Low Carb MD Podcast

Listen to the podcast here.

Full transcript below.

Welcome to the Low Carb MD podcast where we seek progress, not perfection. Hello and welcome back to the Low Carb MD podcast. Unfortunately, we are Trollists this morning. Tro got tied up and had stuff going. He did an early podcast when I was tied up.

So anyways, we have a good one today. I’m really excited about this one. This is someone the first guy that we’re going to talk about is Bill Erico. He’s a doc up in Washington. Someone I met at Low Carb
Denver and he’s been collaborating with Franco Lopez who’s a registered dietitian.

Now, a lot of people think that we’re a war with each other and I think this is a really important topic because we need to realize, hey, we’re on the same team. We got to really look out for the best interest of our patients.

So Bill, welcome.

Thanks so much. I’m really honored to be here and thanks for giving the opportunity.

No, it’s so good to have you. It was great. We had a fun time in Denver or getting to meet each other and I saw that you’re a bigger-than-life personality. You’re an outgoing, super cool guy. So tell people your story how you got started and where you’re at now and how you started collaborating and how you know basically how your practice changed in the last couple years since you started doing Low Carb Step.

Sure thing. Yeah, definitely.

So I’m Bill Erico. So I am a family medicine doc and it’s interesting. I just found out Torel trained at his medical school was Torel College of osteopathic medicine. So I’m a DO and I’m trained by Torel University College of osteopathic medicine in San Francisco, California. So I was like, wow, the Torel connection.

So anyway, so I graduated med school in 2004. Zero nutritional guidance kind of throughout that time. In fact, I don’t even remember, I don’t, people say they remember taking one class. I don’t remember a class. So, you know, fast forward about 13 years from there. You know, I’m practicing as a doc and the Air Force for three years got deployed for a year back in 2009 to Afghanistan. I got out of the military after about six years of active duty in So I had kind of military doc experience working in primary care.

Then moved up to where my wife is from, which is a little town called Omak Washington up here at the kind of the top central part of the state, kind of the eastern rural area. So not basically, if you’re thinking Seattle, think otherwise you’re not thinking rain, you’re thinking dry, kind of deserty, close to Canada. So definitely a different environment. But great environment, awesome place to practice.

Great partners. I’m in a group practice up here at Confluence health. We’re in a satellite outreach clinic up here about 50 minutes from the border of Canada. So we’re up here and basically for, you know, for the last seven years or six or seven years, I’m up here, you know, I have developed quite a big practice. And I think the majority of my patients are pre diabetic or diabetic, absolutely for sure. So my interest in this, my interest in treating this, you know, has always been there. Unfortunately, my training is like like other people you’ve talked to other docs you’ve talked to on your other podcasts have basically been in the medicine realm. You know, how do we, how do we treat the symptoms, get the sugar down?

You know, there was involvement of dietitians in the past. Our clinic is a satellite clinic. So we’re kind of hit or miss whether we get people in. Insurance is always an issue. Travel is always an issue. We have a hub and one at you, patients really can’t get down to as easily sometimes. So we live in a relatively kind of low income, kind of almost poverty level area. So there’s a lot of dynamics that are different than other place other, maybe other docs you’ve talked to.

So the way that I got into low carb, which is an by accident. Okay, so my wife is having terrible gird after her two pregnancies, acid reflux. And so she finally gets the niss and procedure. So she gets the wrap that, you know, basically cinches off the lower esophagus. So you don’t have reflux.

So she gets that in January of 17. And she can’t eat anything after that. She’s like having trouble. She’s
like, gosh, I can’t eat any of the starches. I can’t eat any of the bread. It’s making me bloated. I feel terrible. What is going on here? So she starts researching and discovers that there is a there is a specialized diet called ketogenic diet. She starts researching and she goes, gosh, this guy, Jimmy Moore has been on one of my exercise tape. She’ll lean. I think her name is She’ll lean. She does exercise through Beachbody.

So she interviewed Jimmy Moore. My wife shows me Jimmy Moore interview. And then the rest is history. Like basically we started after my after my updated boards in April of 17, we basically started doing ketogenic diet within two or three weeks. I got all the benefits of ketosis. We started testing. We got into the fasting realm after we discovered Jason Fung. So it all kind of just domino effect after that. So it
was it was a big whirlwind process. And it was exciting.

Back in the summer of 17, I was excited to go to work every day because I had this kind of new trick in
my box. Like in my bag, I could talk to patients about something new. I’m getting some people that are jumping on board with this. They’ve got diabetes or prediabetes. They’re starting to jump on board.

But there was one aspect of it that I think, and the reason I brought Frank with me today is because there’s one aspect of it that I started to realize is that when I’m in and you know this Brian, but when
when I’m in the room with the patient, I’ve got 20 minutes or sometimes 10 minutes to have an impact on what they’re going to do.

So they’re living this
lifestyle. Maybe they’re culturally eating eating things that are high in high-end processed grains, carbohydrates, things like that, that they’re used to. And I have about 10 minutes of an intervention every single time I see them to start to see if we can change their lifestyle. And there were a very wide variety of patients that I could not connect with. You know, it was just kind of this, you know, kind of this, this, hey, I’m gonna try to do it. Next visit.

