0:00 Defeat Diabetes Low Carb Program

0:55 Introduction

3:51 Meet the panel 

8:00 Low carb vs low GI

14:23 Low carb and saturated fat (heart disease)

15:38 Why fat is healthy

20:32 LDL is only one marker

22:42 Can anyone do low carb?

26:15 Low carb = nutrient density

27:12 Long-term low carb

28:37 Intermittent fasting

33:13 Why some people have a supressed ap

34:19 Is a low carb diet expensive?

39:57 Takeaway foods

45:40 Fruits & breads

51:36 How to track carbs

53:48 Low carb vegetarian 

55:54 Weight loss benefits of low carb

59:36 How to overcome cravings

1:02:29 How to navigate conflicting medical advice

Prof Grant Brinkworth (00:05.378)
Well, welcome everyone. And thanks for jumping on today's session. And before we get going, I'd like to first just start by acknowledging the traditional owners of the land of which we're all meeting today and pay my respects to elders past, present and emerging. And today I'm meeting on the land of the Gadigal people and would also like others to, if they feel the need to acknowledge the lands of the people they are jumping in on today.

And also I'd like to particularly acknowledge the impact of diabetes on our First Nations people. Our First Nations people, unfortunately, have a much higher rate and risk of diabetes, and it's really important to acknowledge that. But what we're going to do today is we're really excited to really join today to really talk about the topic of Type 2 diabetes and low carb. Is it for you?

And this is our first-to-life event since our partnership between Defeat Diabetes and Diabetes Australia was announced. And I'd like to introduce myself. I'm Professor Grant Brickworth. I'm the Director of Research at Diabetes Australia. I'm actually a professor in Nutrition and Health. And I've actually done a lot of clinical research in this area around diet and diabetes and the management of diabetes, as well as a lot of work in lower carbohydrate diet. So it's really topical that I can join today.

And so I'm going to be the host for what I hope promises to be a practical and really helpful session. So whilst it's important to acknowledge that there is no one size fits all approach and that we probably need a range of evidence-based dietary approaches to personalised treatment for dietary management for individuals, following the growing evidence base that we've seen, there has been a significant interest in low carb diets amongst both the public and the health professionals.

So today, think what we want to do is explore low carb diets more specifically. We want to talk about including how carbohydrates influence by glucose levels, what low carb diet actually is, which can be confusing for some people, and how it differs from other diets like low carb or ketogenic diets, which people may have heard about or are actually trying to follow.

Prof Grant Brinkworth (02:22.114)
We'll also like to discuss the impact of increased saturated fats on heart health, which is always a very topical issue when it comes to low carb diets and any other medical considerations for starting a low carb diet and its long-term sustainability. So we've got lots to cover. Plus, we also just want to also make it as practical as we can. We want to share some tips for enjoying low carb meals when dining out and revealing some surprisingly high carb foods to watch out for.

And to help me, I'm not just the expert here. We have two great experts here. We have Nicole Moore from Defeat Diabetes and an expert and an accredited practicing dietician. Nicole is one of the so useful for providing some of those practical tips of how we can follow low carb diets. And also is the founder of the Low Carb Keto Health Clinic.

And secondly, we have Penny, Dr. Penny Figtree, who's a GP or a general practitioner from Port Macquarie, lecturer at University of New South Wales Medical School and an expert in diabetes management and has her own online program called Locab Port Macquarie. So I'd like to welcome both Nicole and Penny to the table as well. And so both collectively, I think we'd like to think we bring a wealth of knowledge and experience, and we're lucky to really have them with us today as well. So thank you for joining us.

So we're gonna be answering some questions throughout as well. So be sure to jot down anything that comes to mind and we'll try and get to as many questions as we can. We've got lots of different comments and topics to cover, but we will try and get through so we can get to some quick Q &A as well. Now, where we wanna start is I think I'll kick off. think what we wanted to start off is, you know, how do carbs affect blood glucose levels? And I think it's a really a good point to start to just really go back to the fundamentals and discussing

how carbohydrates actually affect glucose levels. Now, we know that carbohydrates are one of the three macronutrients, so that being carbohydrates with protein and fat. And carbohydrates can exist in different structures. So you have what we call monosaccharides, which are the very simplest form of sugars, which is the most basic fundamental unit of carbohydrate. Then we have disaccharides, which is essentially two, why it's diac, meaning two, there's basically two monosaccharides together.

Prof Grant Brinkworth (04:45.912)
Then we have oligosaccharides, which are three to 10 monosaccharides put together. And then we have the polysaccharides, which are basically long chains of monosaccharides. And these are all carbohydrates. But ultimately, when we talk about carbohydrate and carbohydrate metabolism, ultimately, regardless of whichever type of carbohydrate structure we're talking about, when eating carbohydrate, the digestive tract is always going to break it down into the simplest form, which is what we call glucose. And that's the simplest form. And then that's released into the bloodstream.

And that's why when you consume carbohydrates, that will always cause the biggest rise in blood glucose levels because that's the ultimate form of carbohydrate. And if you look at post-prandial and post-feeding studies, so these are studies that we look at people, follow their blood glucose after they've consumed some sort of food, they consistently show that compared to protein and fat, carbohydrate determined by glycemic load has the greatest impact on rising blood glucose levels. Now,

Glycemic load, I've just mentioned a little bit of topic there and then we're gonna get Nicole and Penny to jump on here in a sec. I've talked a little bit about glycemic load and it's a function of two factors. It's really a function of the total amount of carbohydrate in your meal multiplied by the total amount of carbohydrate which is determined by glycemic index. so that's where glycemic index is where there's different quality of carbohydrates and carbohydrates are broken down more slowly if they're low GI foods compared to others which are more high GI foods.

up that topic a little bit more. But whilst both of these factors, whether it be total amount of carbohydrate multiplied by the quality or the glycemic index of carbohydrate, research shows that actually it's the quantity of the carbohydrate that impacts glycemia the most. And that's probably at the premise and the heart of lower carbohydrate diet. So this is really just preliminary information.

probably a little bit of a textbook lecture maybe, if that's what people think, but it's a good way just to open up to our other panelists now. So I'm going to actually throw it over to Nicole first. So I might throw to you first. So I've sort of talked a little bit about carbohydrate metabolism and then how it raises blood glucose, but can you maybe describe exactly what a low carb diet is? because this term can be often quite used quite loosely, both in clinical practice and even in

Prof Grant Brinkworth (07:06.719)
and even by the general public. So how does low carb diets maybe differ from low GI diets or even keto diets?

