00:00 Introduction and Guest Introduction
03:00 Dr. Penny Figtree's Journey
09:00 Understanding Diabetes Burnout
15:00 Benefits of Low-Carb Diets
21:00 Insulin Management and Challenges
27:00 Continuous Glucose Monitors (CGMs)
33:00 Metabolic Health and Mental Well-being
39:00 Practical Tips for Low-Carb Diet

Dr Peter Brukner (00:02.936)
Hi there everyone and welcome to this Defeat Diabetes webinar. I'm very excited today because we've been trying to get this good person on for a while now and we've finally got her. So let me introduce Dr. Penny Figtree and Penny great to have you here. Why don't we start, look most of our audience have probably heard of you, you're a legend, but tell us a little bit about yourself and what you do and your journey to what brought you here into this sort of world that we're in, this crazy world that you and I have it.

Dr Penny Figtree
Yes, this amazing world. Exciting to be here, Peter. I love your app. It's amazing. So me, so I'm a GP and I've been a GP for a long time. As a GP, your job is, you know, to be up to date with the drugs. That's what I used to think it was. And I tried very hard to get my patients to be well. And I'd always start with lifestyle and I'd watch everyone get sicker. So you'd get to 40 and I'd dear here we go the blood pressure's going up and I'd say you know exercise diet and here's the pills and and I'd just keep prescribing more pills and I just see people getting worse and it was pretty depressing nothing really worked and I'd always be trying it wasn't like I was a GP that didn't try I was really into lifestyle I'd send people to dietitians tell them to eat less, nothing worked. And then one day I stumbled across this insulin carbohydrate model of obesity by accident. Actually, my physiotherapist told me about her husband who'd lost weight listening to Jason Fung on a podcast. So I thought, okay, I'll listen to Jason Fung. And from there I found David Ludwig, who wrote that book, Always Hungry. And in the first few chapters, he just explains how insulin drives fat storage.

Dr Penny Figtree (01:59.438)
And it just made so much sense. so then of course I learned about it and started trying it on my patients. And I'll tell you what, after 20 years of trying stuff, this worked like a miracle from the first patient. And it was sort of miraculous in that at a week they would come back and say, gosh, you know, I'm not tired anymore. I don't need an afternoon nap or my reflux is gone and my hands don't hurt. I'm a massage therapist, my hands don't hurt anymore. And you know, this is one after another. And someone with irritable bowel for years, you know, before she'd go on a trip, I'd have to give her pills to stop having diarrhea so she could go on the trip on the airplane. And I put her on the diet. She wasn't overweight, but I just put her on it to see how it goes. And it fixed her. And I ran into her at a basketball game a few years ago and she went, I will never stop that diet. It's changed my life.

And I had my eyes checked recently and the eye guy said, oh, wow, you know, I see so many of your patients and they're telling me how much their lives have changed. Now nothing happens like that in normal medicine. It's this diet. It's just like amazing. So that's me. So now that's all I do because it's just fixes everything, doesn't it? Apart from a pepcidus.

Dr Peter Brukner
Fair enough. It's interesting, isn't it? You just talked to so many GPs and David Unwin, one person that I've spoken to, and he always says that he was hating work, he was going to retire, no, he just fell as though he was bashing his head against a brick wall, and then discovered this and just got a whole new lease of life and energy and enthusiasm for his work as a GP. And I hear this story time and time again, and for doctors, it's fantastic because... despite what our patients sometimes think, we actually want to make people better. And that's what we're, that's, think the reason most of us go into medicine. And, and this has just been such a revelation, just to change our lives as doctors, as well as our patients lives. All right, let's, let's talk about, we specifically want to talk today about diabetes and some of the, you know, I guess the issues in relation to when things are not going well.

Dr Penny Figtree (04:15.566)
You have this, you talked about this term, diabetes burnout. I guess, prior to discovering low carb, what did you see in your patients with diabetes? Yes, well it's interesting when you talk to patients who are now low carb and they talk about how they used to feel and that was a sense of hopelessness because we tell that's what I would think okay this is a chronic progressive disease and no matter what you do you're going to get worse and you're just going to end up on more pills so there's this fear of just getting sicker and needing more and more medication and of course that fear of insulin and so that's causes diabetes burnout, because it makes you feel absolutely miserable. And then this fear of complications, am I going to go blind? Am I my feet going to stop feeling? I'm going to get kidney failure. So just terrible. you're doing your best. And actually, one of my patients told me she was doing her best. And every time she'd go to the clinic, she'd get in trouble for getting worse and not doing her best. But that, of course, is because that advice of grains and healthy

fruit and grains and porridge doesn't work. And so you're doing your best, you're getting worse, you're on more and more pills. And it's just desperate. And I'd say a lot of people just give up because it matter what they do, they get worse. And I think that's the traditional model really does contribute to this idea of diabetes burnout. It's just giving up because modern medicine is about a chronic progressive disease and pretty much watching people get worse and just monitoring it, which again is what one of my patients said, is she's a fancy specialist in Sydney and just happened to move to Port Macquarie and says it's the best thing about moving to Port Macquarie was getting on low carb with Dr. Figtree. And she said it was about watching her, it was monitoring her getting sicker. That was what the model of care was. So I hope that some of your people who are watching are finding low-carb perhaps is contributing to less burnout and a bit more hope.

So what are the differences in once you go on this low carb approach and you've got diabetes and previously you've been, you know, well maybe depressed or just, you know, really feeling as though you're getting nowhere. I mean, what's the first thing that your patients tell you?