Okay, what did you talk about? You know, there was just not really this this connection that lasted. So what I ended up doing is trying to figure out like how do I do this better? You know, and so in September of 18, I actually went up and visited Dr. Fung’s clinic and shadowed him and Megan Ramos.

And this September of last year, so it was like 2018. And I saw that the biggest aspect of what they do is they do a lot of behavioral interventions. So there’s a lot of talk with empathy. Megan really spends a lot of time connecting with patients. Dr. Fung obviously doesn’t have as much time to, you know, do his part,
but he does do a little, a little kind of intro and they get the patient set up.

But a lot of these like group visits, I realized they had to have the behavioral component of it. And they had to have an individualized approach. And so I came back kind of with this renewed, you know, fervor to kind of like, you know, try to see how I can involve patients with that. And I also had talked to some docs about like, you know, how have you been, how have your experience has been with working with registered dietitians?

And there was one particular doc that’s a low carb doc that I talked to that just said, hey, I don’t involve them at all. I don’t involve the dietitians at all. And I was kind of taken aback by that. It’s like, how can you not involve the dietitians if that is a big part of creating behavioral change?

So I just, I mean, miraculously, you know, Franco comes on the scene, you know, earlier in 2019, late 2018, I came around when you came Franco, but it was, it was basically the, at least six to eight months ago, comes on the scene. I find out this guy’s amazing. He’s got a very well wide breadth of knowledge about dietary, you know, dietary changes, lifestyle changes.

He’s doing it himself. He’s had a lot of experience with, and he’ll talk about that in a little bit, with working with with seizure patients, kids, and then some other more rare genetic disorders. And I’m just like, wow, this, this is possible. You know, it was just eye-opening. I’m like, this, this is, this is the ticket to really connect with people.

And I mean, it’s really been amazing. Like, since I’ve, since he’s been brought on board in our clinic, we’re in a satellite clinic, we’re like way out in the boonies, right? So we’ve got this gold mine in Franco up here of, of just connecting with the community, visiting nursing homes, kitchen, you know, the kitchens at the
hospital, like figuring out like, where, like, where do we focus all the efforts just beyond the clinic?

And then just his interactions with patients have really opened doors for like, like taking a patient that you would otherwise not think is going to respond or connect or even want to try low carb and actually start
thinking about those changes.

And I’ve gotten people out. I’m a deep prescriber now. I, that’s, I’ve for that term thrown around. It’s first time I’ve used that term in my whole career in the last two years, I started using the term
as deep as well.

Welcome to the club. That’s new. Yeah, that’s new to me too.

And then, and you know, that’s where the skill comes in to be able to deep prescribe, say, look, your blood purchase is good. Let’s start taping down the meds. Your sugars are good. Let’s start taping down the meds. And then we were looking down then as we get more clinical experience of doing this stuff,
we just get better at it and better at it. And we start learning and seeing what works, what doesn’t work, what are the biggest meds are going to cause a problem during low carb and keto.

So, and I think having someone like Franco, Franco, your, your resume, I was looking, I was like, Oh my gosh, dude, it’ll take us the whole podcast just to say your qualifications, you know, being a combat
vet, which much respect. Thank you for serving, you know, tennis, Brazilian Jiu Jitsu, all kinds of moi Thai, all this stuff. I don’t even know how to say and you’re doing this stuff.

So, you know, the exercise component, obviously, and then the nutrition aspect is a registered dietitian. And, you know, I’m curious, how did you end up in this room? Because that’s not a typical way to go
from for a dietitian, as far as the low carbon keto and this kind of lifestyle intervention.

Yeah, yeah. No, thanks. Thanks for that. And, you know, just to start off, you know, thank you for inviting me to this show. I’m really excited to be part of it. And the relationship that I’ve formed with Dr. Erco has been
really unique, just as he had experience, you know, or lack of experience working with dietitians in my field, you know, what I was trying to, you know, tell people or inform people, you know, had a lot of pushback, you know, from providers, not really understanding the concept.

