Episode 93 Summary


  • Dr Rob Cywes is "The Carb Addiction Doc”. He is one of the world’s most outspoken voices in the carbohydrate addiction space and has a huge following. He is a practising bariatric surgeon who is extremely passionate about spreading the word about our dysfunctional relationship with carbohydrates, including sugars and starches and the role of this relationship as a root cause of obesity.


  • During liver transplantation research for his PHD, Dr Rob Cywes discovered that preloading livers with sugar was causing  vascular damage to the livers which increased along with the increasing amounts of sugar. This challenged his pre-existing theory that the human body depended on sugar as a primary fuel source and led him to question this theory and also the lipid heart hypothesis. He concluded that, 'It is not fat clogging the arteries. The fat is actually responding to damage and trying to protect the vessels from that damage.'


  • Dr Cywes has personal experience with obesity. He became 50kg overweight while serving as a surgeon. He attempted diet after diet and was never able to maintain his results. He experienced the same struggles that many of us have lived through as he consumed food and drink for personal emotional management, rather than for its nutritional value. 


  • 23 years ago Dr Cywes cut carbohydrates out of his diet and lost 102 pounds - around 50kg and he is maintaining this weight loss from that time.


  • As a paediatric surgeon, Dr Cywes found himself operating on many obese children who were suffering from health conditions caused by chronic, excessive carbohydrate consumption, such as gallbladder problems and ovarian cysts resulting from PCOS. This led him to specialise as a bariatric surgeon to help these children to lose weight.


  • Bariatric surgery is a very effective way to lose weight, but it doesn’t address the reason why people become overweight in the first place. 85% of bariatric surgery fails in the long term if the root cause of obesity is not addressed.


  • Using addiction methodology we can effectively manage the root cause of obesity - addiction to sugar - by addressing an individual’s relationship with sugar and starch as an emotional management tool. Acknowledging the use of carbohydrates as an instant gratification system for emotional management and changing these patterns is essential for long term health improvement and maintenance of weight loss. 


  • It is important to consider all of the tools available when treating each patient. Keto, low carb, GLP-1 agonists, bariatric surgery and very importantly, addiction counselling to address the use of sugar as a self soothing tool are all options which should be considered for merit in the case of each individual. 


  • Semaglutide, also known as Ozempic or Wegovy, is administered as a weekly injection. The newer GLP-1 agonists can be a useful tool as they amplify the feeling of satiety which we often have lost touch with. Dr Cywes sometimes uses Semaglutide for up to three months as his patients first embark on a low carb lifestyle as it helps to overcome their insulin resistance and dampen their appetite during that transition. Dr Lucy has written a blog on GLP-1 agonists such as Semaglutide which you can read here.


  • When eliminating carbohydrates from our lives we need to replace them with new emotion management tools. We also need to challenge our thoughts and behaviour patterns, so that we are able to benefit from an effort-based emotion management system. Include physical movement, music, creative hobbies, meditation or social connection as forms of self care. Change your self identity to align with your new lifestyle choices. Instead of being “an emotional eater” you can be a coffee drinker or a musician, dog-walker, artist or someone who enjoys puzzles.


  • Beware of carb creep!! If blueberries or any other low carb foods trigger your carbohydrate cravings then it may be best to avoid them to reduce the risk of backsliding.


  • How do we start out? One step at a time!! Don’t aim to be perfect. Start slowly, with contemplation. Understand the carbohydrate content of common foods. Do research. Acknowledge your inability to regulate your carbohydrate consumption. 


  • Step 1. Change what you are drinking. Cut out sugary soft drinks, sugar filled “coffee”, fruit juice and flavoured milk. Replace your current drinks with non-caloric drinks. 


  • Focus on what you can eat. Make nutritional decisions in advance. Emotional decisions are made in the moment and can be influenced by how our day went. Be pre-emptive. Plan ahead for success. Once you cut out carbohydrates it’s up to you whether you choose a vegetarian, omnivorous or carnivorous lifestyle. That’s up to you. Choose what you enjoy. The key is to leave the carbohydrates behind. 


  • Develop a deep self awareness. Examine your actions, thoughts and behaviour with curiosity. “Am I truly hungry? Am I just bored or having uncomfortable feelings?” Many of us are driven to eat for emotional gratification and not due to physical hunger. Be aware of the carbohydrates you are consuming and how much you are consuming. 


  • Make a plan to remove potential triggers from your environment. Do not rely on willpower as that is unhelpful and may fail when you are tired or stressed. Create distance, rather than relying on self-control. Be aware of your emotional state and practice vigilance, especially during vulnerable periods. This may mean avoiding the tea room and going for a walk.


  • There are two parts to addiction. The substance abuse and the process addiction. A snack is always an emotional event, even if it is a “keto” snack. Binge eating may still be an issue for some people who are following a ketogenic or low carb diet as they are addicted to the process of eating and the uncomfortable feeling of being stuffed. 