Well, I guess the patients on insulin that start with them, the work, like I love the sick, really sick people. They're my favorite because you can get like amazing, amazing results, you know, off insulin within 24 hours. Not everyone, of course, but a lot of people. And so that gives hope and excitement. I people crying. They're just, wow, got less.

Dr Peter Brukner
What's the problem with insulin then? Why is it so good to get people off insulin?

Dr Penny Figtree (07:22.776)
Well, for the individual sticking it in their leg, needles aren't great. And a fear of a hypo, so those immediate things, injecting and then ways having to eat so you don't have a hypo, and fear of that and checking your blood sugar all the time. But of course, Peter, you know, insulin isn't a vitamin pill, it's not healthy. GP's are taught, jump in there and get them on insulin as soon as you can to get that sugar down, but insulin... is harmful. you do, I tell my patients, I want you on the lowest dose that keeps your sugar under 10. Because there's this balance, it's not just the sugar that's harmful, the insulin is harmful too. So it drives fat storage, people tend to gain more and more weight when they're on insulin. And might put your blood pressure up a bit because it causes salt and water retention at the kidneys. It's actually pro-inflammatory. Insulin is associated with cardiovascular death, increased risk of dying. So you wanna be on the lowest dose that you can. But for a patient, they're probably not thinking about that. That's what I'm thinking, it's not healthy.

Do patients get told that, you all those sort of complications, if you like, when they get started on insulin? I don't think so, do they?

No, I think a lot of doctors probably don't know themselves. That's true. Look, honestly, as I've said on a talk, GPs are taught, like I used to feel naughty that I wasn't, gosh, I should do insulin, know, good doctors aren't scared to start insulin. Cause I was a bit scared to start it. I wasn't confident. And I thought that was a failing in me.

Dr Penny Figtree (09:01.612)
You know, good doctors are quick. You know, you've got to be quick to get them on insulin. Do you know that sort of teaching? Don't let those sugars go too high. If you're scared to start them on insulin, you've got to get them on it. And so there's like a promotion for GP education, insulin initiation. They thought they were clever. there's all these inns. Initiation and intensification. That was what our education session was about. And nothing would be told to these GPs about stopping insulin or not the harms of starting that insulin. So yes, but I don't want to frighten people on insulin. Like there'll be a ton out there on it. Who cares? Just be on the lowest dose that you can to keep your sugars under 10. And I find some of my patients, like I can't get them off it, but they might've been on 80 units and now they're on 20 units and they need that little bit of insulin. Cause we've all got insulin and it's, we need it.

It's great but you don't want too much. So low carb allows you just to lower it down and not be on more and like if you eat high carb and inject insulin you're going to be on higher and higher and higher doses.

Dr Peter Brukner
Yeah, yeah, absolutely. What about other, I mean, okay, that's your insulin group. That's probably what? 10, 20 % of your patients with type 2 diabetes? at the extreme end. And what about the rest of the other 80 % at Pentium? And what do they notice?

Yeah.

Dr Penny Figtree (10:33.582)
They feel better. Okay. So I mean, some people at first week, they have a bit of that transition time, but actually most of them just come back and go, I'm not hungry anymore for the first time. I've got more energy or my reflex has gone and they're just feeling better. They're not falling asleep in the afternoon. They've got more energy and that is great. And mood improves. had a lady the other day who came in and said, I'm not fighting with my husband anymore. I just feel happier.

I'll go with anxiety had gone. So mood tends to improve, energy improves, aches and pains can improve, back pain, knee pain can improve, steadier blood sugars of course, these are the things and people notice them very very quickly, particularly if they go very low carb they'll notice them very quickly. But that gives hope doesn't it and less pills so I'll get that it's not just insulin you get off most of your pills particularly if you're not way down the road of your diabetes, you'll get off your pills really within a week. But definitely over three months you're just dropping pills and then blood pressure often takes that little bit longer to drop. And so again each time someone comes I'll be going are you dizzy when you stand up and if they are I'll be really checking their blood pressure and then stopping their blood pressure pills. So when I'm looking at that big list of pills I'm looking at blood pressure pills... Like I'll see someone come in and I'll go, right, which ones are you going to be stopping? Blood pressure, reflux, diabetes, pills. Really, they're just left on their thyroid medication. You you can really turn that enormous list into nothing, which is very satisfying.

Very unusual. I most doctors just add extra medications. I mean, it's quite rare to be a de-prescriber and yet, you know, so many doctors, you know, will put someone on a medication and then they'll need a medication to counter the side effect of the previous medication and then, and so on and so on and so on. And it must be incredibly satisfying to actually reduce the amount of medications because really, I mean, you know, this most older people in this country are on multiple medications and I'm sure most of them don't need to be.

Dr Penny Figtree (12:46.444)
No. And look, honestly, I love it when you explain it to people and they'll go, so I can eat eggs. I'm allowed to eat eggs, but isn't it bad for my cholesterol? And it's just so tragic. And then you go, look, I'd rather you eat eggs than Kellogg's cornflakes. Please eat eggs. They're nutritious. Don't eat rice crackers. Eat eggs as many as you like. And having permission to eat real food that we've been eating for millions of years. To say it's safe to eat real food. That's how brainwashed everybody is that they need to be eating down the cereal aisle. I just look at that aisle and go, who goes down that aisle?

The poor old egg has had a really rough time. And yet, we've known for 50 years, even Ancel Keys, was the dodgiest guy around, he would say that the cholesterol you eat makes no difference to your blood cholesterol. So we've known it for years and yet this myth has come up around eggs and cholesterol that's deprived a whole generation of people of probably I'll give you having the healthiest food that you could possibly have.