Absolutely. I mean, I think one of the things that I will say to lot of my clients is that, you know, any reduction in carbohydrate in your diet is a lower carbohydrate diet for you. If you manage to lower your carbohydrates from, you know, five pieces of bread a day and three pieces of fruit and to half of that, then you are on a lower carbohydrate diet. The therapeutic carbohydrate reduction, I guess,

definition is that anything that's less than 130 grams of carbohydrate a day and generally, I guess the traditional diet, pyramid diet, people are often consuming anywhere from 200 grams or above. So therapeutic carbohydrate reduction encapsulates anything that's under 130 grams a day. And then you've got, I guess, the definition of a low carbohydrate diet, which

I usually express as around 50 grams of carbohydrate a day. And then you've got a ketogenic, a very low carbohydrate diet that sits as low as 20 grams of carbohydrate per day. And what does all that mean? And I guess I'll use the idea of the good old banana for a moment is if you think about a banana, it's got anywhere between 25 up to 30 grams of carbohydrate. So if you're doing a ketogenic sort

diet, you're going to be clearly not feeding any bananas in your diet. And so it really comes down to ketogenic is 20 grams of carbohydrate, a low carb is 50, but anything under 130 grams is clinically classed as a therapeutic carbohydrate reduction. And whatever you've reduced your diet down to, it's less than what you started. So that's how I explain to people what a low carbohydrate diet means.

Nicole Moore (09:06.336)
In practice, think, whether we're a low-carb doctor or dietitian, we're really looking at that decline as an individual to work out what level we're having, because some people go, well, should I be doing 20? Should I be doing 50? Well, step one, if we're trying to assist with managing blood glucose levels, then we want less than where they're starting at. And depending on how metabolically unwell they are or how high their blood glucose might be, their history, we can then determine

what level of carbohydrate we would like someone to be on. So, yeah.

No, no, sorry. What I'm hearing, Nicole, is that there's obviously a continuum there. Like, obviously, we start at one level, and it's a continuum. And is it fair to sort of say that maybe that what you're, what you're saying here is that we're saying we're talking about low-carbohydrate diets or lower-carbohydrate diets, and we're not necessarily saying no carb. And that's where I think there's a lot of confusion. People think low carb means no carb. I think, I think what we're saying is it's maybe about limiting the total amount of carbohydrates

because we know that that's what affects by glucose the most. if we still have carbohydrate in the diet, to maybe focus on those high quality, low GI diet, the carbohydrate foods, because that's what will help to help to blunt our blood glucose response. Is that sort of fair to say?

Yeah, I mean, I think what we're looking at is definitely, you know, using a measuring tool of some form to determine what's going to be best. Now, I get some people that, you know, when you look at low GI, you know, I guess it's definitely looking at the speed, I guess is how explaining how quickly a carbohydrate is released into the blood. And so you can have, you know, a high GI food that's all measured against glucose, glucose having that.

Nicole Moore (10:55.758)
glycemic index of 100 and everything sort of measured to that. So you know might sit and look at a long grain cup of rice and that sits at a medium sort of cup, GI of around 50. However you know you can look at a Mars bar as well and it's got a relatively medium GI and it's still going to have a lot of added sugar.

So I think how I like to explain it is that, know, GI definitely means that the food that you're going to eat is going to release a lot slower into your blood and clearly that's going to be better. However, I have sometimes people coming in and they are eating a low GI diet, but they still have problems with their glucose. So that says to me that we need to reduce the amount of that low GI carbohydrate. And if people don't progress, that's where we change and individualize the

carbohydrate threshold for everyone. Some people who have been metabolically unwell for a very long period of time, they might have to go quite low and actually drop their total carbohydrate to 50. And if that leaves a bit of wiggle room for a lower GI carbohydrate in there, then that can work. But it's all about measuring the data. What is the centimetre down the belly? What is the blood glucose doing?

If we're not lowering it enough, then we have to individualize it for that person. So I think for some going lower GI can work. But if that's not really working, I ideally would be dropping the total carbohydrate down, working backwards because everyone has a threshold that's different. So that is definitely the difference between a low GI diet and a low carbohydrate. On a low carbohydrate, it's total carbs we're lowering.

on a low GI diet, will be transferring people from that white bread to that grain bread, or that white potato to that sweet potato. But if that's not actually working for someone, and I guess with defeat diabetes, that's where we're actually lowering. People are being down that rabbit hole and they're doing a low GI diet and it hasn't been working. They're just having more carbohydrate than their bodies can manage, then we would lower their total carbohydrates. That's sort of how we would do

Prof Grant Brinkworth (13:07.918)
That's some really good points and I think some key points there is really, think the research does show that yes, low GI can get us so far, but actually it's the impact of the total amount of carbohydrate that can have greater potency if we're really trying to drive blood glucose. And then I guess that picks up this next point and then I'll bring Penny into this is that, we've been talking about low carbohydrate diets, we've been very much focused around the carbohydrate component of it.

Ultimately it means, but if we have a lower carbohydrate diet, we often have to increase what we have to, increase the proportions amount of protein and fat. so whilst blood glucose control is a key therapeutic target in the management of many metabolic conditions such as pre-diabetes and type 2 diabetes, unfortunately a lot of these metabolic conditions, it's not just about the blood glucose control because a lot of these metabolic conditions are associated with often other multiple comorbidities such as increased risk of heart disease.

And I know an often cited concern around low carbohydrate diets has always been because you lower the amount of carbohydrate and increase the amount of protein and fats, that with some, but not all, low carbohydrate diets, they can actually also increase the amount of saturated fat, which raises this ongoing question about does this increase the risk for heart disease? Because saturated fat can often elevate LDL cholesterol, which we know is the bad cholesterol that doctors measure.

So Penny, know, did you want to have any thoughts on this particular topic? Because it's a very hot topic in low carbohydrate world.

It is. Well, first, I just want to say how exciting it is that Diabetes Australia is getting onto the low carb idea. And I think you're going to save a lot of lives. As a general practitioner starting to use this in my patients, it's incredible the medications that we stop. People get so healthy and happy. So thank you, Diabetes Australia, for partnering with Defeat Diabetes, which is an incredible resource.

Dr Penny Figtree (15:12.718)
And I also want to say that porridge puts my blood sugar to 12 and I'm not a diabetic. So even healthy porridge isn't so healthy for some people, even if it's low GI. And now we're getting on saturated fat. So of course people are confused because we're saying low carb and yes, you can eat cheese now. It's full of saturated fat, but go for it. It's healthy.

