Episode 156:
Show Notes
What is lipoedema? Lipoedema is a medical condition characterised by the abnormal accumulation and deposition of fat in the body, often leading to symmetrical accumulations of fat under the skin accompanied by inflammation and fluid retention. It usually affects the lower part of the body and almost exclusively occurs in women, as oestrogen and oestrogen receptors in the fat tissue play a significant role in its development. It is important to note that lipoedema is not the same as being overweight or obese, and it can affect individuals of various weights. The fat cells in lipoedema-affected tissue differ from those in obesity-affected tissue, with an increase in both the number and size of fat cells, along with leakage in the connective tissue and interstitial fluid. This condition can significantly impair functioning, and while treatment options exist, it is crucial to raise awareness so that women can seek appropriate care.
Calorie restriction does not work: One common myth around lipoedema is that it can be treated or cured with calorie restriction or dieting. However, this approach doesn't work. Many women suffering from the condition have been advised to lose weight and have spent significant time restricting their calorie intake, often leading to malnourishment and thinness in the upper body while still having lipoedema-affected areas such as the hips, bottom, and legs. Lipoedema is not the same as obesity and is not caused by overeating or lack of physical activity and it does not respond to undereating and over exercising.
Some things can be done: Another myth is that you can't do anything about it, This is not true.
Treatment and Management #1: One approach is to focus on reducing your overall inflammatory load. All of us experience some level of inflammation, with varying degrees among different people. One of the first steps in reducing inflammation is to eat whole, unprocessed foods. To increase the benefits using a dietary approach, you can then move on to reducing/eliminating sugars and starches by adopting a ketogenic diet. This can pack a double punch in knocking down inflammation in the body.
Another anti inflammatory tool in your toolbox is movement. Our bodies like and need to move. Moving frequently decreases inflammation, whereas stillness and stagnating increases inflammation. It’s just how our bodies are!
Treatment and Management #2: The next approach to consider is how to decrease the accumulation of fluid within the interstitial spaces, which are the spaces between the fat cells. It is important to address this issue because prolonged presence of fluid in these spaces leads to increased inflammation and scarring. There are therapeutic interventions that facilitate the reduction of this fluid, reducing inflammation and minimising the formation of scar tissue. Depending on which stage your lipoedema is at, light weight compression garments can help squeeze the fluid out of the interstitial spaces, as can massage and manual lymphatic drainage.
Treatment and Management #3: There are two myths around liposuction in regards to lipoedema. The first is that it is a cure and the second is that it is a cop out. The fat distribution of lipoedema can be incredibly debilitating for many women and the domino effects of the disease can be a waddling gait, limited mobility and osteoarthritis of the hips. Liposuction can help preserve function and regain function, so it is most definitely not a cop out! Be mindful that lipoedema is essentially diseased fat tissue so it is important to find a qualified surgeon who deals with lipoedema as their main focus.
In regards to curing lipoedema with surgery, we don't actually know what causes lipoedema to occur in the first place. So if we don't know the cause, we can't just treat it by getting rid of the currently affected tissue, the root cause is still there. It is a valuable and valid (albeit expensive) treatment option, but it is not a cure.
Treatment and Management #4: The last and hardest treatment option is to learn self compassion and self acceptance. We know that telling someone with this condition to just learn to love their lipoedema can be insulting, but one of the core pillars here at Real Life Medicine is to live your best life now rather than waiting for that perfect time in the future when your body is doing and looking how you want it to move and look. We don’t mean you have to be embracing and loving every part of you all day every day, but try to start moving away from criticism and resentment, and imagine loving your body (the only one you have!) for what it can do and what it tries to do, rather than hating it for what it can’t!
Could you have lipoedema? Take our quiz:
https://www.rlmedicine.com/lipo
Lipoedema Inflammation Buster Package:
https://www.rlmedicine.com/lipoedema
Episode 156:
Transcript
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 Mary Barson: (0:23) Hello, lovely listeners, Dr Mary here. And I am joined today by the fabulous Dr Lucy. Dr Lucy, tell me something interesting that has gone on for you this week.
