Dr Ron Ehrlich talks with Dr Laureen Lawlor-Smith about reversing type 2 diabetes and chronic illness through low-carb and ketogenic diets.

Show Notes

• Dr Laureen Lawlor-Smith website – Low Carb Keto Health
• Dr Peter Brukner Unstress Episode on Defeat Diabetes
• Dr James Muecke Unstress Episode on the future of diabetes treatment
• Dr Tabitha Healey Unstress Episode on practitioner burnout

Timestamps

[00:00:00] – Introduction to the episode and guest, Dr Laureen Lawlor-Smith
[00:06:52] – Dr Laureen Lawlor-Smith’s journey from conventional medicine to low-carb and ketogenic diets
[00:10:09] – Personal health transformation and impact of low-carb nutrition
[00:19:37] – Reversing type 2 diabetes through dietary changes
[00:26:39] – Difference between ketosis and ketoacidosis
[00:30:12] – Using ketogenic diets to manage neurodegenerative diseases
[00:38:52] – Managing medications and patient care on low-carb diets
[00:43:05] – Final thoughts on rethinking conventional healthcare approaches

Dr Laureen Lawlor-Smith on Reversing Type 2 Diabetes

Dr Ron Ehrlich [00:00:00] Feeling stressed, overwhelmed. It’s time to Unstress your life and focus on controlling what you can control. I’m Dr Ron Ehrlich, host of the Unstress Health podcast, inviting you to join the Unstress Health community and discover a holistic approach that helps you more effectively face the daily challenges of our modern world and effectively recover each and every day. Unstress Health is here to provide you with advice and support that is independent of industry and influence and influence. That’s easy to miss but difficult to ignore. Our focus is on building mental fitness. Your mind can be your best friend or your worst enemy. Mental fitness is the key. Our three phased approach Target mindset Whose positive intelligence quotient and move from self-sabotage to self-mastery. Secondly, the challenges We redefine what stress means in our modern world. And thirdly, Recovery master the five pillars of Health. As a member of the Unstress health community. You’ll turn obstacles into opportunities with expert led courses, curated podcasts, personalised health assessments, supportive community, and much, much more. Join Unstress health today and together let’s not just survive but thrive. Click on the link below or visit unstresshealth.com. Well, there are two stories that I’m very interested in pursuing. Two A lot in a lot more detail. One is public health, which is what this whole program is about. But as I’ve moved into workplace wellbeing over these last couple of years, it’s come to my attention that burnout is a problem. And burnout is characterised by the acronym D, i e. People feel disengaged. That’s the they feel ineffective. The I and A is they are exhausted. And it is rather sobering to learn from our previous podcast with Dr. Tabatha Healy, an oncologist who now specialises in health coaching for the medical profession. When she shared with us rather disturbing statistics of 44% of doctors are burnt out and 60% of nurses. Now, when you juxtapose that against the epidemic of preventable chronic degenerative diseases, you start to get an idea of how these two stories may be connected and what could be more disengaging and feeling ineffective than being in a practice which, year after year after year, you have a waiting room full of people who really are coming in to have a prescription written. And, you know, they’re going to be back in a couple of months for a repeat of those of those prescriptions. And it must be a little bit soul destroying, particularly when you follow the so-called public health advice given to us by authorities. And you think, God, I’m doing everything I possibly can, and yet my patients, it’s not making any difference. And all I’m doing is writing prescriptions and that is a soul destroying thing. Now, I have to say that I know many doctors who are practising that kind of medicine. They call it allopathic medicine. It is perhaps more accurately referred to as prescription based medicine, but the average appointment time is 10 to 15 minutes, maybe even less. They write a prescription. It’s sobering to learn that 95% of antidepressants prescribed in this country, 1 in 6 Australians have antidepressants are prescribed by general practitioners in a 10 to 15 minute appointment. So that gives you a hint as to the way allopathic medicine is practised. And what I was going to say is I know many practitioners who do that, and I also know many integrative practitioners that really look at the root cause of disease and try to address that. And the thing both practitioners have in common is they truly want the best for their patients. So I want to say that right up front because it’s a really important point. Both practitioners practising very different forms of medicine want the very best for their patients and if the evidence is anything to go by, there is a very serious problem with the way the vast majority of doctors are practising medicine. I would say unwittingly the medical profession of the last 40 years, and I say this unwittingly, they have presided over the worst epidemic in preventable chronic diseases in human history. However, there is an alternative for both doctors and patients, and it’s a win win win all round. Apart from the pharmaceutical industry, which is a loss, but that’s another story. My guest today is Doctor Laureen Lawlor-Smith. Now, Laureen graduated from medicine in 1983, has spent almost four decades in general practice. Now, two and a half years ago, she left mainstream general practice and now practices full time, utilising low carbohydrate and ketogenic nutrition to assist patients who can be helped by this approach. Now, there is a personal story here, and I don’t want to spoil it for you, but it’s an it’s a very compelling one. It’s clearly not an uncommon one, and yet it’s an incredibly inspiring one. And this is inspiring not just for patients, but if you are a health practitioner, a medical practitioner, practising allopathic medicine or your doctor is, you should be pointing them to this episode because it can be a game changer. It has been a game changer. She co-wrote the guidelines for managing Type two diabetes with Therapeutic carbohydrate reduction, which were adopted by Diabetes Australia and the Australian Diabetes Society in 2023. I personally am very proud to have supported defeat diabetes in this endeavour as well. We’ll be talking to Dr. Peter Brukner, the world famous sports physician. And we have also spoken to Dr. James Muecke, former Australian of the Year in 2020, who has championed both, have championed this cause, and Lorraine has been at the coalface writing these things. And she tells a very compelling and inspiring story. I hope you enjoyed this conversation I had with Dr. Laureen Lawlor-smith. Welcome to the show, Laureen.