And I grew up in the low fat era. I was terrified of fat and I had the low fat yoghurt, lots of sugar added. And I was your low fat person. And now I'm eating fat and I'm not scared of it because I realized that the fat in our food is actually really healthy. And so I can understand why people are confused. But you might be reassured to know that there's not any real evidence in

humans, if you put them on a low-fat diet, it actually doesn't do much for them. So the evidence for it being harmful is really not there. And when you go on a low-carbohydrate diet, what we see is the big risk factors for cardiovascular disease go away. So having type 2 diabetes is probably the biggest risk factor for heart disease out there.

Thanks.

I remember being told at university that a person with type 2 diabetes has the same risk as someone who's had a heart attack of having a heart attack. So having type 2 diabetes is an incredible risk factor for having cardiovascular disease. And we see on a low carb diet, type 2 diabetes, often people achieve remission. We also see blood pressure improve.

Dr Penny Figtree (16:56.802)
And we see these funny lipids, a lot of people don't know to look at, which is their triglycerides and the HDL cholesterol, they get better. So we see it. They suddenly improve on your. They're a real marker. They're saying you're metabolically unwell and this is a risk factor for heart disease. Gosh, you've gone low carb. They're better now. That shows me you're at lower risk. As well as that.

inflammation. Heart disease is an inflammatory condition and we see on low carb that people's inflammatory marker, their CRP, that goes down. So inflammation goes, people lose weight, diabetes goes away, heart disease goes away, these lipids improve. So your risk for heart disease reduces. But then we've got left that one little guy, that LDL cholesterol that terrifies everybody. And what

you probably don't realise it's a lot more complicated than LDL cholesterol. This bad cholesterol comes in seven different sizes. And those people with diabetes have got the nasty ones, which are called small dense particles. So if you eat a high carbohydrate diet, you will increase the number of your LDL particles that are nasty, that are small and dense, more likely to cause heart disease.

certainly does.

Dr Penny Figtree (18:23.714)
But you go on a high fat diet, you'll see that cholesterol become a large fluffy particle, which is less likely to cause heart disease. So looking at LDL cholesterol alone is not a good marker. And that's why doctors are moving to measuring something called ApoB, which is more accurate for particle number and not so much particle size. But anyway, that's boring. But what I want to say to you is eat fat, enjoy it, eat the cheese, don't eat the biscuit. And the problem with saturated fat is too.

Number one, saturated fat in your liver. Okay, so that's the fat you need to worry about. Not the fat in your meat, but the fat you make in your liver is saturated fat. So that comes from sugars and starches. So your body makes saturated fat in your liver. You get fatty liver disease. That saturated fat, and that's the guy you don't want, not the one that you're eating. And so

overwhelmingly I think your risk of heart disease will reduce dramatically by cutting out the sugars and starches and eating those fats that come with cheese, full fat dairy, with meat and a bit of dark chocolate after dinner. So that's my rant.

No, it's not a rant. I think you make some really interesting points, particularly around that LDL is only one marker of heart disease risk. And we have these other markers like triglycerides and HDL. And we know that the research, I've done a lot of research in this area, and we know consistently research shows that when people go on lower carbohydrate diets,

They elevate the LDL cholesterol, which is a good thing, and they lower their triglycerides. And just to really pick up on your point about the LDL response, that's a really interesting one because, you know, it does remain a primary therapeutic target for health professionals managing and reducing the risk of heart disease. But the LDL cholesterol response, as you've really pointed out, Penny, associated with a low-carb diet. may not be as simple as just measuring.

Prof Grant Brinkworth (20:25.3)
LDL cholesterol itself, you've sort of mentioned it's quite a blunt tool and there's so many sub fractions. And the research actually shows that the LDL particle size is probably a better predictor of heart disease risk rather than the LDL cholesterol itself. And the research does show that LDL with low carbohydrate diets, it tends to increase the size of LDL particles and reduce those nasty small LDL particles that you've talked about that tend to be more

atherogenic or increase our risk for heart disease. So I think that the jury's sort of still out, isn't it? I mean, like, I think what we do need as well is that we need longer-term studies for both not only lower carbohydrate diets, but also high carbohydrate diets and all of our dietary patterns to really understand what the long-term effects of these things are. But I think that, you know, based on the evidence, I think in summary...

assessing just absolute LDL by itself doesn't tell us the full story. And I think that's what you've been telling us, Penny. And I think the most prudent approach is obviously to closely monitor health risk factors when adopting any new dietary approach, including low carb, so that physicians, and you can work with the healthcare professionals like accredited practicing dietitians like Nicole, that can actually then monitor your risk factors as you're following different dietary patterns. So adjustments can be made.

that are appropriate for your individual needs. So Penny, another question I had for you quickly is, so we talked a little bit about monitoring and management from a healthcare professional perspective. So can anyone do low carb or is it really what are medical considerations that I should make or that my GP should consider? And how will I even know if I'm improving my health if I actually wanna do a low carb diet?

Grant, so when as a GP, like it's not dangerous. I think people think eating meat and above ground vegetables, well, I have to check with my doctor. So basically that's all low carb is, but the problem with this way of eating meat, above ground vegetables, no starches is medications become toxic. So the diet in and of itself is just a healthy diet. Anyone can eat it.

Dr Penny Figtree (22:41.678)
But the problem is if you're on particular medications, they become really powerful and potentially lethal. So the two that I never want to miss are two diabetes medications. One of them is insulin. So I often get people off their huge doses of insulin within a week. So it's fast. And if you go on this way of eating, you've got to have your insulin dose the day you start the diet. people on insulin.

And then another medication belonging to a class called sulfonylureas. They've got many different names. So you'd need to ask a GP. They usually start with G. And so these drugs will force your blood glucose really low, and you'll have a hypo when you eat this way. And so this is what's fun for me, because I'll meet a new person, and they'll be keen to try this. And I'll have their insulin, and I'll stop their sulfonylurea, which also makes you put on weight.

and actually accelerates decline in your pancreas dysfunction. So it's a great one to stop. So within day one, they're already off to two medications pretty fast. So can anyone do it? Yes. But you need to check with your GP about insulin, cell phenol, ears, blood pressure medications, particularly fluid tablets can become too powerful, really fast. And another one that is a really great diabetes medication and very, very popular. So it's going to be pushed.

is called an SGLT2 inhibitor. It ends in the word, frozen. That one your doctor will be wanting to just check on. It's subtle. A lot of us keep it going, but it does have one side effect called ketoacidosis. But the two that you don't want to miss are just insulin and sulfonylureas. And then some patients who have bipolar disorder might be taking lithium. And those levels can drop a little bit. And so you might want to get that checked.

that there's really only two that are dangerous. And in women who are pregnant, we don't have a lot of research in that area. So I maybe wouldn't be saying go keto, I'd just be going respect, don't eat too many carbohydrates, but not go super low, just because we don't have any evidence in that particular group. But really for diabetes patients, it's just powerful medications that are the problem and not the diet. But Defeat Diabetes has a letter for your GP that explains all of this.