Dr Lucy Burns: (0:38) Well, I was just sneakily getting my microphone ready because I suddenly thought, oh my god, it's on the other side of the table. That's no good. So something interesting this week. Well, interestingly, I discovered that one of our little doggies who is, so we've got two white fluffies, they’re about 12. And they do love snuggling up in winter. But I've also realised that one of them is snuggling up because she's a little bit sore in her back legs. So I hadn't realised that she's, as dogs do, they get older. And the way she's managing herself is to just reduce her movement. And I just thought, Oh, she's just snuggling. But actually, she's snuggling, because it's more painful for her to move, which I would like to lay claim for credit, but I haven't. My vet studying daughter has pointed this out to me, and then proceeded to demonstrate with a, you know, very good hip examination of a dog, to which she nearly got bitten. So now we're in the process of just changing things up for the little doggie to make her more comfortable.
Dr Mary Barson: (1:41) Oh poor little love, I do hope that you are successful in your aims there. Poor love.
Dr Lucy Burns: (1:50) Yes. What about you, Mares, what good things happened to you, or interesting things to you this week?
Dr Mary Barson: (1:55) Well, in October last year, I think was October, we had a fire in our shed. And it was bad. But we put it out. And that was because we're on the solar panel and the inverter, and rats, chewing wires and all these horrible things. And the upshot of that is that the insurance company is paying for a new shed. And they came along today, not the insurance company, but people who know what they're doing, and dug a really big hole. So we've got like the excavators have just dug this big hole. And with the rain and winter and mud, there's just like this wonderful, enormous, amazing pile of muddy dirt and this huge hole, which my kids have been loving and we've been having more baths than we would usually need to because of the mud.
Dr Lucy Burns: (2:49) Indeed, indeed. There's a bit of me that's going, Ooh, big hole in the ground like a swimming pool. Cold water swimming. All right, darling. So I thought we'd have another little chat about lipoedema today given June is Lipoedema Awareness Month. And I thought it's something that does affect a lot of women in particular. So it's time for a little chitty chat about it.
Dr Mary Barson: (3:13) Let's do it. Such an important topic. And I think an often overlooked topic, which is no good. We're going to bring it out to the light of day.
Dr Lucy Burns: (3:23) Yes, overlooked, misunderstood, and plenty of mythbusting today.
Dr Mary Barson: (3:29) Yes, yes, absolutely. We're going to shine a light on lipoedema, let's do it.
Dr Lucy Burns: (3:34) Indeed. Indeed. So the first thing is that you may know that I'm pronouncing it, and you are too Mares. Ly-po-deema, like liposuction, as opposed to lip-o-deema. Which, you know, you're perfectly entitled to pronounce it like that if you like, but it can be a bit confusing because lip-o-deema sounds quite a lot like lymphoedema. And they’re completely separate conditions. And it can also sound like lipidemia, which is a type of fat in the blood. So demia is blood and lipids, fat, lipids, the fat so ly-po-deema is what I think we're referring it to.
Dr Mary Barson: (4:16) Yeah, I think that that’s clarified that point. Good job.
Dr Lucy Burns: (4:21) Indeed. So one of the things that and it's interesting because I didn't learn anything about lipoedema in my medical training, I suspect you didn't either. And for a lot of people, they just think they're fat. That's really that people have told them for decades. You’re just fat. You’re just fat. Just lose some weight.
Dr Mary Barson: (4:43) Yeah, it is tricky. It's not the same as being overweight or obese. Lipoedema is not obesity. Sometimes they can occur together. People can be overweight and have lipoedema but people can also be normal weight and have lipoedema. So they're not the same. They are different and it's quite a specific condition relating to the accumulation and deposition of fat in the body. And it is a condition where it's chronic, like sort of long, long term condition, where people get these sort of symmetrical accumulations of fat under the skin with combined inflammation and oedema like fluid in the tissues that can create all kinds of problems. And sometimes this abnormal fat accumulation can be quite significant indeed, and can really hamper people's function. And the treatment, there are treatment options out there. But people need to be made aware of it in the first stage else, you know, they can't seek appropriate treatments.
Dr Lucy Burns: (5:53) Correct. So if you look under a microscope, the fat cells of lipoedema affected tissue are completely different to the fat cells in obesity affected tissue. So there’s certainly, in lipoedema there is certainly more fat cells. So the fancy name for fat cells is adipocytes. So there are more of those. And they're bigger, which is similar to the obesity side of things. But it's also the tissue between the fat cells that's affected. So there's interstitial fluid. So interstitial again means fluid that's outside blood vessels. So the connective tissue, the little sort of if you imagine like a web of tissue, fine tissue that's joining all these cells together. There's a problem with that. And what it is, is that we think the blood vessels within that tissue become leaky. And so they leak fluid into the interconnective tissues so that the tissue between the cells is also swollen, that's the oedema bit of it. And it accumulates these proteins. And then those proteins form a bit like a gelatinous kind of mass. And then over time, they can scar and become fibrosed, so that people with lipoedema end up with really lumpy, often painful, fatty tissue.
