Episode 134 Show Notes
Dr Laureen’s journey - Despite following and dispensing conventional medical advice around diet and exercise for 35 years as a general practitioner, Dr Laureen Lawlor-Smith found herself obese, with pre-diabetes, sleep apnoea, and filled with shame. After discovering the transformational benefits of a low carb lifestyle, she was able to reverse her health issues, lose weight and improve her overall health. Discovering the low carb lifestyle has completely changed her life. Her experience led to Laureen leaving general practice and co-founding the Low Carb Keto Health Clinic where she helps patients lose weight and gain health. She has reconnected with why she became a doctor to start with and now absolutely loves her job again.
Unhelpful advice - Doctors often recommend lifestyle changes but many are unable to provide effective advice. The conventional adage of “eat less and exercise more” sets patients up to fail as it is unhelpful and incorrect, and just does not work. Trying to follow this advice, and inevitably failing to lose weight or enhance health, sends many patients down a road of negative self-talk and shame.
Being obese and pre-diabetic was a gift - Dr Laureen considers her past health issues a gift, as they allowed her to see the flaws in the standardised medical advice around weight loss. She has also been able to appreciate how the young and metabolically flexible often do not understand the ineffectiveness and the struggle of following low calorie, low fat diets, which ultimately lead to further physical and psychological health issues for the majority of patients.
Dr Laureen is passionate about providing patients with information to help them make their own decisions, rather than dictating what they should do based on guidelines that have been formulated for overall population health rather than what is suitable for each individual person.
Dr Laureen conducts a thorough metabolic assessment for her patients, which includes blood tests and body composition analysis, as well as an in depth consultation to discuss the health and weight loss goals.
Salt, statins, the pharmaceutical influence on guidelines - Originally coming from a place of trusting conventional patient guidelines, and believing them to be unbiased, up to date, and accurate, Dr Laureen now understands how the pharmaceutical industry influences and distorts the guidelines as well as the studies used to construct the guidelines. Dr Laureen explains how slowly the guidelines are updated or changed, citing salt intake to illustrate this point. Salt intake guidelines state that everyone needs and can benefit from a low sodium diet, however there are a number of recent studies clearly showing that very low salt intake is much more dangerous than very high salt intake. Dr Laureen also explains that when eating low carb real food, most people need to add sodium to their diet as the drop in insulin means you will pee out a lot of salt, and you are also getting much less salt into you because of the move away from ultra processed products containing considerable amounts of sodium. So unless you have salt sensitive hypertension or severe renal failure, “too much” salt is not an issue.
Dr Laureen is also right across the cholesterol guidelines, and explains how the current industry reliance on statins seems to disregard the 40% increase of the risk of developing diabetes that is a side effect of taking a statin. Dr Laureen is a wealth of knowledge around medications and living a low carb life. She is a compassionate and wise woman who we are proud to share the low carb real food space with.
Book your ticket to the low carb road show! Thanks to our platinum sponsor, LAKANTO
The Low Carb Roadshow - Dr Laureen will be a presenter at the Low Carb Road Show in Adelaide on the 29th of April where she will be talking about cholesterol with a particular focus on the current guidelines around cholesterol. Many, many people are very concerned about their cholesterol due to the prevailing narrative that all cholesterol is evil and that you can never have too low cholesterol, and other similar falsehoods. We are so looking forward to hearing Dr Laureen unpack all these fables, present the evidence, and give our audience the opportunity to make an informed decision and have a meaningful discussion with their own treating doctor, armed with some really sound information. Don’t miss out on this fantastic opportunity to benefit from Dr Laureen’s wisdom!
Visit https://www.rlmedicine.com/the-low-carb-road-show-adelaide to reserve your seat today!