  • Childhood conditioning around sugar is an important factor in the etiology of carbohydrate addiction. It is often used as a reward, to soothe and to celebrate. Education in both parents and children is important to create a change in what we are feeding our children and how we are teaching them to manage their emotions.


  • Get to know yourself. Take baby steps. Replace unhelpful habits and responses with new beneficial ones. Acknowledge your dysfunctional relationship with carbohydrates and create distance between yourself and them. Accept that this is an ongoing process and continuing progress is more sustainable and realistic than perfection.  


We have a challenge coming up! Our 7 Day No Sugar Challenge! It starts in a couple of days and we would love to have you join us. 

Click here to find out more

Dr. Robert Cywes is a clinically practicing doctor and surgeon who is dual board certified in Adult General Surgery and Pediatric Surgery.  He specializes in Weight Management and Bariatric Surgery for adults and adolescents. He has been performing bariatric surgeries for 18 years, performing over 8000 surgeries.

Dr Cywes’ mission is to educate the public about a carbohydrate addiction approach to treating obesity, diabetes and metabolic syndrome. As "The Carb Addiction Doc" he lectures internationally regarding the physiological impact of carbohydrate consumption and the behavioral aspects of carbohydrate addiction as the cause of obesity and obesity-related co-morbidities. He passionately teaches the use of substance abuse methodology, rather than a diet and exercise approach, for the effective long term treatment of obesity.

Follow Dr Robert Cywes: 


Show notes:

Sugar addiction, with Dr Rob Cywes - The Carb Addiction Doc

Dr Mary Barson: Hello, my lovely listeners. I'm Dr. Mary Barson.

Dr Lucy Burns: And I'm Dr. Lucy Burns. Welcome to this episode of Real Health and Weight Loss.


Good morning gorgeous ones. I hope you're all happy, healthy, and well. It's Dr. Lucy here. I'm super excited with our guest this morning. I'm interviewing Dr. Robert Cywes. He's an international star, if you like, in the carbohydrate addiction space. He's a bariatric surgeon practising in the States, but is really passionate, not just about surgery for weight loss, but understanding the root cause of obesity. And as you know, for many of us, it really does relate to our relationship with carbohydrates, and sugar. Sugar, which is of course sweet, and carbohydrates, which are often our starches. They all fall under the same banner. One of the things I want to talk to you about briefly before we get cracking, though, is that we have a challenge coming up. Seven days to kick your sugar addiction. $7 for seven days.  The link is in the show notes below and we'll be talking about it a bit more, but it does start in a couple of days. So, we are here to support you through this because we recognise that the first seven days are often the hardest. Lots of resources, lots of coaching and lots of fun. So if you're interested in busting through your sugar addiction, start with our $7 for seven days. Okay, talk soon, darlings. And let's get cracking by introducing Dr. Rob.


Dr Lucy Burns: So, Rob, I'd love it if you could just explain a bit about your background in what you do. And you know, in particular relation to low carb, but also to perhaps the other things you do in the health space. 


Dr Rob Cywes: Yeah. So it really is a multipronged evolution to where I am right now. I am a classically trained adult general surgeon and actually a paediatric surgeon. So my specialty is in paediatric surgery, operating on children. As part of that I spent time in a laboratory doing a PhD. And my PhD was actually in liver transplantation and energy dynamics of liver transplantation and I worked with a group who created the glycemic index. David Jenkins, in 1981, wrote the seminal paper that discussed the principles of the glycemic index, which is the current methodology of treatment for diabetes with especially type two, but also type one diabetes. And the problem that we faced is that the work that we were doing, in the tremendous belief that the human body depends on sugar as a primary fuel source, and that it was necessary to consume carbohydrates, and that if we pre loaded livers prior to transplantation, they would perform better in the new recipient. That was the principle of my research. And we realised that to a small extent, early on in the loading of sugar that was relevant, but very quickly, the more sugar you put into the liver, and we became very good at adding sugar to the livers, the worse the organ performed, and we could actually kill livers with sugar. And what we saw in a very rapid period of time was the evolution of diabetes at a vascular level. And that didn't make sense in the context of what the theory was. So that was my PhD, which gave me that insight. But at that time, we were so and this is what happens in science to a lot of people, we were so absolutely certain that the necessity of carbohydrates was so important that we, the conflict with the data we were getting was so great. We discounted our own data, so that we could support our argument. And, you know, as much as we're scientists, we're human as well. And it took me a decade to really reverse that thinking and understand that we're actually at a microscopic level, seeing the evolution of diabetes in the liver vasculature. And once you make that connection, you really can't unsee that. 


So that has become a problem that I have in the conflict with lipid heart, which is where people think that fat in the diet clogs your blood vessels. And that is not true unless the fat is clogging the arteries to protect the vessels from damage. And it's the damage that's the issue, not the clogging, so we can talk about that. So, that was part of my PhD while I was becoming a surgeon, and I'm a paediatric general surgeon - I did a lot of general paediatric surgery. But at the same time, while I was doing that, with a Wendy's and McDonald's within our hospital that we had free access to; and quitting playing sports and a bunch of things. I ended up at 300 pounds, about 50, almost 50 kilos overweight, and I realised that I had a personal issue, and like so many of my patients, I became an expert at failing weight loss programmes. 


