Ever wondered why cutting carbs has become the go-to dietary change for many looking to lose weight? In this episode, we dive into the science behind low-carb diets and how they can not only aid in weight loss but also help manage your weight long-term. Don't miss this exclusive conversation with Dr. Will Yancy, a leading weight management specialist with the Duke Health System, as he shares expert tips and knowledge on the subject.

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Show Notes:

- Benefits and Effects of a Higher Fat, Low Carbohydrate Diet

• Triglyceride and Cholesterol Impact:

  • High-fat, low-carb diet leads to decreased triglyceride levels.

  • Consuming more fats can increase good cholesterol (HDL).

• Addressing Metabolic Syndrome:

  • Diet assists with heart-related factors: mildly elevated blood pressure, blood sugar levels, and waist circumference.

  • Improvement in insulin sensitivity.

• Comparison with DASH Diet:

  • Low-carb plan potentially more effective in reducing blood pressure.

• Additional Health Benefits:

  • Positives seen in conditions like PCOS and Fatty Liver Disease.

  • Anecdotal reports of reduced migraines and reflux.

  • Some patients were able to reduce or eliminate certain medications.

• Quality of Life and Cost Benefits:

  • Reduced medication reliance means cost savings and enhanced feelings of control.

• Potential Benefits for Post-menopausal Women:

  • Weight management becomes crucial.

  • Low-carb can assist with abdominal weight gain seen post-menopause.

  • Potential for reduced hunger, fewer cravings, better sleep, and more energy.

• Conclusion:

  • Endorsement from Dr. Yancy of Duke Lifestyle and Weight Management.

  • Comprehensive weight loss approach mentioned, catering to different needs.

Key Takeaways:

A high-fat, low-carb diet can beneficially impact cholesterol profiles, particularly in reducing triglyceride levels and increasing HDL.

1. This diet positively addresses various factors of metabolic syndrome, enhancing heart health.

2. For blood pressure management, a low-carb plan can outperform even specialized diets like DASH.

3. There are wide-ranging health benefits from the diet, from managing conditions like PCOS to potentially reducing migraines.

4. Post-menopausal women, in particular, might benefit in terms of weight management and symptom alleviation.

5. The overarching message: While the low-carb diet is impactful, it's essential to find an approach that fits an individual's unique needs, as illustrated by the comprehensive offerings at Duke Lifestyle and Weight Management.

Transcript:

Welcome back to Better Than a Pill. Today I'm so excited to have Dr. Will Yancy here with us,

and Dr. Yancy is an Internal Medicine Doctor and weight management specialist with the Duke

Health System. Dr. Yancy is the director of Duke Lifestyle and Weight Management Center.

Formerly known as the Duke Diet and Fitness Center.

The Diet and Fitness Center was a residential weight loss program that served clients from all

over, and that's where I know him, that's where he worked together, and as I was involved in

during work with clients at the center, I got to see firsthand how many people benefited from Dr.

Yancy's work. Now the program has shifted, but it now provides the same comprehensive,

supportive weight management care to outpatients who live near enough to Durham, North

Carolina for outpatient clinical visits.

So welcome Dr. Yancy, and thank you so much for being here today.

Thank you Carrie, and thank you for inviting me. It's my pleasure to be here. I'm a big fan of

your work and I remember many patients coming into my clinic telling me how you had cured

their back pain or their shoulder pain, or their hip pain.

And, it's my pleasure to talk to some of your followers.

Awesome. Thank you so much again for coming on and I'm so excited. 'cause today we are

gonna talk about the power of a low carb diet for weight loss and weight management. So let's

get into this and just let's start off by, you know, tell us a little bit about how long you've been

doing the work you've been doing in weight management and when you began to become an

advocate for the low carb diet.

Of course. Well, um, I won't go back too far, but I do want to say that I started, um, having some

interest in fitness, particularly as an athlete when I was younger and paid attention to nutrition

somewhat at that point. But when I went to medical school, it became more of an interest of

mine, and so I paid more attention to nutrition, um, education when we had classes on that in

our.