Yeah, yeah. And I remember my dad who ate eggs and chops for breakfast and then all of sudden he'd be so cross because he had to eat bird seed. So they're making us eat bird seed. But he did it because that was healthy and you know, we had bird seed. Yeah, so that's what I think. I think people get desperate because the current treatment doesn't work. But when they switch to low carb, it gives them hope, less pills, they can see themselves getting better.

Dr Penny Figtree (14:29.632)
And that can help with this feeling of diabetes burnout. But some people find it, struggle with it. I hope today I can throw some of those ideas out to people as to tips and tricks to do low carb because it's, man, if you've got type two diabetes, if you can do it, you really should be giving it a go, even half doing it.

All right, let's tackle those tips and tricks now, Penny. mean, because often, you you might suggest, I'm sure you've had the experience, you suggest low carb to someone that's, no, I couldn't possibly do that. You know, I couldn't give up bread or I couldn't, you know, couldn't, whatever. How do you handle that sort of that scenario?

Yeah. Well, firstly, I think once you understand, like if you go, well, you're full of glucose and bread is full of glucose. So it's probably better not to eat it, even though it's whole grain. and then they think, yeah, it makes sense. So that just an understanding of that simple fat, that glucose is in these carbohydrates and you're full of glucose. So I'll often say, think of yourself as someone with a food allergy.

So, like my son is allergic to egg and dairy and he can't eat cakes. He's 18, he just doesn't. So if you've got type 2 diabetes and you're full of glucose and your body can't deal with glucose, then you're sort of allergic to carbohydrates. Or again, like someone with celiac disease, they can't eat gluten. So think of yourself as someone who's got an allergy to glucose and that can sort of help you when you're at a party and someone's trying to make you eat cake. Think, well, I'm allergic to that.

I can't eat that. So firstly, I explain simply what it means. So an understanding I think helps. And then secondly, making the diet simple and easy and almost the same as what you currently eat, but just tweak it a bit. So it's not complicated. think people get on the internet and they look up keto diet or low carb and it's full of rules and what's a macro, you know, gosh, you got to have an app and count.

Dr Penny Figtree (16:39.574)
It's just too overwhelming. It seems too hard. I just keep it simple. So I'll if you have spaghetti bolognese, you can still have the meat bit and you can still have Parmesan cheese, but you can't have the pasta. But some people might make zucchini noodles or if you're me, I just use an iceberg lettuce leaf and put it in that. But it's the same. everyone else in the family wants pasta. They can have it, but you're sort of the same, but just tweak it or hey, you have a chicken sandwich for lunch. Great. Have the chicken, just have more of it and don't have the bread and put it in a lettuce leaf. Just so often go through what do you currently do? And then I just tweak it. So, and once people go, okay, it's not that hard, super simple, then, then I think that helps. So keeping it simple and understanding and thinking of self, like you've got a food allergy. That's my tricks. So when I first see people and then when they come back, then we do another other barriers, but I think the internet makes it too hard and that's why your app is great because it makes it simple.

So even going to Maccas, mean, you can have the burger without the bread. Exactly. There's of simple options up there.

Yes and now people go when I'm traveling what do do? And of course it's so easy and I think at McDonald's now you can go in it's like you can choose your own make your people tell me you go in and press on that screen and they'll order all of those burgers and you eat them just like a biscuit yummy.

Dr Peter Brukner (18:13.166)
Great. Okay, what about one of the common responses we get is that, what about all that fat? Okay, you know what, you want me to eat all this, you know, butter and eggs and dairy and so on, you know, why not drop dead of a heart attack?

Dr Penny Figtree
I love that. yeah, I know. that's the diff that I think that derails a lot of people is their local friend is a doctor or, you know, someone down the street, but, a lot of old doctors who aren't up to date might, might terrify people. What about you cholesterol? well, firstly, cheese. Well, that's great. Isn't it? think everyone pretty much agrees, even the heart foundation that cheese is great. So it's full of saturated fat, but is associated with less chance of dying.

So that's good. Cheese is healthy. And everyone agrees with that and it's full of fat. So terrific. And then, well, I think if you're type two diabetic, your problem is high triglycerides and this low HDL, which is an abnormal sort of lipid profile that you see in type two diabetics, strongly, strongly associated with heart disease and on a marker of metabolic dysfunction. And you want to reverse that. And what reverses that is a high fat diet so you don't need to worry about all the, the only reason they were about fat is because of your LDL cholesterol. Well, fat will lower your HDL, will improve your HDL cholesterol. It's healthy. And honestly, my patients, I don't see their LDL change. usually, the LDL cholesterol, that bad cholesterol stays the same in the majority of people. In some people it gets better. And then there's a few people, gets a tiny bit, that LDL goes up a tiny bit.

But in diabetic patients, I have never seen a problem with their cholesterol. All I do is get so excited that those triglycerides have come down and that HDL is going up. And that's because they're eating low carb high fat diet. So I don't worry. That's great. Eat that.

Dr Peter Brukner (20:16.94)
Yep. Yeah, absolutely. mean, I think the whole cholesterol thing has been skewed by the pharmaceutical companies and wanted to put everyone on. It's very interesting because, you know, I believe that probably high triglycerides are far more important than higher LDL, but there's no drug for high triglycerides. So we don't talk about that. There's a drug for LDL, so let's put everyone on it. You know, I mean,

Great, Kato, what do you think?

Dr Peter Brukner (20:43.95)
I don't like to sound like a cynic, you can't help being a bit cynical when you're in this game for a while, do you? It's sad. And I think the best way to get your triglycerides down, which we like to talk about this triglyceride-HgL ratio, is eat lots of healthy fats. The more fat you eat, the more fat you lose. It's quite bizarre, really.