And, you know, my background started, you know, since I was a child, I was born in El Paso, Texas, but I grew up in Mexico the first eight years of my life, and right across the border. And I
grew up in the eighties and nineties and during the fat-free craze. So my my
mother and my family was, you know, really into the fat-free thing. So, you
know, everything from, you know, fake bacon to egg whites and, you know, fake
butter, you know, so I kind of grew up thinking this was how nutrition, you know,
the healthy way of eating. And, you know, that was always in the back of my head.
When after high school, I joined the army. I served in as enlisted. After, you
know, I did a deployment in Iraq, 2003, 2004 with the first armored division.
During my time, as you mentioned, you know, I’ve always played sport, so
tennis. I used to box too as a child. So I was, you know, pretty active. And when
I joined the military, I excelled. I did pretty well, you know, with my physical
training. So the after deployment, I was stationed in Fort Knox, Kentucky, which
is mainly a training site for non-commissioned officers and officers. And
during this time, I was assigned soldiers who weren’t being able to meet
their physical training standards. So during this time, I was working with them,
you know, primarily exercise and, you know, teaching about what I thought was
nutrition. And I really, really enjoyed this. And just to back up, during my time
in the army, I was actually a tanker with the M1 Abrams, so completely unrelated
to nutrition. But this last year that I was in the military, I was working with
these soldiers. I really enjoyed it. I really felt like they were, you know,
better meeting their goals. It was just dissatisfaction that I hadn’t felt, you
know, I felt somewhat in my job, but it was just different, you know, being able
to see them progress in their health and feel better. So after I did my
time in the army, I pursued the career. I started with business and I, you know,
quickly realized that wasn’t what I wanted to do. So as I researched a little
bit, I found a nutrition program near where I was living. And there was a
new Mexico State University. So I completed my undergrad nutrition there
with human nutrition and food science. At the time, you know, with the exercise
component of it, I was also doing an emphasis and exercise physiology. So my
my intention was to do, you know, sports nutrition and kind of work in that, you
know, field of nutrition, you know, with athletes or or even even with a special
forces or specialty in the military. After I did my undergrad, I got an
internship in Seattle and that’s what brought me out of the Southwest. So I
went to Seattle, Washington with a CMR health institutes. And that was actually
a big Hispanic population for many of the field workers, working with apples,
cherries, which, you know, I don’t know how familiar you are, but we’re a big
agriculture community here. So they, you know, I kind of it’s the internships are
pretty competitive to get in. But due to the fact that I spoke Spanish and, and
you know, that was also minority being a male in the field, you know, there aren’t
many male dieticians. I was able to get placed there. And during my internship,
I did a rotation at Seattle Children’s Hospital. During that time, I was a first
that’s when I was first introduced to the ketogenic clinic during that time
was just focusing on epilepsy primary. And once I saw what you could do with
patients with these neurological conditions through nutrition, I was just
blown away. You know, so my interest in sports nutrition just faded away. And I
really, you know, dove into into the ketogenic clinic in ketogenic therapies.
So I later had the opportunity to work at a pediatric hospital back in El Paso.
So we know at the time, it was my fiance, we we got married in Seattle, we relocated
back to El Paso. And I worked there for about six years at a adult in
the pediatric hospital. During that time, I was able to establish a ketogenic clinic.
So I had the the great opportunity to team up with a pediatric neurologist who
was very on board with a ketogenic clinic. So he actually sponsored many of my
training and seminars that I did. And we established a really nice clinic. We
started we had about 50 patients at the time. And you know, the seizure
improvement was just, you know, drastic, you know, some some seizures, you know,
kids suffering from multiple seizures a day to just going down to a couple of
months, some even going seizure free and medication free, you know, and then I
started as I attended more seminars and trainings. I saw the opportunities as
a ketogenic field was growing with other neurological disorders. So I started
working with with kids with autism. And again, same same, you know, the ones
that really were able to, you know, implement the diet and consistently, you
know, the teachers will report that a switch went off and there, you know,
even social skills improve, able to focus, concentrate. And then also worked
with a patient with a brain tumor, brain tumor that had been resected for
several times, kept on growing back. We started the ketogenic diet. The tumor
shrunk, stayed small, even though she had some cysts built up around the brain.
This patient had had a the cyst removed within a day or two, a patient was up
eating, you know, active. So so really, I mean, what I was seeing from these
patients, what was just really incredible, you know, so, you know, I
started questioning everything that had been, you know, learned during my, you
know, school, during my time in school, as far as what nutrition should be, we
should be avoiding fats and I was seeing these patients that I was, you
know, at the time, doing really high ratios of fat to carbohydrate and protein,
a four to one ratio, meaning four grams of fat to one gram of carbon protein.
Now, you know, what people do more is like a one to one ratio, which is a
modified ketogenic diet. But at the time, you know, seeing this, and I was just
seeing the improvements in cognition, no issues with cholesterol, no, no issues
with, you know, no heart disease. So, you know, and some of them going on for
years. What was really impressive to me is that some of them, you know, we
could be on a strict diet for about two years, and then we know off the diet,
you know, but even winning off the diet, whatever occurred, you know, in the
cells and the neurons, you know, repaired some damage where even if they
weren’t fully in the diet, the seizure control remained. And, you know, so that
was, I knew that they had to be more to and as we’re still finding, we still
don’t fully know a lot of theories. But anyway, so just, you know, after my