Dr Laureen Lawlor-Smith Bio:
Laureen Lawlor-Smith has been a doctor since 1982, owning and managing her own General Practices in Adelaide's southern suburbs for much of her career. After 35 years as a general practitioner, Laureen co-founded the Low Carb Keto Health Clinic and decided to focus her skills as a Low Carbohydrate Ketogenic Practitioner. Laureen is passionate about helping people change their lives and improve their health through lifestyle medicine. Laureen has personally experienced the dramatic effects of a low carb dietary change, having reversed her own pre-diabetes, fatty liver, sleep apnoea and obesity when she discovered the low carb keto lifestyle.
To contact Dr Laureen:
Email: [email protected]
Episode 134 - Why does your doctor prescribe medication?
Dr Mary Barson: (0:11) Hello, my lovely listeners. I'm Dr Mary Barson.
Dr Lucy Burns: (0:15) And I'm Dr Lucy Burns. Welcome to this episode of…
Both (0:20): Real Health and Weight Loss!
Dr Lucy Burns (0:23): Good morning, gorgeous listeners. I am super excited to be with you today because I have the most amazing superstar guest from Adelaide. She is an absolute dead set legend. Her name is Dr Laureen Lawlor-Smith, a guru in the whole low carb and keto world. And I am thrilled to have a chat with her today. If you are confused or concerned about your cholesterol, then Laureen is the woman for you. Laureen, gorgeous thing. Welcome. How are you?
Dr Laureen Lawlor-Smith: (0:55) Good morning. And thank you so much for having me on Lucy. I'm just such a big fan of what you and Mary do. So I'm thrilled to be here.
Dr Lucy Burns (1:02) Ah, well lovely, I'm thrilled to have you. Because I know that, you know, like many of us, you did the, you know, standard general practice the hard slog of general practice for many years. And then you moved into the world of metabolic health, which is just phenomenal. So I'd love you, perhaps to tell us a little bit about why you did that, what was your journey there.
Dr Laureen Lawlor-Smith: (1:27) So about five years ago, I was obese. I was pre diabetic, I had fatty liver, and I had sleep apnea. And I was following all of the advice that I was giving my patients and all of the advice which is in the standard medical world. And I was getting fatter and sicker. And I felt incredibly, I had a huge sense of shame. Because I'm a doctor, of course, and I should know better and why couldn't I just, you know, control myself and lose weight and get rid of these conditions. And then I came across low carb, and it changed my life. So I don't have fatty liver, I'm not pre diabetic, I don't have sleep apnea. I’m still a bit overweight, but I'm not obese anymore. It’s completely changed my life. And I feel so much better. And I feel that I've got a sense of control over my future, my future health and my future destiny. And then I started talking to my patients about it, and realised that this is such a powerful tool, you can reverse diabetes with this. So you can have someone who's diabetic on multiple drugs. And three months later, they're not diabetic, they’re on no drugs at all. And once you see that you can't unsee that. Now having spent 35 years of watching people get sicker and sicker and writing more and more scripts. And really, they're not making a lot of difference to the progress of disease. And all of a sudden a conversation about lifestyle and reversing the disease is absolutely life changing. So I left general practice about 15 months ago, and I now just do full time, low carb and ketogenic lifestyles. And I just love my job. I've gone from a burnt out general practitioner who didn't want to work anymore, to someone who gets up every morning and loves going to work. And I just love what I do.
Dr Lucy Burns: (3:10) I love that. I love that. And you know what, you're not so lucky. Because we once you see, as you said, once you say the benefits and the changes to people's health with low carb, you can't unsee it. And I know lots of people feel this way. But then we get to work in a job where we can talk about it all day. And I know other people sometimes feel that they have to kind of restrain themselves, like they’re being a bit of a zealot, and they just go oh ah. Well, I'm so lucky. I get paid to be a zealot. Hurray!
Dr Laureen Lawlor-Smith: (3:42) Yes, yes! I agree entirely. Yes. In fact, sometimes it's hard to shut it down when I leave work. The people around me don't really want to hear about it too much more. So…yes!