I know when you say to people, they've never done a trial on a low fat diet and shown improved health outcomes. So why would you do it? There's no evidence.

Well, there's been a worldwide trial for about 50 years on a low fat diet.

It's been a funny disaster.

It's got better.

Dr Penny Figtree (21:28.366)
Yes, and I just like you conspiracy theorists. I have to be careful.

Okay, what are some of the traps? mean, you you're at work and then the tea room and it's full of biscuits and it's someone's birthday and we have a cake and all these sort of things. mean, how do get around that sort of thing?

Do know what I want to write to work, Kuffa? I feel like it's, honestly I do. The tea room is a dangerous place, probably the most dangerous place in the majority of Australian workplaces. Don't you think? It's just full of cakes. Even at my work, I go in and there's this chocolate, my goodness. Once I hit the chocolate, there's a big packet of chocolates on the table and I hit them.

Well patients bring you chocolates, don't they? thank you doctor, here's some chocolates.

I The nurses, I feel sorry for nurses. I have a few patients with nurses, they got so hard because they do, they get chocolates, chocolates, chocolates and it's terrible. So the tea room is a dangerous place. Acknowledging that and going, yes, it is. Try not to go in there. It's probably your best bet. But yes, so when it's someone's birthday, it's hard. Now, one of my staff members, she's very low carb, two of them are low carb. And so when it was my birthday, she made me a low carb cake. But what do you do? Well, one of my patients recently posted a picture on our Facebook group of her. She made keto cheesecake. So there's lots of keto cheesecake recipes using the artificial sweeteners. Take that into work and put that out as an option. And then everyone will go, well, that's yummy. They'll all like eating that. And they won't know the difference. And so you can sort of feel normal because you're eating something too. And also, remember this is something I like to tell people is it's not just about how you it's not about the future so often you think if I eat that cake it won't you it's you're thinking about your hba1c perhaps in three months time but when you eat low carb you feel well whereas if you go and eat carbs the next two hours you feel sluggish and tired and awful and maybe the next day you don't feel so great so if you can just avoid that relapse of eating that cake. Like in an hour, you're gonna feeling great. Whereas if you eat that cake in an hour, you're gonna feel rubbish. So it's pretty immediate. I know my family, eat, sometimes my husband will get pizza. So I just eat the topping. I get my fork and I eat the topping and leave the base. And he's not as good at being low carb as me. So he'll eat his and then my base.

And he looks terrible after he's gone to sleep. You know, and I'm feeling terrific because I've just eaten the delicious topping. So within an hour, it's different. So I think if people think, it's not, it's not about the future. It's not about three months. It's about two hours. How am going to feel in two hours if I make that choice? So that can help. But thinking, is it a food allergy? I've got a food allergy, so can't have it. So that sort of a tool, a mental tool. And then in two hours, if I eat that, I'll feel terrible.

But then at the same time, you eat it, don't punish yourself. So some people are aiming for perfection and then they give up because they can't be perfect. You don't have to be perfect. You don't have to just do your best most of the time and you'll reap the incredible benefit.

Dr Peter Brukner (25:04.11)
Yeah, I think that's that's so true. I was actually going to ask you, mean, if someone comes in and they're looking embarrassed, they say, I fall off the wagon, you know, I had last weekend, I had a party, whatever, whatever, you know, I mean, what's your approach? know, what do you take the hand and give them a slap? you know, what do you say? You can't do that anymore, can you?

No!

Dr Penny Figtree (25:26.346)
I can't get cross with them. No, I just go, that's completely fine. Completely normal. You're a human. all would, no one's perfect. and who cares? That's a learning curve. It's often a learning curve because you go back to high carb, you see blood tests go crazy again. You don't feel well, you're feeling tired. And then you go, I think I'm going to go, I felt so much better before. So you might even take for granted how great you're feeling.

go back to the carbs, remember how terrible you feel and go back again. And I think it's almost part of changing your behavior and learning. And then you just look back at the experiences, okay, what led me to go off? How can I deal with that next time? And think about strategies. Like sometimes people are craving something sweet. so you go, all right, well, why don't you make a keto cheesecake or, and just have it sometimes. It doesn't mean you can't have yummy food. Let's work on that.

But definitely, I think it's part of the journey. really do. It's just learning and, and, and a patient of mine said her trick is if she goes off, just get back at the next meal. Don't think next Monday or start next week, just get back on, you know, and that I have plenty of patients who go away for a weekend and then Monday they're, they're back on. and some people get back on by not eating till dinner the next day. They sort of go, right. Starting tomorrow and I'm not going to eat till dinner and they sort of boom back into it pretty quickly. But definitely perfection is not the goal.

Dr Peter Brukner
What about cheat day? I people say, you know my that I have a cheat day, you...

Dr Penny Figtree (27:05.838)
I don't like Cheap Day because I want you to think this is how I eat, this is me, this is... I mean, look, I have one lady, said a Christmas day she was going to eat the cake and I went, yep, fine, do that, that's fine. But I don't encourage Cheap Day. Like I just think I want you to make this who you are and be happy and this is the way you eat and this is your life. But of course, if you go to a party and you think, yep, I'm going to eat the cake at that party and I'm going to get back on the next day, great.

But I guess I don't plan cheat days. I do worry there's too much cheat days. I remember Simon Thornley saying at the conference, it's like letting the tiger out of the cage and going for a walk. It's sort of dangerous to have these cheat days because you might get that all the sugar cravings might come back and before you know it, every day is cheat day. I would prefer, I think being on

most of the time, but if sometimes you accidentally don't, then that's okay. But I wouldn't be planning cheat days, but that's me. I think you just figure out what works for you and you'll learn. you find cheat days are great, then okay. If it works for you, terrific.