Dr Penny Figtree (25:06.048)
If you chose to join defeat diabetes, they would give you a letter to take to your doctor who could just check that you were safe to take it. But remember metformin, azenpeak, you know, most of the medications are completely fine.

So Penny, what I'm hearing just as a sort of a take home is, yeah, like from my understanding, know, low carb diets, people think they can often be a bit of a weird thing, but really low carb diets are really...

centered in the premise of healthy eating. It's all based on the principles of eating low energy, dense, I'm sorry, low energy, nutrient dense foods, whole foods, the foods that you just get from the everyday supermarket. So I think what we're saying is that largely, if you're working with healthcare professional, most people should be able to adopt a lower carbohydrate diet approach. But particularly if you're on medications, it is important to do that in close consultation.

with a GP. if those medications need to be reduced, which can only be a good thing, that that actually can be done in a safe way. A question that I get asked a lot when people ask me about low carb diets is, are low carb diets actually sustainable for the long term? And I'm just reading a question here from one of our viewers, David, also asked about long term keto diets and intermittent fasting. Are these all things healthy to maintain in the long term?

So I guess from a research perspective, we probably need more well-controlled studies, as I've talked about, to really understand the long-term effects and the safety effects of all dietary approaches. I think always more research is required. However, from the research that I've done, we've actually shown in the studies that we've conducted that over a period of at least two years, that in people living with type 2 diabetes, compared to a traditional high carbohydrate, low fat diet, a low carbohydrate diet actually that's higher in portions of fat.

Prof Grant Brinkworth (26:54.85)
protein was equally effective, if not more effective in some patients sustaining long-term weight loss. But a lower carbohydrate diet, as we've discussed before, is more effective in improving blood glucose control and reducing those cardiovascular disease risk factors without any detrimental effects on other outcomes, including renal function, mental health, psychological performance, and even other systematic reviews, which are

reviews are systematic reviews are basically studies of studies. So they are a systematic review of all the studies on a particular topic that are published in the medical literature. And they've also shown the similar results that people living with type 2 diabetes that at least over a period of six to 12 months, low carbohydrate diets will achieve greater weight loss and improve blood glucose control and reduce cardiovascular disease risk. Now to David's particular question about long-term keto diets and intermittent fasting.

I mean, I've done a lot of work in low carbohydrate diets, which is more or less a keto diet anyway. I haven't specifically done a lot of research on intermittent fasting diets, but my understanding from my reading the literature is that there is also a moving evidence that these are other dietary approaches that have shown to offer effective alternatives for some people to achieve improved health outcomes. But again, we need those long-term studies to really understand the long-term health and safety effects.

But I think the key messages is really that there is no one size fits all. carbohydrate diets have great clinical application for people living with type 2 diabetes. But it's important to undertake any dietary change in close consultation with a health care professional, such as accredited practicing dietitians who can monitor your health response and adjust accordingly, but also importantly ensure that the dietary approach that you've chosen remains nutritionally replete.

because we can have a dietary approach that's low in energy, helps us lose weight, but we don't want, we want to also make sure that those are, that we're meeting all our nutrient requirements as well. So maybe other panelists, Nicole, did you have any further comments around intermittent fasting diets or other dietary approaches that this list has talked about?

Nicole Moore (29:05.086)
I guess I always answer people do often ask about the longevity and whether it's safe. And I think it all comes down to measuring your health biomarkers. If you're keeping a Chlo-5, you're triglycerides in your HPL and your liver function tests and your waist tip is shifting down and you're maintaining better glycemic control and better blood glucose. And that happens long-term. say, well, then this is...

and all your markers are getting better, not worse, then you're doing the right thing for your body over that time. If things were not going well or there were some biomarkers that were not doing what they should be doing, then we would fine tune and individualise. mean, even when we talk about fat on a low carbohydrate diet, we're also talking about lots of really good fats. Saturated fats are healthy and stable, but we're also encouraging fatty acids and...

oily fish and avocados and nuts and seeds and olive oil. We're discouraging, you know, seed and vegetable oils because we know they're high in, you know, omega six or poofers that can be quite damaging and oxidizing to our body. So I think long term is if you keep, you know, in contact with your your GP and that your markers are getting better, then it's got to be good for your health. If your diabetes is in remission and that's long term.

then it's got to be good for your health. Intermittent fasting, think, you I go back to, you know, I say when we lived in a cave, you know, it wasn't always food. So I think we're really reflecting how we, our ancestors. And so I think we should feed when we're hungry and not when we aren't. I think people feed to a clock.

And we know on low carbohydrate diets that improvements in sort of insulin stability impact our ghrelin and leptin and we feel less hungry and more satiated. So so many people come in and they say, don't feel like breakfast and I didn't really want to eat till 11 and I say, well, then don't eat till 11. You eat when you're hungry. Don't starve your body. If it's hungry, feed it. But if it's not, wait.

Nicole Moore (31:12.106)
And if that means there's some days you're doing a 16 hour fast and having a brunch and other days you need breakfast because you wake up hungry, I think if we are more in tune and mindful with actually our body's cues for hunger, I think in society today people are eating and being driven by, you know, times and not actually by physical hunger. And we know for some who have struggled with their weight and their blood glucose control, that they can feel quite hungry all the time.

with a high carbohydrate diet, they're not eating enough protein, they're not eating enough healthy fat and they feel hungry every few hours and it's this never-ending feeding cycle. When they go low carb they go, geez I wasn't hungry for four hours and they think that's quite unusual and fasting is a very natural part of I guess, makeup. So I think with intermittent fasting and low carbohydrate approaches I think they work well and it's just about fine tuning, individualising

and measuring your health markers so that over time, if they're getting better and not worse, this type of structure of eating is working well for you.

There are some really good points, Nicole, and I really appreciate you came on and mentioned them. I really like the point you talked about around why people maybe have suppressed appetite, because we know that the research shows that protein compared to particularly carbohydrate is a lot more satiating. So when we talk about satiation, we talk about suppressing appetite. And that's why people that tend to follow lower carbohydrate diets

tend to do better because they don't tend to be as hungry all the time. Therefore, they don't eat as much total energy. Therefore, they're able to maintain a healthier body weight much more easily. So, you know, that's some really good points. So now I think it's time to like really switch on to some of the more fun things around low carb diets. We sort of talked a lot about the theory and the medical stuff, but I guess let's talk about some of these practical things. So Nicole, I'm going to pick on you again. know, a question that often comes up is,

Prof Grant Brinkworth (33:16.312)
you know, and it's quite topical right now because we are in a cost of living crisis situation and, you know, and some people are doing it really tough and we acknowledge that. And so we often get this question, is, you know, is low carb diets expensive? You know, what do you think about that?

