Episode 148: Show Notes
Out of the blue: Dr Terri-Lynne Smith’s family’s world was turned upside down when their 6 year old daughter was diagnosed with type one diabetes. As a dietitian, Terri-Lynne knew what foods contained carbohydrates and had a good idea of serving sizes, but counting every single gram of carbs her daughter consumed opened up her eyes to not only the actual amount of carbs in seemingly innocuous dishes, but also the body’s immediate and noticeable response to carbs. This led the family to become more mindful of their own carbohydrate intake and to make changes to their diet to better support their daughter's health. Through practicality and happenstance, they discovered that reducing their carbohydrate intake made controlling their daughter's blood glucose levels much easier. Now, several years later, the family continues to prioritise their carbohydrate intake for the benefit of their daughter and their overall health.
BMI and the middle ground: The doctors discuss the BMI (Body Mass Index) as a tool to determine individual weight goals, and clarify that the BMI was originally intended as a tool for public health, not for individualised use. Dr Terri-Lynne, as a GP and dietitian specialising in weight control and metabolic health, expresses concern over the BMI being used to define obesity. She believes that the definition of obesity should be more nuanced and consider individual circumstances. Dr Terri-Lynne emphasises that even small amounts of weight loss can have significant benefits and that reaching a specific BMI or healthy weight range does not need to be the goal. She advocates for a nuanced, middle ground approach, which may not be as sensationalised as extreme views and therefore may not receive as much attention or followers, but is actually much more effective for helping people reach their health goals.
Motivation: It is not possible for anyone to maintain motivation and unexpected stresses can derail even the best-intentioned plans. So any changes you make to your lifestyle need to be sustainable, automatic, and not require superhuman effort or motivation. The doctors discuss the pitfalls of dieting, which often involves short-term, extreme measures that are difficult to maintain over the long term. They note that the promise of "maintenance" after achieving a weight loss goal can be misleading, as it often leads to people regaining the weight they lost. Overall, they suggest that a more nuanced and realistic approach to lifestyle changes is needed, one that takes into account individual circumstances and focuses on sustainable habits rather than short-term fixes.
Dr Terri-Lynne’s website:
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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. How are you this morning? I'm hoping you're having a fabulous start to your day. And I can tell you now it's only going to get better because I am interviewing the most spectacular guests of all time. Apologies to all other guests. But I have a real, you know how every now and then you interview a unicorn? Well, today is one of them. So I'm interviewing Dr. Terri-Lynne South. She is a GP. But on top of all of that, she's an accredited practising dietitian and they are rare as hen's teeth, to have an accredited practising dietitian, along with the medical doctor. She's also the chair of the RACGP. So the Royal Australian College of General Practitioners, specific interest group in obesity medicine. And she's the medical director of a fabulous country, a country, fabulous business called Lifestyle Metabolic. You can probably guess from all of that, what her passion is. So gorgeous Terry, welcome to the podcast.
Dr Terri-Lynne South: (1:23) I'm very pleased to be here. Thank you for asking me.
Dr Lucy Burns: (1:27) You are welcome. As I said, we have lots of fabulous guests, but very few are as supremely qualified as you to be able to talk on this area that we all love so much. And I guess is so dreadfully needed within our community.