One of the common criticisms or comments that are made often by other doctors is that, that keto is fine, but it's not sustainable. You know, can't keep at it. What's your response to that when your patient comes in? know, Dr. Such-and-such said, know, keto is terrific, but I'll never be able to last longer than a month on it.

And I have to, my husband always says, don't get defensive because I get so angry.

Dr Peter Brukner (28:44.756)
I can't imagine you being angry, Penny. Come on.

The first thing I think is your low fat diet is not sustainable guys, you know, like who are you pointing fingers at us? You're just complete failures. How's your man shape looking? You know, is that sustainable? So firstly, it's not even an argument against the diet because they're, they haven't got it on themselves. But is it not, of course it's sustainable. I mean, what's not sustainable about meat and vegetables?

You know, it's eating real food. It's not being hungry, not being cold, feeling great. So many carbs swaps. You know, you can always find something that's similar in a keto world. Even those awful breads that I don't encourage. You can get keto breads if you want. Not that they're terrific, but you can sort of get that. So whereas low fat's all about counting calories, being hungry, being miserable, can't eat anything, keto's the complete opposite it's a hundred percent sustainable much more sustained I think the VERTA health trial showed that didn't it they've got people still five years out on the diet

Yeah, I... I'm sure the people who are saying that have never tried it. once you try it, once you go on the diet, you feel so good. I mean, that's why it's sustainable, know, because you feel great. I mean, that's, you know, that's the thing that keeps you going really.

Dr Penny Figtree (30:12.846)
You're not going to sleep after lunch.

Yeah, exactly.

And you've got your yummy granola.

Yeah, that's all good. Yeah, just had a bit of that last night. That was good. Okay, what about the use of CGMs, continuous glucose monitors, wonderful little contraptions that you stick onto your arm and gives you immediate feedback on your blood glucose levels? Yeah. What's your approach to that? How do you talk to your patients about to encourage your patients with type 2 diabetes to use them?

Dr Penny Figtree (30:51.31)
Absolutely and actually at the moment there's a trial offer for the Freestyle Libra and the Dexcom G6 continuous glucose monitor. So if you go to their website like the Dexcom G6, if you Google Dexcom G6 they have a trial offer it's $31, normally $730 free shipping and then the Freestyle Libra CGM is normally $100, it's $15 if you go to their Abbott website.

I know! Quick!

That's amazing.

I know, it's amazing.

So why should why should people do is that? Yeah, why should people use the same?

Dr Penny Figtree (31:32.11)
Because they're amazing. They're amazing. So a CGM is a little sensor that you have on your arm and it gives a continuous readout of your blood sugar. One of them feeds to an app on your phone and every five minutes, the Dexcom is telling your phone app exactly what your blood sugar is. And with the freestyle Libra, you just have to hold your phone up and it tells your app what your blood sugar is. So you don't have to stick your finger to know what your blood sugar is. So even when you're asleep, it's measuring what your blood sugar is. And it's incredible feedback.

So for me, I'm a bit strange, but when I eat porridge, my blood sugar goes to 12, which is odd. But I wouldn't have known that if I hadn't worn a continuous glucose monitor, because it shoots right up and then quickly drops right down to 2.9. Not healthy. for type, so my patients, I've actually got a friend who's got pre-diabetes and he's not into this. He's not into low carb, but I got it. He, I told him about the discount. So he went and got one and he's sending me texts.... watermelon takes my blood sugar to 10. I'm never eating watermelon again. And he could see his other friend who was healthy wearing the monitor and his sugars weren't going anywhere. So he could see that there is a problem with me when I and when I eat these watermelons look, when that and pasture it goes so high, but then I ate eggs for breakfast and it was flat trace. And so you learn exactly what foods are keeping your sugar down. It's an immediate feedback and it just supports this idea that why low carb is great. You're not bringing the glucose in and you're a diabetic so you're not good at dealing with glucose. So eat the foods without the glucose and that sensor gives you that immediate feedback. So it's fantastic and I encourage pretty much everyone even if you don't have type 2 diabetes to wear one just to check you're not like me and you spike or if you're pre-diabetic or diabetic it's so educational.

And actually one of my patients, came in, her HBA1C was 5.8%. So it's called pre-diabetes. And she'd seen a dietician who couldn't, said, you're eating a perfect diet. I don't know why you've got this. So she got a CGM and her morning smoothie, which had Ensure in it, was taking her blood sugar to 12 because Ensure's main ingredient, know, it's sucrose, which is sugar. And the minute we got rid of that Ensure smoothie, her HbA1c went back down again. that CGMs are just a wonderful tool if you've got any sign of problems with your glucose.

Because everyone's so different. mean, what you know, as you mentioned, mean, watermelon sends you off and it may not affect you. You something else will, we're all different. And I think it's important to know what's the, what are the things that really send your, your blood sugars up and so on. Yeah. So I think, I mean, you only, you only use them for two weeks at a time. I mean, if it's really only $15 or something like that, then that's the best, the best value $15 you'll ever get.

You only need it really for two weeks because you you try a few different foods in that time and you you've learned so much about your body and its response to different foods and so on. So that's great.

Okay, if everyone wants to try one, sometimes it's tricky putting them on. you just have to do a bit of a Google search and be brave. Sometimes I put them on for my patients, but you feel a bit nervous the first time you do it, but it's easy. yes. And actually, the one thing I want to say is for the average person, just keeping it your sugar under 7.8 on the CGM. So don't panic, you know, if it goes up a bit, it's allowed to go up a bit, but just don't make it go up.