Well, I guess going back to the point before, because people do they say to me often, when we start talking about avocado and olive oil and nuts and seeds and salmon and meat and chicken and fish and eggs and their eyes get wide open, I can't afford all this. And I talk about the fact that down the track, they're going to feel less hungry anyway. they might be some of those foods can be a little bit more costly.

but you're not going to be eating as much. So therefore, you actually save money in the end. But the other side of it is it can be very budget friendly. I mean, if you look at some really good proteins, you can go and buy great cheap cuts of meat from your butcher and slow cook a lot of stuff. So if you go for cheaper cuts and slow cook, you still get your great protein intake without maybe the cost of a wagyu steak. We're certainly not sitting here talking about eating aged wagyu beef.

talking about being practical. So go buy cheap meat and slow cooker. Eggs are fantastic protein and got good fats in them and they're cheap. So I think you can do lots of things with eggs and know the research shows that eggs aren't dangerous. So you can eat as many eggs as you like. And tinned fish is great. So get a good quality, get tinned fish that's not in a vegetable oil, get it in spring water. Tinned fish is a very economical way of getting

proteins in. And, you know, I think if we can focus on those more cheaper sorts of protein, we can keep the costs down. We don't have to eat avocados and macadamia nuts every day. You we can go and get a packet of raw mixed nuts and eat those, which might be a bit cheaper. We can have a boiled egg. You know, we can get some good quality, you know, ham off the bone and have that with some some veggies. So I think it can be very cost effective. You can bulk cook.

Nicole Moore (35:26.894)
You can use mince meat. Minced meat is great to do lots of budget friendly meals from meatballs to risoles to low carb cottage pies. So I think we're in saving money in the end. We're not buying those expensive boxes of breakfast cereals that, you know, it's six dollars for a box and you'll eat, you know, if you've got kids like me with 18 years old, they'll be lots of boxes of those things. So I think you'll save money on all those nasty little muesli bars and and and expensive

breakfast cereals and you just go for veggies that grow above the ground as Penny mentioned and they can be frozen. think, know, veggies that grow above the ground, the broccoli and cauliflower, they probably sometimes might be more nutritious because they've been snapped frozen and have been sitting in the grocery store for like, you know, a whole week under the light. you know, cheap veggies that are snapped frozen that grow above the ground are great to use.

And, you know, sure, berries are expensive. We often talk about eating berries as a low carbohydrate, low sugar fruit, and they are quite costly, but frozen berries, you can get the no-name brand and use those. You can buy your no-name brand Greek yogurt. You can buy your cheap cups of meat, lots of eggs, lots of fish. And that will be a very budget-friendly version of a low carbohydrate plan. And you just won't eat as much. You know, I always say, you know,

want to a steak the size of your head if you want, but most people can't. So they find they feel full, they don't need to snack, so you're saving money and you can buy quality, really budget-friendly, low-carb foods and make some really good bulk meals out of it. So that's usually what I mention to people. I don't sit there and say, buy five avocado weeks and a kilo bag of macadamia nuts because already their budget's probably spent.

It's sitting down with people and being really practical about low carb and giving lots of ideas. And as Defeat Diabetes, we've got lots of recipe ideas and you can find those that suit your budget for the moment.

Prof Grant Brinkworth (37:34.968)
that's something fantastic. You took some of the ideas out of my head because they're the sort of tips that I tend to give as well. think also, you know, the beauty of low carb diets is that we really promote, apart from over consuming a lot of those starchy vegetables like potato, sweet potato and,

And pumpkin, mean, like lot of the other veggies are all basically free go. so, yeah, buying vegetables that also in season is another great tip, you know, because there's obviously a lot of seasonal variation. I love what you're saying there, Nicole, about frozen veggies, because a lot of people just often think that frozen veggies have poorer quality or tin veggies are poorer quality. But that's actually a bit of a myth, because when growers...

buy them and they snap freeze them or the nutrients already snap frozen in there. Another and I think the other important point we've already talked around some of the benefits of low carb diets, particularly for patients or people living with diabetes that are on medications is one of the great advantages that I've seen from research of lower carbohydrate diets is that often you can reduce your medication costs, reduce your medication. So that's another savings in itself.

that yes, it's not a direct food savings, but you're saving in other ways because you're genuinely more healthier and therefore you have lower health care costs, which I think is something we have to think about when we think about healthy eating. So another sort of thing that comes up, I guess a practical thing comes up with low carb, and I might turn to you, Penny, is that you're a consultant, you're GP, you consult to patients and people living with diabetes and other metabolic conditions.

So within, and you have your own online program, you know, what do you advise patients about takeaway foods when they're not at home? You know, we don't all, we all live very busy lifestyles. We all aren't necessarily buying foods and cooking them at home at least every day. So, you know, can you still enjoy takeaway and eating out when doing a low carb diet? there any tips and hacks around that for us,

Dr Penny Figtree (39:35.714)
There certainly are. And it's funny seeing different people, one after the other, in my office. One person will come in and go, it's so easy. Eating out is so easy. gosh, no worries. And then the next person will sit down and go, it's so hard when you're eating out. There's nothing to eat. That's fascinating how different humans do this. But honestly, it is so easy. And it's different, isn't it, to low calorie diets? That's hard because you're hungry, cold, and miserable. But this, you eat when you're hungry and you feel great.

so yes, the takeaway is very easy in my family where we're low carb, including my university student daughter. and they like G Y G and those Mexican type places because you can just grab the meat, the sour cream, the guacamole. You just say no rice, no beans. Can I have more lettuce? You know, you're not suffering. You're eating a delicious meal. at the same time, you know, everyone knows I hope and have heard of the bunless burger.

So if you're really busy, you just cruise into McDonald's and get your Angus burger patty, a bit of Jack cheese. If you're embarrassed, you can just order the big burger and take the bun off and just punk it in the bin and then eat the rest. And it's so filling. And once you've started doing that, you realize how good you feel after that. And you never want to eat the bun because you realize it doesn't make you feel good. And then kebabs, I mean, they're great, aren't they? In Port Macquarie.