Dr Terri-Lynne South: (1:44) I was just gonna say it's not only that I give a unique perspective being dual qualified. Lucy, you and I are of the same generation. And you know what is wonderful, I'm about to have a very special birthday ending in zero this year. What is wonderful is I'm actually embracing that birthday, in the getting of wisdom. I've been a health professional for over 25 years. And what is so, I think, lovely is to be able to look back and see the things that I now understand with greater depth and greater nuance, and also what has changed, you know. And these are some of the things that we can talk about as, as a dietitian, or, you know, why is it that I'm talking about low carbohydrate when I left graduating university with all about, you know, the Australian dietary pyramid and going for seven serves of breads and cereals? So it has been an interesting 25 year journey. And there's been ups and downs on the way. But I thought your listeners might be interested in my personal reasons for really delving into low carbohydrate. I think Dr Lucy, you know the story. But let me just say that, you know, I was a busy mother of two young children, and out of the blue, and this is how these life changing events happen, my youngest, was just turned six years old, and she was diagnosed with a type one diabetes. And this, you know, to be honest, there was a family history and my husband and I had noticed some subtle signs. But I was definitely much more being the parent than a doctor, when I noticed she was going to the toilet all the time. And there must have been some denial going on Lucy because I came home from work with the urine dipstick tests for her, for her urine glucose. And you know, I dipped it and it lit up like a Christmas tree. You know, there was no, there was nothing telling that it wasn't right. And in my head, I'm going, Oh, maybe they're off. You know, maybe this is not a real result. Because as a parent, you know, it's like, no, I don't want this to be real. And I did take my daughter the next day to see my GP. And she did the finger prick. And you know, the level on the blood glucose meter was high. And my GP is looking at me going, Terry, why didn't you take your daughter straight to emergency? And I said to her, because I wanted you to tell me it wasn't real. I wanted you to tell me that the measuring I was doing at home wasn't real. Anyway, long story short, she was diagnosed with type one diabetes. And we were very privileged to be able to have her the best therapy straightaway, which was an insulin pump. So she has a little cannula under her skin and she's constantly getting insulin titrated to her blood glucose and she's on a continuous glucose monitor. And we came home from hospital about a week later. And then all of a sudden our world is turned upside down and we have to count, on behalf of our six year old daughter, every single gram of carbohydrates she consumes. Now as a dietitian, you know, I knew what foods had carbohydrates in them. I have a fairly good idea of serves, we would learn her serves or portions of carbohydrate when I used to talk to people with type two diabetes as a dietitian. But now with, certainly with the insulin pumps, and sometimes with the pens, it's all about grams. So all of a sudden, every single gram of carbohydrate she had to eat, we had to count. And oh, my goodness, you know, that's when it really came crashing in our faces of, like, goodness, Eliza, we've just given you, you know, your usual takeaway meal, I can't believe how much carbohydrate that has in it compared to what we would have had. And then to see those effects immediately on her blood glucose level. So it was through practicality and happenstance that we as a family actually really started to reduce our carbohydrate intake. Because we could see dramatically how much easier it was to control our little daughter's blood glucose levels. So that happened maybe six, seven years ago. And we've been mindful of carbohydrate, both for her, for ourselves, adults. And for us as a family. We've had some challenges along the way.
Dr Lucy Burns: (6:06) I'm sure you have. I mean, it's so interesting, isn't it? When you've got that, like the CGM, so the continuous glucose monitor, you actually get an insight into exactly what's happening with her that, you know, general people don't. The other things that affect it apart from food, like I'm sure sleep and stress and illness and all of those other things that we have no idea about.
Dr Terri-Lynne South: (6:28) Absolutely. Yeah, absolutely. And I have actually, when one of her sensors was literally just about to run out, I did wear it with her for a little while. One, was to sort of to, you know, to be wearing it out and around the shops, and for her to see me wearing it. Because she'd get, you know, quite concerned that people were coming up to her and pointing at this thing sticking out of her arm and asking about it. So in order to, you know, sort of help her get used to it, I did the same thing. But I also was interested to see how my blood glucoses were responding to my intake and, and I had gestational diabetes, you know, I have the genes. That means if I don't be very careful, you know, I have a very, very high risk of developing type two diabetes. And here I was, I could actually see it, I could see my body's difficulty in adjusting to my carbohydrate load in real time. And again, it was a fascinating thing, and very much helps you, you know, you can't have anything better than your own personal biofeedback which is what we're talking about with these things.
Dr Lucy Burns: (7:28) Yeah absolutely. And I've worn a CGM before too. And it's interesting because I, I did mine when I was when my carbs were very low. And look, honestly, most of the time, my carbs are very low, because it just suits me to eat that way. But I had just these rock solid glucose is a variation was between like, well, it was actually at the low end. So maybe between about 3.8 and about five, and it was like they never, it never varied. And it was like, Wow, it's amazing. Your food does make a difference to your blood glucose.