Dr Laureen Lawlor-Smith [00:06:52] Thank you very much for having me. I’m excited to be here.

Dr Ron Ehrlich [00:06:55] Lorraine, you’ve been in practice for quite a few years and and like many patients, a person’s health is often a turning point in their personal and professional lives. And let’s face it, doctors are human, too. Did that happen to you?

Dr Laureen Lawlor-Smith [00:07:13] Yes, completely. Happened to me, also happened to my husband, who’s also a GP. So I’ve been. I graduated in 1993 and I’ve been in general practice for 38 years, owned by General Practice. And I’ll do that from a personal perspective. I’ve had problems with my weight all of my life. I’ve been on and off various diets, and I’ve followed the dietary guidelines, which is eat less, exercise more focus on a low fat diet. And essentially I had lost weight and I put that back on again. I’d lose weight, put it back on again. And I just got fatter and fatter and fatter. And about eight years ago, I was obese. I had pre-diabetes, I fatty liver, I had sleep apnoea, and I’d pretty much given up because I knew that eating less and exercising more doesn’t work for my own experience and for patients experience, and I just didn’t really know where to go with it. I just felt trapped. And it was at that time that I came across low carbohydrate eating and I went off to a low carb diet on the campus in Sydney, and I met the dietitian I worked with. Now Nicole Moore, and I started a low carbohydrate diet. And, you know, I’m a more greater lifestyle, ketogenic diet and I lost weight. My fatty liver went away, my pre-diabetes went away, my sleep apnoea went away. And for the first time in my life, I felt like I had some sort of control over both my appetite and my eating. And subsequent to that I started using low carbohydrate nutrition with my patients and I discovered that diseases that I had previously told patients were irreversible and aggressive type two diabetes are in fact reversible. And the a lot of the diseases that I was treating that I thought were long term diseases like high blood pressure and then liver were also just manifestations of insulin resistance. And we reversible too. So two and a half years ago, I left general practice and I now went three days a week in low carbohydrate and ketogenic nutrition. And I do. That is because that’s what people get better. So that’s my little personal life. My and my husband Graham developed Parkinson’s disease, early onset Parkinson’s disease in his early 50s to about 12 years ago, and we became aware of the daughter and ketogenic diet to neurodegenerative disorders, including Parkinson’s. And he’s now on a ketogenic diet and he’s doing fabulously well. So for someone who’s had Parkinson’s disease for 12 years, if you met him, you wouldn’t take it at all. He’s on one medication and he’s very, very, very stable. So it was like I was honestly like experiencing a miracle, both personally, but also professionally.

Dr Ron Ehrlich [00:10:11] I mean, it’s breathtaking. That story is breathtaking enough for one practitioner, but let alone collectively with over, I’m guessing, 60 years at least, of clinical education and practice and with a with a whole list of diseases that many people will be very familiar with and be familiar with the advice they have received from their doctors to hear this. This is why I’ve been so looking forward to talking to you, Lauren, because I kind of suspected this was a story. Well, it’s it’s such an important story on so many different levels. You know, I mean, presumably this wasn’t just you going to university. You guys had both been through continuing education through that 30 year period.