Dr Lucy Burns: (3:54) Yes, I know! So it is, it's wonderful. The interesting thing, I think that happens in general practice -and you mentioned this too, is that, you know, if you read any guidelines, the first thing that will always be is “attend to lifestyle.” But most doctors don't know how to…well I think probably one of the lifestyle advice we're giving - were giving, you and I used to give, is unhelpful and incorrect, and it wasn't working. So then what happens is that now doctors don't give lifestyle advice. And then just, you know, many times will go straight to the script pad.
Dr Laureen Lawlor-Smith: (4:30) Yeah, I agree entirely. So you know, I did 35 years of “eat less and exercise more,” and it just doesn't work. And anybody who's done it will know that it doesn't work. And saying that to someone is a) setting them up for failure, but b) setting them up for a whole negative cognition about themselves. They’ve been given this advice and it doesn't work. Well, there must be something wrong with them. And therefore I'm lazy, I'm a glutton, I'm whatever. And it just sets up this whole negative self talk and then we have patients who come in who are ashamed of where they are. And that's been generated by what we've been telling them. So if you tell someone to do something that doesn't work, it's just a disaster for them from a health point of view, but also from a cognition point of view, from a self esteem point of view.
Dr Lucy Burns: (5:14) Ah, Could not agree more! Could not agree more! And as you and I were talking off air, the tool isn't working. So you know, we internalise and blame ourselves. And we'll use sometimes really negative language to try and motivate ourselves. Which again, becomes really unhelpful.
Dr Laureen Lawlor-Smith: (5:31) Yeah, completely. And I think it's a real gift that I was sick. It was a real gift that I was obese and pre diabetic, because if that hadn't happened to me, if I’d just been one of those naturally skinny people with a great metabolism, I would be looking at these people coming in and saying, “Well, you're just not listening to me are you? You're obviously not doing what I'm saying.” And I would have blamed the patient, whereas because it happened to me, and I was following the advice and it wasn't working, it allowed me to see the folly in what I was doing. So I just think it's been a great gift to me that I was metabolically unwell, because it's brought me to this place where I'm really happy to be.
Dr Lucy Burns: (6:09) Yeah, I love that. Laureen. And you're right. I mean, I think for a lot of people, you know, they go and say, and again, I'm not going to generalise completely, but they may say a nutritionist or a dietitian, who's often young, and young people are usually - not always, but usually more metabolically flexible, and don't have the same issues that you and I both had. Of trying to eat low fat - I cannot believe how much low fat food I ate for so long, processed, but it didn't matter because it was low fat…lolly snakes didn't matter because of the whole low fat, fat free, and it was like, ah, no wonder, because here, I was thinking I was being and I'm using, you know, inverted air quotes, “good,” because I was following this low fat diet. But it just made me sicker and sicker.
Dr Laureen Lawlor-Smith: (7:00) Completely. And I think that's the sad part about it is, people in the health professions, dieticians included, are being taught the wrong thing. So the new dieticians, we had a dietitian working with us as a receptionist, sorry, she was a dietician student working with us as a receptionist, and she was talking to us about what she has been taught, and calorie counting and low fat eating, and eating less and exercising more is what they're being taught. I don't know about medical schools, I presume it's the same. So we are still being taught stuff that just doesn't work. And it just blows my mind. I don't understand why we're doing that.
Dr Lucy Burns: (7:35) No. Well, you know, again, we can dive into that but we do know that there's a lot of, changing belief systems can take a long time. And lots of people need to hear the information a number of times or really need to have the evidence almost, you know, like, almost need to be slapped in the face with the evidence before they're actually prepared to entertain the idea that maybe what they've been saying for the last 20 years is wrong. And, you know, I mean, you and I both know this with cholesterol medications and lots of medications that when I was going through medical school, statins had just been invented, they were meant to be the best thing ever, they were going to save lives. And you know, I didn't have the skill to be able to critically evaluate the propaganda. You know, and particularly, things like relative risk and absolute risk, I had no idea what that meant. So I just believed it.