I tried them all. I lost weight. It didn't work out and then I realised I went back to my roots. And this is the early or the mid 90s. So this is pre keto, pre anything. Atkins was just on the way in. And I heard some of Atkins’ work. I knew my work from the lab and I realised that you know what, what's happening here is that I'm eating and drinking, not for any nutritional value. I'm eating and drinking opportunistically. I'm eating and drinking for personal emotional management. I'm exhausted. I don't have any other resources. I had sliced away parts of my self care plan, because I was working 100-120 hours a week in the hospital. And I realised that what was left in my emotion management toolkit was sugar and starch. And that I was eating sugar and starch, not for any nutritional value. But other people were smoking. Some of my colleagues were drinking alcohol. Some of them were disruptive physicians. I was eating and drinking primarily for the emotional restitution, and because it was excessive, and wasn't controlled by my nutritional hormonal system, that excess was overpowering that system and was making me fat. So I cut carbohydrates out of my life, and I lost 100 and where I'm sitting right now, I'm down 102 pounds from that time.  That was 23 years ago. 


Dr Lucy Burns: Yeah. Right.


Dr Rob Cywes: So that's part of the journey. Yeah. And then the the only other concept there is that I also realised doing paediatric surgery that I was operating on a lot of kids who were morbidly obese. I was taking out their gallbladders, taking out their ovaries, which were all unusual diseases. Ovaries from polycystic ovarian syndrome, a twisted ovary that had died, that kind of thing, consequences in young kids or young adolescents, who were getting diseases of adults, but really from sugar. And these were the diseases of carbohydrates. And yet, people were blaming fat for gallstones. And I rapidly realised that in this population, I could serve them by dealing with their endpoint diseases, but the source, the root cause of this was their affinity toward carbohydrates as an emotion management tool in these young kids. And I started a bariatric surgery programme, because I'm a surgeon, so you know, I've got a hammer in my hand, let's use that to get these kids to lose weight as well. Very, very effective. By far the most effective form of weight loss is bariatric surgery. So it's by far overwhelmingly the best diet anybody can be on. But it doesn't address why they became fat in the first place. And the “why” is far more important than the what. You can cut back calories with surgery, and somebody can lose weight, but they're not going to keep it off until they change that emotional relationship that they have with carbohydrates as a drug, as a substance abuse system. As an instant gratification emotional management system. 


So more and more of my practice focused on managing that root cause and helping them to address their relationship with sugar and starch, primarily using addiction methodology, not diet methodology. And then we found that a huge volume of patients didn't necessarily need surgery. And those few that, so we’re  doing less and less of that surgery, but those few that are struggling or are brittle diabetics about to die. Surgical intervention is, it's not one or the other. It has value, but it has limited value in certain people. Because the worst thing is to die of diabetes or the consequences of obesity. And if we can save them from that, while we're working with them, that has merit. And it has longitudinality. It has sustainability. But if it's not sustainable, then nothing like that has value. And I think the knock on surgery is primarily because it's - 85% of them fail - not because the surgery fails, but because nobody has that conversation with their patients. And then we blame the surgery for our inadequate understanding of obesity. We can treat excess weight very effectively, but we don't understand obesity. And for me, obesity is the addiction to sugar, whereas excess weight is the consequence of that addiction. 


Dr Lucy Burns: I totally agree. And I really liked the way that you said then, that… because I think what happens in and particularly in medicine is that sometimes people get wedded to their own ideology, like their way is the right way and everyone else is wrong. And quite often, it's actually taking tools that work in each system and bringing them together for the individual. But that doesn't sound very, that's not as exciting and it's not as controversial and it's, you know, you've got to kind of wade your way through rather than just being able to stick to your guns and go, “Well no, surgery is the only way. That's it.” Or even people that say, you know, “Low carb and keto is the only way if you can't do that that's your own fault”. And it's actually trying to get all the tools for the people. But like, I mean, like you, I've seen plenty of people who have had bariatric surgery who never had that addiction addressed. That need to soothe with sugar was never discussed. In Australia, you have to see a psychologist, but it's really to make sure that you're potentially fit to consent for the procedure. And, I think sometimes a lot of people think that having the procedure means that they won't have to do any work on themselves. And so, you know, there's no buy-in to go with a psychologist pre-surgery for them, because they think that the surgery is going to be their solution. 


Dr Rob Cywes: Well, the psychologist is really screening them for other mental health disease, which is ridiculous because we don't do that when someone's having a breast augmentation or a nose job or having their gallbladder taken out but we do it for bariatric surgery.  Screening somebody and preventing them from having a potentially life saving surgery, because they might have bipolar disease or might have some other disease is ludicrous. We wouldn't do that, ”Oh no. You can't have your cancer treatment because you've got bipolar disease.” It's nuts! However, the flip side is that it is malpractice to my mind for someone to treat COPD, lung disease from smoking without addressing the smoking. And yet the majority of my colleagues in the bariatric surgery space treat the obesity - which is not the problem, it's the consequence - without ever addressing their relationship with sugar and starch. So that's the first part that is a problem. 