Dr Laureen Lawlor-Smith [00:11:03] Absolutely. And the problem is, it’s the way that all of is treating diseases is still what’s taught. You know, low carbohydrate diet to become a little bit more mainstream. But I would suggest the majority of practitioners still frown upon them and don’t consider them to be first line in terms of management. I mean, I had a patient with type two diabetes in this morning and, you know, type two diabetes is a disease of insulin resistance is a disease of carbohydrate intolerance actually reduced to carbohydrates. You become more insulin sensitive and you can control your diabetes much better, if not reverse it. And she’s having a fight with her endocrinologist who’s saying that she thinks she needs to eat more carbohydrates. So her process is increasing carbohydrates and increasing your insulin dose, increasing carbohydrates, increasing your insulin dosing. Meanwhile, she’s putting on weight and getting sicker. So I think one of the most profound experiences was the sense of distress and guilt that I felt, because, you know, clearly for a considerable period of my practice, I’ve been doing patients harmed by the advice I’ve been giving them. And yes, I’ve been following the guidelines, but I’ve been making them worse. And that’s pretty sobering. It’s more sobering to know that we continue to do the same thing. If you take a look at fatty liver disease. Fatty liver disease is a disease of insulin resistance. It was not it was not published about when I went through medicine. So I graduated in 1982, was not described until 1980. So fatty liver disease is a disease of insulin resistance. We tell people that they need to treat the fatty liver disease by decreasing the fat intake. It’s got nothing to do with fat. It’s all the excess glucose that can’t be managed by the body because of the insulin. Resistance just gets converted in fat and stored in the liver. So, you know, we we still say to people, decrease the amount of fat in you died and it doesn’t work. Whereas drop your carbs and you can reverse it in 4 to 6 weeks. In every single patient, if they leave it as it is now, 1 in 4 Australian adults has got fatty liver disease. An increasing number of Australian children have fatty liver disease. It’s a leading cause of liver fibrosis and cirrhosis, the leading cause of liver cancer. It’s the fourth most common cause of having to have a liver transplant in Australia. It’s not one cause in the United States. And this is a modern disease which has been brought on by our dietary advice, eating lots of ultra processed foods, and we continue to manage it in completely the wrong way. Apologies. I’ve been offered a bit of a change.

Dr Ron Ehrlich [00:13:43] No, no, no, no. You look, this is actually a theme we’ve pursued on this podcast several times, and it’s always it’s always great to hear it first hand from not only in the trenches, but somebody who’s been suffering from all the diseases that they’ve been treating. And I know that type two diabetes used to be called late onset diabetes, but I think that’s true of children now, too.

Dr Laureen Lawlor-Smith [00:14:09] Absolutely. It’s an increasingly an issue in in children. So the incidence of type two diabetes is a double since I’ve been in practice. So that’s about 13% of Indigenous Australian adults have got type two diabetes. It’s 1 in 20 Australian adults and pregnant women. It’s 1 in 6 pregnant women get gestational diabetes. And if you’re an Indigenous Australian it’s 1 in 4. Like this is this terrible epidemic which has been created by the advice we’re giving people and we get what we do, what we do we do. We don’t change the advice. We just prescribe all medication.

Dr Ron Ehrlich [00:14:43] I mean, the the whenever people think of nutritional stress and it’s a word we’ve used on this program and I’ve used in my practice for many, many years, people always think of fast foods and pizzas and all that. But I’ve always considered the greatest nutritional stress to have been the food pyramid, which morphed into the food plate, which now morphs into the Australian healthy eating guidelines. That is the. The greatest nutritional stress on society. How did we get it so wrong?

Dr Laureen Lawlor-Smith [00:15:15] I think if you look, I think we based our dietary pyramid on guidelines on what happened in the United States and what understanding was that was about politics and industry. So there’s two things that the food pyramid got wrong. Number one, the bottom of the food pyramid is carbohydrates. And we’re told we should have several serves of carbohydrates a day. But the second thing we were told is that we should stop eating animal fats, saturated fats, and we should replace them with, say, those polyunsaturated seed oils. And I think those two things together have both been problematic. So, you know, we’re eating lots and lots of carbohydrates, but people are focusing on low fat food, which tends to be higher in sugar. But also people are eating processed fats, which were actually only invented at the turn of the century, which are associated with a higher incidence of inflammation, but also a high higher incidence of insulin resistance. So the food pyramid is just completely wrong. And you know what my concern, rewriting the dietary guidelines again, my concern is that a lot of the people writing the dietary guidelines have conflicts of interest. And as harsh as this may seem, I think if you’re writing the dietary guidelines, you should be receiving no money from that from the food industry and should be receiving no money from the pharmaceutical industry. Otherwise, you’re conflicted. But that’s not the way things run. You know, people who do have conflicts of interest do get put in these positions. And yes, I declare them. But I think it’s an amazing person who can have such conflicting interests and not let it affect the way they make decisions.