Medical training and certainly fitness issues. Um, and then finally it was solidified when I went to

medical, to, um, medical residency. Um, and I moved away from the state I grew up in, in

Durham, North Carolina, and stayed in the state for all of my training until residency. And, um, in

residency we, um, we have a really, really impressive type of training.

Not only do we spend a lot of time on the inpatient side, Treating patients who are really sick,

but we also have an opportunity to treat primary care type patients, outpatients, um, who are

actually our primary care patients. And I got to know my patients for three years and recognized

that a lot of them I was treating, um, for health problems related to their weight.

So diabetes, high blood pressure, um, their cholesterol, their sleep apnea, their arthritis and

back pain. I was referring them to procedures and surgeries and starting medications, and I

thought, gosh, if I can just help them to lose some weight. And all of 'em struggled with it. Um, if

I could just help them with that issue, then I could probably reverse these other issues and take

away medicines and avoid procedures, some of which might have complications.

So that was my goal. And I returned to Durham, um, to, uh, do a fellowship in general internal

medicine, which was focused on learning how to. To do research. Um, and it turns out that when

I came to Durham, which at the time was known as the weight loss capital of the world, um,

many residential programs like the Diet and Fitness Center were in the, um, Durham area.

Um, people came from all over the world to lose weight, and Durham was known for that.

Nobody was doing research on, um, weight loss though. And so, um, there happened to be one

person who was just starting a research study and it was on the Atkins diet. Um, and that's how

I got involved in it.

That's awesome. And I love what you shared about, you know, being able to reverse people,

um, conditions and get them off their medications. That's really powerful. Absolutely. And, and

the story about how we got involved in the Atkins or low carb diet is also pretty fascinating, and

it's just by serendipity, I think.

Um, one of the, um, researchers in general medicine, uh, was uh, was taking care of his primary

care patients and. One of 'em said, uh, you know, what do you think about the Atkins diet? I'm

thinking of doing it. And he said, well, it doesn't sound like it's gonna work very well. You're

gonna eat a lot of fat. Um, I don't think you're gonna lose weight.

Um, well, the patient did it anyway. Came back and this doctor, Dr. Westman said, well, let me

check your cholesterol. 'cause I would think it would go high if you're eating a high fat diet. And it

hadn't gone higher. It actually looked better. So this happened with another patient and he

decided, I need to look into this as a researcher.

I want to find out what the evidence is. And didn't find much evidence. Um, so instead he called

up Dr. Atkins to ask him where his evidence was, and he said, I've got 6,000 charts of patients

that I've seen all of 'em doing really well. And Dr. Westman, like a good, uh, researcher, said,

well, we want a little bit more than that.

We'd like to see a clinical trial. And it turns out, Dr. Atkins. Teamed up with them to do the first

clinical trial, and that's when I came to Durham. So that's how I got involved in this. And that led

to subsequent research, many of which, um, were very eye-opening about this approach. Um,

and it kicked off my career in obesity research.

Um, and, and a lot of that research has been on this type of eating pattern. Wow. Well, thank

you for sharing that. I'm just curious, is this a diet that you personally use? It's a question I get a

lot. Um, and it's fascinating that people always wanna know what the, the, the speaker or the

researcher or the doctor is doing.

It turns out that I do keep carbohydrates pretty low. I've been fortunate most of my life that I

have not had a weight problem, and I think this is. Really important for people to understand that

as we gain weight, we probably tolerate carbohydrates less. And I'll talk about that more during

this presentation.

But what I've done is I've adapted my diet over my aging, um, and, and I've reduced my

carbohydrate intake with time and as I've learned more about this eating approach. So, um, as I

speak, Um, my wife and my daughter are probably preparing a low carb meal right now that I'll

enjoy after this presentation.

Um, and we, we do that, um, every night of the week, um, during the day, earlier in the day. I eat

more carbohydrates when I'll be burning more energy and when I'm more active and I'm able to

tolerate those carbohydrates. So I would say that I do practice this way of eating, but not as low

as some of my patients need to go, um, for them to have success and lose weight and keep it

off.