Dr Mary Barson: (7:16) Yes, and it gets inflamed as well. So the inflammation is there's a bit of a chicken and egg process going on there. But the dysfunction of this, this fat cells in this altered environment, creates low grade inflammation, which can then also cause increased leakiness of the blood vessels and increased pain and increased fluid and it can get a bit of an unpleasant cycle going on there. But inflammation is a key hallmark of lipoedema and also presents us with one of the levers that we can use to treat it.
Dr Lucy Burns: (7:56) Absolutely. Absolutely. So one of the myths around lipoedema, so the first thing I think to recognise is that standard calorie restriction, ie. dieting, doesn't work for lipoedema. But Mares we would also hazard that it doesn't actually work for any forms of overweight or any forms of fat. No, it doesn't work. But what happens is that many women for decades have been told to lose weight, go on a diet, so they will and they spend aeons with calorie restriction to the point where they can actually be quite malnourished and emaciated and very, very thin in the top half and still have lipoedema affected hips, bottom and legs, and so therefore be bigger in the bottom half.
Dr Mary Barson: (8:48) That's right. And lipoedema does more often affect the lower half of the body. Not exclusively, but more often. And we also didn't mention that it affects women far more commonly than men, because oestrogen and oestrogen receptors in the fat tissue play a significant role in its development. And yes, back to the mythbusting, it is not same as obesity and dieting doesn't work. It's not caused by overeating and not moving enough. And it is not treated by dieting and increasing your exercise to reduce, to get more calories out than you're putting back in.
Dr Lucy Burns: (9:31) Yes, it will not respond to undereating and over exercising.
Dr Mary Barson: (9:35) That’s right. Thank you, that's a little bit more articulate. I've still got a cold, people.
Dr Lucy Burns: (9:42) We forgive, we forgive you. It's fine. So yes, you're right, Absolutely. It has nothing to do with excessive energy acquisition. So, you know most of the time fat will come when we've got more energy and we don't know where to put it. So we store it in our fat tissue. Lipoedema has got nothing to do with that. As Dr Mary said, It is mainly women, in fact it would be exclusively women, except that there are some men who have some oestrogen related conditions. And interestingly men who have significant obesity, oestrogen is made in our fat cells, whether you're a man or a woman. So men with obesity can have raised levels of oestrogen, which can therefore precipitate lipoedema in susceptible people. There is most definitely a genetic link. But sadly, it's not just one gene. If it was just, you know, one gene, there may be some sort of fresh hope for gene therapy, but they've identified dozens of genes. So we know that it's genetic, but there's not a genetic cure on the horizon.
Dr Mary Barson: (10:47) Yeah, it's, as with many things, it's a bit more complicated than that. What do you reckon would be another myth about lipoedema that would be worth busting right now?
Dr Lucy Burns: (10:59) That you can't do anything about it. So some people have this idea, there's nothing you can do. Just like it or lump it, which you know, if you have lipoedema, you will know well, and truly about lumping.
Dr Mary Barson: (11:10) Yes, absolutely. So I think that would be a beautiful time now to talk about, you know, what are some of the effective management strategies, things that people can do to, you know, to help treat this condition and help improve their health and quality of life.
Dr Lucy Burns: (11:28) Yeah, so I think there's a couple of broad umbrellas that we would put it under. So the first umbrella would be looking at all the things that we can do to improve our inflammatory load. So all humans have some levels of inflammation, some more than others. And we do lots of things to ourselves to worsen those. So the first thing would be looking at what can we do to improve inflammatory load. The second thing is looking at what can we do to reduce the amount of fluid in those interstitial spaces, so the area between the fat cells. Again, what we will almost want to do is sort of squeeze the fluid out, because we know that the longer the fluid stays there, the more inflammatory it gets, the more it scars. So we've got the therapies that revolve around that. In fact, I can't remember how many umbrellas I said there were, but I'm going to come up with four. The third umbrella is there are some surgical options, and we'll talk a bit about those. But the fourth umbrella, and this is probably the hardest, the hardest one I would say for people to learn is self compassion and self acceptance. And that is hard when we have a society that is so obsessed with aesthetic perfection, and that certainly women with lipoedema often feel so far away from that ideal.