Dr Ron Ehrlich [00:16:54] Or affect their livelihoods. But but I guess there’s another aspect to this, which is not just the guidelines, but it’s actually seeing the results at the coalface as the patient sits opposite you. And I’m just I know we had a conversation before we did this interview. You were you’ve got involved in sitting down round table. You’re based in South Australia. And as you’ve already alluded to, endocrinologists after they after a patient is seen as a GP, they’re often referred to the specialist to manage their type, their diabetes, and that’s often an endocrinologist. And you’ve had some interactions with the speciality. How was the risk, how was this incredible results that you had got yourself and were observing in your patients? How exciting, how thrilling to be reversing disease. What could be better as a doctor? How was that received?

Dr Laureen Lawlor-Smith [00:17:53] I think the endocrinologists are looking for the large double blind can’t be double blind, but the large randomised trial comparing people on low carbohydrate diet with people not on all that carbohydrate diet. And in the absence of that, they’re pretty sceptical. The problem you’ve got is that people choose what they’re going to eat. You know, I can say to people, well, I think you should decrease your carbs, but if you don’t want to do it, you’re not going to do it. So if you have a you know, there’s a guy called David, Dr. David Iman, who is a GP in the United Kingdom, and he, I think, has got the the longest term data of anywhere in the world published or anywhere in the world basically for the last ten years every type to diabetic and he’s in his practice has been offered the opportunity of trialling a low carbohydrate diet and less than 50% of them chose that. And I think that’s probably what it’s like in the real world. There are people who would rather take the tablets and change their diet, but you know, of that 50%, half of them achieved a type two diabetes remission at ten years. So that’s 50% type two diabetes remission at ten years or over. Overall, I think it’s 23% over the whole group, including the group that didn’t undertake a low carbohydrate diet. Yeah, that’s that’s incredibly powerful. If I had a drug that gave you for the whole population 23% type two diabetes remission at ten years, I would be a very rich person. I would probably have a Nobel Prize. But this is a dietary change. He he hasn’t he hasn’t won any awards. But the problem with that sort of information is it’s not good enough for the American ologists. They really want the randomised controlled trial.

Dr Ron Ehrlich [00:19:39] So so yes, you have you still got me here. I’m just dumbstruck. That’s why you may have thought that the thing froze because I’m just kind of almost with my mouth open, amazed that even a patient sitting in front of you who you’ve tried this on and comes back and all the stats stack up, you are seeing a remission before your very eyes. But that’s not enough.

Dr Laureen Lawlor-Smith [00:20:04] No, it’s not enough. So the inequalities outside. Mostly still step sceptical. I mean, I was privileged enough to be able to get together with Professor Steve Stripe’s here in South Australia, who’s an addictionologist, and together we put together a set of guidelines for using therapeutic carbohydrate reduction in Talk to Diabetes, which have been adopted by Diabetes Australia and Australian Diabetes Society. So I think that’s giving it a little bit more legitimacy. And in particular, the endocrinologists are concerned about what the potential downsides of these dietary changes are. And so we cover off on all those concerns as well. So it is becoming more mainstream, but I’d consider it to be largely fringe. You know, I would suggest, I don’t know, probably 95% of GP’s probably on on board with it and I’d say the majority of endocrinologists. So for example in South Australia we have one endocrinologist who practices low carbohydrate medicine and they would use the standard Australian dietary guidelines.

Dr Ron Ehrlich [00:21:10] Hi, Dr. Ron. Here it. I want to invite you to join our unstressed health community. Now, like this podcast, it’s independent of industry and focuses on taking a holistic approach to human health and to the health of the planet. The two are inseparable. There are so many resources available with membership, including regular live Q&A on specific topics with special guests, including many with our Amazing and Stress Health Advisory Panel that we’ve done hundreds of podcasts over listening to with some amazing experts on a wide range of topics. Many are world leaders. But with membership, we have our own stress level podcast series where we take the best of several guests and carefully curated specific topics for episodes which are jam packed full of valuable insights. So join the Stress Health community. If you’re watching this on our YouTube channel. Click on the link below or just visit on stress health.com to see what’s on offer and join now. I look forward to connecting with you. I mean, apart from a reduction in revenue for the pharmaceutical industry, what are the other adverse reaction? What are the other, you know, side negative side effects of a low carb diet? I mean, I know there’d be less medication on many different fronts and that could have a certain impact on on revenue. And I can understand that would be a very negative thing. But but what are the what are some of the other negative side effects of of a low carb diet?