The second part that's a problem, though, and the caveat to that, is that in our space and the space where we don't necessarily recommend surgery, or even medications, and we can talk about medications a little bit, nobody would deprive a heroin addict of methadone, for example, or suboxone. Nobody would deprive a smoker who's struggling to quit of chantix or a nicotine patch. Nobody would prevent an alcoholic from using antabuse, and yet we vehemently oppose surgery. It should be an adjunct. It should be an add-in. It should be a tool that they use on a journey. It should not be a standalone. So I think there's criticism at both sides. At the surgical side and at the non surgical side. These are tools we have in our armamentarium that are potentially helpful. And you know what, while the surgery is the endpoint pot, there are other things that are coming on the market and I'm sure in Australia, you've discovered this, that are extremely effective at helping our patients - especially early on, or if they hit a speed bump or they’re struggling to go to that next level - that are available. And I see some of my colleagues using them. This is a non surgical space. And then other of my colleagues say, “Oh, no no no, we've got to be purist. We're not allowed to use any of this stuff, you know, we're not allowed.” It's nuts, and particularly the drugs that we're using more and more, I don't know if you are. 


So let me back up for one second, I will go out on a limb and tell you this, it is impossible to be obese, which is more than about 10 or 15 kilos overweight - I'm not talking about a little bit of just lazy weight gain, I'm talking about significant obesity - it is impossible to be fat, or type two diabetic without going through the eye of the insulin resistance needle. In other words, what's required to become obese, what's required to become type two diabetic, is insulin resistance as a prerequisite. And there is a powerful set of medication that is available to help, not to do it for you, but to assist with insulin resistance while you're working on getting rid of the carbohydrates. So if you don't get rid of the carbohydrates, none of this matters. And those are the GLP-1 agonists. And we're using them a fair amount in our practice right now, to assist those patients who are struggling, but not as an alternative. but, again, as a tool less than surgery. But a little bit more than cold turkey. 


Dr Lucy Burns: Yes, absolutely. And it's so interesting, because in Australia, we've only just had access to these. We had the ‘Saxenda’, the daily injectable for a significant amount of time and I must say I wasn't super impressed with its data. And you know, it was too expensive in Australia and you know, the trials seem to indicate that after two years, you've lost 5% of your body weight. So you know, I'm thinking “Wow. So you’re 100 kilos and you’ve spent 400 bucks a month to lose five kilos.” But the newer ones, the semaglutide, is seemingly much more effective. And I believe there are other ones coming to Australia that you probably have in the United States that are even more effective. And I think though, like you said, so many people don't sort of do that holistic model of looking at all of the things they just give them the injection and say, “See you later.” Half of the people don't seem to even really know what it is, or what to do with it or what the side effects are, or how to manage it. And like you, their successes seem to be the people that can do low carb with the idea that this is what they're doing forever. You're not just going on these injections so you can lose five kilos to turn up to a wedding. It says for ongoing management of your hormonal underlying metabolic dysfunction. 


Dr Rob Cywes: Yeah, you're exactly right. And I think first of all the the once daily injectables were not as 

effective and it was too onerous for people to be injecting themselves once a day, if they weren't seeing positive results. We typically use the more powerful once a week GLP-1 agonists. We don't use them all the time. I use them for up to three months to get people across the hurdle of insulin resistance and also help them to dampen their appetite a little bit, because ultimately, no matter what we say, and I respect this, but I really try to get my patients away from this, is that the prerequisite here is not weight loss. The prerequisite is biological restoration and vicariously along that pathway, you see weight loss. But that is not why people come in, they still want to see massive rapid weight loss as advertised on TV by Nutrisystem or Weight Watchers. You know, lose 20 pounds or 10 kilos in 10 minutes. That's their expectation and if they don't see that, they abandon it. And so there's multiple levels psychologically where and biologically where the benefit is there. We don't use these medications at the outset. We don't use them on everybody. But they really are assist devices when people are struggling. 


The ideal person is somebody who can come in, wow, have that epiphany, recognise their relationship with carbohydrates is broken, get rid of carbohydrates from their life, and start playing the guitar and running five K's every day. But that person is rare, as rare as rocking horse manure. They don't exist. The reason people become addicted to carbohydrates is because of psychopathology that they don't even recognise themselves. And if that's not addressed, then, you know, it's easy to tell someone to go and exercise instead of eating carbohydrates as a way to feel good. But the reason they eat carbohydrates is because exercise doesn't do it for them, at least at the outset. They may come from what's called an authoritarian family background where they set ridiculous outcome parameters from them and they can't benefit emotionally from an effort based emotion management system. So instead of feeling great about the fact that they went for a run, they feel terrible that they only ran five K's instead of 10K. Or they have all the intent in the world, my permissives have all the intent to, “Oh, man, I'm gonna go for a run. But just before I go, I'm going to drink some orange juice to power me up”. And by the time the bottle of orange juice has finished, they kind-of passed out on the couch and the run doesn't happen. So we have to understand the personality and work with that individual from where they came from, not where we would have them. And so many people in our space have, either never understood or forgotten their early struggles. And they don't recognise that early transformation. It's always uphill before it's downhill. And we've got to help those people up the hill first, otherwise, they don't climb the mountain. 