time in El Paso, I worked with the VA, I did a home health, looking at rural,
working with rural patients living in rural areas. And, you know, we, we
wanted to always go back to Washington that in care for the big city life, I
looked around, found this great opportunity of a rural place where I could,
you know, kind of bring my ideas, this company, you know, that we work for now
really gave me a platform to be able to implement programs, be, you know, be
able to work with different providers at different clinics. And this was the
beginning of the year. And this is where I teamed up with Dr. Erica and
the, and another provider, they’re the clinic. And, you know, with learning what
the diet was doing, I, I went through the same journey myself. And, you know,
so when I’m talking to the patients, I can talk, you know, from experience what
has worked, what hasn’t. And for me, you know, eating a low, low fat, high carb
diet was, was okay, when I was really physically active, you know, needing to
eat six, eight times a day, you know, just to keep the energy going. But as soon
as my activity decreased, my triglyceride levels went up, I was tired all the
time. You know, I gained weight. I was having a hard time focusing, you know,
so I slowly begin to adapt, you know, adopt a low carb wave eating. And, you
know, for the first time, I could freely with no guilt, enjoy, you know, egg yolks,
butter, you know, steaks. And it was just, you know, you know, completely turned my
whole world in the way I approached nutrition. And since then, you know, I’ve
what we work on now, not necessarily, you know, you know, telling everybody they
should go on the ketogenic diet, but more whole foods that include animal, you
know, products, plant products, and just come coming back to basic nutrition,
especially with this, this community here, which is a big agriculture community,
big on raising cattle and, and, you know, so being able to use their own
resources has really worked well for the community and for what we’re practicing.
Yeah, it’s awesome. When you’re doing your experience, I think some of those
things are surprising to me. I never heard about a ketogenic diet, kind of
reversing seizure disorder and that they could go, they could liberalize the
diet down the road. That’s something that’s really interesting. And I’ve heard
some accounts of that. One of my patients lost a bunch of weight doing low carb
keto, then had some life stresses. And after that, of course, my dog wants to
say hi to everyone. After that, she, he started gaining his weight, he went
off and started eating regular food again, started gaining weight. But his
Piedola demon never came back that he had for 15 or 20 years. And then now he’s
back on keto again and doing great. But he said he was surprised because three
days in lost all that swelling they had for all those years it was gone, you
know, just because he was holding on to so much water weight and salt retention
from his high insulin levels. So that is interesting. Because I’ve always
wondered with the seizure disorder, how much is it from inflammatory? How much
is it from the high fat diet? How much is it from cutting out the process? I
don’t know. I mean, we don’t know. I don’t think but it’s really encouraging to
see that and to hear you guys teaming up and what you’re accomplishing is
pretty cool because, you know, Bill, like we were talking about it, it’s hard to
manage everything. You know, we get people on track and then we don’t have
time to answer those phone calls do routine follow up. And that’s a critical
part of the equation. That’s what Virta is doing. They’re following up with
these patients and making sure they’re staying on track and that they’re doing
okay. Because like we talked about is like, you know what, sometimes someone’s
on board and then they go home and they go, what was that we talked about last
time? And then, you know, then their sugars go out of control. And then now
they’re now they’re a captive audience and they’re killing it. I had two people
that I posted on Twitter that just absolutely dropped their A1C from
8.9 down to 6.2 within three months of changing their diet alone. And so
that’s it’s pretty exciting when we’re seeing those things and then looking
from the neurologic’s perspective is pretty cool too. So, so yeah, and also,
you know, with the neurologic perspective of it now, you know, we’re also working
with some Alzheimer’s disease and there’s some ongoing studies. A lot of
this training has been, if you’re familiar with the Charlie Foundation and
that’s kind of the main organization as far as a medical ketogenic therapies,
you know, so just being able to, again, the same thing with Alzheimer’s
disease is just, you know, we don’t fully understand. But inability, you know, for
the brain to use that glucose was just providing that alternative, you know,
nutrients. And particularly, with those patients I concentrate on medium chain
triglycerides. But go ahead, Dr. What I wanted to make sure I added, and this is
this is important, that I wanted to make sure I added is that when I started by
a journey, my own personal journey, I became a little bit biased because, you
know, I’m a lucky guy. I have a very supportive wife that we did this together.
And from the get-go, it was this is amazing journey. You know, we she she
cooked the meals. We made sure that we brought, you know, we brought our own
food to different events that we knew were going to be, you know, giving us a
bunch of, you know, processed foods and things like that and desserts. So we were
very committed and we succeeded, like, by leaps and bounds, you know. And so what
the mistake I probably made and I found later that I made is that I went into
these patient visits, very excited, but I kind of steamrolled over these patients
a little bit and said, this is what this is, you got to do this, you know, I
probably didn’t say it in those ways, but I was very excited, very high energy, and
then I go into these visits and I literally lost a patient because of it.
I, I, a patient wanted to be, wanted to stay on her insulin because she just
thought I was just steamrolling over her with, with my excitement and energy. And
then so, you know, fast forward a little bit and I’m talking, I’m, I’m listening to
just different ways people are navigating this and, and you know, Dr.
Anwen, I think really struck me as an amazing person in that he practices
patients, like better than I’ve heard most people practice, in that he listens, he
individualizes everything to every patient and takes his time and does
motivational interviewing because you have to get the patient buying into it