Dr Laureen Lawlor-Smith [00:22:54] I’ll just pick up on you and get it just right. So, David, Almonds. So I have $100,000 Australian a year. In his small general practice on diabetes medication in his patient groups. It does save a lot of medication. The problems with low carbohydrate diets only come if you’re on medication. So if you’re on a medication that low carbohydrate diets are going to decrease blood sugar. If you’re on a medication, that’s also going to decrease blood sugar. There’s a risk you blood sugar might drop too low. You might have a hypoglycaemic episode. So drugs which decrease blood sugar, which include a group of drugs called sulfonylureas and insulin, they need to be adjusted downwards. And that’s pretty simple and straightforward. The second group of drugs is drugs which reduce your blood pressure. So you got a low carbohydrate diet in general, your blood pressure will drop. And this means that a lot of people don’t need a blood pressure medication anymore. And if the patient isn’t aware of that, we say, okay, let’s drop carbs down and don’t talk to him about the blood pressure. Then they may in fact become light-headed and fall over and come to harm. So again, for all our patients, we get them. For most of them, I get them to measure their blood pressure at home. I give them a date prescribing regime. So as their blood pressure drops, they can they can decrease it by operation medication. The third group of drugs is there’s a group of drugs which increase ketone production. So low carbohydrate diet, ketogenic diets increase ketone production. In general, a low carbohydrate or ketogenic diet will not give ketoacidosis. So ketoacidosis is a disease where ketones are high and the blood is acidic and it’s a severe illness potentially fatal. It usually occurs in type one diabetics who are not enough. Insulin generally doesn’t occur in people. Type two diabetics are on a low carbohydrate diet, except for when you add in a drug which also increases ketone production. So there’s a group of drugs called Delta two inhibitors, which work by causing the leakage of glucose through the kidneys. So you lose about 20g of glucose through the kidneys are dying with these drugs. They also increase daytime production. And these drugs by themselves in patients with type two diabetes can produce ketoacidosis. So that was very long winded. But if we start with a diet that could increase ketones that we add in a drug which can increase ketones, that combination increases your risk of type two acidosis. And again, this is managed by it. There’s a couple of ways you can do it. We used to just stop the CO2 inhibitor and a diabetic control largely and just monitor them. Endocrinologists weren’t happy with that approach only because these drugs also are quite useful for renal failure, not fighting. Now what we do is we maintain the patient on them and we talk to them about sick day management plan and if they need to stop them and basically make them acutely aware of the fact that this might be an issue and usually get them to check ketones as well. So in summary, drugs that drop blood sugar, that drop blood pressure or increase ketone production all need to be managed in people who are on a low carb diet. And that’s really simple and straightforward to do. And apart from that, a for some really rare inborn errors of metabolism, low carb eugenic diets are very safe things to do.

Dr Ron Ehrlich [00:26:25] And I know you’ve mentioned ketoacidosis a couple of times there, and I think I have a sense that many doctors don’t fully appreciate the difference between ketoacidosis and ketosis. Is that your observation?

Dr Laureen Lawlor-Smith [00:26:39] Completely.

Dr Ron Ehrlich [00:26:41] So just give us just give us ketoacidosis and ketosis 1 to 1 definition. What’s the difference in case a doctor is listening to this and just needs a little bit of a refresher?

Dr Laureen Lawlor-Smith [00:26:52] So it’s ketoacidosis is when you produce excessive quantities of ketones and you have an acid base imbalance in your blood to blood becomes quite as we got it. That’s dangerous and potentially fatal. Ketosis is a normal physiological state. So when you are burning fat for fuel, one of the by-products of burning fat for fuel are ketones. And in fact being in ketosis is our natural state. So newborn babies are in ketosis, breastfed babies. You are in ketosis. Throughout our two many years of being hunter gatherers, prior to the agricultural revolution, we were all in ketosis all of the time. So it’s a natural state. It’s not associated with an acid base balance. In fact, you could have incredibly high ketone levels and not be acidic and be completely full on. Now give you an example. For example, we treat people with neurodegenerative disorders. We also treat people with a sort of brain tumour called God Bless Dimer, which is an almost universally fatal brain tumour. In these people we need to get really high ketone levels. And we get people with shit on levels of four, five and six. They don’t have excessive acid production. They’re completely healthy. They feel completely fine. It’s all to do with that acid base imbalance. So you can’t diagnose ketoacidosis just on ketones. You need to actually look at acid base balance as well. And the difference is if you’re in ketosis, you feel really well, Your brain’s functioning well. You feel great. Whereas if you had ketoacidosis in general, you vomiting if you’re really unwell. So most people don’t understand the difference. And most people would say if you ketones right, it’s like 1.5. my god, this is a huge problem. But for our patient group it is absolutely not a problem. In fact, it’s a therapeutic target because we want them to produce lots of ketones because the ketones have a therapeutic effect on their brains.