Right. Oh, that's great to hear. I love that. So you actually are actually practicing what you

preach to some degree, which is great. Yeah. Well it's, I think it's, IM it's important to realize that,

um, sugars and particularly refined starches, um, are not really your friend if you're trying to

manage your weight.

So, could you explain the science behind how a low carb diet aids in weight loss and, and

especially in like, women, women over 40? I'm just curious. Yeah, absolutely. So I think it's

probably the same for most people, to be honest with you. I don't know if there's a difference

between men and women. I've, I've actually seen success in both, but there are some reasons

why women who are over 40 or um, or postmenopausal might want to consider it.

But the, the, the mechanism, there's probably a few mechanisms. Um, as many people know,

there is some water loss with a low carbohydrate eating plan or a keto type plan. That's the term

that people are using nowadays, um, for this way of eating. Um, and there are some distinctions

there. Keto is usually, um, considered a very low carbohydrate plant when people have less

than 50 grams of carbohydrate per day.

To give you some perspective, a typical American has about. 200 to 300 grams of carbohydrate

per day. So this is a big change in their eating. Um, the, the, the foods that people eat on this

type of plan are proteins, like meat, um, or, or um, uh, beef poultry. Fish and shellfish, eggs and,

uh, leafy vegetables and other low starch vegetables.

Things like broccoli and cauliflower and celery and asparagus and, um, cucumbers, things like

that. And a few other foods like cheese and avocado, olives. Those are foods that are part of a

low carbohydrate plan. When people, uh, reduce their carbohydrates, um, and, and eliminate

those foods like pasta and rice, potatoes, um, bread, sweets, even fruit, and focus on the other

foods I mentioned, the, the.

The, um, the proteins and the vegetables, they're less hungry. Um, so, um, they don't eat as

much. And so they're, they're probably, um, that's probably the biggest part of why people lose

weight on this plan is that there's just less hunger and there are less food options for them and

so they eat less.

But there also is some water loss, as I mentioned. Um, and that happens. Probably in the first

week or two and then levels out after that. And our research has shown that effect. Um, and I

can go into some, uh, mechanisms behind that. And then lastly, and probably most importantly

is this way of eating reduces blood sugar and also importantly reduces insulin levels.

Um, so when you eat carbohydrates, They raise your blood sugar, which then in turn raises your

insulin level. And insulin is a hormone that not only tells your, um, your, your tissues to bring in

glucose, so it can use it as energy, but it tells it to store that glucose, that sugar and save it for

later.

Store it in fat. And it makes it really difficult to release energy from your fat. So it's a, it's a

process of storage as opposed to burning, um, your, your energy, your fat. Um, and, and so if

you're lowering that insulin level, then you're, um, you're more likely to be able to burn your fat

and to use up your energy and, um, and rev up that, that fat burning that you wanna rev up.

Interesting. And as we age, how does the metabolism of carbohydrates change? Great

question. So insulin resistance is the issue. And so this happens at young ages, but it happens

even more at older ages. So as people, um, eat carbohydrates and raise their blood sugar and

blood insulin levels, the body pushes away from the insulin.

It's a natural response of the body to any elevated hormone level is to resist it, to resist the

impact of it. And so the insulin doesn't work as well, which means that the pancreas in your body

that makes insulin needs to make more insulin to get the same effect and keep the blood sugar

under control.

And that is a vicious cycle. As people eat carbohydrates, the insulin level gets higher and higher,

the resistance gets worse and worse until eventually the blood sugar is. So high that the insulin

can't control it, and a person develops diabetes. Now that insulin resistance happens as people

gain weight.

Or as they eat carbohydrates. But it also happens, even if they're being careful with their food

intake, it happens more frequently as they age. And so the, the, the prevalence of insulin

resistance may be 20% in 30 year olds, but it's more like 50 to 70% in, in 60 to 70 year olds.

Um, so that's why we need to be more careful with our carbohydrate intake as we age.

Right. And I would imagine it, that's regardless of whether you are overweight or not. Correct?

Correct. So it's, it's, it's a, it's a combination of the two. So if you think about it, and, you know,

when, if you're, if you're combining two things, age and weight, then it's like a double whammy.