Dr Mary Barson: (12:54) And especially this, you know, our cultural obsession with thinness. And this idea of particularly the incorrect idea that lipoedema is just fat, this is fat, just burn it off, just eat less, just move more. Because that is not what lipoedema is. It's not just fat, it's a more complex condition than that. So unlearning those messages that this is your fault, that there should be an easy cure, but I can't find an easy cure therefore there's something wrong with me, I think is extremely important. I believe that you can be very beautiful and have a wonderful life with lipoedema. And that there are definitely things you can do to manage and reduce the lipoedema that would help improve your function and your quality of life and sure, improve your aesthetics as well. But you don't need to wait for some magical time in the future when your lipoedema’s completely under control, to be worthy, happy and living your best life.
Dr Lucy Burns: (13:50) Indeed, indeed. So if we look at the first umbrella of inflammation, Mares this is one of your genius zones you love anti inflammatory lifestyle effects. What have you got for us?
Dr Mary Barson: (14:03) So yes, anything that we can do to reduce our overall, you know, inflammatory milieu within our bodies is going to be really helpful for lipoedema is one of those umbrellas. So things that can be extremely useful is eating real food. That's a great place to start. Whole, real unprocessed foods is a great place to start. And if you then want to kick it up a notch, lipoedema is one of the conditions for which a ketogenic diet can be quite useful because of the antiinflammatory effects of the ketone bodies. So ketone bodies, you know, when we follow a ketogenic diet when we're eating a diet that is low enough in carbohydrates that our body naturally starts making more ketones, then these ketones, our body uses them for fuel instead of glucose. These ketone bodies have a potent anti inflammatory effect. And they are anti inflammatory within themselves. And they also probably reduce the production of other inflammatory mediators like cytokines within our bodies. And if you're eating real food, ketogenic diet, so you know, a ketogenic diet could be nothing but canola oil and whey protein, like you could do that. And you would be in nutritional ketosis, I don't recommend it, but you would be. However, that's a very processed and pro inflammatory diet, but if you're eating real, whole food, and in addition to that, keeping your sugar and starch intake quite low, so that your body's naturally in nutritional ketosis, it's like a powerful double punch, one two, to really knock inflammation down in your body. And it has other fluid effects as well. It's useful for our gut microbiome. And if we're eating real foods, we're going to improve our omega three intake of our lovely omega three fatty acids, which are anti inflammatory. And also really pay attention to your stress management, and to your sleep. And you do all of these things, and you can very powerfully reduce your inflammation.
Dr Lucy Burns: (16:27) Absolutely. And I'm going to just emphasise that sleep is like a secret weapon. It is, people who have chronic sleep deprivation and a lot of us, you can survive on six hours a night. Some people, it's very, very few, are okay on that. But the majority of us, six hours a night is not enough, long term. Now, of course, we all have seasons. You, Dr Mary have a young baby.
Dr Mary Barson: (16:56) I get sad when people talk about this, I'm like, aah.
Dr Lucy Burns: (16:58) I know. But it is not something that you're planning to do for the rest of your life, six hours a night. And look, I certainly got six hours a night for a long, long time not realising exactly how I was depriving my body of just valuable, nourishing rest that you get for free with these amazing benefits. And now of course, I'm very keen on getting at least seven and a half, usually eight hours a night, which I would get most nights and like everything in life, doesn't have to be every single night. But if you can do it most of the time, then you're doing pretty well. The other one I know that you're big on is sitting as a pro inflammatory state. So again, it's tricky with lipoedema, because prolonged standing is painful as you can accumulate fluid in your legs. But I think the idea of a mixing up sitting and standing can be really helpful for reducing that inflammatory load that comes with prolonged sitting,
Dr Mary Barson: (18:05) Our bodies love movement, they do and yes, you don't need to stand all the time. You don't need to lie, but mixing it up and moving around. Even just like small amounts of incidental movement really do make a significant difference to our, to our inflammatory milieu, to use that term again. And definitely it's great to go out into exercise and strength training and to really, you know, work on your fitness and your strength. That is also a different to increasing your movement. Staying still for a long period of time, is pro inflammatory. Getting up and moving around frequently, is anti inflammatory. It's just how human biochemistry works.