Dr Terri-Lynne South: (8:00) Absolutely. And what's been interesting with my daughter is, you know, some of the artificial sweeteners, and all of those sorts of things, you know, may not have calories, but they actually make her blood glucose go up. So it's very interesting to, to see the difference between what it says on the tin or on the piece of paper, or the you know, the average and all these sorts of things, and to see it different in an individual. And that certainly is something that I often counsel my patients about is you can have statements, and you can have research, but that's often what is average, but those averages and those statements won't necessarily apply to the person in front of me. That patient in front of me from an individual and personal response to something, whether that is intervention, diet, a medication or any of those things.
Dr Lucy Burns: (8:49) Ah, absolutely. And I couldn't agree more with you. I just think that idea that sometimes we will take public health advice, population health advice, and then apply it to an individual and it doesn't always work. And I mean, we can look at, you know, something as basic as the BMI for that. As a, you know, the BMI was never supposed to be an individualised tool. It was a public health tool, but yet, it's used on an individual level.
Dr Terri-Lynne South: (9:19) Yeah, I have real problems with the BMI. And as you know, Lucy, my special interest as a GP in this metabolic space, particularly has to do with weight control and health conditions associated with excess weight. So that's where my business name from it, the Metabolic part of things come from that point of view. And yes, I do have real problems with BMI. I'm really looking forward to coming to the Low Carb Road Show down in Brisbane because that's actually what I want to expand on. So my little topic on that day will actually be picking what the definition of obesity is. What its true definition is if I consider it a chronic complex and post condition. And then the sort of things that influence that chronic complex health condition, and management options. But particularly looking at how low carbohydrate may help both the metabolic consequences of having a higher BMI, as well as if people are wanting to have some weight loss for other reasons, whether they be mechanical, mental health, not just metabolic. I also think that when we're talking about weight loss, we're not necessarily saying that someone has to get to a target BMI, or they have to get to some arbitrary healthy weight range. For someone to be able to do something mechanical, that is really important to them, such as be able to tie up their shoelaces or have less pain from their severe osteoarthritis, or be able to fit in, you know, public transport to go on a long awaited trip, it doesn't necessarily mean that they have to reach this, as I said, very arbitrary BMI, it might actually only be, you know, five or 10% weight loss. So it doesn't have to be huge amounts to necessarily have improvements in metabolic health, mental health, as well as mechanical aspects as well. It's also individual so sometimes I feel as though we throw the baby out with the bathwater when we have these very black and white and polarising views. I love working in the middle. I love working in the nuance. And I'm very much about individual holistic care. But these things that we talk about, which is, you know, health concerns of living in a larger body. It's so nuanced and complex. But I love it.
Dr Lucy Burns: (11:34) Yeah, absolutely. And we often talk about this idea, though, that if you're in the middle, it doesn't get as much traction, you know, it's a bit boring. It doesn't, you know, we don't have you know, 500 million Instagram followers, because I'm not banging on about one extreme view that I don't deviate from. And the same with you. It's like Mary and I are always talking about we're loud and proud omnivores, but no one cares about that. You know, if you're plant based or if you’re carnivore, they’re the two extremes, you get a lot of, you get quite noisy, but no one cares about the omnivore. So within extremes, there is always some people who do well at those extreme ends, but the majority of people need that nuanced, in the middle, holistic, somewhat unsensationalised approach.
Dr Terri-Lynne South: (12:23) Yeah, that's exactly right. But what I do find is yeah, that's, as you mentioned, some individuals will, will do very well, at extremes, but not all people do that. So, again, you know, when a patient comes to see me, I almost feel like I'm a little bit of a detective trying to work out, you know, what are the clues in their history and their current concerns that are going to give me ideas of what is most likely to be the best way forward for them. And then I, you know, as an expert, have a good research, theoretical and practical understanding of how to actually try and achieve that. And if something doesn't work, readjusting it. Now, the chronic test, reflect, how's it going? All of those sorts of things. I'm, I'm not a one horse race, I've got multiple options, which I think is really important to be able to have there to apply to that individual in front of me.