and becoming on board with it. So I, it kind of unfortunately took a couple of
sort of bad encounters and even some feedback from patients saying, hey, you
know, he’s really just this, this crazy keto guy, you know, and like what’s going
on here? You know, what’s he trying to sell us or whatnot? They’re a little bit
suspicious feeling at the time, you know, so, so now, I mean, that’s, and again,
this is, this is a, this isn’t a journey. This isn’t something that we’re ever
perfect at the beginning and that’s what I’m learning is I go to these, I go to
low carb Denver last year, this last year and I’m listening to Dr. Anwen’s talk
and I’m like, gosh, I just need to slow down. And I can find ways of connecting to
these patients a little bit better. And so I really feel like that was like a
perfect time, like a perfect segue into involving them with, with, with
interventions with Franco, who has worked with our organization to get some more
intensive four week group classes with our diabetics. And then also what I
definitely want him to talk about for sure is, is the diabetes prevention
program he’s doing for prediabetics. So, so basically, I just wanted to say it’s,
it’s what I find the most important about being a doctor is, is, is understanding
your patient and where they come from in their demographic and their culture.
And there may be there, maybe there may be a history of abuse, mental health where
they’re at with mental health. And I don’t think you can do that unless you
know the patient. So I think it’s a unique opportunity is family medicine
doc or internal medicine doc, or pediatrician for that matter, to have that,
that initial encounter, just say, okay, I know that I know this person’s going
through stress. This is how we navigate it a little bit better. And maybe they
need a little extra support with behavioral health. And they need to
definitely be involved with some group class group classes. And I’ll tell you
what, in the last six months, I know for sure, I’ve had a lot more patients
be open to change, feeling like there’s hope, knowing that that they’re going
to pick themselves up several times after they drop, or make mistakes or
fail. And I even tell them I fail times. And they find that really nice to hear
that from a professional that has really tried this and also has some
failures in his life. So, but I wanted to definitely ask Franco to maybe give us
a little bit of information on how his visits are different than ours, then
kind of the MDDO type visits, how they differ, how differently maybe he
connects with people, how the different discussions and how he
navigates culture and individual lifestyle. So, could you touch on that,
Franco? Sure. And I just want to add that when I first started learning the
McKitto Genic Diet, it’s almost like eye-opening. So, you come back really
excited and enthusiastic to be able to implement this with people. But then
you quickly realize that when you’re telling somebody to change the way
you’re eating, you’re pretty much telling to change your life. Because
especially in this country, a lot of things revolve around food and
gatherings and culture and family. So, what I have learned, now when I
see a patient, I really try to be self-aware to not impose my beliefs and be
open to what they’re doing now and work with them. So, we really work on
individualized patient-centered care. And when we start off the visit, I
always, of course, review as far as I can with the chart and get a good
information, get a good history. And Dr. Erika, with the little time that he
asks, you see the patients, he’s really good about including some
details and notes about what they’re eating, what changes he’s doing. So, that
already kind of gives me a heads up. So, the first thing I always ask him is,
what brings you in? And if they say, well, I want to change this, improve my
blood sugars, or they may say, well, the doctor sent me or they said I should come.
That just gives me an idea right off the bat, what stages have changed
their end? And from there, I kind of take it, I have the opportunity and
us as dietitians to really dig deep into their daily routines, their
behaviors, what has worked in the past, what hasn’t, as providers, you
all, you have so many things to focus on in such a little amount of time. But
as dietitians, our primary thing is lifestyles, whether it’s nutrition,
physical activity, or stress management, but really, is that one component that
we’re able to really dive in. And it can be a really personal thing. It can
be like Dr. Arco said, associated with trauma or with the way that the family
interacts, or where they live. So, I really work with a patient to see where
they’re at. I work to really help them explain the pathophysiology of what’s
going on, how they can, you know, they give them the tools to learn that they
can manage this condition. And we’re primarily talking about diabetes. And
you know, helping them understand. So, these group classes that we have on
monthly basis, you know, kind of gives them all the nuts and bolts of, you
know, what’s going on, what is this about, what do these medications do, how
do I affect the body. And then I can work with them as individual basis. So,
you know, really being able to see that whole picture, you know, if we make
so, you know, slight modifications, you know, so if, you know, if they’re eating out all the time or have frozen meals,
okay, let’s just focus on one meal and, you know, using things like motivational
interviewing and, you know, sometimes suggesting some changes, then we take it
really slowly and gradually. And initially, my visits, I try to schedule them to see
me pretty frequently as we’re adopting a new behavior. And then, you know, and
then, you know, it’s, you know, the visits go on. I, you know, I exhaust the visits
that the interests cover. And then I ask, you know, the providers or Dr. Erykko, you
know, send me another referral so we can continue these visits because, I mean,
it’s a behavior that we’ve been doing for a lifetime. And it takes a lot of
work, you know, getting used to eating certain way. And the other thing I do is
I really try to involve the family, you know. So, you know, we see pediatrics too,
who are already developing prediabetes, especially Hispanic kids, you know. So,
I invite, you know, grandma, you know, whoever all, you know, uncles, whoever
all is caring, you know, for whoever all is involved for the care of the child,
or involved in the preparation or, you know, when they’re coming together, you
know, so really taking that family approach, but really focus each thing
on the individual. And, you know, what I help them understand also with checking
