Episode 142: Show Notes
Educating medical students and leading them to think critically about the evidence a high carb lifestyle is having on our health is Dr Louise’s forte. Although it can certainly be nerve wracking facing a room of medical professionals who have been taught to believe in the standard dietary guidelines, Louise understands the importance of the situation and knows that if she presents the evidence and asks them to think critically about the state of affairs, they will make up their own minds and the penny will drop.
The frustrating state of diabetes prevention in healthcare. While skin cancer is identified and treated with the earliest detection of sunspots, diabetes is commonly left unaddressed until the patient passes the tipping point and has developed the condition.
25% of diabetes complications happen during the pre-diabetic phase, and 93% of pre-diabetes can be reversed with a low carbohydrate diet. However, the definition of pre-diabetes fluctuates across the medical system and is usually set too high so as to reduce costs on the healthcare system, leading to missed opportunities for prevention. The irony is that medications and appointments for diabetes are expensive and drive up healthcare costs for the individual and for the whole of society, making prevention through low carbohydrate advice a much more affordable and effective solution.
Your progress doesn't have to be perfect to be progress. Taking into account a patient's individual challenges, the professional and personal pressures doctors are under, as well as the influence of guidelines, pharmaceutical companies, and the food industry, it is clear that dietary interventions are complex! However, Louise stresses that progress can still be made by making small changes and observing their benefits, eventually leading to gradual improvements.
Aiming to make low carb prescription as easy as possible for other health professionals, Louise has launched her own website:
https://lowcarbscripts.com/
Lakanto presents The Low Carb Road Show 2023
www.lowcarbroadshow.com
With thanks to our major sponsor Lakanto
lakanto.com.au/
Tickets are now on sale for The Low Carb Road Show.
To hear Louise speak in Brisbane
rlmedicine.com/the-low-carb-road-show-brisbane
Transcription:
Episode 142
Dr Mary Barson: (0:11) Hello, my lovely listeners. I'm Dr Mary Barson.
Dr Lucy Burns: (0:15) And I'm Dr Lucy Burns. Welcome to this episode of
Both: (0:20) Real Health and Weight Loss!
Dr Lucy Burns: (0:23) Gorgeous ones. It's Dr Lucy here this morning and I have an absolute treat for you today. I'm super excited because I have with us in the studio, Dr Louise Phillips. Now, the thing about Louise that is so amazing is that she is the doctor that teaches doctors about low carb. I went to one of her webinars recently and was blown away, she's so easy to listen to, and just weaves this beautiful story which makes you know, I mean, you hear us talking a lot about you know, the penny dropping, and she just dropped pennies galore. And I could see people's eyes ding ding ding ding dinging. So we are super lucky because two things, she's here today to talk to us, but she's also presenting at Low Carb Brisbane. So for those of you who are looking to come to Low Carb Brisbane, it's on Saturday, May the 20th. And tickets are on sale at the website, which is www.lowcarbroadshow.com. Now Louise, gorgeous girl. Welcome to the podcast. I'm so excited to talk to you today.
Dr Louise Phillips: (1:30) Thanks so much for having me. And that beautiful introduction, Lucy.
Dr Lucy Burns: (1:34) Oh, you're welcome. Because I mean, look, we all know this. Doctors, doctors can be a prickly audience. And part of it is our training, you know, we're trained to be critical, not critical, as in, you know, judgy, but critical as in think critically. And so we really require a lot of evidence in order to change our mind from the standard way we've been either taught or the way we think. So for me, watching your presentation, it was brilliant. But also, I was so full of admiration, because I thought you were very brave, and basically it sometimes feels like you're going into the lion's den.
Dr Louise Phillips: (2:18) Yeah, absolutely it. It was a little anxiety provoking to present to these GPs. However, at the same time, it's such an important topic. And basically, we were presenting the evidence and asking them to make up their own mind. And so in doing that, we sort of had to steer clear of the most controversial areas, it was really asking them to think critically about the state of affairs.
Dr Lucy Burns: (2:43)
Oh, absolutely. And so lovely listeners, Louise was talking about cholesterol, which of course, is a, ah you know, look, we all know it's a hot topic in the low carb world and statin therapy, and all of those sorts of things. But she's an absolute powerhouse with her knowledge. And not just knowledge, but the ability to back it up with the evidence. So I was super impressed. So lovely, with that in mind, your talk is going to be on metabolic health. Give us a little snippet. I don't, you know, you don't need to, obviously present your whole talk since we are on a radio type medium, can’t do slides or anything. But I'd love to hear how you introduce the topic, both to your patients, but also to even, because you were mentioning off air that you have medical students and GP registrars and people that you supervise and mentor.