Um, but people who are older are gonna have more insulin resistance and people who are

heavier are gonna have more insulin resistance compared to their age max peers.

I understand. And so do you think, or is a low carb diet sustainable and is it a healthy option for

long-term weight management? This is one of the million dollar questions, and this is one of the

questions that I get frequently. Um, and maybe for the last 20 years, I've got it repeatedly. Um,

and, and the first response I have to that is it's very difficult for people to follow any diet I.

That helps them to lose weight. That's why people have started to think that diet is a four letter

word in the sense of a bad word, because it's the kind of thing they wanna avoid. It's also

thought of as a temporary type thing. What I talk about is eating plans, and I want people to

think about eating plans or eating patterns as a lifelong long-term solution to their weight.

Oh, Exactly, and any type of eating plan that is restrictive and helps people to lose weight is

difficult to maintain because our metabolism, our body fights against that. I think a low

carbohydrate plan can actually be more likely to be sustained in certain situations because

there's less hunger involved.

Um, whereas with a lower fat diet, a higher carbohydrate diet. Hunger can be a real issue. Now,

the reality is that our, our, our, uh, society, our culture is set up for a higher carbohydrate. Um,

eating pattern. And so that makes it difficult for people to sustain a low carb approach and think

about the foods that people typically enjoy.

Treats, of course, desserts, they're common sodas and shakes and things like that are sweet

and high in carbohydrate. And then a lot of the foods that people tend to binge on that are not

even sweets. Things like bread or pasta or rice in large amounts are high carbohydrate foods.

And, and so it makes it a little bit more difficult for people to follow a low carb approach because,

The, the foods that are most available are higher in carbohydrate.

Right? And, and so what about if somebody's doing the low carb diet and then they stop? Are

they going to gain that weight back? Yeah. And, and that's the same, that's the, that's the, my

response is similar to the last question. It's the same with all diet approaches. So, and if you, if

you are following a restrictive diet, a diet that's helping you to lose weight, and then you go back

to your old way of eating, then you'll gain weight back.

And actually, you know, a lot of them. The press now is about weight, new weight loss

medicines. It's the same thing with the medicines. So I like to think about these treatments as

similar treatments that we would use for high blood pressure or, or for diabetes. If we bring the

blood pressure down or the blood sugar down with medication and then we stop that medicine,

we would expect the blood pressure to go back up or the blood sugar to go back up.

Similarly, if we control the blood sugar, the blood pressure with an eating pattern. Or our weight

with our eating pattern. And then we went back to our old way of eating, then our weight, our

blood pressure, our blood sugar would go back up. Um, so it's important to maintain that way of

eating. Now a lot of people think about a low carb or keto plan, think, oh gosh, I can't continue

that.

That's really restrictive, but. Low carbohydrate eating can be on a continuum. There's a stricter

phase that helps people to lose weight, but you can add carbohydrates back in and make it

quite a, um, a, a, a, um, a balanced type meal or at least more variety to it. Um, And, and

maintain your weight. It's just a, it's really important to do it gradually, um, add the carbohydrates

back in slowly.

And in that way, I'm able to help people to maintain their weight loss. As you can imagine,

exercise is another important part of that equation, and you need to figure out ways to exercise

more. It's, not a great way to lose weight, but it is a great way to maintain your weight after

you've lost.

And of course there are other benefits. I'm sure you've. You've, um, brought up to all of your

followers. Yeah, no, that's great. And it's because it's a lifestyle, is what we're, what you're even

saying too. It boils down to our lifestyle and, you know, we're using the term diet or I am. And,

and it's really more, like you said, more of a lifestyle plan and it's adaptable. What I'm hearing

you say is like you can go more strict on the low carb if you need to lose weight, but you can

wean carbs back in.

Um, and, and that's good to hear. It's adaptable in many different ways. And when we're trying

to work with people on weight, which is really a difficult problem, we wanna figure out ways to

help them to, to adhere to the plan as best as they can. And sometimes that means making

some, um, compromises, um, and if that helps them to be successful.