Dr Ron Ehrlich [00:28:45] It’s interesting, isn’t it, because it’s well known and it’s the basis of Pet scans that cancer cells love glucose. So I think they inject radioactive glucose and the radioactive glucose will rush to the cancer because cancer loves glucose. So it just kind of seems almost too simple to suggest you shouldn’t be feeding a cancer cell.

Dr Laureen Lawlor-Smith [00:29:13] It’s interesting. I mean, it’s ketogenic diet to got evidence in various forms of cancers, but not all cancers. And again, the problem we’ve got is the funding for these studies comes from the pharmaceutical industry. And there’s no money to be made by advising people about QJ diets when they’ve got cancer. So there’s just a paucity of research. There is increasing research, but there is a paucity of research. So this gentleman in New Zealand and Hamilton, New Zealand, by the name of Dr. Matt Phillips, don’t know if you’ve heard of him. He’s a neurologist. Ideally, you should have a chat to him. He’s he’s just an amazing, amazing man. And he’s one of the people in the world who’s doing the majority lot of research on ketogenic diet. So he’s got evidence from Parkinson’s disease, Alzheimer’s disease, Huntington, Korea, a motor neurone disease and Alzheimer’s disease. And he’s also doing he’s in the middle of a big study treating people with God bless diamonds.

Dr Ron Ehrlich [00:30:13] Wow. Well, I mean.

Dr Laureen Lawlor-Smith [00:30:17] No, I’m sorry. I was going to like, it is a death sentence. Like it’s a death sentence. And, you know, I have one patient with training at the moment and he’s down the track. He should have had a recurrence. He doesn’t have a recurrence yet. I can’t tell you what’s going to happen in the future, but this gives people a lifeline. It’s just an amazing you know, I come to work. I love coming to work because I really feel like I’m helping people. I’m offering people treatment that might not be available elsewhere. But a lot of the time I just see people get better. They they feel better. You know, they lose weight if they want to lose weight. Their labs all get better. And they’re empowered because I have now got a tool that they can use to help them stay healthy.

Dr Ron Ehrlich [00:31:00] Now, now you’ve just said something that has piqued my interest, you know, particularly as a practitioner of 3538. Well well, you know, many years practice. You know, you love coming to work. And we did a program recently with one of your contemporaries down in Adelaide, Dr. Tabitha Healy, who has been talking about burnout in the medical profession. And the statistic of something like 44% of medical practitioners and 60% of nurses are suffering from burnout characterised by the acronym dodgy, disengaged, ineffective and exhausted. And here you are after 38 years, anything but burnt out. Why?

Dr Laureen Lawlor-Smith [00:31:48] Seven years ago, I was burnt out. I really didn’t know how much longer I could do it for. One of the beautiful things about general practice, long term general practice in the same area is you develop long term relationships with people. Now you see people over decades, you know, you know their parents, you know their kids, you know their grandkids. You know what the strengths are. You know what their challenges are. And, you know, you develop a deep investment in their well-being. And quite frankly, watching people. Get sicker and sicker in spite of what you’re trying to do. And being on more and more medications is just soul destroying. It’s really difficult. Yeah, I was I was burnt out. I think this if you look at General Mills, a lot of resources like, you know, disease dying. But you know, general practice is because of the epidemic of chronic illness that we’ve got. It’s just become a really difficult place. And this is, you know, sometimes this sense of no matter what you do, things don’t get much better. So, you know, we’re down down to 11% of graduates are choosing general practice. We need 50% of graduates to choose to in practice just to replace the ones that are leaving. And you probably everybody know it’s really hard to get a GP appointment. Yeah. And it’s been I think it’s it’s because, you know, a lot of people just don’t get better and that’s very difficult to take.

Dr Ron Ehrlich [00:33:12] And a lot of people don’t get better following the advice of the doctors like you were giving for so long. I mean that in itself must be soul destroying. I, I remember we did a program with Julia Rutledge, Professor of Psychology in New Zealand, on food for the brain kind of thing. And she said it’s perfectly natural for doctors to be sceptical and curious and sceptical. And my question to her was, at which point of the medical education process does that curiosity kick in? Is it only in third, second or third year when you’re studying pathology and pharmacology, or does it kick in in first year when you’re studying biochemistry and physiology because you’ve made the point about double randomised controlled trials, But we still do have the basic sciences, don’t we? Do they still count for something.