Dr Louise Phillips: (3:39) Yeah, absolutely. So I really became a GP because I wanted to help people improve their health. And I was also very interested in preventative health. And by the time you're looking at end stage disease, when people are older, it's a little bit too late because most of the medications we use for chronic disease don't work very well. So you're sort of using band aids to keep rusty ships afloat, rather. So and at the beginning of life, I'm looking after all the little babies and the children and the healthy young people. And I just see them progressively get more and more unhealthy. Then I came across the fact that so much of our chronic disease at its heart is high insulin levels. And that's why my passion is metabolic syndrome, which targets high insulin levels, because that's the cause of metabolic syndrome. So I really look at any parameter of metabolic syndrome, which is abnormal blood fats, increased weight around the middle, high blood pressure, increasing blood sugar levels, and I will point things out to my patients and in doing that, I'm able to target things at an earlier stage and try to reverse things a little bit earlier. And with medical students, they basically sit in with me so I'm practising mainstream medicine, and I will have maybe five, five or six patients a day that will also be looking at metabolic health, so they'll just observe what I do. Sometimes I’ll give them some resources to go home with or to look at. And with the registrars, I basically present to them several times a year and talk about metabolic syndrome. I'll talk about diabetes. And if I'm talking about antenatal care, I will also bring in things like polycystic ovaries. And if I'm talking about antenatal care, I'll also talk about gestational diabetes. So I sort of bring it in into my teachings throughout the year.
Dr Lucy Burns: (5:31) Which is wonderful, because it's so important. And I think, certainly when I was going through, people, and I don't know if it's still happening, but the idea is that if you've got raising blood sugars, the message seems to be “your sugars are going up a bit, don't worry, you haven't got diabetes yet.” And it's like we’re waiting till they get it. And then we can leave in with our prescription pad and prescribe something for them.
Dr Louise Phillips: (6:00) Yeah, absolutely. And that's what can be so frustrating. You know, with skin cancer, we would sort of target sunspots, but with diabetes, we sort of wait until they actually have diabetes. So I undertook a certification pathway last year, which is quite rigorous with the Nutrition Network. And in the course of that I sort of looked at metabolic syndrome and the different definitions around the world, and also the different definitions for pre diabetes. And the problem with the definition of pre diabetes is it's based on also trying to reduce costs for the health care system. So you know, they feel if they diagnose too many people with this condition by setting the target too low, that they're going to investigate a whole bunch of people. And my concern with that is that 25% of the complications of diabetes happen within the pre diabetic phase. So this is the damage to eyes and blood vessels in the heart and the kidneys, and the nerves. And in addition to that, Dr Unwin has done a study in a general practice environment where he has been able to reverse 93% of pre diabetes with low carbohydrate advice. And even with this 46% of diabetes with low carbohydrate advice. And so that tells me that this condition is, means that we can prevent 93% of diabetes. And it's, it doesn't really cost anything, I can prescribe this advice in my clinic. And the patients don't need to buy a book or anything. I give them some resources, they can just go home and buy slightly different food.
Dr Lucy Burns: (7:27) Yeah! And I mean, look, it's so short sighted, I think by the health budget, and I get it, you know, everyone's got governments and the government's have got budgets for today, not for the future. So, you know, the savings to the community through reduced medication prescriptions. I mean, I don't think people necessarily realise how expensive medications are to the community, even if they're not necessarily expensive to the patient, because they're subsidised. The budget. It's billions.
Dr Louise Phillips: (8:00) Yeah, absolutely. And I think this is really brought home if you listen to any podcast from America, and people will be paying, you know, $1500 a month for one of their diabetes drugs, an SGLT2 inhibitor. And in Australia, maybe that costs you $40 a month, if you don't have a healthcare card, and perhaps $7 or $8 a month. But that is still quite a lot of money if you add it in with your six other drugs that you need to take plus having to see your GP several times a year to get prescriptions for those drugs plus become sick at the end of it anyway.