Dr Lucy Burns: No and I think it's really interesting. I see, and you probably do, too. There's almost like, there's these two cohorts of people.  There's probably people who've never really tried to lose weight before, they've just eaten and drank way too much and then they discover low carb and bang, they just go and do it. And they lose 50 kilos, and then everyone's cheering them on. It's like, “Yay, go!”. And then there's the other people and potentially more women whose whole self-worth is wrapped up in their size and what they look like, and society's judgement of them and whatnot. And the idea, you know, they have been hooked into perfectionism. So they're either doing it perfectly or they're on a bender, and all of these sort of maladaptive coping strategies that people have around changing their their food, based probably on what Dr. Mary and I call “diet trauma”. You know, where you turn up to Weight Watchers and be weighed, and everyone's screaming out what your weight is and if you haven't lost, you know, what, what have you done wrong? And all of that sort of stuff, I think is also tied in with it. As far as that kind of fear of failure. 


Dr Rob Cywes: I think you're absolutely correct. And the other part also is that people start, as I've been kind of discussing through this discussion so far, they start by trying to treat the consequences of the problem, not the cause. And the consequence is the obesity, so by the time you're in Weight Watchers you already recognise you have a weight problem. But you really don't have a weight problem. What you have is a dysfunctional emotion management system. And if you don't begin to develop a more functional way to manage emotional tension, whether that's anxiety or depression, or stress, or even boredom and pleasure, our emotions. 


So obesity is not a problem. It's not a disease. It's a lifestyle. It's an entire way of life, and we're continuously looking for an opportunity for that snack. It becomes subconsciously intuitive, and unless we remove and replace and addiction management is about replacement. Diet management is about removal. You can't eat this, you can't eat that. This is what we want you to eat. Here's the broad range of foods you can eat. So you're looking within the range of food that you can eat and not looking on the outside. “I'm not allowed to have, I’m not allowed to have that.” Instead: “I can have this. I can have that.” And you are proactive about planning what you're going to be eating. You always make nutritional decisions in advance. You always make emotional decisions in the moment. So if you have no idea what you're eating for dinner tonight, and it's seven o'clock, it's almost always going to be tempered by how your day went. But if it's seven o'clock tonight, you make a decision about what you're going to eat for dinner tomorrow night, it's almost always going to have nutritional value. So a large part of the approach we use is not just the diet, but it's how can I return back to nutritional eating and then how can I also develop other algorithms for self care? Can I put in a little bit of quiet time or meditative or prayer time in the morning? Can I go back to something I used to love to do, which was playing music, but my guitar’s gathering dust in the cupboard? Can I haul some of that stuff out? Can I go for that walk? It doesn't have to be exercise, I hate that word. I prefer the word physical activity. Because physical activity gives you the ability to accomplish something even if you weigh 200 kilos. “I can accomplish something. I can walk down to the mailbox and back.” But, by the time - and I've been there - you know, when I was 300 pounds. I wasn't going to do that. I wasn't going to get on the treadmill and run for 10 minutes or 20 minutes, but I could amble down to my mailbox and feel good about it. So it's those little things that we start with. 


And I think the mismanagement - keto is very easy to do for a few weeks or a few months - and then life throws you an emotional curveball and where do you go?  You go straight back to the ice cream, or the pasta or whatever it is. Eric Westman has a beautiful phrase. He calls it Carb Creep. You know, if you put two coathangers in a cupboard and you come back a year later, the cupboard is full of coathangers. I don't know how that happens, but if you bring a couple of blueberries back into your house, then suddenly you open the fridge the next day, and there's some coke and there's some orange juice, and there's some ice cream. The carb creep happens and there's no way on God's Earth you are going to stay on a ketogenic or a carb free diet, if you're surrounded by those drugs of choice. Very, very challenging, especially early on. So the lessons are more behavioural than they are caloric or dietary. 


Dr Lucy Burns: Yeah, I completely agree. So, if you're talking to somebody about okay, “We recognise that this is a carbohydrate problem and you know, you need to consider stopping your sugar and your starchy carbs.” And they look at you and they go, “Oh, how am I going to do that?” What sort of advice do you give them? 