Then, um, then it, you know, there's not a, a written rule that you have to follow it the same way

as everybody else has followed it. The other part of that, though, that I remind patients is we

wanna make sure it's working for you. And so you wanna monitor your weight, or if you're trying

to control your blood sugar, you wanna monitor your blood sugar, and see that it's actually

helping those issues.

That makes sense. And you know, even in, and I've, I shared this with on another episode not

too long ago, even in myself, I know that, um, if I have an apple, my blood sugar is gonna spike.

Right. Right. And I can feel that. But if I have it coupled with some walnuts or something, it kind

of is helpful.

Right, right. It's. So I've had to be mindful of those things myself, you know? Yeah, yeah. And

that's a, that's a hint that I give to a lot of patients is if you're having something that is a carb,

then have it with some other food that has protein and fat in it, and that balances out the carb.

You don't have as much of a spike in your blood sugar, um, because of way the way digestion

occurs.

And then you don't have as much of a spike in your insulin either. Right. And so I know you

touched on this a little bit, but what are some other misconceptions that people have about the

low carb diets that, that you, that you could address in, in those concerns that they may have?

Yeah, there are a lot of misconceptions about the low carb plan and um, you know, the first is,

The, the, the concern about the high fat content of it.

So, um, what's interesting about that is in our research when we followed patients and asked

them what they're eating at baseline before they started in our study and then asked them what

they were eating afterwards, they actually weren't eating a lot more fat than what they were

doing at baseline. Now what they were doing was reducing their carbohydrate intake quite a bit,

so their fat intake went up a little bit.

Their protein intake went up a little bit, but their carbohydrate intake went way down. So the

number of calories that they were eating was less. Um, but the amount of fat was not a lot more.

The other part about, um, this, that, um, people don't always think about is that they're not

necessarily eating, um, just saturated fat, which is the fat that people are the most concerned

about.

The concern for saturated fat is a little bit overblown, and research has actually shown that it's

not as concerning as something like trans fat, which fortunately is no longer in our foods. Um,

but uh, at the same time, whenever you're eating these foods that are higher in fat, you're

usually getting unsaturated fats along with saturated fats.

So there are only a few foods that are primarily saturated fat, and those foods can be avoided if

desired, or they can be balanced with other fats that are unsaturated fat. And the unsaturated

fats, um, are heart healthy. There's there, there's unequivocal evidence for that. And if so, if you

have a, a, a higher amount of unsaturated fat to balance out the saturated fat, that's gonna

balance out any risk that you might be concerned about from the saturated fat.

Right. So that's one of the misconceptions I would say. Um, another is that it's all water loss,

and I talked about that already. That happens in the first week. There's some water loss, um,

that's related to a few things. Um, you use up some of the stored carbohydrate in your system,

in your liver, in your muscle called glycogen, and that's stored with water, so you release some

of that water.

Um, it turns out that insulin does a lot of bad things in our body. Um, and, and, and so, Having

high insulin levels not only makes it difficult to lose fat, but it tells your kidneys to hold on to

water and to sodium. So you, you, when you start a low carb plan and you reduce your insulin

levels, you actually lose a lot of water and you lose some sodium.

Um, and so there's some water loss at the beginning in the first couple of weeks, and then the

body equilibrates to that and, and that's not an issue anymore. The weight that you're losing is

fat. Um, just, um, on, as an aside for that issue, um, they, um, people can get symptoms at the

beginning of a low carbohydrate plan that are sometimes attributed to what they call the keto flu.

Things like headaches, symptoms like headaches or muscle cramps or fatigue. Um, and those

can be avoided if you hydrate, drink plenty of water and you also replace the salt. And we often

just tell people to have a cup of broth each day for the first week, and that usually avoids those

symptoms.

And after that you don't need it anymore. Of course, we want you to keep drinking water. Um, so

those are two of the misconceptions. Um, some other misconceptions are that, um, it can cause

bone loss. We haven't had studies that show that that can happen. And in fact, several studies

have shown it's not an issue.

Some misconceptions are that it can cause kidney problems. Um, the reality is that if your

kidneys are working okay, then research shows that no matter what amount of protein. Intake

you have, which is, is the possible concern, um, your kidneys will continue to do fine. What we

don't know is if you have kidney disease to begin with, if it's an issue.