the blood sugars, I help them understand how it’s a really useful tool to have
immediate feedback on how your body is responding to certain foods. And this
is the individual part of it, you know, that, you know, I may respond a certain
way when I eat, you know, a cup of potatoes and different when I, you know,
rice and some other person, you know, same, you know, different with things. So,
you know, this is where, you know, our microbiome or gut bacteria, you know, kind
of plays a major role on how our foods are processed, you know, what effects
that has on their sugar, you know, so, so with that, you know, then they
understand of why I should be checking the sugars, you know, because first when
they come in, sometimes they’re like, you know, I don’t even check my sugars
because they’re makes no difference what I do or eat, you know, so as we’re able,
you know, to work closer, you know, I oftentimes say, just start with one meal,
check before and after, see what your sugars did. And then the next day,
repeat the meal, you know, but change the quantity, change the starch at a fat, at a
protein, you know, walk five, ten minutes after, and then you can see, you know,
what your body’s doing. So now, you know, now patients are really, you know,
seeing individually how their body is responding, you know, to these changes
and, you know, just having more adherence, you know, to the changes they’re making,
you know, because they’re having immediate results and then this is all
confirmed that when we recheck their A1C or their triglyceride levels have
improved, and what he says lowering, and they’re, you know, weaning,
tapering off medications. Yeah, Franco, I think that’s really important. I think,
you know, getting the family involved saying, look, you can’t be making tortillas
and rice when this person’s struggling with their sugars or, you know, some people
can get away with a little bit of carbs a little bit tortilla. Maybe it doesn’t
change it. And there’s sugars much. And, you know, I’ve been playing with the
continuous glucose monitor this week, excuse me, and it’s been a lot of fun
because, you know, when I’m fasting, my sugars go up, my bacon, how fat and my
sugars are going up. And if I was just looking at my sugar levels, the most
dangerous thing I could possibly do is work out really hard because I worked
out for an hour and my sugar went from like 78 to 114 during workout and after
workout, I was like, wow, that’s kind of interesting, right? Because everyone
thinks they have to carload to work out. So all these guys were 300 pounds are
running on the treadmill drinking Gatorade because I think I need my energy.
Your body will provide that. Trust me, if you’re 300 pounds, you have enough
energy to provide, right? So it’s very interesting. I think that’s a really
important point. And the other thing I like it and is the group approach where
you can have a bunch of people in a room and talk about it with medical stuff,
you know, it gets touchy because we’re talking about HIPAA violations and all
that. But from a nutrition standpoint, one person is going to ask a question
and answer that question for 10 different people and allow us to really reach a
lot more people and educate people and they can learn from other people’s
experiences. And I think also having the support of a group is huge, you know,
where people know next week I’m going to go and, you know, I would be with my
friend again and hear what they’re doing from desserts if they feel like
having something or how they’re doing their dinners or how they’re preparing
their food for the week. Because ultimately, we want people to be able to
help each other not have to have the doctor or the dietitian involved anymore,
you know, and one question for you after making that point, what has been the
kickback? Because my concern as a primary care is the diabetes education
that people have been receiving has been detrimental in my opinion. Because
they’re saying, Hey, take 40 or 50 grams of carbs with each meal because carbs
are essential. Your sugars are 400, but let’s give you some carbs with each
meal. And we’ll give you insulin to cover those carbs. What you’re doing is in
the face of that, you’re saying, look, let’s go on a low carb ketogenic or
whatever type of approach. What kind of what kind of a kickback have you
gone from other dietitians or nutritionists in your area? Is that has it been an
issue?
I think I think, you know, when I first came here and, you know, I’m kind of
we’re based out of a place called the Wenatchee’s was about two hours away.
And that’s where the main hospital is. And that’s where the majority of the
dietitians in my group work out of, you know, but, you know, you know, I went
through a series of interviews and, you know, that they saw, you know, how
passionate I was and kind of the approach that, you know, I’m still doing whole
foods and not saying this, this diet is better than the other, just meeting
that the person where they need to be, you know, but knowing that that, you
know, what we’re doing here is working. And then we’re seeing the results.
You know, so I think, you know, overall, you know, they’re happy with that. And
you know, what I did forget to mention is the other program we have now is
a diabetes prevention program. And this is through a curriculum through the CDC
that it’s a year-long program for people with prediabetes. And this is
something that the organization said that, yes, let’s offer this to the
community. So it’s free to the community for anyone that has prediabetes,
because in order for most entrances or Medicare to see a dietitian, they either
need to have diabetes, kidney failure or obese, which is a new thing for
intense oral behavioral therapy. Otherwise, they’re not able to receive any
nutrition education until they become diabetic. So this is a great program.
I started out with 17, where I think week 12 now, week 13, you know,
still holding strong with 14, their average weight loss has been about seven
pounds that they’ve been able to sustain. And the first week is weekly, we meet
at the local library here. And as you mentioned, you know, having that, that
group support people bring in ideas, sharing struggles, you know, but I do
modify some of the content, you know, and I tell them, you know, this is kind
of my bias, but I’m going to let you know where I’m coming from, you know, but I
inform people and what we’re doing really is empowering the patients, you
know, so, you know, I do mention, you know, some of these recommendations are
really coming from from a weak science and bias studies, you know, so let’s,
let’s really, you know, look at where this is coming from, and how they’re