Dr Laureen Lawlor-Smith [00:34:06] I guess that they are. But I think, you know, when you’re a medical student you, you take everything I did, you take everything as gospel. And so I, you know, I came out of medical school and I was in idealistic and I thought, I think given all the information and all the knowledge and the skills I needed to change the world, and it’s not true. I think to some extent, unless you have a personal experience of ill health and the system failing you, I think it’s very difficult to make the leap because it is difficult. Making the leap from what I’ve been doing is harming people too, and this is something else I can do. So I think, you know, the people who are naturally slender and metabolically healthy don’t have too many problems. And they see all these patients coming in, putting on weight and getting diabetes. I think it’s much easier to think to blame that on the person rather than to actually sit back and saying, okay, you know, we’ve got. You know, the sense of obesity, for example, has quadrupled since I’ve been a general practitioner. It’s quadrupled. Like, it’s unbelievable. You know, we now have 1 in 2. Australians have got a chronic illness. Now 1 in 3 Australians have got two or more chronic illnesses. We’re spending 90% of the money that we’re spending on health, on chronic illnesses. It’s only if you really experience that yourself that I think you can look and say, okay, is what we’re saying wrong? And is there another way? And I think what fascinates me about the whole thing is, you know, everybody sitting back looking at this this absolutely absolute disaster that is our healthcare system. You know, it’s just, you know, being crushed under the deluge of chronic illness and nobody sitting back and saying, what’s causing all of this? This is really strange. You know, why have all these illnesses dramatically increased over the last four decades? You know, it’s not that the population’s getting that much older. You know, we’ve all not suddenly become lazy and gluttonous. You know, our environment is is changed and it’s time to look at the environment and tackle the environment. Tackling our food, environment and the rest of our environment say we can stop this from happening.

Dr Ron Ehrlich [00:36:08] Yes. I always wonder when I hear people argue that it’s because we’re getting older as a population. It doesn’t quite explain why children are now getting sicker as well. Because they’re not getting older. They’re still children, you know, I mean, they are children do get older. But listen, when we talk about low carb, this is another thing, too, isn’t it, that what is low carb to one person? If, for example, the dietary guidelines recommend 310g of carbohydrates a day and then they do a study on low carb in inverted commas, and it’s 200g of carbohydrates a day. And they say it doesn’t make much difference. And to other people, low carb means something else. What does low carb mean to you?

Dr Laureen Lawlor-Smith [00:36:51] So the the official definition is less than 130g of carbohydrates per day. And the sort of people we’re seeing who have that overweight or they have metabolic problems or they have some sort of health problem, it would be unusual to get someone to respond to less than 130g a day. In general, we would start at less than 70g a day for people who are who are really unwell, for example, have type two diabetes, will often start them at the ketogenic range, which is less than 20g of carbs. But I but the reality is everybody’s got a carb threshold. Everybody’s got a level at which the system is going to stop coping with carbs, and that depends upon your age and you know, what sort of damage you’ve done to your system before. So attitude is we tend to start pretty low. And then when people achieve what they want to achieve, we gradually increase the carbohydrates until I hit the point where they know that we was going to fall off. And in general, the person knows that themselves because when you’ve got insulin resistance, you’re hungry all the time. You crave carbohydrates, you really tired, you can’t lose weight and you’ve got brain fog. And what tends to happen is that that all goes away. As you increase your carbohydrates, all of a sudden your hunger kicks up and you feeling tired and you’ve got the brain fog back again. So you need to back off again. So that was a long winded, but not.

Dr Ron Ehrlich [00:38:16] In that group.

Dr Laureen Lawlor-Smith [00:38:18] The minority of people. You have to be a really fit, active young person to be able to cope with over 300g of carbs a day. It’s just not physiologic. So, yeah, it has to be less than 130. That’s the that’s a definition. But in general, you need to go significantly lower than that.

Dr Ron Ehrlich [00:38:37] And given that 1 in 2 Australians is suffering from a chronic illness, the management of the medications through this process is clearly a very important part of the patient management story, isn’t it?

Dr Laureen Lawlor-Smith [00:38:53] Completely. It’s it’s I, I spend the majority of my time doing prescribing, which is a joy. Yes, it is a risk. It’s it’s an unusual thing for me to prescribe something new. In general, I’m spending my time day prescribing and patients. I just love it. And, you know, sometimes it’s heartbreaking. Sometimes people come in on their just this huge list of medications and you really wonder how many of them are actually doing them any good and how many of them are doing them some harm.

Dr Ron Ehrlich [00:39:24] And how many of them have side effects which need to be managed by another medication. I mean, I’ve said it often, our health care system is a fantastic economic model. It’s just not a very good health model.

Dr Laureen Lawlor-Smith [00:39:37] I agree entirely. Yeah.

Dr Ron Ehrlich [00:39:40] Yeah. You you both you know, you mentioned your husband, who’s a GP, was diagnosed with Parkinson’s 12 years ago. And on a ketogenic diet, you wouldn’t even know he’s got Parkinson’s. He’s managing it well. You listed out your liver ops, OSA, obstructive sleep apnoea, diabetes, etc. etc. You guys are on a. Ketogenic diet.

