hairs because if you’re doing all those other things, it may not matter, but if you’re eating a high-fat diet and you’re eating meat that’s full of hormones and stuff like that, that may be one thing that’s inhibiting weight loss.

But on the therapeutic order of things, if everything else is right and you’re eating steak and you don’t know where it came from whether it’s hormone-laden steak or pesticide-laden vegetables, I don’t think it’s going to cause any problem in your weight loss for the ketogenic diet. It may be splitting hairs, but a lot of these high fat diets, that’s one avenue where toxicants can get into your body, but before I even worry about that, I’d worry about the avoidance issue first.

Air purifiers optimizing your own body’s endogenous detoxification. Are you pooping? Are you sweating? Are you drinking plenty of water? Are you getting fresh air in your home? Are you getting out in the fresh air? All those things first. Are you applying cosmetics or anything on your skin that can inhibit fat loss? Those things we look at first. Then, my favorite fat loss supplement and favorite detox supplement, like I said before, is fiber. We can always increase our fiber in our diets. That goes a long way to helping your gut bugs help you detox and helping bind things so you get rid of them. Really, think about detoxes optimizing your own endogenous detoxification systems and not so much taking something.

Carole:                  Nice. We talked about that. What forms of exercise? You mentioned just the daily activity things and maybe even sitting in your chair and fidgeting. What type of form and resistance training is on your list, but what other types of exercise do you consider good, healthy forms of exercise that aren’t going to cause excessive stress in the body?

Dr. Keoni:            Well, the best form of exercise really is something somebody is going to do But again, you want to think about exercise in context. If you are exercising to help your bones, probably the worst thing you can do for that is swim. That’s analogous to space environment. You’re not having gravity, work on your bones. Swimming is not great one for bone health. If you want to boost up your cardiovascular fitness, probably the best form of exercise to do is aerobic type exercise, but I think the best overall type of exercise where you can also get a good aerobic workout with it is more of the resistance form of exercise, but it only comes down to what people are going to do and what they’re going to be consistent with and what they’re going to do without injuring themselves.

We give home workouts without equipment. We just meet the people where they are. There are some very effective workouts out there that will help people just do their own thing in their house, but one very effective form of exercise, the researcher’s phenomenon, is just five minutes a day has shown benefit. You can do a minute of squats at your desk after working an hour and sit down and go back to work and do a burst. Then, another hour, get up, do a minute of squats. Do five sets of that. That’s five minutes of working out. You’re working it in with your work schedule. The research is really cool on this because it also shows when you do that, you tend to be more productive.

Carole:                  Yeah. I was just thinking about that because just getting that extra blood flowing, some of us think you are [crosstalk 01:00:16].

Dr. Keoni:            … been more productive. It breaks up the monotony of the day. I really like burst training. Then, once you’ve said, all right, I did my three to five sets of squats. Now, I’m going to do lunges in place. You do a lunge. You get that range of motion that hurts the most. You can take your phone and put a timer on one minute. Do the next leg, one minute or just do one minute, gets it down, do some work. Then, next time you do it, do the other leg. [crosstalk 01:00:39] push-ups, one minute. You them off the wall. If you can’t do them off the floor, you do them off the knees, off the table. There’s so many ways to incorporate exercise in your lifestyle. You don’t a need a gym and the burst training really fits in well in our time-starved life.

Carole:                  I love that. I’ve got add that into my life today. As you’re talking about this, I’m like, “Why am I not even doing that?” I work at my desk all day long like this is … [crosstalk 01:01:09].

Dr. Keoni:            It helps. It doesn’t have to be a minute. I like to do it to where you get a burn. It could be 30 seconds or you can sit in a squat position and pulse there till you get a burn. Then, you’re done. Then, do another set later, but all of that works. The reason why exercise is so important, as I said before, is throughout history, we’re getting more and more sedentary. We have to make sure that we move and the burst training is a great way to get it in there. It’s a great way to be more productive at work. Again, we talk about productivity, but in also if you’re an entrepreneur like me and you are, what happens is it spikes your creativity centers too overtime.