Dr Lucy Burns: (18:53) Indeed, now I get it. I know for some women with lipoedema, particularly for if it's advanced, you know, movement can be difficult. One of the things that is really helpful, and again, I know that it can be tricky. That is hydrotherapy, or swimming. Swimming is so good for people with lipoedema because it sort of creates this hydrostatic pressure, which is all about reducing that fluid in between the cells. So it's like wearing a compression garment all the time while you're in the pool. Obviously, you can move without the stress on your joints. But I do understand that for some women, it's very confronting to get into a pool. When they really don't like perhaps the way they look.
Dr Mary Barson: (19:39) Yeah, yeah, that is where that you know, self compassion and working on your beautiful mind can be helpful to reframe and flip those thoughts and that can take time. If you're not there right now there is absolutely no reason to feel shame or guilt about that. But you could work towards loving yourself as you are and getting out there and moving and doing the things that are good for your health and that bring you joy, regardless of whether or not you conform to some ideal aesthetic or not.
Dr Lucy Burns: (20:11) Indeed, indeed. So then we, I guess moving on from the hydrostatic pressure, there are other ways to improve the fluid or to reduce the fluid between the fat cells. So one of these is compression garments. And this is not just, look again, it's, yeah, it's not just your Spanx, no. And it depends a little bit on again, what level of lipoedema that you're at. But certainly in early stages, you can just wear lightweight compression garments, which I actually wear. I don't have lipoedema, but I have some venous insufficiency, which means my ankles, feet swell, particularly because I do spend a lot of time sitting. And so I wear these just, yeah, I mean, they're, they're actually quite comfortable once you're on because your ankles come back. But there's plenty of garments available they do, you can get some that are off the shelf, or you can get custom fitted ones. Custom fitted ones are obviously expensive, more expensive, but they do potentially fit you better. And there are people whose jobs out there, that's that's all they do. They design and fit garments for people with lipoedema or lymphoedema. So again, if you're worried that you're too big, or you're, you know, they're going to judge you. They're not, they're absolutely not.
Dr Mary Barson: (21:29) I've got another myth that I think we should address, two myths. One is that it is cured by liposuction. And the other one is that, you know, liposuction is a cop out. So let's talk about liposuction, shall we?
Dr Lucy Burns: (21:46) Indeed, indeed, and I think it's a great topic to talk about because, I mean, there's been a lot of issues, you know, around cosmetic surgery, and particularly liposuction. It's not particularly well regulated. You don't need a lot of training to be able to set up and do liposuction. And there are plenty of people who have had liposuction and they don't have lipoedema. They just want to get rid of you know, some fat on their hips or something like that. One of the things that's really important to recognise though is that lipoedema is diseased fat tissue. It's not standard fat tissue. The capillaries in lipoedema are very fragile. the lymphatics in lipoedema are heavily involved and again very fragile tissue. If you damage your lymphatics, through whatever mechanism, then it's lifelong consequences. So anybody that wants to get liposuction, please I'm urging you, do not just go to some random person who says they know how to do liposuction, absolutely go to someone who is qualified and deals with lipoedema reasonably exclusively because there's a lot involved. So two things I would say certainly liposuction is not a cop out. For many people with lipoedema, it improves their function. So the fat distribution in lipoedema can be really debilitating. It can be particularly on the inside of the legs just above the knees. People can end up with these really large fat pads, which actually change their gait. They end up waddling, they end up with that chronic waddling, end up with osteoarthritis of the hips, and become really, really hard for them to move. So for a lot of people, having liposuction is function preserving, nothing to do with aesthetics, all to do with function. So it's certainly not a cop out. But the second myth, I think, is that there are people out there who will tell you, lipoedema surgery is a cure. Now, that's assuming that we understand the cause of lipoedema in the first place, and we don't. So the mechanism that causes lipoedema is still there. Whatever it is. So people will say, Oh, it came back because the surgeon didn't get all the lipoedema affected tissue. No, we don't actually know what causes lipoedema to occur in the first place. So if we don't know the cause, we can't just treat it by getting rid of the currently affected tissue, the root cause is still there.