Dr Rob Cywes: First question.  How do you eat an elephant? And the problem with a lot of the keto diet people is “Here’s your piece of paper. Off you go. You start tomorrow.” And if you try to eat the whole elephant, because basically, by the time you're obese or type two diabetic, carbohydrates are your entire universe, subconsciously, whether you know it or don't know. So that's the size of the elephant. But if you try to do it all at once, if you try to do it too quickly, you're gonna choke on the elephant. You may get keto flu, you may feel awful, and you always do. So, if this is a change in who you are, as a human being, you're not going to change that by hitting the six, you're going to put the ball in play and hit the single. And if you're not up to bat, because you got out right away, it doesn't help you. That's a cricket term, which…


Dr Lucy Burns: No, Australians play cricket, it's all good!  


Dr Rob Cywes: Yeah. So the point is that we're not going to do this all in one day. Let's start slowly. Let's change what you're drinking. The starting point. In fact, before we even start, there's a beautiful book by a guy by the name of Prochaska who is a psychologist. It's called, ‘Changing for Good’. They looked at people who successfully smoked and they looked at the steps they went through. The first point is that everybody comes in wanting to lose weight. Well, you've got to connect them to the concept of carbohydrate addiction. ‘How is it possible that an apple could potentially be causing me harm? It is impossible that that's the case.’ Okay, let's go and do the research. Let's go and compare the amount of carbohydrates in an apple versus the amount of carbohydrates in a doughnut. 


Let's start with contemplation as the first stage, without changing anything. Understand the environment you live in. Understand that the Clif Bar or that protein shake that you're drinking is loaded with a bunch of sugar with a title ‘protein’ on it, and understand where the carbohydrates are. Because I think, Lucy, one of the key things that we stress is this. ‘Carbohydrates are not the problem’. Carbohydrates are not the problem. It is your relationship with them that is. Alcohol is not a problem, but if you're an alcoholic, it's your relationship with it that is. And that's a change in thinking. It's not that these things are bad, it's that, ‘I don't have the capacity to control my relationship with them, because if I did, I wouldn't be 300 pounds’. So we have to look at the relationship and therefore, no matter how healthy the government or the USDA or my friend says an apple is, I've got to understand that if I'm diabetic, my blood sugar is going super high for four hours afterwards. And that's not a good thing. If I'm an obese person, that apple is going to enhance my insulin resistance. But I don't want to start with the apple, I’ve just got to understand the knowledge. 

So the first step is contemplation and it takes a few days for people to know where the carbohydrates are hidden in their diet, and also to come to terms of: 


“Why am I eating this right now? I just had dinner.”
“Why am I sitting in front of the TV with a bag of pretzels? Or popcorn or chips?”
“I'm about to have lunch? Why am I standing in front of the fridge staring at the fridge?”

“Is this because my body needs nutrition?” 

“My selenium levels are a little low? Or is this because I need emotional restitution?”


And what else can I go off and do so you're going to connect with who you are right now? Because, you can't change something if you don't know what you're actually changing. So the contemplation phase is very important. Then we start with little changes. In our practice, we start with just changing what you're drinking. Find eight or ten different things that you can drink that don't contain calories. And I don't care if it's a Diet Coke. Are we perfectionist? Hell, no. You're really obese, you're clearly not a perfectionist right now. You may be wanting to be perfect, but let's start with something you can drink that doesn't contain calories. And if you find that range, and you develop that relationship, you've already excluded one of the dominant sources of carbohydrates, which come in our cokes and our other drinks, but it includes orange juice. Let's get rid of that.  Then let's start modifying our diet. 


Dr Lucy Burns: And also, I think flavoured milks in Australia. Really popular. I don't know over there, but yeah.


Dr Rob Cywes: Absolutely. 


Dr Lucy Burns: Chocolate milk or iced coffees. 


Dr Rob Cywes: Exactly. I don't know with coffee. Starbucks doesn't sell coffee. Starbucks sells ‘crystal meth’ occasionally flavoured with coffee. It’s the biggest purveyor of drugs in the United States. So, you know, because it's all the sugar. You're going there for the sugar, not the coffee. Nobody spends $7 on a cup of coffee, but they will spend $7 on a frappo-lappo, high sugar, low fat, you know, “crystal meth hit”. 


Dr Lucy Burns: Yeah. 


Dr Rob Cywes: So, you know, you've got to understand that environment. That's the contemplative phase. But you're drinking a cup of coffee - absolutely fine. You know, again, is it perfect, no, but it's perfect enough to help you to deal with your carbohydrate addiction. And that's the important thing. Nobody tells an alcoholic what they should drink. But everybody in the ketogenic space loves to tell people what they should eat. And it's not about what you should eat. It's about what you're giving up, it's about what you're not eating, then what you should eat is wide open to you. So you know, I don't care if my patients are primarily vegetarian or primarily carnivore, anything in between. It doesn't matter. It's about not eating sugar and starch. And you can set yourself up there, otherwise we make it too narrow. And I don't want them to be like me. I can share my story with them and my story is a story of evolution toward a certain point, but I don't expect them to do the same thing. The expectation is that they'll progressively understand their relationship, their dysfunctional relationship and begin to address that. 