Dr Laureen Lawlor-Smith: (8:31) Completely. I mean, I used to come from a position of, I followed guidelines all the time, I believed that the people that wrote guidelines were unbiased and if they recommended something, that's what I do with my patients. I've moved away from that. And the reason I've moved away from that is because I think that the pharmaceutical industry has had a big impact on guidelines. And most guidelines are written by people who are receiving money from the pharmaceutical industry. And I think that's, that's wrong. And we should be having guidelines from people who don't receive any money from the pharmaceutical industry. Unfortunately, most of the studies that have been done are driven by the pharmaceutical industry. And so I think we've got really distorted. I think one of the other things about guidelines is guidelines are really about population health. They're not about the individual sitting in front of you. It's all very well saying that this is a guideline for the population. But what about this person sitting here? What about for them? Does this guideline suit them? And I think it's really important for people to understand where they are metabolically, what their risk factors are, and the impact that any intervention is going to have on them. And if it's a statin, how much of an impact is it going to have?
Dr Lucy Burns: (9:45) Yeah. I couldn't agree more. And I think this is part of the, you know, the whole problem. We have low fat guidelines, we've had salt guidelines. And people, largely, are following these. They're following low fat, they didn't realise that low fat meant, often, high carbohydrate or high sugar. Because, again, if you don't know about nutrition, why would you know that? And that low salt is helpful for a small portion of the population who do have, you know, hypertension that responds to salt restriction. But for the majority of us, salt is not the terrible thing that we're, you know, led to believe it is.
Dr Laureen Lawlor-Smith: (10:26) Yeah completely. I think one of the things that really surprises me is how slow guidelines move. So the data around salt intake, there are a number of studies, maybe three or four years ago, which were really clear that very low salt intakes were much more dangerous than high salt intakes. That you're much more likely to die from a really low salt intake than you are from a high salt intake. And yet, our guidelines still recommend that everybody has a low salt intake. And as I say, it really surprises me that the evidence seems pretty clear. But the guidelines haven’t changed. And as you know, with patients that we're dealing with, when you go low carb, or keto, and insulin level drops, you pee out heaps of salt. And so you need to replace salt. I think the other thing is most people getting most of their salt content from processed foods anyway. So you drop your processed foods, you go low carb, and all of a sudden you need to add salt and it just blows people's minds. They say “you're telling me to add salt?” and I’m going “Yep absolutely, you need to add salt. You won't feel well unless you add salt.” So yeah, it's one of the things about this whole journey is there are so many steps along the way, where I found that the advice I've been giving is completely wrong. In fact, the opposite is true. It's just it takes you a while to get your head around it. And then, you know, dealing with people on their low carb journey, you're dealing with that as well. Sometimes they look at you as though you've got two heads because you're telling them something which is completely the opposite of what they've been told before. Clearly, you know, someone who's got severe renal failure, or salt sensitive hypertension, you need to manage that. But as you said, for the absolute majority of people, salt is not an issue.
Dr Lucy Burns: (12:03) Yeah, yeah, absolutely. And this is the problem, as you said, with population guidelines that then we apply to individuals. And you know, for many people, they need individualised medical care. And I think, again, even with people's low carb journeys, there are people that just get onto low carb, and they have very few hiccups, you know, they might add some salt when they first start, they're just cruising along and everything just goes really well. But for other people, it can be a little confusing. They've got some, perhaps other medical issues and they do need to see somebody for that individualised advice.
Dr Laureen Lawlor-Smith: (12:39) Yes. So what I what I do, principally, is, I see people for a metabolic assessment to start off with, so we do a set of Bloods, we do a body composition analysis, and they sit down with me for an hour and I talk about what their goals are, what their problems are, how we can approach them. And then we monitor things. So for example, someone who just wants to lose weight with a low carb approach, but who doesn't really have any metabolic problems, who's not on any medication. Usually, they really need to see me once, that's all. But some, I'll see a lot of people who are on medications, which can be affected by a low carb or ketogenic diet, or have got metabolic or other issues that need to be monitored. So a common one is someone on blood pressure medication, often they need to wean off their blood pressure medication quite quickly, because their blood pressure will drop as soon as they go on a low carb diet. And this is the same with diabetic medication. So some people on this journey need really close medical follow up as their metabolic health gets better. And we wean medications and watch things like their cholesterol and some people it’s just a quick check to see what your metabolic health is like, and off you go. And we have a fantastic low carb dietician Nicole Moore, who sees the patients and monitors them and helps them on the journey.