Okay. You if you're getting above say eight, then that's too high. Don't eat that food. But don't, if it goes to six or seven, then that's normal. It's normal to go off a bit.

Dr Peter Brukner
Good point. Good point. Running out of time. I really want to spend probably the last few minutes talking about the brain and the effect of sugar on the brain or carbohydrate and the positive effect of a low carb because I'm sure in your general practice, you see a lot of mental health issues. I think the diet is the big exciting new frontier in in managing what is really an epidemic proportions in our society of anxiety, depression, bipolar, et cetera. Tell us a little bit about your experience using diet as a of a psychiatric tool, if you like, to improve mental health.

Dr Penny Figtree
Yeah, I really am excited about this. So for patients actually with type 2 diabetes, you know, you've got double to triple the risk of developing depression because it's actually a symptom of the disease. The brain is part of the body and it is affected by the insulin resistance that is type 2 diabetes. And there is inflammation in the brain and there's abnormalities in neurotransmitters. So being depressed and having diabetes, you might think, I'm just depressed because I've got type 2 diabetes and have to take tablets. But actually you might be depressed as a symptom of the disease, the way the disease is affecting your brain. They're very much interlinked. So metabolic health and mental health are very similar. And improving your metabolic health actually improves your mental health. And this is a new and exciting area of psychiatry. It's called metabolic psychiatry, where they're improving insulin resistance is improving diseases like treatment resistant bipolar disorder. Even in schizophrenia, there's case reports coming out. They're about to recruit for a randomized control trial at James Cook University, looking at serious mental illness and a ketogenic diet because it affects how the brain works and the brain works better. So there's a heap of research that's about to come.

And I can tell you in my practice, I see this all the time. So people come in, like the woman who said, I'm not yelling at my husband anymore. This is because she wasn't depressed. You when you're depressed, you're anxious, irritable, know, you're miserable, you got no joy in anything. And this had lifted. Another woman had said, her children said, mom, you're back to normal. Cause she'd been very depressed, even though she was on antidepressants. She just suddenly felt normal again, once she got on a very low carb diet.

She was there for weight loss. And I've got another gentleman with schizophrenia, similar, much improved. So it's not just me seeing it, the studies and the science are coming. And I want to tell a story that I love. I have, got time to tell a story.

Dr Peter Brukner
Absolutely, absolutely. I've heard this one before.

Dr Penny Figtree
This is my favorite story and this is why the science is coming. we all know nutrition is powerful but who's going to pay for it? You know it's really high, it's hard science to do, it's not like a drug trial where you've got a rich drug company and they're happy to pay for the pills and you give the people the pills and they take it. Nutrition science, who's going to pay for it? No one and it's different, adherence has to be, it's difficult to get everyone to do it correctly. science and... and to get the science for psychiatric illness and keto diets is difficult. But what's happened is we've got someone with a ton of money who wants to research this. And this is why. If anyone has kids who play Roblox, it's a computer game. Well, that family, their beautiful son called Matt Pazuki went off to university and developed treatment resistant bipolar disorder, incredibly unwell into hospital. They saw everyone, the best psychiatrists did everything they possibly could but he was just sick actually living on the streets despite the best money and the best parents. And then one day someone mentioned to the dad, I went on the ketogenic diet and it fixed my bipolar disorder. So they got their son, they put him on the ketogenic diet and he's fixed. So his bipolar, he's still on some medication but it's completely in remission, he's symptom free.

You know, living a full and happy life. And because they've witnessed this, they're just so passionate about studying the mechanisms as to why this diet has helped what the ketones are doing. So they're funding basic science, they're funding that trial at James Cook University, that randomized control trial, they're funding a trial at Stanford Interbipolar at Ohio State with Jeff Bollock, he's looking at depression in university students. Edinburgh Uni is doing a trial into bipolar disorder and apparently they're finding the higher the ketones the better the people's mood are. So brain health and metabolic health are so interlinked and this is why in patients with depression they've got with diabetes they have more depression because they've got insulin resistance affecting the brain. So I guess my message it's a bit complicated is a low carb diet could potentially help your mood but if you're feeling this despair and hopelessness and cranky and not happy, then please see a GP because this could be a depressive illness, which is a symptom of your type 2 diabetes and how it's affecting the brain. So don't just worry about your eye disease, your kidney disease. Just check that you're not depressed and see your GP because it's part of insulin resistance is mood disorder.

Dr Peter Brukner (41:07.518)
Absolutely, but unfortunately, once again, lot of doctors don't realize that. So you've got to find the right GP. Not everyone's lucky enough to be in Fort Macquarie and have you as their GP, Pennington. Yeah, it's a real issue. I mean, there is more and more understanding, certainly. There's a lot of good videos out there now, and Chris Palmer's book's very good, they're Brain Energy, and there are a number of different things out there. But it's still...

You know, it's all slow. had my own experience. uh, you know, I had a lady come up to me. was ordering a coffee at university. A lady came up to me and said, uh, you know, that, um, she was, said, no, my husband and I cricket fans and I just been doctor of the cricket team. And she said, Oh, because of you, went to, we, changed our diet to a low carb diet. And, uh, she said, my husband's been bipolar all his life and he's now off all his medication. And I just want to say, thank you. You've changed our lives. I, well, yeah, the coffee tastes.

I find it so exciting. I actually get sort of tired from getting, you know, it's like, it's almost urgent feeling that you want to help everybody. But your book is amazing. So many of my patients have read your book. So you must get that all the time.