The kebab master shop even has a low carb option where you just get the meat and the salad without the bread. So eating out is pretty easy. And when we have pizza, you might not do this, but I do it. I order a lot of toppings and then I get my fork and I eat the topping and leave that miserable base. I just look at it and go, that is awful. And I notice people around me getting really sleepy and tired.

after their pizza, whereas I'm still feeling really good because I've just eaten all this meat and olives and cheese and delicious food. But some people can't do that because they find the base irresistible. I don't, but that might that can be a go. And if you're going out to a like an Italian restaurant, well, that's always easy because they've always got veal with a creamy sauce. You pick the meat with the vegetables.

Dr Penny Figtree (41:59.232)
So fish and salad, meat and salad, you go to the RSL, you get the big roast, but you say, no potatoes, can I have salad instead? A bit careful with the salad dressing because they'll put sugar on it. So you might say no salad dressing. But the more you do this, the more you realize it's actually really easy. And breakfast is just so easy. That's avocado and eggs. It's just easy. And I always feel sad when I look at the people around me eating big juices.

all their big porridgey things and I know that you're going to feel they're poor pancreas. It's just screaming trying to deal with all that glucose coming in. But so there's so many options. And when you first start out and you're going out to dinner with friends, I think the best tip is to look at the menu before you go. They're always online and just plan out what you're going to choose. So when the social pressures are there, you're already confident in what you're going to pick.

and that helps and you get better at it and then it becomes easier and easier the more that you do it.

Thanks, Penny. There's some great tips there from you. I think the thing that we need to be mindful of is now is the way we live our lives and we have takeaway options, restaurant options. I think we should not be scared to actually ask people to modify the food options. And you're surprising how many restaurants or even takeaway places will do that for you. And so I think that that's what we've got to empower ourselves.

to know what we need to do to follow a low carb diet and actually help the community to support us in that. And then I think, I don't think that any listeners should be scared to ask to have menu items modified to be able to meet their needs. So thinking even more practical than Nicole is, know, there are so many foods out there and it can be confusing. whilst many of us know which foods typically are high in carbohydrate, like the typical rice, pastas and potatoes,

Prof Grant Brinkworth (44:01.954)
you know, surprising there are still many foods that are much higher in carbohydrate that you wouldn't think so. And we've already heard Penny talk a little bit about porridge and the impact that has on her. But we also, know, breads and even even in eating many fruits are much higher in carbohydrate. And I think fruit is a really interesting one, as we're always told to eat more fruits like vegetables. But this can be quite confusing because, you know, many of the fruits we eat.

know, particularly following low carb diets tend to be much higher in sugar and carbohydrate content, which makes that message very confusing. So we've got a listener here that's also asked. So this is Robert has dialed in or messaging and he's asking which common fruits are good to miss or eat daily. And Pipp's also asked about sourdough. There's so many different breads out there. Is that OK on a low carb diet? So

Nicole, any thoughts on fruits and maybe breads?

Yeah, look, I mean, I always say fruit is nature's candy. And, you know, I think that we've come from a society that potentially used to eat fruit seasonally. And I always go back to my cave analogy is, you know, we would gather our berries. There wasn't a banana tree and a mango tree necessarily outside the cave. And that we really need to be mindful of fruit, particularly now it's dried and it's organic and it's

know, we've juiced it and, you know, once you start stripping away the fibres and juicing, you're just getting pure, you know, basically pure sugar. So I think, you know, all fruit is carbohydrate driven. Berries, sort of strawberries, raspberries, blackberries tend to be your lowest end. So, you know, if you're looking at, you know, as we can see the picture there, you can see berries, avocados.

Nicole Moore (45:56.63)
When you look at those, we class them as green, I guess, because they might only be sitting at, and we'll do it per 100 grams, between five to six, maybe seven grams of carbohydrate per 100 grams. Now, every four grams of carbohydrate is technically equivalent to a teaspoon of impactable sugar in our blood. So the green ones are ones I'd be consuming more daily because they're the ones that are not going to give you a big sort of...

increase in the amount of glucose in your blood and are going to be sort of a safe one, I guess, to include daily. And we know avocados are great fats as well, so adding those every day. Blueberries tend to be a little bit higher, sorry, blueberries, and they sit at around 12 grams of carbohydrate, sort of a hundred grams. So that's sort of spiking around three teaspoons of

technically sugar our body needs to manage. And as we go along with apples, pears, these fruits will have more impactable sugar that our body needs to deal with. And then you go down to the red. So you can see banana can sit anywhere between 20 up to sort of 30 grams of carbohydrates. So if you start breaking that down to four grams of carb is a teaspoon of some form of sugar your body has to manage.

know, mangoes, bananas, grapes. You know, it's just a lot more load on the body. And again, it comes down to the individual. I'm probably going to start people on the green fruits to begin with and keep an eye on what their glucose and their weight, if that's what we're looking at it's doing. But again, then I'm not going to say you can never eat a banana. It's not going to kill you. It's more about looking at the frequency of how much fruit people are consuming. And I encourage people to eat more nuts and

some Greek yogurt and some cheese to of snack on rather than eating three pieces of fruit. I generally just encourage dried fruit. I guess it's a lot more concentrated. And you look at 100 grams of apricots and you're going to get up to 70 grams of carbohydrate in dried apricots. Whereas we just said a banana, fresh banana is 30. But then we just said our berries go down to four to six.

Nicole Moore (48:09.102)
I guess that gives you a really good understanding if you're starting to visualise teaspoons of impactable sugar in our blood, how fruit really can put a lot of pressure on our body. So hopefully that answers your questions in terms of what fruit. I don't think we can never not eat, you don't have to never not eat a banana or enjoy delicious mango, but I think people are eating three or plus serves of fruit in different forms and they're having their juice in the morning and then they're having their two or three pieces of fruit or they've snapped on some dried fruit.

That's putting a lot of load on the body that the body is not managing if you've got blood sugar issues. So I think those other fruits occasionally are fine. I think if you want daily fruit, I'd be going for those green fruits. And again, the question with bread is, we talked about before, obviously going for a grain or a sourdough is going to slow down the release of that glucose into your bloodstream. So they are better and they are lower GI versus a white bread.

I guess it's still going to break down and require your body to manage it. So it's in moderation. I think it's about the individual. It's about your sugar levels. I'm going to put people on no bread maybe to start with, or a defeat diabetes, you know, lovely almond flour bread recipe. There are some breads on the market that you can buy that, you know, quite low in carbohydrate.

You'll see them, say 85 % low-carb. And I might start there and then you can work backwards. Can I have sourdough? Sure. Check what your glucose are doing. It's frequency of carbohydrate loading that is the big issue. So if we're reducing the frequency, go and enjoy your sourdough bread on the weekend, but top it with loads of protein and healthy fat, eggs and avocado. But we just need to be aware fruits and bread still create impact or

you know, require our body to manage that sugar load in some form. And if you have type 2 diabetes, you have a need to get your glucose in your blood more under control, then these are things we need to be careful of. So enjoy your banana or your sourdough. I just wouldn't be doing it every day at the moment if you're trying to get your glucose levels under better control.