So we start with the drinks, you know. Dr. Boz does the same thing. To ask someone to do intermittent fasting right away, It's crazy. Because when you're insulin resistant, your blood sugar is going up and down all the time. And every time it goes down, you get hungry. So starting to get rid of the carbohydrates from your food is the second stage, but eat three or four times a day, and then get to a meal and we say, ‘Hey, I'm not hungry’, then drop that meal. So it's a default system rather than an intentional system. So many people want to be ‘OMAD’, eating one meal a day. Well, OMAD should happen. It shouldn't be a necessity or something that you have to do, ‘I must be OMAD’. No you don't. Two meals a day. Three meals a day is fine, but what you'll find if you are astute or at least observant to your dietary process: ‘I don't need to eat right now. I don't need breakfast.’ Hey, that's great. Let's drop breakfast. It's perfectly fine, there is no meal that you have to eat. Breakfast is probably the least important of those, but Kellogg's will tell you otherwise. 


Dr Lucy Burns: Yeah, of course they will! But what I love is that in all of this, you've really talked a lot about the idea of being really self aware and looking into what's happening with you. So asking yourself, you know, ‘I'm actually hungry?’. Or, you know, ‘Maybe I'm bored?’. Or, “Maybe I'm just pissed off and cross?’ or ‘Maybe I'm lonely?’ or, you know, you're asking yourself all the time, ‘What do I need here?’ You know, is it nutritional sustenance or fuel or is it some emotional thing that I'm looking for?


Dr Rob Cywes: I think you're right. You know, the concept of hunger is also in my practice and in my understanding, is a mismanaged word. We no longer live in an era for most of us, of food scarcity. So hunger, historically, was, ’Hey, I need nutrition! I need to grab my bow and arrow and my digging stick and go out in the plains of Australia and go and fight, shoot something or dig it up’. We no longer live in that environment. Most people live within 50 metres of a tsunami of an abundance of available food. So scarcity is no longer an issue, it's this wall of abundance that is. So hunger is no longer a nutritional driving force. It's no longer a word that's associated with malnutrition, or lack of nutrition. Hunger has become, ‘I need a cigarette’. When an alcoholic says, ‘I need a drink’, it has nothing to do with the fact that they're dehydrated. When an alcoholic says, ‘I need a drink’, it's a recognition of their having a little emotional moment. They need emotional relief. And so, therefore, one of the things we teach our patients to do - and the beauty about a ketogenic diet is it just radically reduces hunger, and or at least the that biological intensity of, ‘I must eat right now’, which has got a lot of emotional overtone, even though it's a sugar overtone as well. And that once you get into a state of early ketosis, that hunger, the nutritional driving force goes away. And then hunger is typically as you said, ‘I'm bored, I'm depressed, I'm angry, I'm sad, I'm anxious’. 


So hunger has become a word of instant gratification for emotional reasons and one of the things we try to teach our patients very early on, is to try to be pre-emptive, about your meals. If you know when and what you're going to eat each day ahead of time, you're taking care of your nutrition. Once, twice, maybe even three times a day. But if you do it in the moment, you're gonna get yourself trapped into, ‘Am I eating because my body needs it? Or am I eating because my brain needs it?’ And you know, I feed my dog twice a day, every day, at the same time. You don't have to be that religious about it, but if you adapt to a similar pattern, it becomes a nutritional force rather than an emotional force and you don't even have to think about it. But I know already, now, what I'm eating tonight for dinner. 


Dr Lucy Burns: Yes. Me too.  


Dr Rob Cywes: And I can look forward to it. I'm empowered by it. Right. And so, it's not just what you're eating, it's the whole pattern that has to change.


Dr Lucy Burns: And I think, coming back to something you said earlier, which I think is absolutely true, where you mentioned that, you know, it's almost like somebody's whole identity is wrapped up in their food. So, in order to lose weight permanently, you really do have to be looking at ways to change your identity. And I don't know if this was true for you, but it certainly was for me, that my whole life used to be around, ‘How could I get my next little hit of sugar in a sort of socially acceptable way?’ So things like parties, and barbecues and morning teas at work, my eyes would light up for those because it was like, ‘Yippee!! I can have all this cake and it's actually socially acceptable. It's perfectly fine.’ Whereas now, I couldn't give a toss about a morning tea, you know, I'll go, but it's no longer the highlight of my day. 