Dr Mary Barson: (24:31) That's right. And you can’t sort of have the surgeon turn around and say, Well, you failed, you failed my lipoedema liposuction. You can't fail it. It might not be the whole picture. It's not addressing that unknown root cause. But things that can and do, because we know that inflammation is involved, we know that lymphatics are involved. So that anti inflammatory diet, those compressions, those ongoing things, those can really help it from coming back with a vengeance.
Dr Lucy Burns: (25:05) Absolutely. And look, I think what liposuction does is it's a select tissue debulking. It does reduce an inflammatory load. So it can be helpful. But it's incredibly expensive. So people need to be aware of that. It's not covered at all by Medicare. So for the majority of people who are having liposuction, if they need it, and as we just heard earlier, it's a symmetrical condition. So if you have it on one leg, you usually have it on the other leg, and it will cost somewhere between $30,000 and $50,000. So it's certainly a big investment for something that is not a cure, but certainly can improve function for those women that need their function improved. And it can reduce the progression. You know, it is certainly useful, but it's not the cure. So with that in mind, we need to therefore go to this fourth pillar, which is, of course, some form of making peace with your body. And I think when people who don't have lipoedema, tell other people to make peace with your body that can feel a little insulting. And so I am a woman who doesn't have lipoedema.
Dr Mary Barson: (26:14) I am a woman who doesn't have lipoedema. But I'm certainly not bodily perfect.
Dr Lucy Burns: (26:22) I am not bodily perfect either. And I don't function particularly well, because I seem to have no muscles. So that's, that's again, it's something I guess I've had to come to terms with is this acceptance of my body, flaws and all, it doesn't always look good. It doesn't always look pretty. My bones and muscles don't look the way other peoples do. But it is what it is. And what I do is try and do the maximum I can with what I've got. And that's what I would say to anybody who's got lipoedema. If you can find it in yourself to just live your life to the most maximal fun-ness that you can, without worrying whether everybody on the beach is looking at your cankles, then please do that. Because honestly, the person who is most worried about how your body looks is you. You truly are. And I get that. But just find everyday little ways to challenge yourself to be able to live your life with as much vitality as possible.
Dr Mary Barson: (27:34) Our bodies are vehicles. They are not ornaments. And, you know, I love to celebrate my body for what it can do. And not to hate it for what it can't do. And not to hate it for how it looks.
Dr Lucy Burns: (27:47) No, no poor old bodies, they're just trying to do their best. So summary for you lovelies, the pillars for looking after a body with lipoedema. And honestly, there's roughly 10% to 11% of women have this disease, not everyone's diagnosed. So, you know, that's close to 3 million people in Australia. So it's a lot. Well, actually that 3 million people 10 %, probably 100. And it's probably one and a half million. I forgot half their populations male.
Dr Mary Barson: (28:17) Yeah. Sorry, sorry, boys, you're very important too.
Dr Lucy Burns: (28:23) Yes. So we do know, real food, like a low carb processed food diet is missing the point. Real food diet first, then reduce your carbs. And if you can, you know attempt a ketogenic diet, there's scientific evidence that it's helpful. We know about compression, manual lymphatic drainage. We didn't talk too much about that. But you can do that. Whatever way thinking about it just squeezing out that, that fluid out of your interstitial space, whether it's swimming, whether it's wearing compression, where it's having the pumps, whether it's going to a massage therapist, doing those is really helpful. Surgery as a tool, but not a cure. And learning to love and accept yourself in the most way that you can, again, doesn't have to be perfect. You don't have to be completely loving on yourself. But what we want to do is not completely hate on ourselves either. Good, lovely peeps, if you think that you could have lipoedema, we have a questionnaire that will help you. Again, it's not a diagnostic questionnaire, but it will help you decide whether you may or may not have it, in which case, if you may, then you can go down the path of getting a further diagnosis. And we also have a special package which we call the Lipoedema Inflammation Package, which of course goes through the processes of a low carb real food diet with the option of doing a ketogenic diet, along with beautiful hypnosis for stress management and love and acceptance. The links for all of these will be in the show notes or you can go to our website, www.rlmedicine.com Alright, lovelies have a beautiful, gorgeous week. We'll see you next time..
Dr Lucy Burns: (30:10) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns…
Dr Mary Barson: (30:17) and I'm Dr Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com
Dr Lucy Burns: (30:28) And until next time…
Both: (30:30) Thanks for listening!
Dr Lucy Burns: (30:32) 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.