Dr Lucy Burns: (8:33) Yeah, absolutely. And you're absolutely right. The drugs are not designed to reverse your conditions. They're just designed to manage it.
Dr Louise Phillips: (8:41) Yeah, absolutely. Yeah, I think it's, I think it's a case of as doctors or healthcare professionals, we are scientists, and we wanted to help people and that's why we became the job that we're doing. And it's just that it's in amongst a lot of other money making industries, like pharmaceutical companies and food industries, and, who all I guess give money to government.
Dr Lucy Burns: (9:03) Absolutely. Absolutely. And we talk a lot about that, as you know, on the podcast how, ugh, how it is hard to get big systemic change, because it's going to mean that somebody along the way is going to lose some money and no one wants to do that. So what I love, Louise, is two things. One, you do, you know, what is considered traditional general practice. So you know, the full deal. Somebody comes in your door, you don't know if it's going to be a baby with a cough or, you know, a person whose blood sugar is 30. You know, and that is one of the things with general practice is you just never know what's coming in. But what I love is that you're able to weave this nutritional advice into your consultations. Tell us how you do that.
Dr Louise Phillips: (9:51) So basically one of the things I love about general practice is the variety and I really enjoy talking to people of different ages and and helping them with their health. I've developed some tools myself, which consist of, you know, a very simple patient handout, as well as a visual PowerPoint that I use to help explain concepts to patients. And I'll either raise, you know, if their blood test has been abnormal, and that one of their liver enzymes is up that I target, then I will point out to them about what fatty liver is, and I'll show them this diagram. And I'll invite them to come back and see me for a half hour appointment if they're interested in reversing it with diet. Equally, I also get some patients that come and see me just for that, and they might have the whole PowerPoint I'm through with them and the handout, and it's very individualised. So I'll find out what their goals are, what they'd like to do. And we'll just do a few measurements, which is usually a blood pressure, a waist circumference and a weight. So it's very much what we do in general practice anyway, which is what we call chunking. So we split a big job into little small items. And I find that using these tools, I'm able to do that. And I do allow a couple of catch up spots for myself, because I like to run mostly on time. And I just expect that sometimes someone will come in and it'll take 45 minutes. And that just gives me some breathing space to, to catch up.
Dr Lucy Burns: (11:18) Oh absolutely. And you know, for I'm sure patients are aware, but you know, just to reiterate, in a general practice setting, it is very hard to manage time, because there are other people sometimes controlling your time, other people within the practice, whether it's practice nurses needing you for things that aren't scheduled in and all of a sudden, you're trying to juggle everything. So it's wonderful that you have that flexibility in there as well. And I just love that.
Dr Louise Phillips: (11:48) Yeah, I really like the serenity prayer where you've got to accept the things you cannot change, you know, the wisdom to know the difference and the courage to change the things that you can. And time management in general practice is just something you have to accept, that there's that unpredictability of things. And so I just prefer to just factor in a little bit with that. And although I do as much as I can to try to manage my time, and you are managing it down to the last minute or two minutes with patients, and assessing things in those terms, it's really doing what you can and changing those structures that you can.
Dr Lucy Burns: (12:21) Absolutely. And I love the way that you're able to take some science and complicated, often complicated, it is complicated, like, I know that you came when I did a talk on menopause for Low Carb Down Under. And as I was researching that, I thought, oh my god, it's actually complicated. You know, you, you talk about one thing, and then you look and you go down a rabbit hole looking at evidence and you know, you can find evidence sometimes for lots of things. And then you have to go and look at the paper and then you have to assess is that paper actually any good? And it is, it's much more complicated than I think people realise. But the genius is being able to take that complicated information and distill it to make it palatable, to use a food analogy, and digestible for patients.
Dr Louise Phillips: (13:14) Yeah, absolutely. It is. It's trying to find what it is in a nutshell that matters here. Because really, that's the take home point. What we're prescribing is, is basically to eat less carbs, eat real food, add some salt, prioritise your protein, eat less often. It's kind of simple in its heart. And sometimes you can just say that to people. And they take that and run with it. And they come back five months later, and they've lost six kilos, and they're feeling great.
Dr Lucy Burns: (13:43) You're absolutely right, everybody has a different backstory. So for some people introducing low carbohydrate lifestyles easy, they just go, Oh, I'm just gonna do it. And off they go. And other people have layer upon layer upon layer as to why it's not so easy for them. And I know that you're, you do this, you know, for people that find it difficult, we need to find ways to make it easy for them, because the difficulty is not their fault.