Dr Laureen Lawlor-Smith [00:40:03] Yep, that’s right. A ketogenic diet.

Dr Ron Ehrlich [00:40:05] What what does that what does it study in the household that people don’t follow?

Dr Laureen Lawlor-Smith [00:40:10] So in general, we are both on time restricted eating. Principally, I mean I because I think it’s healthy for your metabolism but B, when you’re when you drop carbs, most people aren’t hungry in the morning. And I’m a big advocate. If you’re hungry and if you don’t, you’re not hungry, don’t. So we would I would have a black coffee for breakfast. Graham would have a coffee with some cream. And again, he’s he’s got a high metabolic rate the mean he’s also more active than the he’s a crazy cyclist so he’ll have a coffee with some cream he might have some in Quito would up his ketones.

Dr Ron Ehrlich [00:40:49] Just remind our listener what that was in C.

Dr Laureen Lawlor-Smith [00:40:52] Medium chain triglyceride oil just it can just buy coconut oil every supermarket’s got me in chain triglyceride oil and it’s it’s an exotic to an outside source of ketone so it heats up 50 times without ever having to produce ketones. And then so for both lunch and dinner, we’ll have a piece of protein which is usually usually animal protein 999 times out of 100 chicken meat, fish. And then we might have some vegetable. So it would be a salad or some vegetables, some cooked vegetables which are usually aboveground vegetables we might have for snacks. We might have nuts. I quite like beef jerky, Bob or beef jerky. I don’t get them. Applaud the grass-fed organic and taste fantastic. No additives. So I have some beef jerky. We might have some cheese for treat. We might have some some berries and some praying. That’s pretty much it. That sounds pretty boring, but it’s it’s great food. And we have things. We do things. Like I said, this was a lunch. I had a cottage pie, which is essentially a beef meat spiced with some mashed cauliflower mash on top taste. Great. You can do all sorts of different recipes. It’s pretty much a yummy diet.

Dr Ron Ehrlich [00:42:13] The, if you will, meeting really just is about to graduate and you graduate. What would you be advising her professionally? Professionally.

Dr Laureen Lawlor-Smith [00:42:24] I would I would be talking to her about carbohydrates. I’d be talking to her about the dietary guidelines came in just as I graduated. So I graduated in 83. They’d just come in. I’d be talking to her about the dietary guidelines and asking her to have a look at the science, which would have been very difficult then because there’s lots and lots of information about carbohydrates and saturated fats, particularly saturated fats, being okay in the diet. Now, I don’t know that there was that much in the literature, but I just talked to her about taking might be taking the dietary guidelines with a pinch of salt and maybe not taking the other guidelines at face value, maybe just having a think about whether they made sense or not.

Dr Ron Ehrlich [00:43:05] Lorraine, thank you so much for joining us today. Joining us tonight for sharing the story, which is pretty boring and I’m so glad you’re enjoying it. So much for joining us. So much.

Dr Laureen Lawlor-Smith [00:43:17] Okay. Thanks very much. I’ve really enjoyed the chat.

Dr Ron Ehrlich [00:43:19] Well, what a unique idea addressing the cause of disease and in the process taking so many boxes of accompanying diseases and side effects that you end up with a patient who’s healthy. I mean, how exciting is this? How inspiring is this and how rewarding is this? Here was Lorraine, who faced who was really facing burnout herself, experiencing very poor health with all the conditions she outlined outlined in this episode, and not only turned it around for her own health, there’s a win. Not only now finds medicine inspiring and enjoyable after almost 40 years in practice, there’s a winner. But inspiring patients or guiding patients to better health, there’s a win, and the overall effect on public health is a huge win. In fact, the only loser there is the pharmaceutical industry. And it may go a long way to explain why it is the big industry of that US $1.6 trillion a year and growing by the day. This is a great story and it’s nice to know that Diabetes Australia and the Australian Diabetes Society are embracing this low carb approach. And interesting also to hear of Lorraine’s husband, who is also a GP who has been diagnosed 12 years ago with Parkinson’s and on a ketogenic diet, which is a very powerful tool, particularly with neurological problems, but many of. This is you would barely notice that he has Parkinson’s. Such an inspiring story Was so great to speak to her. I hope this find you will. Until next time. This is Dr. Ron Erlich. They, well, feeling stressed. Overwhelmed. It’s time to unstressed your life. Join the unstressed health community and transform stress into strength. Build mental fitness from self-sabotage to self-mastery. And together, let’s not just survive, but thrive. Expert led courses, curated podcasts, like minded community and support and much more. Visit UN stress health.com today. This podcast provides general information and discussion about medicine, health and related subjects. This content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.