But there, there could be some benefits from reducing your blood sugar, improving your

diabetes with a low carb plan that offset, um, any issues that might be concerning the high

protein content of the plant. So those are some of the misconceptions. I wonder if there's some

that you can think of and I, I'm happy to talk about those too.

I think you touched on a lot of them and I think that, you know, the one that resonates right now

is, you know, I think fat, um, gets a bad reputation and, and you know, we need fat. And I

learned that, you know, later, not in school, that's not what we learned. Right. But, you know, we

need fat for our brain. We do.

Yeah. To protect our nerves. Exactly. That's what's protecting all of the nerves throughout your

body is fat and it's used. Yeah. It's part of hormones. Um, so it has many uses in the body.

What, what I think many people don't know and we don't learn in school, is that there are many

essential amino acids, which are part of proteins.

There are several essential fatty acids that we need. So those essential means that if you don't

get those from your diet, You'll have health problems and may not survive. Um, that means,

that's, that's what we mean by essential. It means your body cannot make them. It turns out

there's no such thing as an essential carbohydrate.

Um, those carbohydrates are not essential. Now, carbohydrates sometimes come with

essential, um, nutrients, like vitamins and minerals, um, or, um, certain other nutrients. But, um,

there's not an essential carbohydrate. Right. And, and that makes sense. And, you know, just

thinking too about carbohydrates being in, um, our, our fruits or vegetables like carrots or, or

things like that, you're able to still integrate those, um, into your life, especially if you're not doing

a strict form of the diet.

Correct. Correct. Yeah. And like I said, this is all on a continuum. So, so I teach patients that

we're gonna avoid even carrots when we're doing the strictest phase, but when we start adding

carbohydrates back in, when you're closer to your goal, then you might add in carrots, you might

add in sweet potatoes and small amounts, um, legumes or beans, um, and fruits.

And those are all foods with good nutrients in 'em. Good fiber, some of 'em with good protein.

They give you some, um, some variety to your eating and in small amounts can be a part of a,

a, what we'd call more of a moderate carbohydrate plan. Excellent. And I mean, to me it just

makes sense to have more protein because your body needs it and it fills you up.

And it doesn't sound like, based on what you said, that there's any real limit, um, assuming that

you have, you know, healthy kidneys. Is that, is that, is that correct? Yeah, I think what we know

from research is that most people can only eat so much protein, to be honest with you. If you

eat more protein than your body needs, then your body starts, say your stomach becomes, um,

uncomfortable and you don't want to eat more again.

That's part of the reason why this way of eating can help, um, when people need to lose weight

because they're less hungry. But, going beyond. With the protein intake, people really cut back

on their food intake. So, it's hard for people to eat too much protein. I can give

recommendations in our clinic when we see them on how much they should have.

Um, but in general there are, there's a growing belief that, uh, when people are trying to lose

weight or manage their weight, that protein is, is one of the most important nutrients to get. And

probably for two reasons. First of all, as you lose weight, you lose some protein. Along with the

fat that you're losing and we wanna try to preserve that.

Um, I'm sorry, muscle. We wanna preserve that muscle. You lose some muscle along with the

fat that you lose. Um, and then we also know that protein is the most satisfying of the nutrients.

And so you're less hungry. So two reasons to have protein. I. Yeah. Excellent. And, and you're,

you can also kind of choose where you're gonna get your proteins from and where you get your

fats from and more healthy options too, on, on this diet.

Correct. Right. And, and so we know there that people have different preferences for foods and

different tolerances for foods and, and we can help them to, to, um, to choose the ones that are

gonna be the healthiest for them, but also, like I said, make some compromises if it helps 'me to

follow the diet and have success.

And it sounds like, so the diet is very good for lowering insulin and helping people with diabetes.

What about, what are some other benefits, um, in terms of, let's say heart health or bone density

or hormone levels? Yeah. Excellent. Excellent question. And, first off about diabetes, I do want

to give some information about that.

It is very powerful for lowering the blood sugar and in fact, It's important for people to know that

it's so powerful that if they're on medicine for diabetes, they often need less medicine, right

when they start the eating plan. So, so for people particularly who are on medicines that lower

the blood sugar too low, potentially like insulin.