Dr Louise Phillips: (14:13) Absolutely, I think, you know, dietary interventions are very complex, actually. Because the patient is a very individual person, and they have different pressures on them, be they from work or home or addictions, etc. And then you're placing them with a doctor who's got a lot of pressures on them in terms of time and their previous learnings and their family and work. And then you've got that within a world which is influenced by guidelines and pharmaceutical companies and the food industry and living in a high carb environment, basically, and you're trying to help someone find their way within that. So it is extremely complex. And I think the thing is, though, that it doesn't have to be perfect to make progress. You can just change one little thing and actually observe the benefit of that, and try something else and just have those little 1% gains and gradually improve like that.
Dr Lucy Burns: (15:06) Ah, fantastic! Wonderful! Ah Louise, it has been so good talking to you, because, I know our listeners can't see you, but I can see your face and your passion and your excitement when you're discussing, you know, low carbohydrate, you can just see it. And I think it's so wonderful. And I'm sure that like me, that having these tools to offer people. It revolutionises your practice. Because suddenly you're seeing tangible change, which, prior to that, it was never tangible change. It was often just, Oh, good, here's this, you know, here's another script, here's another script, oh now we need to add another script. And now we're actually going, Wow, here, look at you go!
Dr Louise Phillips: (15:46) Yeah, absolutely. I think that's what I love about this is that it's helping people with something that actually works. And you know, the previous diets, I might have prescribed, they just don't work. And so because this targets the underlying mechanism. That's why eating less carbs, or eating less often works. So it's a joy to work with patients like this. And I'm also working with patients who are keen to look after themselves, who are keen to help themselves, which is actually the majority of patients, I think, unless they're affected by depression or something like that. They're really interested to know how they can get better without drugs.
Dr Lucy Burns: (16:24) Yeah, absolutely. Absolutely. And as you said, the benefit of being able to, to change and reverse chronic disease with lifestyle means that yeah, you save money, you save, as in the patient saves money, there's less drug interactions, and, you know, they, on top of all of that, they feel better. Like, isn't that what we all want?
Dr Louise Phillips: (16:45) Totally! What I also like, what I do is that I'll sometimes be speaking to the lady, and she'll go home and speak to her husband, and she'll come back and see me and tell me how they've really, you know, improved their diet as well. Or they'll talk to people at work. And they may make just some small simple changes, like drinking less soft drink and drinking more tea bags, flavoured tea bags or something and water, and that just really improves their health.
Dr Lucy Burns: (17:11) Ah absolutely. And you’re totally right there, for the majority of families, and it's not all, but for the majority of families, the woman in it is the person who determines the food, the cooking, the shopping, what goes in kids lunch boxes, if they have children, all of those sorts of things. And so if the ripple effect of helping one person change, and opening their eyes, can be just, like it's phenomenal.
Dr Louise Phillips: (17:39) Absolutely, it is. Yeah. And next month, I'm giving a talk with the, it’s run by the Nutrition Network, but it's with the Women's Health Symposium, and it's about how to sneak some time for yourself to care for yourself as a woman, and it's all about those little tiny gains as well. And I think that if women have a little bit more space for themselves, then they can sort of work on this side of things a little bit more as well.
Dr Lucy Burns: (18:02)
Absolutely. I love it. You are just the teacher that teaches. It's wonderful. And I know you've got another, you've got a workshop coming up for general practitioners who are actually keen to learn more with another doctor and it's fantastic. I just love, I love it. Wonderful. Oh gorgeous Louise, thank you so much for being on the podcast.
Dr Louise Phillips: (18:23) Thank you so much for having me today. Lucy. It's been a pleasure.
Dr Lucy Burns: (18:26) Oh excellent. And lovely listeners, Louise, as I said, is speaking at the Brisbane conference. She's a GP in Albany Creek in Brisbane and you are gonna love her. All right, gorgeous ones. We will talk soon, take care.
Dr Lucy Burns: (18:44) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns…
Dr Mary Barson: (18:52) and I'm Dr Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com
Dr Lucy Burns: (19:03) And until next time…
Both: (19:05) Thanks for listening!
Dr Lucy Burns: (19:07) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide, individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