Dr Lucy Burns: (13:18) Absolutely. And as you alluded to earlier, you know that obesity is a complex condition, there's not just one cause. And I mean, you know, that I'm stating the obvious there. But the interesting thing is that, you know, there are companies, influencers, people who will tell you that it is. And I think recently, and again, I'm sort of delving into my mind palace to retrieve a memory, where the American, someone in America who was very influential, who said that obesity is a genetic condition, so there's nothing we can do about it. And it was like, well, there's a sliver of truth in that, there's definitely genetic implications. And you just talked about having gestational diabetes indicating that you know, you have insulin resistance, you're genetically prone to develop type two diabetes, and potentially obesity as well. But just because you've got the genes doesn't mean you have to have the condition.
Dr Terri-Lynne South: (14:13) Yeah, that's exactly right. I find that a lot of, you know, black and white statements, there's often a kernel, just a little kernel of truth, but it's been reduced down so much, that it's almost like, it's not helpful at all. And look, us as human beings, we want the simple alright? We want black and white, but it really is hard to do when something is naturally so so complicated.
Dr Lucy Burns: (14:40) Yes. And in fact, I think the classic black and white question that we get asked, I'm sure you do too, is you know, people say, Oh Dr Lucy that all sounds good but look, it's a bit complex. Have you just got a meal plan I could follow? I'll just do that. And, you know,
Dr Terri-Lynne South: (14:58) Tell me what to do.
Dr Lucy Burns: (14:59) Just tell me what to do. And, you know, and look, the temptation with that is that that will work for a week or two, until things, you know, life, it gets busy or complex or in the way, and suddenly that plan just falls by the wayside.
Dr Terri-Lynne South: (15:14) That's exactly right. I, you and I are humans as well. And, you know, we actually, you know, also get waylaid by some of our own biological drives, and our psychology and all of these sorts of things. And particularly one with myself is in regards to motivation, you know, we think that motivation is something that you will always need or always be there. And if you don't have it, you beat yourself up. Motivation goes like a sine wave, you know, we're not meant to be highly motivated all the time. Motivation goes up and down. And often, you know, Lucy, you and I will see people when their motivation is on the upswing. But you and I also know that we can't expect that motivation to stay so high, and that literally, you know, life. Otherwise known as S-H-I-T happens. We wouldn't be a human being if it doesn't happen. And you know, there are lucky people that tend to have periods of stability. But right now, in these times, I think a lot of people are finding that they are having to adjust to lots of chronic stress. But often you'll have these completely out of the ordinary big stresses that you can never imagine are going to happen, but do, to everybody. And yes, if you're having to have a lot of motivation to stick to your new lifestyle, it will go out of the window when something more important or more stressful or more urgent comes along. So definitely any sort of change to lifestyle, whether it's a change in your sleeping, your activity, your exercise, your eating, your drinking, your socialising, any of those sorts of things, they really do need to be something that you could conceivably do for the rest of your life, which ultimately means automatic, habitual, and not requiring super amounts of effort and motivation.
Dr Lucy Burns: (17:04) Oh absolutely. Which, you know, is the whole reason dieting fails. Because dieting is always a short term, fairly intense plan with the idea that you're going to lose, you know, 10 kilos in 10 weeks or five kilos in five weeks, like there's always some sort of endpoint. And you're going to do something that's reasonably extreme, because you know, it will work short term, but it is not a long term option solution, it just, you know, I have a little chat I do called the Maintenance Myth. Because the Maintenance Myth indicates, and I'm sure you've done dieting, Terry in your younger years, where, I used to do this, and I would be, it would be hard and I'd be hungry, and I'd go to bed early so I didn’t have to eat and all these crazy kind of techniques that I would do, because I was very disciplined. But there was always the light,at the end of the tunnel was always this idea of, Oh as soon as I get to my goal weight, I'll be in maintenance. And maintenance, the promise was more food.