Yeah, I think what we all do, I as I said, no one ever used to come up to me in the street and say, you know, thanks for fixing my ankle or something like that. mean, you know, but now it happens the whole time, you know, people send you an email or contact you and so on. So, you know, there's a lot of people out there who've been really helped by this whole process. And I just wish I knew about it, you know, 50 years ago, know, 30 years ago, whatever. you know, I just think of all the bad advice I got people for first 30 years of my medical career, but I'm determined to make up for it as much as I can. I'm sure you feel the same. And, you know, as you said early on, I mean, your enjoyment of your work is so much more now because it's so rewarding. You know, you must get enormous satisfaction when patients come back in and they're off their medication and so on.

Dr Penny Figtree (43:12.586)
I do. I do. love it. I love checking blood results. You know, it's my favorite thing. I'm always taking photos because just watching those HPA1Cs and the liver tests get better and triglycerides coming down. It's, know, you just don't see that, do you? Just normal trend is everything getting worse and don't eat cake. That's about the best thing you could say. You can't think of anything to say to your patients. I used to try so hard. It wasn't like I wasn't interested. And I used to

I remember Googling why do triglycerides go up, trying to get them down. And there's nothing, is it when you Google triglycerides, there's always waffles. And now you go, just don't eat carbohydrates and they'll be better in two months. They'll be fixed. It's not there. I don't know how that's being hidden, but it sort of is being hidden. But I do think it's sneaking out, don't you? I think it's sort of spreading. you have hope?

It's interesting.

Dr Peter Brukner (44:09.454)
I do, I do, most of the time. Sometimes I feel as though we're bashing our head against a brick wall, but most of the time I'm feeling more more positive. And essentially it's being driven from below. It's been driven by patients who are educating their doctors. And in fact, one of our questions today is, have you got any advice on dealing with a GP who's skeptical of low carb despite good results? And we hear about that all the time. They're the classic case of, the GP diagnosed you with type 2 diabetes, write you out a prescription, you go away, come back three months later and you're in remission and the doctor says, those drugs are fantastic. And you say, no, I threw the prescription in the bin, I've ended up going low carb. And the doctor says, let's change the subject. Because it's quite confronting. what most people don't realize is that most doctors, and it's the same, don't know much about nutrition.

I don't think I got a single lecture in nutrition in my medical degree. was a long time before you came. a thing. Well, probably it would have been the wrong advice.

I think that's a good thing.

I know, because people always say there's no nutrition in medical schools and go well that's probably the thing isn't it? I start doing a brainwashing. But yes, we need do it with BP.

Dr Peter Brukner (45:27.87)
Yeah, what do you say? think eventually the GPs are going to get it. They're going to see so many people who are improving their... But I was talking to a GP the other day who's a very passionate low carb promoter and so on. And he said he's got 10 partners in his practice. And he shows them the results and he talks to them and so on. Not one of them wants to embrace low carb. So there's this real... resistance among doctors where we're very conservative. We're very traditional. believe everything we were taught in medical school till the day we die. And we're very reluctant to sort of change those ideas. And we're also very much under the influence of pharmaceutical companies. A lot of medical education comes from the pharmaceutical rep and so on. look, and I acknowledge, you know, doctors, GPs in particular are so busy, they don't have time to explore lots of these areas. So I think their patients are going to educate them more than anything.

Dr Penny Figtree
Yeah, yeah, that's what I see. they'll go, she was a bit worried or they looked a bit worried or I actually had a letter from a kidney doctor who was not cross with the person being on the diet. So I was happy about that. But they said, I'll watch the LDL carefully. Yeah, no, that was all I worried about. But and I think we'll the patients will teach them. So that's my experience. So initially the doctors going home and then they go, okay, this is interesting. So hopefully if they're a sensible human they will slowly see this and perhaps see it a few times and it'll be normalized and then they'll just slowly just soak it into their heads and be on board but if your doctor is very much against it I wouldn't bother pushing it you know your job isn't to convert them but you don't have to do what your doctor says so often I'll see on Facebook people go my doctor wants me to take this tablet and I don't want to and I think why do you need to do it's not like a jail, you don't have to do, you don't have to do anything your doctor tells you. If you don't want to take your blood pressure pills, it's your choice, your body, you don't have to do anything. So you can go and listen and go, all right, thanks very much. And just get from the doctor, blood tests perhaps that you need and just be quiet about it and show them, but don't bother having an argument because it's not your job to convince them. And it'll just make you cranky. And I think actually that was one of the other points I wanted to say is... if you're having trouble sticking with low carb or friends are pushing saying don't be stupid, you need a supportive community and that would be a Facebook community that's a nice one like your community that you have. Not a crazy one because there is pretty crazy one. So just a nice one that's moderated like yours. And you can say, I went to my doctor and they said this and then you'll have all these friends who are going to jump on and.

and you'll feel normal. Because you can go out into the world and feel weird, but that group will tell you, actually, I'm normal and they're weird. So those tea room people are weird and you are normal. And so that I think is important. Because even me as a doctor, I'll be in my low carb bubble and I'll go, yeah, it's all good. And then you go out and you go, I'm a bit crazy. No, I'm right. I'm right. And they're wrong. Because...

They're weird, they're looking at it so differently. It is all just about the pills. It's just, I'm thinking I'm gonna go to an obesity conference for normal doctors and just to see how they think, just to.

Now you'll get too angry. You'll get angry.

Dr Penny Figtree (49:10.73)
It'll all be about cutting out the stomach.

Yeah, exactly. And then you'll have all the muffins for morning tea and things like that. Yeah. Look, we better get on to a few questions. We're running out of time. We've got a handful of questions. So the first one, Penny, is I'm pre-diabetic and I've been on the Defeat Diabetes Plan since late May. And I commonly experience problems with my bowels and incomplete emptying. What can I do to improve that? Because generally, mean, a low carb diet improves bowel... doesn't it really? what about in this case, what advice would you have for this person?