Prof Grant Brinkworth (50:25.518)
Thanks Nicole, and you've talked a little bit about also different levels of carbohydrates in different foods. So Penny, this really is a nice segue to this question around, or this topic around food labels when following a low carb diet. Sharon's asked, people also talk about net carbs. Is that taking away the fiber from the carb? How do we actually accurately?

track our carb intake for a day that's in a realistic way. So maybe if you want to put some comments around food labels and how we actually even count carbs.

Okay, I always try and keep it really simple for people. It doesn't need to be complicated. In Australia, when they put carbohydrate on your food label, it's net carbs. All net carbs is carbohydrate minus the fiber because fiber is a carbohydrate. So in America, if you check the food label, the carbohydrate contains the fiber number. So you're adding up fiber and carbohydrate together in America.

But in Australia, when they write total carbohydrate, it's giving you net carbs already. So you don't really need to worry about it too much. All net carbs is it's just taking out fiber because fiber doesn't tend to put up your blood sugar and get into your body. So you don't really need to worry about it. So for you as an Australian, looking at a label, you've automatically got net carbs. So I would tell you, don't worry about it. I tell my patients, look at the label and look at

per 100 grams because the food companies decide what the serving size will be. So it's very different between products. You can't compare them. But if you look at per 100 grams, well, that's a percentage. So you look carbohydrate per 100 grams, less than five. Just walk around the shop, carbohydrate, look at per 100 and you want it to be less than five. And that's where I start everybody. And we just keep it really simple.

Dr Penny Figtree (52:30.612)
Later on, if people, you I would need them in ketosis, we'll do more tricky things. But honestly, for the majority of human beings, just go carbohydrate per 100, less than five. And in Australia, that's net carbs automatically.

Now, know that we are running short of time and we need to wrap up, but let's see if we can get to at least three of these rapid fire questions, okay? And then we'll have to wrap up maybe with a conclusion statement from each of us. So let's have a look at some of these questions that coming through. So Nicole, Jenny's asked, I'm already limited with my diet. I'm a vegetarian and can't even have onion or garlic. Will going low carb make it even harder? Rapid fire questions, Nicole.

Look, it's doable, absolutely. You can use garlic infused oil, number one, so you don't have to, you know, you can still get all your nice garlicy flavors. We're talking about eating plenty of vegetables that grow above the ground from a vegetarian or a vegan perspective. With vegetarian, you can still be doing fish and you can still be doing eggs. If you're vegan, you can still be doing tofu and tempeh and doing nuts and seeds, you know, nut meat. So, you know, there's still plenty of options there.

It's, you you do have to sit down and have a bit of a think about it. We do cauliflower rice instead of regular for us. We do zucchini noodles or konjac noodles for our stir fries, you know, with our eggs or our nuts. And there's even some lower carb beans like lapini beans and black beans, for example. So you can go and still do a great, you know, vegetarian chili con carne with some cauliflower rice and some smashed avocado on the side. Plenty of options and ideas.

You can use the tops of spring onions if you've got a FODMAP issue and you can't use onion, you can use your garlic infused oil. So, you know, I can sit down with clients and we'll come up with lots and lots of different ideas and chia puddings that are low carb and stir fries with konjac noodles and low carb soups, all vegetarian and still low carb. So yes, you can, don't be afraid to do it. You just probably need to sit down with a low carb dietician to actually, you know, work out some menu ideas for you. Once you start.

Nicole Moore (54:38.968)
Seeing it, it will get easier and easier as you go.

That's fantastic Nicole and I think that you're right. Just working with a health professional, nutritionist that's very creative, there's many ways you can think about food more than what we genuinely do. I think we genuinely just eat the same foods day in day out, whereas there's a whole plethora of things that we can do. So John's actually messaged through, he says that he has type 2 diabetes, but he's been on a low carb diet and he's lost so much weight.

and shouldn't lose any more. that's fantastic. Well done, John. I congratulate and applaud you for being able to achieve that. So Penny, how can potentially John still continue on a low carb, but maybe to help stabilize his weight or even put some weight on?

It's interesting, I often get this from patients, but we all have a warped idea of what a healthy weight is. So often people think, oh I'm really, you know, I'm too thin, but actually they're still unhealthy. So what I would always do is their waist measurement and their height. You want your waist to be less than half your height. So just get a tape measure, don't, who cares what the weight, the scales say, just make sure you're skinny around the middle, because often you've still got a bit of a belly there and that's

get Google to do.

Dr Penny Figtree (55:56.034)
will reflect fat around your organs that we don't want. So just check your waist is less than half your height. But if you're there and you're just perfect, well, just you've got various options. So if you love eating this way, well, now you've lost your body fat, you just need to be adding that fat back to your food so you can't burn you as much. So you're going to be adding more olive oil or plonk some butter on your vegetables. So the fat is just going to be coming from what you eat now. So adding more fat is

step one and you'll find just follow your your hunger because honestly your body's telling you what it needs and so when you eat you're to eat a great meal and just add extra fat so that's one option and another option is you might if you want try adding a few more carbohydrates maybe you can tolerate them maybe you can't but you can just do a little experiment you might think i'm going to add you know some chickpeas and see how that goes and you just maybe a bit more fruit and see how i go but if you

weight comes back, you know that isn't right for you and you jump back on it. But there's no reason why you cannot be on a very low carbohydrate diet and maintain your weight. Indeed, I have some, I've had a few people who so get into it and they're keto baking, they're eating so many keto treats, they put on weight. So add more fat to your food would be the simplest answer. And check your really article weight.

So thanks, Penny. So we'll try and get through just a few more. And I think we do need to wrap up. But I'll take this one. So Glenn's actually said that he likes a glass of dry red wine with his dinner. And we get this question all the time about alcohol intake. Look, from my experience through clinical research, working with patients and people living with metabolic conditions,

We found that using a flexible approach is the most practical for people to achieve long-term success. So my advice is that if you like to have an alcoholic drink, you don't necessarily need to eliminate everything completely. I don't think that's been any message from today, but just to really limit the amount of alcohol that you have because it still can be quite high in calories. so, yeah, it is important not to go overboard, but specifically for dry red wine, it is pretty low in carbohydrate.