Dr Terri-Lynne South: (18:05) Yes, exactly.
Dr Lucy Burns: (18:07) And so you know, you do that, you get there, maintenance, more food. Yay. And then it just sneaks back on. You think, oh.
Dr Terri-Lynne South: (18:15) I have a saying that my patients will know, which is while I think that any sort of weight loss is difficult, that keeping it off is actually harder. I almost feel as though you need a Plan A for weight loss and a Plan B for keeping it off. They often are quite different.
Dr Lucy Burns: (18:35) Yes. And they're not more food.
Dr Lucy Burns: (18:40) And again, that's the thing, that is the thing, do this and then you can go into maintenance, and you'll be allowed, you are allowed using, you know, all sorts of permissive language, you'll be allowed to eat more. And it's like, okay, well, how about we just, yeah, they are different. But I think, in some ways, you know, one of the things that we will sometimes say is that the thing you do to lose the weight is the thing you do to maintain the weight, so therefore, don't do extremes, because it won't work. And again, it's that kernel of truth, isn't it? Because it will actually work short term. So if you only want to lose five kilos to go to a wedding, and you don't care if you put it back on again, well then, okay, run off and do a diet. But for most of us, if you want to actually change your life, change your health, then it's not about a short term fix.
Dr Terri-Lynne South: (19:27) Yeah, exactly. That's what I say too, whatever you do to start that ball rolling from a weight loss point of view, you really need to be thinking that you can do it for the rest of your life.
Dr Lucy Burns: (19:37) Yeah, yeah. Yeah. And that's where the psychology comes in doesn't it? And understanding those stories
Dr Terri-Lynne South: (19:42) Absolutely. The psychology of behaviour change and as well as what drives you to do what you currently do.
Dr Lucy Burns: (19:48) Yeah, I love it. I love it. So Terri-Lynne, this has been brilliant and I can't wait to hear your talk at the Low Carb Road Show in Brisbane. So gorgeous peeps. If you would love to come and hear Terri-Lynne, an absolute expert in obesity management and obesity medicine, please you can buy tickets for the Low Carb Road Show Brisbane and the links will be in the show notes. But Terri-Lynne if people want to actually follow you, how do they find you? Where do they go?
Dr Terri-Lynne South: (20:13) Yeah, I do have a website, which is www.lifestylemetabolic. Oh my God, that's a long word. And a Facebook page as well, and I am on Instagram, but I'm a bit old school. I don't really know how it works. Like, TikTok, don't even let me go there. Gosh, I'll get myself into trouble.
Dr Lucy Burns: (20:34) Oh I know, don't worry. We have it the same although, we've learned Instagram. And that's the thing, sometimes you have to, we tell all our peeps this, and I'm sure you do, too, that you know, learning new things is hard. And when it's hard, we will resist it. Because it's hard. Why would we do something that's a bit hard. But once you get the hang of it, then it becomes easy and second nature.
Dr Terri-Lynne South: (20:57) I've jumped in the deep end with regards to all things social media. I'm still learning.
Dr Lucy Burns: (21:03) Yeah, absolutely. And it's wonderful. Because you know, as you learn, you get better and it gets easier. Metaphor for life. Wonderful. All right, gorgeous woman. Well, thank you so much for your time today and again for being a speaker. And I think that people are going to get all sorts of wealth out of your talk and it's going to be brilliant.
Dr Terri-Lynne South: (21:19) It's absolutely my pleasure. Thank you.
Dr Lucy Burns: (21:28) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr Lucy Burns…
Dr Mary Barson: (21:35) and I'm Dr Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com
Dr Lucy Burns: (21:46) And until next time…
Both: (21:48) Thanks for listening!
Dr Lucy Burns: (21:50) 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.