making these observations and then know how these recommendations are in
place. So, you know, just see what works best for you. So even my patients
with prediabetes, I give them all a bunch of sample glucometers, you know,
so that way, you know, even though you don’t have diabetes, your sugars are
still going to respond a certain way. So, you know, why let’s start now
looking to see how they’re responding and, and you know, then you can make
changes according to that. So, so I think overall, you know, the
organization has been really supportive of what we’re doing here and the
approach that we’ve been taking. Yeah, and if I can add really quick, so I
think I’m not sure if this sparked some of this closer monitoring and
some of the organization’s changes, but we had been on the radio with Dr.
Kleckner, a different partner of mine and Franco several months ago. And
actually Dr. Kleckner and I went on the radio before before Franco got here.
But basically, we had just talked about, you know, our passion with,
you know, using a low carbohydrate approach and intermittent fasting. We
mentioned intermittent fasting and trying to get some group visits going.
And it was, it was very interesting. There was a very big negative response
from our dieticians in Wenatchee. And I tried to probe like what the
negative response was. And it actually turns out it wasn’t about the,
it wasn’t necessarily the fact that we were, that we were focusing on low
carb. It was the fact that we weren’t involving them. And so it was actually
a blessing in disguise because originally I was like, you know, gosh, we’re never
going to work together. This is, this is not going to, this is a, a
bad idea now because now we’re going to get kicked back from our own
organizations, dieticians and stuff. But what it actually, what I, what I feel
like was the silver lining in all of this is that they, they realized that
because after we had talked about it, because we wanted to all get people on
the same page as far as lifestyle changes, they were willing to work with us more.
And I don’t know if that sparked some of, you know, what happened later, but I
feel like it came right at the time that you arrived, Franco. And I, I just feel
like it’s been such a positive experience since then. So it’s almost like
you need the, you need a little bit of a, a jolt to the system to kind of
have a spark change. But it was, it was interesting. Because at first, I thought,
gosh, they’re totally against low carb. But it was mostly just because I didn’t,
I didn’t mention their names. I didn’t mention like, hey, we have dieticians
that can help with this. It was mostly like, Hey, this is Dr.
Clackenin and I’s ideas. And so they were kind of, you know, pretty, they
wanted to be involved. And now I really understand that that it’s important to
involve your nutritional support with all of this, with, with all the reasons
we mentioned. It’s so that was an interesting component there.
Yeah, no, it’s like super exciting what you’re doing. I think this is the way it has to go.
You know, we have to start making these changes and we have to start learning from
each other and moving along. And we really have to work with each other on this thing.
We can’t be at war with each other. I think that’s kind of a big, huge point. And the
doctors can’t do it all. We have to realize like we can’t manage to follow up, do all
this stuff on our own and we need a lot of help. So it’s kind of cool, you know,
getting a system in place. And the critical thing you guys are talking about is doing
the pre-diabetes stuff. Why should we wait till someone blows their engine, then fix the engine?
The best thing to do is prevent it before it happens. It’s a lot easier to prevent that person
from going on insulin than to take them off of insulin. Right. So I think once we start learning
more about this, it’s like, look, the money savings from preventing people from getting diabetes
in the first place is huge. That’s why I like the fasting insulin levels and following people
closely. We could really make an impact before it becomes a problem.
Yeah, most definitely. And Dr. Eryko has been really good with, as you mentioned,
the fasting insulin, especially with the pediatric population that we’re mentioning.
So here there’s a big Hispanic population. And that’s something else that we’re both able to
bring to the table. So Dr. Eryko does speak Spanish and he speaks to the patients. And they really
appreciate that. And myself as well. So sometimes a lot is lost in translation or the patient
understanding the importance of it. But yes, as we’re checking the fasting insulin levels,
we can see this insulin resistance developing early on before we even see the A1C elevating.
So we can really start addressing the problems. And oftentimes, with this Hispanic population,
it’s a sweet and beverages. We’re talking about the Gatorade and living in Mexico.
Thinking, well, the United States is telling us, this is a way to eat. This is a healthy way to eat.
Let’s do it. Let’s not question that. And we’re just kind of going along with it. But
in the same thing with Gatorade, they see our sports drinks. They see athletes drinking it.
And they think, oftentimes they tell me, I’m not drinking soda pop. But then as I dig in,
it’s like, oh, yeah, but I’m drinking a lot of energy drinks or artificial sweetened drinks and
just helping them understand that it’s still converting into sugar. But really,
having that communication or having that message be consistent with what I’m saying and with Dr.
Arco saying, it just makes a huge difference. It’s an example.
Yeah, it’s education. There’s so much money flowing in. I’ve spent a lot of time in Latin
American countries doing medical missionary work. And it’s incredible. Coke is everywhere.
Soft drinks and soda. And the guys will come in. They’re sugars through the roof and they’re
drinking a soda. I’m like, dude, your sugar is 300. You’re drinking a Coke. He’s like, oh, yeah,
but I don’t need dessert anymore. Right? Because it’s so prevalent. It’s just everywhere. And
people think it’s normal. They go, this is just what everyone does. And so it’s a huge thing. You
see Mexico is having a huge epidemic. They’re having all kinds of problems. And so I think a
lot of that’s educating people and saying, okay, look, and seven eating this with every meal. Maybe
we do it every once in a while. Maybe we change this or like you’re saying, just making those
little changes because it’s overwhelming. And the bottom line is carbohydrates are very addictive.
And if we say, okay, stop everything right now. And that’s it. You’re never going to have
bread or a taco ever again, super stressful because let’s cut down the can you give up soda for a