Prof Grant Brinkworth (58:14.722)
but it's always best to try and avoid those sweet wines because they're the ones that genuinely have the added sugars and that's what we've been talking about. We're trying to avoid. So I think maybe we'll just pick off two more, one each for Penny and Nicole, and then I'll let them off the hook. So maybe Nicole for you. Helen said that she fell off the wagon over Christmas. Now we've got Christmas in July coming up, so maybe people are almost going to be falling off the wagon much sooner than we thought. And again, at Easter. So, you know,

Helen's struggling to get back on track. Do you have any tips about overcoming any of these cravings?

Yeah, well, I call it the reset bridge. I think that when you're in a low carb space, you don't feel the cravings as much because you've got nice stable glucose, your body is feeding off your own fat store. So you've got this internal food source. You're not hungry and you don't crave as much because you're not getting these big jumps with the glucose and the insulin. then, you know, then they're dropping down. So cravings get a little bit better. But then when someone when you go and eat a carbohydrate or a piece of cake,

What people have to anticipate is they're going to get this really big surge of glucose and insulin to make them really, really hungry. And I always say there's no such thing as willpower. You've just got to be ready that if you do eat some carbs and you do find your cravings and hunger get, you know, coming back, is my reset bridge is to get back over to the other side where you think, how was I over there? I wasn't hungry. I wasn't craving. It was like easy. Now I'm here and I want to eat every piece of cake inside. I can't stop thinking about sugar. I can't stop thinking about bread.

and they try to keep going back to where they started and they go, right, today's the day. And they try to do a little fast and they're to eat their two boiled eggs and they're just too ravenous and they can't, you and they fall off the wagon again. You know, the reset bridge is to get back there. There's a little bridge to connect you to the other side of the low carb world. And that requires you to really feed up your body on, you know, good fats and protein.

Nicole Moore (01:00:08.354)
So I sort of get them visualizing a little bridge to get back over the other side. You need to be putting in avocados and you might need a little bit of cream in your coffee. You might need a really big omelette with lots of avocado with a blob of butter on top. And if you feed up on those good proteins and healthy fats, things will stabilize. And if you've got cravings for bread or you want cake, then go and make yourself a low carb option of that. Go and buy a low carb cake or make something from like Defeat Diabetes. You've got loads of low carb.

cupcakes and muffin recipes. So if you need some chocolate, go and get some 80 % dark chocolate. If you need bread, make a really big low carb toasted avocado chicken sandwich. Feed up and then things will settle down again. So it is going to be a lifestyle where we can't avoid eating those things, but some people do get a real true, I guess, carb addiction or craving and struggle to get back on track. So feed your body, feed it lots of protein, healthy fat.

Feed it foods that are similar to what you're craving but without the carbohydrate load and things will settle down. And then you'll start to not feel like those things again. And I think if you know what's coming, you can be better planned to manage that. And that's how I find people can reset themselves. So don't despair if you're craving cake and biscuits. Make a low carb option, find a low carb option and feed up on protein and healthy fats to satiate yourself and things will calm.

Cool, well thanks Nicole. And then I guess finally we are sort of running out of time. So Cynthia has, I think this will be the final question we're able to get to and then we'll have to wrap up. But I guess for you Penny, what is more effective in defeating diabetes? We talked a lot about low carb, we talked about intermittent fasting, keto, maybe even a combination of both. know, Cynthia has heard conflicting medical advice that those with diabetes shouldn't do intermittent fasting yet something indicates that they

it can reverse diabetes, you know, what's your really your take home message to try and help with some of this confusion?

Dr Penny Figtree (01:02:12.622)
Well, the science is new, so there's no real answers. But what you have to do is find what works for you. So I have people, and they love it. And they're keto, super low carb. And you're not hungry, and they're fasting, and they're doing it all. But then there's other people. They can't do that. That doesn't work for them. And so they will just go low carb. And they're a lot better off for that. So it's what works for you. They all work. They're all helpful. Personally, if you really want to

To win, think a ketogenic approach is the most powerful approach, but not everyone can do it. And with that, you don't eat, so you're intermittent fast without anyone telling you to because you're not hungry. So yes, that's very powerful. But for you, you have to think, what can I do? What is sustainable? What makes you happy? What works in your life? That is what works. Low carb works. And which lever you pull and how much you pull, it just depends on your personality.

is what I think and I don't think we've got big studies comparing what's best, you know, we just know that limiting carbohydrates works.

Prof Grant Brinkworth (01:03:23.776)
Really, so that's really all we have time, but I think it's important that we maybe just close off with the final, with a few final comments, one final comment from each of us. So really the final advice for how to change to a low-carb diet. So my advice to people is always to seek advice and get support from a healthcare professional. So this includes registered nutritionists or practicing accredited dietitians.

Because not only they can help provide professional advice and tailor a low carb diet for individual needs that will help you be more successful, but I think they will also be able to monitor your progress and health. And research shows that particularly for people living with type 2 diabetes and taking diabetes medication, we've talked so much about the benefits of low carb diets can actually assist you to reduce those diabetes medication requirements, which is a good thing, but for safety, these things should be reviewed and decisions should be made by your overseeing clinician.

and practicing dietitian. So that's really my advice to get started. Maybe Nicole, final comments from you.

Yeah, look, I think it just needs to be really simple and it doesn't have to be complicated when it comes to food. You know, when you think about the low carb or ketogenic diet, it's really about eating vegetables that grow above the ground, you know, throwing in berries and avocados, healthy fats like olive oil and butter and cream and eating protein, which is if you can catch it, you can eat it. So I always have the motto where everyone goes, wherever you go, if you can catch it, you can eat it. And it's probably OK, except for obviously small children and humans.

So, you know, whether you're at the restaurant, you can catch the steak, but you can't catch the bowl of pasta. So that's how I like to keep it really simple from a food perspective.

Prof Grant Brinkworth (01:05:05.804)
Nicole and Penny, final comment from you then.

Dr Penny Figtree
Don't feel overwhelmed and just get rid of the white stuff. It's that white food that's probably killing you and you didn't even realize. So easy and just start with breakfast. Get rid of the breakfast cereal and you'll be set up for the day. Get some eggs.

Prof Grant Brinkworth
Some really good simple tips from both Nicole and Penny there. So just remember, there's other programs out there like Defeat Diabetes that are all clinician led that can actually help people to achieve a low carb diet and the benefits that low carb eating can provide. So I think that's all we've got time for today. So I'd like to, on behalf of the audience, I'd like to thank Nicole and Penny for joining us on the panel today. And on behalf of Diabetes Australia and Defeat Diabetes,

I'd like to thank all the listeners for jumping on. I hope it was informative. I hope you got a lot out of it. And we look forward to seeing you next time.

Thanks everyone. Thank you.