Dr Lucy Burns: (13:55) I love that. And what I love, Laureen, is that you've set up a clinic in Adelaide. So for those of you who would love to connect with Laureen, it's called the Low Carb Keto Health Clinic. And as you mentioned, there's Nicole Moore, who was on the podcast a couple of weeks ago, total, another low carb legend - and trailblazing dietitian, so she's a rare breed. And so people can book into see you or organise telehealth and really get that personalised approach, which I think is fantastic.
Dr Laureen Lawlor-Smith: (14:24) Yeah, we love it too. It's just great. And I love working with Nicole as well because Nicole has been doing low carb keto for 15 years. She was sort of doing it behind closed doors when she was at risk of being deregistered by Dieticians Australia. So in terms of the dietary advice, she's just, she nails it! So it's just really good, I really wear the metabolic health medical hat and she wears the dietician hat. We've also got a coach, Jody Bund. Some people really need some coaching as well around all of the stuff that you and Mary do so well - around mindset and motivation and dealing with things like shame and self compassion. Often the mental hurdles, the cognitive hurdles, the emotional hurdles, are bigger than any of the other hurdles.
Dr Lucy Burns: (15:11) Yeah, absolutely. And I think that's the key. You're right, there's sort of, again, the two groups, one group that will just go off and do it. But the other group, particularly for those that have had a lot of diet trauma, and really, and, you know, like, I was talking to one gorgeous woman the other day, who was told her whole life, she was called fatty boomba. She was a chubbier child than her siblings and so she was treated differently. She was given labels like little elephant, fatty boomba, come on fatty karate, all of these sorts of words, and then told that, you know, “you can't eat that, your sisters can, but you can't.” And so she's then developed, you know, again, what we would call scarcity mindset around food, and that, you know, just a whole heap of stuff that needs to be unlearned, and which is unlearnable, which is great, but she didn't know this. She didn't know these reasons. Her tools, like you and I talked about, her tool was “Come on stop being so lazy, stop being…” it was negative self talk, was berating, was, you know, talking badly to well, not badly, but using harsh language to try and motivate herself because that's what she'd been modelled.
Dr Laureen Lawlor-Smith: (16:20) It's so sad, isn't it?
Dr Lucy Burns: (16:23) Oh yeah
Dr Laureen Lawlor-Smith: (16:24) I see a lot of insulin resistance - you do, huge amount of insulin resistance. And I would say probably 90% of the people who come in my door are insulin resistant, most of them don't know they are. And we determine that on the basis of blood tests. Or when we do a body composition analysis, we see a lot of visceral fat, which is the fat around your organs. And when I explain to them that they are working against their metabolism, they are working against their biology, and by doing what they're doing, they’re never ever going to achieve their goals, I often get people crying. Because you know, they've spent a lifetime of blaming themselves and beating themselves up. And it hasn't been their fault at all.
Dr Lucy Burns: (17:03) No, absolutely not. Absolutely not. Laureen, I'm super excited that you're presenting at The Low Carb Roadshow in Adelaide. And I know you have a topic that is close to many people's hearts, which is really unpacking cholesterol, cholesterol guidelines, in particular. And a lot of people are very concerned about their cholesterol, again, we've been told cholesterol is evil. You know, there is no such thing as cholesterol that’s too low, all of these stories. So I'm very thrilled that you will be able to unpack this, present the evidence, and then people can make an informed decision and have, hopefully, a discussion, robust discussion, perhaps, or respectful discussion, with their own treating doctor, armed with some really sound information.
