Welcome to part two of our LowCarb USA conference summary. While part one focused on dietary choices and metabolic health, part two will entail presentations directed at healthcare practitioners. While not all of us are practitioners ourselves, it can be helpful (and interesting) to learn about emerging research and do a deep dive into the science behind health. Keep reading for some insight into intriguing case studies, emerging research in dietary choice for neurological disorders, insulin changes throughout a woman’s lifespan, practical advice for practitioners suggesting ketogenic diets, and the history of diabetes care.
Houston, we have a problem: how do we help the challenging patient?
Dr. Lenzke provided insight into some case studies from his daily practice. His wide variety of patients ranges from monks to individuals with poorly controlled diabetes mellitus to a patient with a glycogen storage disease. His problem-solving skills, continuous glucose monitors (CGM), and utilization of a low carbohydrate diet have improved his patient’s metabolic health.
The many variables that impact blood sugar lead to a detective-like approach to patient care. Stress, exercise, diet, sleep quality, and pain response and just a few of the pieces of the blood sugar management puzzle. A multi-faced approach includes a low carbohydrate diet and brain-gut-microbiome interactions. The communication between the brain and gut plays a role in how we absorb nutrients and manage our metabolic health. Common factors like stress, poor sleep, alcohol, artificial sweeteners, and lack of exercise can all negatively impact the gut microbiome. Lesser known microbiome assassins include antibiotic use and environmental factors such as maternal health. In order to improve the gut microbiome, we can employ strategies that reduce stress, increase exercise, improve food choices, enhance sleep, and stop smoking or drinking (in excess). The use of probiotics/prebiotics and intermittent fasting has also been shown to improve our microbiome when taken appropriately. Dr. Lenzke stressed the importance of patient education and the use of feedback via a CGM to help guide our daily choices.
Ketogenic therapies for neurological and neurodegenerative disorders
Amy Berger, MS, CNS presented promising data on the utilization of ketones (either exogenous or endogenous) for use in patients with neurodegenerative disorders. While she acknowledged that ketones may not be the perfect option for every patient, she displayed encouraging brain imaging results and studies of patients with neurodegenerative disorders effectively utilizing ketones to power the brain. This is a promising new frontier and may provide an alternative cognitive fuel source and increase the quality of life for both patients and their caregivers. We look forward to future research in this space.
Dave Feldman’s update on the Lean Mass Hyper-Responder Study
Dave Feldman, an engineer and founder of Citizen Science Foundation, provided a progress report on the Lean Mass Hyper-Responder study. Lean Mass Hyper-Responders are a specific subset of individuals that are characterized by abnormally high LDL cholesterol (200+ mg/dl), high HDL (80+ mg/dl), and low triglycerides (<70 mg/dl), while practicing a low carbohydrate diet. This population is unique in that they have extraordinarily high cholesterol levels that would typically be concerning due to the increased cardiovascular and metabolic syndrome risk factors. However, these lean mass hyper-responders present with low insulin levels, a low waist-to-hip ratio, low blood pressure, and low triglycerides, which is not what we would expect from people with high cholesterol. The current study is following 64 participants that fit this criterion and adhere to a ketogenic diet. As a frame of reference for just how high the cholesterol is for these participants, the average LDL in the study is 233 mg/dl. This places them in the top 1% of the top 10% for LDL. The interesting aspect of the study is that while they have alarming high LDL, 66% of the participants have a total plaque score and a total calcification score of ZERO after an average of four years on a ketogenic diet. While the study is still ongoing, it is interesting to note that, for this subset of individuals, a high LDL does not appear to cause the vascular damage that we would expect. We look forward to further updates in this field that has the potential to change how we view cholesterol.
It’s not just PCOS! Inflammation and insulin resistance across a woman’s lifespan
The aging process is complex. Our bodies are constantly changing in order to adapt to our environment and prepare for new life events. Dr. Andrea Salcedo spoke about these life changes with respect to Polycystic Ovary Syndrome (PCOS) and insulin fluctuations. While we know that PCOS is the most common endocrine disorder affecting reproductive-age women, PCOS can present in a variety of ways. A traditional diagnosis of PCOS will involve employing the Rotterdam Criteria for which at least two of the three criteria are satisfied: (1) irregular menstruation, (2) clinical evidence of hyperandrogenism, and (3) polycystic ovaries as evidenced by an ultrasound. However, there are many aspects of PCOS that are specific to each individual. In search of commonality between women with this endocrine disorder, Dr. Salcedo proposes a theory that insulin may be not only driving the symptoms of PCOS, but also many of our physical changes through life.
With regards to PCOS, in a healthy person, normal insulin levels allow ovulation to occur. When this insulin becomes irregular, the body does not allow ovulation to occur, leading to the irregular periods included in the Rotterdam Criteria. With regards to insulin driving our major physical milestones in life, puberty involves a significant increase in fasting insulin to facilitate growth. Pregnancy is commonly accompanied by insulin resistance and mild fasting hypoglycemia. The suckling involved in the postpartum/lactation stage of life increases prolactin (a hormone that stimulates milk production), stops ovulation (until mom becomes nutritionally complete again), and decreases insulin levels. Lastly, menopause is marked by increasing insulin levels and increases in insulin resistance. This contributes, in part, to the increase in central obesity (fat stored around the belly) for post-menopausal women. Future research into Dr. Salcedo’s common thread of insulin driving our physical changes could provide valuable insight into how women can best progress through stages of life while maintaining metabolic health.
The 4 pillars of a successful low-carb practice: providing comprehensive care and meeting patient’s needs
Dr. Jodi Nishida provided an insightful look into her Hawaii-based practice. She discusses the importance of medical intelligence, with an emphasis on patient history, reviewing symptoms, and setting goals that are both time-bound and measurable. Her focus on food intelligence and becoming an “ingredient expert” in order to adequately communicate with her patients was refreshing. The practice is very comprehensive and emphasizes a CLEAN keto. Dr. Nishida promotes an emotionally intelligent environment where healthcare professionals listen and communicate with their patients.
Chasing Blood Sugar: Diabetes, diet, and the limits of medicine
Gary Taubes took us on a journey through time with the evolution of diabetes treatment methodologies. He chronicled the initial struggle to identify the disease and treatments where standards of care consisted of starvation. The revolutionary discovery of insulin in 1921 and the adoption of insulin as a viable diabetes treatment method were discussed. Mr. Taubes spoke about the challenges and problem-solving process of the utilization of insulin and balancing feeding with insulin use for diabetics. He concluded with the technological origins of self-blood glucose monitoring, the monitoring of hemoglobin A1C, and strategies for reducing the complications of diabetes.
Where do we go from here?
This concludes our two-part summary of the LowCarb USA conference. We hope you enjoyed an overview of our five-day learning spree. We will be diving into many of these topics in further detail later with individual blogs.
In our continual quest for knowledge, we will be attending the 8th Annual Biohacking Conference this week. Stay tuned for our summary of that conference as well as some insight into the latest in biotech for health.
Author: Dr. Colleen Gulick