Um, or glipizide. Or glyburide, which are certain pills that, um, that can make the blood sugar go

too low. Those medicines need to be adjusted the day they start the eating plan, or else their

blood sugar might go too low. And that can be dangerous. And so that's what we do in our clinic

when we start somebody, um, on those medicines, on a low carbohydrate plan.

The other medicines we use for diabetes like Metformin, um, the new injections, um, like, um,

Ozempic or Trulicity, um, the um, Uh, the, most of all the other diabetes medicines are less likely

to make the blood sugar go too low, so those are usually okay to continue. Um, so the other

things that can improve, um, so a lot of people worry about the cholesterol with a low carb,

higher fat plan, as I mentioned, but study after study has shown that when you get a, a, a

cholesterol profile that your triglyceride level actually decreases.

In fact, the best way to lower your triglyceride level is to eat less carbohydrate, and then your H

D L. Improves. And in fact, one of the best ways to raise your good cholesterol, the H D L

cholesterol, is to eat more fat. Whatever kind of fat it is, saturated fat or unsaturated fat. And so

again, that's why eating a higher fat, low carbohydrate plan.

Balances out balance the concerns about the bad cholesterol that could go up too, because

your triglycerides go down and your good cholesterol goes up. So you're getting a balance there

and not increasing your risk. And in, in fact, most patients are decreasing their risk so that, um,

those two, um, measurements, the triglycerides in the HT L are part of a group of.

Um, of factors that, um, are related to heart disease called the metabolic syndrome, and that

includes mildly elevated blood pressure, mildly elevated blood su sugar, and then an elevated

waist circumference. And the low carbohydrate plan, um, uh, hits all of those, um, and, and

improves all, all five of those factors.

And there's some other ones. Insulin sensitivity is part of that as well. Some other things that we

have seen from our patients and also in research is we've seen, um, in a, actually, in a, in a

recent blood, um, a research study that blood pressure goes lower with a low carbohydrate

plan. So that's been seen in previous studies, but it actually was, um, was tested against the

dash diet, which is a diet that was designed for, um, lowering blood pressure and the low

carbohydrate plan.

Led to lower blood pressure than the dash plan did. So that was a pretty remarkable finding. It's

the first time those two diets have been tested against each other. Um, some other, um, issues

that are related to insulin resistance have been shown to improve too in some studies. So

polycystic ovary syndrome is related to insulin resistance.

Fatty liver disease is, um, is associated with insulin resistance and weight loss in general

improves those. But a low carbohydrate plan might be a really good plan for people with those

issues. And then anecdotally, we've seen some improvements on certain issues like reflux and

there's some research on that as well.

And in fact, some research that we've done, um, and migraines, I've had patients come in and

say, Migraines went away with the low carbohydrate approach. So this isn't universal. Some of

these have not been tested in randomized trials to find out for sure that, um, they'd lower it

better than another diet approach.

But at the same time, anecdotally, we've seen these improvements. Have you seen people get

off their medications, whether it's with diabetes or, or, or, or something else? Frequently. Yeah.

This is, that's the, that's one of, that's really the, the most rewarding part of doing this and that

this is what I've, I've enjoyed more than anything is helping to cut back on medications, um, or

even take people off medicines.

And so we have anecdotes of taking people off. Um, you know, 60, 80, a hundred units of

insulin and they're off of it. Um, and so those are, those are insulin doses that people have been

on for years and maybe even decades. Um, and they're able to come off of that medicine and

shift over to the other types of diabetes medicines or come off of medicine entirely.

But more often we shift them to the other types. Um, Uh, like Metformin for example. Um, I've

seen people come off of cholesterol medicines before. I've seen people come off of their

migraine headache medicine before their reflux medicine before. That was actually one of the

first research studies that I've done.

It was a one on, um, on heartburn and reflux. Um, so, uh, that, that's probably the most exciting

thing for patients. That's when they feel like they're in control and that they don't need the

medicine. Their health problems. And, and that's just, um, that's the kind of thing that, um, just

brings joy. So it's why I like doing this.