Dr Laureen Lawlor-Smith: (17:53) Yeah, I think it's incredibly important that as a doctor, it is not my job to tell you what to do. It is my job to give you the information, so you can decide what's best for you. And unfortunately, I think out there, there's a lot of “You should do this,” and “you should do that,” which is often guidelines based. And my approach is really, you know, an individual person approach. So it's, what is your risk? What benefit are you going to get from a statin? And how does that pan out over the next five to 10 years. I mean, one of the things about statins is that statins increase your risk of diabetes, by about 40%. And all of the people are being put on statins should have informed consent, they should understand that taking a statin may or may not improve their cardiovascular risk, but it's definitely increasing the risk of diabetes. So over a 10 year period, 200 people taking a statin, one of them is going to get diabetes that they wouldn't have got if they hadn't taken the statin. So it's those sorts of subtleties that we really need to understand, you know, here's your risk, you can take this drug, how is it going to benefit you? Is there any potential that it's going to harm you, and then, allowing you to make a decision for yourself. And there's just a lot of fear around cholesterol, you know, everybody thinks that, you know, cholesterol is going to kill you. And the reality is that there are many, many people who have heart attacks that have got completely normal cholesterols, as you and I both know, and a high cholesterol is not necessarily harmful. There are many people who've got a high cholesterol, who've got no coronary artery damage at all. So it's just sort of teasing out the subtleties and allowing the person, giving the person the power to be able to make that decision for themselves.
Dr Lucy Burns: (19:31) Yes, absolutely. And I think this concept of shared decision making is really, you know, really important. And you know, what, there are some people I've spoken to, and I'm sure you've spoken to, whose doctors will not see them if they don't do what they say. It's like, wow, wow. So amazing. So amazing.
Dr Laureen Lawlor-Smith: (19:51) And they get berated by them as well.
Dr Lucy Burns: (19:53) Yeah! Yeah! And then they leave in tears. It's yeah, it's just unhelpful.
Dr Laureen Lawlor-Smith: (19:58) You know… “if you don't take this drug, you’re gonna die!” and it’s not accurate and it's emotional blackmail, it's horrible. I just can't, I can't believe that this still happens, but it does.
Dr Lucy Burns: (20:10) Well, gorgeous listeners, if you're looking for a really informed, compassionate, patient-centric doctor, you can't go past Dr Laureen. She is brilliant, knowledgeable, intelligent. And, you know, we would highly recommend anybody to go and see her if they're really interested in personalised metabolic health. And again, I will link all of her details in the show notes, but she is at the Low Carb Keto Health Clinic in Adelaide, she will be speaking at Low Carb Adelaide in April, you can buy tickets. And again, shownotes, in the show notes, just find those. And I, you know, I just think that we're so, you and I we’re so lucky. We just get to do this great, great job. And it's so much fun.
Dr Laureen Lawlor-Smith: (20:52) It is. It's like, it's changed my life. Again, I love going to work. At the end of the day, I often say to my team, I've had a great day. You know, I love coming to work because I feel like I'm making a difference in people's lives. And people are getting healthier and people are achieving some of their goals. Not everybody, doesn't work for everybody. But a lot of people are achieving their goals and it's just such a fantastic place to be. It's why I did medicine. It's why I did medicine, you know, 40 years ago, which makes me sound very old. But there you go. That's the truth.
Dr Lucy Burns: (21:22) You're wise.
Dr Laureen Lawlor-Smith: (21:23) Yes.
Dr Lucy Burns: (21:24) And in fact, wise now that you've had your, like a lot of us, the epiphany of going “oh my god, everything I've been saying for the last 30 years was wrong!”
Dr Laureen Lawlor-Smith: (21:32) Yes.
Dr Lucy Burns: (21:33) Indeed. Alright gorgeous one, have a beautiful day, and lovely listeners, have a gorgeous weekend and I will talk to you soon. Bye for now.
Dr Lucy Burns: (21:48) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns…
Dr Mary Barson: (21:55) and I'm Dr Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com
Dr Lucy Burns: (22:06) And until next time…
Both: (22:08) Thanks for listening!
Dr Lucy Burns: (22:10) The information shared on the Real Health and Weight Loss podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended, to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.