Replies

• Friday is hectic end of week transition to weekend - Most peoples work schedule is 8-5 M-F. Asking me to take out time from work to watch, is a wrong presumption of priorities
  October 7, 2022

• Excellent Grand Rounds! Thank you! I love the Friday time slot. Much easier to attend live for me.
  October 7, 2022

• Dr Tim Noakes has been tweeting that fat oxidation takes place when insulin level goes below 6 This point is also worth noting
  October 6, 2022

• Thank you Shashi for your interest and inspiration in this project/resource getting done! ~Pam
  October 5, 2022

• Mark, I think that is the case in one of my patients. It totally makes sense that if the liver is just full of sugar it can take a long time to unload. I am encouraging fasting to speed up that process. I do like the idea of metformin and/or GLP 1 as well. This one patient is making progress on everything else and she is still hopeful although frustrated that she’s not making the gains that others often see. But everyone is different and we will keep working on it. Thanks for your support
  September 15, 2022

• Jarrett folks w advanced fatty liver take months and may never fully reverse the hepatic glucose output and have persistence elevated glucose and insulin. that being said there is only one way out and that is unpack the liver as well as ectopic intramuscular fat driving the IR. Metf and GLP1 can be allies. If they are making some slow forward progress w waist, glucose , as well as how they fell you are on the right track. Mark
  September 15, 2022

• Wonderful ideas. I would agree. We’ve been doing this 'full steam' for the past four or five months and it has been very rewarding to see the successes with my patients. I already have about 40 or 50 people doing it and most of them are loving it. Definitely a different process for everyone in how they respond, but all great!
  September 13, 2022

• Keto-mojo. We keep them in the office and patients can "check them out" for a month at a time. I sanitize the pin pricky thing (super technical term) and restock the supplies each time. About 50% of our patients love it so much that they end up keeping it and buying it from us. Ketosis is 0.5mmol or higher. As for the "when to eat" lever, we actually use various fasting protocols with each individual patient. Mindset and headspace can be a tricky thing when turning off the food button so we allow each patient to flex their fasting muscle at their pace. Some patients are doing well to keep to an eating window while others rock out a 5-7 day fast. Practicing medicine this way has literally put the joy back into it for me; you get a front row seat to watching patients make themselves better. Super cool.
  September 13, 2022

• Very good Megan, thank you. That is very interesting. To follow up, how are you doing the ketone monitoring? I assume via blood? And are you having patients do that at home or in your clinic? And at what level do you say they are truly in ketosis? And when you say you look at the "when to eat lever", I am assuming that you recommend not eating until they do go into ketosis?
  September 13, 2022

• Not everyone can get into ketosis via low carb. I believe there is up to a 1/3 of the population who won't reach ketosis simply by following low carb (or even ketogenic). In our office, we also utilize time restricted eating and train for extended fasting. We monitor with keto-meters and learn at what point patients actually hit ketosis depending on how long it takes for their glycogen stores to become depleted. So I would suggest taking a look at the "when to eat" lever.
  September 13, 2022