Oh, that's so good. I mean, that's, that's awesome. And to get off medication and to not have

any side effects from those medications and be able to do it with your lifestyle, with your diet

and, and exercise, that's just, that's great. Yeah. That's good work. You're doing well. It's very

rewarding for sure.

And obviously it's less costly for the patient. Um, the medications can often be a reminder that

they have a health problem, and so there's better quality of life and better, um, uh, you know,

emotions and, and, and mood because they're, they're not as tied to their medicines. Um, it just

helps them to feel more in control of their health.

Excellent. And just one more question. What about, um, the low carb diet with menopause has,

have you seen any, any correlations there? Um, and how it affects the symptoms with

menopause? Yeah, good question. And we touched on that a little bit at the beginning, so I

wanted to spend a little time on that question.

Um, there, there's actually not research to show that this approach has a benefit over other

approaches, specifically in women with menopause. Um, I. At least in a, in a prospective

randomized controlled trial, which is our highest level of evidence there, there was one research

study, the Women's Health Initiative, which is one of the largest diet studies ever done.

Very famous study that used a low fat, um, diet approach in it, but. After the study, they decided,

well, let's look at what women actually ate. Because the women reported the foods that they

were eating and they were able to break them up into different groups. And they had four

different groups. One was a Mediterranean type, um, eating pattern.

One was a low fat eating pattern, one was a, um, dietary guidelines type pattern, and then one

of 'em was a low carbohydrate pattern. Now that low carbohydrate pattern. Wasn't really as low

as what we frequently teach people, but it was lower in carbohydrates than the other three

patterns. And it, in fact, those were the, um, the women who gained the least amount of weight

during the Women's Health Initiative.

And so it did seem like, at least in that study, there was some benefit in post-menopausal

women, um, in terms of weight management by restricting carbohydrates or reduced

carbohydrate intake. Um, the other thing to think about though is that, When women go through

menopause, they shift into more of an insulin resistance type, um, uh, hormonal picture.

Um, so a lot of women will mention that they're gaining more weight around the midsection.

They call that abdominal or central adiposity. Uh, And that's more like the, the, the male pattern

weight gain. Whereas younger women, if they're gaining weight, they tend to gain it around the

hips and the legs, the thighs.

Um, so with menopause, there seems to be a shift to more abdominal weight gain, and that is

also associated with insulin resistance. So reducing insulin resistance by reducing carbohydrate

intake might. Help or benefit that weight gain around the midsection? Um, the studies would

show that, um, that low carbohydrate eating leads to less hunger and potentially less cravings.

And these are symptoms that women report when they go through menopause as well. And,

some studies have shown that. People sleep better and feel better rested and have more

energy when they're doing a low carbohydrate, um, eating pattern. And those are symptoms,

um, that, um, women who are postmenopausal would benefit from.

So, I think those are reasons to consider it. Um, you know, the, the, the, the other one we talked

about earlier, which is as we age, we, we have more insulin resistance, we. Don't tolerate car

carbohydrates quite as well. And so, um, so whether it's a menopausal hormone change or not

with age, it might make sense for women to reduce carbohydrate intake.

Yeah, that makes sense to me. And thank you so much for, for sharing that. And thank you so

much for coming on here today and sharing all of this valuable information. It's my pleasure.

Thank you for inviting me on and I hope this was useful information to the people who are tuning

in. Um, and, and as you mentioned, we're at Duke Lifestyle and Weight Management.

If you, if you wanna meet with me or one of our many other providers, we have. Um, we have

dieticians, we have, uh, a behavioral therapist, and we have multiple medical providers who can

help you with your weight loss goals. And it doesn't have to be a low carbohydrate approach. It

could be a Mediterranean or a high carbohydrate approach.

We have a meal replacement plan, and we prescribe medications for weight loss. We do it all.

We take a comprehensive approach to, helping people to lose weight.

Thank you. And if you want to know more about where to find Dr. Yancy and the program, I'm

gonna include the link to the Duke Health website with his information in this episode.

So remember, we do new episodes every week on Wednesday, and I look forward to having you

join me then.