week and see how you feel and see what your sugars look like. And then I think having the
follow up with checking the glucose and all that kind of stuff is huge. So I’m really
encouraged by what you guys are doing. And you’re teaming up and you’re doing your stuff. And
and it’s pretty thing awesome. I’m really encouraged to hear it. Yeah, and I really,
what I’m really thankful for is just all the other docs that you’ve had on, in particular,
Dr. Ken Barry, who was on with you and he was talking a lot about how he uses fasting insulin
and can show the patients when they have a normal blood sugar and a normal A1c,
they can still have an increased insulin level. And you can explain why it’s hard to lose weight
and it’s hard to do this from an insulin level. And so it gives you more of a discussion you can
have and it makes you start early. And I like that because I never really discovered that till
recently. And I was using just blood sugar and anyone’s hemoglobin A1c as our markers. And you
can really miss the buck there. You can really become way behind the power curve with intervening
in someone’s life and making change. So and I tell people earlier, make the change the easier. So
it’s been a blessing just just listening to the different docs that you’ve had on the more of
the experts in the field, I should say, and so that I can become more of an expert locally and help
help a lot more people out. And just having like, like little seminar, it’s been amazing. Like just
I had a, I think it was March of 18, April, Dr. Klecker and I had another doc in town here.
We had just a little, little group seminars, like maybe 50 people to 70 people like they’re
just from the community. And it’s amazing. It’s made such an impact on even like local
restaurants here, like offering, kind of rice cauliflower, you know, in addition and just
different things like you can add to the menu ketogenic options are also like actually on
menus now. And that’s just local. That’s not if you go to, so it’s like the grassroots effects
are paying off slowly. And I think that’s how we turn our country around. I mean, we just have to
like each work together and try to share ideas and this podcast has been amazing. And I’m really
grateful that I, you know, that I, you know, came across came across you in Tro and just
been able to meet you and connect with you and just network. So it’s awesome.
Yeah, and we love it because it allows us to give a platform for people like you who are doing
good work as we could all learn from you and what you’re doing. So we all have our step. We all have
our things that we’re learning and, you know, being able to be a frontline dietitian and say,
hey, look, other dieticians, look at what I’m doing. Look at our success. Look how we’re doing.
Let them judge for themselves at some point, we have to step back and go, you know, my
diet bench are getting worse. They’re getting more insulin. They’re on more drugs, they’re having
more complications. And I think that’s what inspires us because we’ve all seen those disasters,
Bill. I know you’ve seen them just like I have with people going to kidney failure and can’t
walk them in their 50 because of the ravages of this disease. So if we can reverse this disease
process or better yet prevent it from happening in the first place to allow, allow people to know
that they have power over this. And it’s not just mom had diabetes, grandma had diabetes,
grandpa had diabetes, I’m going to have diabetes and die that way. You know, I think that’s what
we’re passionate about and hearing your story. And I think having you guys having the courage to
come on also because I know there’s a lot of people who just don’t get it yet. But the science is
there. We’re seeing a lot of better outcomes in people. And we’re seeing people come off their
meds or preventing them from going on meds with just some simple lifestyle changes. So I think
when people have the results to and you educate them, hopefully this doesn’t have to be a long-term
process either. Within three or four months, they can learn and figure out and see the benefits
and see their sugars improving where they don’t have to see Franco for the rest of their lives.
Right? Once they get on track and then we bring in the next people and do the same thing and
just rotate people through and educate the community. And then you do see like you guys are saying,
you know, rice cauliflower instead of rice, your tortillas made it a low carb way,
bread made it a low carb way. There’s ways to do it where you don’t have to give up everything
you love. But then what I find is a lot of people after a time say, you know, I really don’t even
think about bread anymore. I used to be freaked out by thinking about not having sourdough bread.
Then I saw my sugar spike up when I had it. Then it was easy for me to give it up. So, you know,
doing the education, the follow up and all that kind of stuff is awesome. So guys, I will put
links so people can track you both down and find you and Franco, I want to put some links to your
stories that you’ve done. Also some of your news articles and all that. And so all this stuff will
be in the show notes. So sorry to say crazy day today. I have to run. I got a couple of merchsies
going on. I got things delivered at my house. This has been nuts. I’ve been trying to mute it as
so much as possible. But hopefully we can see you got my editor can mute some of my stuff out of
here, but it’s crazy here. So you guys, thanks for putting up with me and for joining us. This
is really important stuff. And so I will make sure in the show notes, we have links to both of you.
And I’m really excited about what you’re doing. And I think this is going to catch on in other
communities. And I think you guys are putting the bugs in other people’s ears and say, yeah,
why am I not doing that? And I think the other important, really important issues look,
we’re not a war with each other. Let’s try to help the darn patients. Let’s drop the egos,
docs, drop your egos, you know, dieticians who’ve been doing the same thing for the last 40 years,
drop your ego, look at the patient, see what is going to give the best benefit to that patient.
And that’s what we have to do. And so that’s why I’m really encouraged about what you’re doing. And
everyone, thank you for joining us. We greatly appreciate it. And next time we’ll have
throwback. I know everyone misses him when he’s gone. I miss him too. But don’t tell anyone.
But thank you for joining us and keep up the great work.
Thank you for listening to the low carb MD podcast. We hope you learned something of value today.
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