Well, yes, I'm commonly giving advice. So often on a low carb diet, what you'll find is you'll get a bit dehydrated because when your insulin drops, you lose a bit of salt and water in your urine, which makes you a bit dehydrated. So your body grabs the water from your gut and it makes you constipated. So strangely enough, it's usually due to low salt. So I don't know what your blood pressure is, but most people do not have a problem with salt and their blood pressure is fine.

So for my patients, I would be number one saying add salt to food. And sometimes you need two teaspoons a day. I'll give them a little electrolyte mixture, which is two teaspoons of salt, two teaspoons of light salt in a drink bottle and sip on it slowly through the day to replace your salt. Or you can buy fancy supplements like LMNT, which is just a salt substitute. So adding that salt, and I see really sick people with chronic kidney disease and I'm still telling them salt.

Dr Penny Figtree (50:45.134)
Another way might be like a chicken stock cube and have two of those a day in hot water because that's salt. And then just check your blood pressure a couple of days later at the chemist and make sure you're not one of the rare people in whom their blood pressure goes up with salt. So number one, add salt and water. Number two, magnesium citrate. So I tell people to get magnesium citrate.

The Swiss brand at the supermarket is citrate. So you just take two of those a day. And the citrate part helps you go to the loo. And thirdly, there's nothing wrong with some psyllium husks or metamucil if you want to. And with that, my three big steps. But fourthly, sometimes adding MCT oil will help as well. But usually it's just more salt and a bit of magnesium citrate.

and checking that blood pressure. But it's weird, the salt is a huge thing, the electrolytes, and it's so hard to get your head around. On this diet, I don't hold onto salt, so I need to add more salt. It's like opposite, just do everything the opposite.

Yeah, the salt thing is huge, think. I have a lot of salt in my bone broth in the morning and salt in all my food. I use the new Australian ones, they're terrific. And I'm into no longer exporting to Australia. There's one called Sodie, which is available on our website, our Defeat Diabetes website, our shop.

And I find that really good because they've got sodium, potassium and magnesium. So they're terrific.

Dr Penny Figtree (52:21.902)
Yeah, yeah, so Peter tell me how much salt are you adding what's your salt?

Well, I probably add, well, as I said, I have cup of bone broth first thing in the morning. So I'm pretty liberal with the amount of salt I put in that. I don't measure it out, but it's probably half a teaspoon or something like that. then eggs, I have a lot of salt on my eggs and salt on my meat. And then I'll have an electrolyte drink during the day, especially on hot days, I might have two and so on. So yeah, I guess I'm just every chance I have to add salt.

And as we know, particularly when you're starting off on your low carb ketogenic type diet, you get this keto flu that for a week or two you don't feel that great maybe. And that seems to be due to low salt. But as you said, Penny, we've been told for 30 years, salt, salt's bad, salt's bad. And the same as we've been told, saturated fat's bad. And it hasn't helped us at all. So it's hard to get your head around the fact that it's okay to have salt. We actually want you to have salt. But yeah, anyway.

Dr Peter Brukner
All right, thanks for that. What else have we got here? What about, you mentioned the CGMs, you mentioned a couple of brands, what's your favorite sort of brand? You want to talk about the differences between Dexcom and the Freestyle Libra?

Dr Penny Figtree (53:48.254)
Look out, the Freestyle Libra might be a bit easier to use when you first start out. It's one where you just stamp it on your arm. But it doesn't feed the Dexcom G6 is one you put on your stomach and it's a bit trickier to maybe get your head wrapped around because you've got to put numbers in to make it match. But it feeds continuously to your phone so you don't have to remember to tap it onto your arm. So I think try both, they're on sale, just quickly get them and see which one you like the most. A few people tell me that they want to calibrate it to their finger stick blood and the Dexcom you can calibrate it to your finger stick blood to make it more accurate. And that's important to note that at really high blood sugar levels, they're not as accurate. It's more down the bottom in the lower numbers that they're super accurate.

Just try, just have a go, who cares which one you do. They're amazing. If you've got pre-diabetes or diabetes, why have you not done this? It's going to be, this is, I think in the future when you see a doctor, this will be their first step. I want you to wear this, let's figure out what's going on. Hopefully.

Dr Peter Brukner
I think we're not too far away from having a watch that is able to monitor your blood glucose. And I think that'll be the real game changer. And I know they're all working on that at the moment and the technology is almost there, I'm told. that'll be a big help. Well, Penny, look, I think we've run out of time. That was fantastic. Before we go though, tell our listeners where they can find you and how they can find you. And yeah.

Where's your clinic?

Dr Penny Figtree (55:31.47)
How can I find me? Okay, well, I'm in Port Macquarie. I do do Skype consults. I've got a Facebook page, which is Dr. Penny Figthree. And I'm on Twitter. That's where I'm always having fights at Penelope Figthree on Twitter. That's where the science is. I love that. And then there's my website. You can reach me through there. I'm planning a little course attached to it to make it simple. I always feel like... the internet makes it so confusing that doesn't need to be confusing. But basically my website or, you know, Facebook.

Dr Peter Brukner
Great. Okay, well, thank you. No, good. If people are looking for some great advice, I mean, as you say, you do, you do telehealth consults and so on. yeah.

Dr Penny Figtree
On page, my Facebook page, I'll always post latest science or things that I'm currently reading about. Thank you, Peter, for having me.

Dr Peter Brukner
Penny, it was a pleasure and we really appreciate it. We'll get you back on because there are a billion other topics that we'd love to talk to you about. for the moment, thank you and thank you all for listening and we'll see you next time.