Exercise does that. Then, the great thing that most your listeners really like is just doing that over time. Once it becomes a habit, once it becomes where you have to exercise or you do it out of habit or you’re moving out of habit, what it shows is that you are going to be much more resistant to fat gain. That weight thermostat will not go up. It will not go up. It may even tend. Those are those are generally what I’ll tell people. It just depends on what they enjoy and what they’re trying to get out of the exercise.

Carole:                  That’s really great. It’s one of the things … It’s right in alignment with what I recommend my clients is do what you want to do. Do what you love to do. Do what feels good to you. It may be something different than what you thought in the past because so many people get the idea like, well, I have to go to the gym. It really doesn’t even have to be that way.

Carole:                  Here’s the thing about that. We talked about if food is out of the way, it’s hard to eat if it’s like sitting behind something we don’t see, it’s hard to eat or if you have to reach up for. Well, it’s the same thing with the gym. If you know that you can do a good workout at home without equipment and we give these workouts or clients all the time, then you don’t need to go to the gym. It’s right there in your home or if you go to work and you see your gym shorts and shoes right on your car seat when you get in your car to go home, that’s a cue to go to the gym. It’s using these nudging mechanisms to keep you from eating and then also help you work out or stay active.

Carole:                  Nice. Just give me an idea. I’m going to do a challenge in my … We have a Facebook group for my program members. I’m going to do a challenge where I’m going to go record a video in there when we’re done and say, “Here’s the squat challenge. Just for one minute, we’re going to do something.” When you see this, you have to do it too.

Dr. Keoni:            [crosstalk 01:03:40].

Carole:                  … make a snowball effect where they post their own, and every time they see if, they’ve got to join in too.

Dr. Keoni:            Right. Well, it’s funny. Just to tell you a quick story. I gave a talk in the UK. We gave a talk out there a lot with a talk about diet stuff. Well, my talk was on exercise and brain health, but I didn’t have a chance to work out the whole two days. I worked out during the talk is that I don’t have talks. Everybody did it with me. We did a minute … I took a break. We did a minute squats. Then, we did a minute lunges. I got a whole workout in an hour and a half of my talk. Everybody got a workout in the audience. I got a workout in. I was very efficient productive.

Carole:                  No excuses.

Dr. Keoni:            That’s right.

Carole:                  I love that. People want to get in touch with you and get more information. We’re going to link this below, but what’s an easy way that they can …

Dr. Keoni:            Well, I’m on Twitter, Koeni Teta. People can find me on Facebook. I use my personal page. They can find me there. My clinic is it’s a Metabolic Health Clinic, but the website is nhcnc.com so Naturopathic Health Clinic of NC clinic of North Carolina.com. They can just call and if they want to get in touch with me. They can find all my information. If they want to get on my newsletter, they can find the information there and sign up for that too, but I’m on the web. They can find me if they really want to.

Carole:                  Excellent. Well, is there anything else that you were hoping I would ask you about or that you wanted to share?

Dr. Keoni:            I don’t know. I could talk to you just about this stuff all night. Again, I guess the main takeaway from this for my clients and it sounds like your clients is really that the main takeaway is think about health before you think about losing weight. That’s first. Monitor that first. Usually when you think about health, the weight follows.

Carole:                  That’s great. This is great. That’s a great recap and conclusion. Too long, didn’t breathe. Here’s the short note. Just my final question for you then, if you knew today was your last day on earth, the meteor was coming at us, it was going to kill us all today, what would your final meal be?

Dr. Keoni:            My final meal, it’d probably be chocolate. I have to have chocolate in there. It’d be chocolate. By the way, we can do a whole … We should talk about chocolate because I know that herb inside-out, Theobroma cacao. It has lots of longevity aspects to it. The problem is very high calorie. When you mix with sugar can make you gain weight, but I go home and probably eat a ton of chocolate and enjoy the view of the meteor coming at you.

Carole:                  This is going to be spectacular show.

Dr. Keoni:            It’s going to be a great show. Yes.

Carole:                  That’s great. I love it. Well, thank you so much, Dr. Koeni. Thank you, everyone, for watching. If you’ve enjoyed us, give us a thumbs up and subscribe if you want to see more of these. We’ve got more interviews coming. Thanks for watching. We’ll see you next time. Bye.

Dr. Keoni:            Bye, everybody.

 

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