Dr Rob Cywes: Well, it can still be the highlight of your day, because you're gonna have social interaction, you maybe have a cup of coffee or something like that. So the purpose of that morning tea is no longer about the ‘crystal meth’ that you're consuming. It's no longer ‘having a cigarette’, which is the equivalent of eating in the modern era. It is more about the social connection, which is a very, very important emotion management system that's very healthy. So human, I call it ‘empathetic human connection’, is wonderful as a resource to feel good, that doesn't require the high from carbohydrates. So there are values to those things, but we surround ourselves with our ‘drug’ of choice. A chain smoker is never without their cigarettes. The fat person is never without some form of readily available carbohydrate, little bag of candy in their pocket. In their car, they've got their little thing or, we always know where our ‘drugs’ are. The alcoholic always knows where the alcohol is. So that's what I was talking about. This is a lifestyle. This is a way of life. And every human being psychologically or mentally has to have what I call a quirk, that defines who they are. And if you talk to someone for five minutes, and you are listening for that quirk, you'll pick it up. Some people are the smoker. Some people are the obese person or the diabetic. Some people are the religious person, the chatty person, the comedian, the golfer, but they reveal where their head goes every five or 10 minutes, with any conversation you have with them. Because that's what's at the uppermost part of our subconscious brain for psychological relief, for that emotional tension relief. So, a large part of our obesity management programme is to redefine your label. To redefine who you are, as a human being. Are you going to go from being that overweight person to being the runner? Are you going to go from that to the singer or the painter or the poet or the chatty person? I don't care what that is, but you don't want to go from being the obese person to the smoker. You don't want to do a drug transfer?


Dr Lucy Burns: No, no! But it's interesting, isn't it? Because so many people will come and say, ‘Oh, I'm a sweet tooth. I'm a chocoholic. I'm an emotional eater. I'm a comfort eater’. It has weaselled its way into their identity. And they have to let that go. 


Dr Rob Cywes: Well, at least those people have an inkling of recognition that their relationship is a problem. The more challenging of folks is the 200 kilo person who walks in and says, ‘Oh, he doesn't eat very much. He hardly eats.’ You know, that's like you’re standing in front of the cup and stumbling around, and ‘Oh, I didn't have anything to drink’. It is not plausible. It's not possible to be that weight or to have type two diabetes, and not to have an excessive relationship with carbohydrates. Now, that's not because they’re lying. For example, I can tell you that throughout the day today, I will have no idea how much coffee I'm going to drink, but I will know that I am drinking coffee. And the truth is that most people have no idea how much carbohydrate and how often they actually eat, because it’s who they are. It's just a pattern of what they're doing. Just like we have no idea how often we blink, we have no idea how often we snack and how often we do stuff, because it's itinerant, and it's opportunistic, and it's become part of the subconscious fabric of who we are. But I can tell you categorically and I've, I've yet in 23 years had somebody to prove an alternative. It's impossible to be morbidly obese, it's impossible to be type two diabetic, without chronic excessive carbohydrate consumption. Protein and fat will never ever make you fat. Because the human body has built in satiety mechanisms for those two. It has satiety defying mechanisms for carbohydrates, because of the addiction. That's why you can drink 24 beers in 12 hours, I know you're Australian, I know, a lot of Aussies are like, they're proud of the fact of how much beer they can crunch in a day, there's no way on God's earth, they're going to be able to drink 24 bottles of water in 12 hours.


Dr Lucy Burns: No!


Dr Rob Cywes: It's just not going to happen! 


Dr Lucy Burns: No. 


Dr Rob Cywes: And yet the same volume, but a different driving force. The endpoint of eating a bag of chips is the end of the chips. The endpoint of eating a steak is when you’re full. And people are very comfortable leaving half a glass of water on the table. They're uncomfortable leaving half a beer. People are not comfortable, at least in our space in the obese space, about leaving half a bag of chips, or half a box of chocolates or half a rack of cookies. It's drive-bys. We keep going back, we keep going back, even though we tell ourselves, we're not going to. So the purpose then, is not to have it there.  Addiction is about not being able to control the relationship, and therefore having it away from you. Rather than saying, ‘Oh, I don't eat those’, or ‘I can just have one’. 


Dr Lucy Burns: Yeah.


Dr Rob Cywes: I can tell you categorically after 23 years, if there's a punnet of blueberries in my fridge, they will be gone by the end of the evening. So therefore they don't exist. Because I got to know who I am and this far in, 23 years in, and I know that I still can't trust myself. And it's just a question of figuring out, how can I distance myself from this enough that it doesn't have that little inner voice trigger? Now, for the most part, I don't go and seek it out anymore. That's the transformation. We eat other foods, but it's still, you don't want to put yourself in a vulnerable position. And that's got nothing to do with diet. 


Dr Lucy Burns: Everything you're saying is just sending me off so many million light bulbs. And I think, you know, I love what you're saying because it agrees in so many of the principles that I love, which is, you know, we're often saying that, ‘Weight loss is more than a meal plan. It's a personal development journey’. You have to learn to know yourself, learn to know what your triggers are, and what is one person's trigger is not another person's and telling somebody they just need more willpower, that's unhelpful. And the interesting thing is that my sugar addiction is now very well managed, but it's never gone. And even today, just before we got on this call, it was so interesting to me, I'm listening to myself going, ‘Oh, that's interesting’, I opened up the door to get out some tea, and sitting there, one of my kids had left open half a block of chocolate, and I looked at it and my little brain went “Ding, ding, ding”. And then I just shut the cupboard and my brain was thinking about it and I went back to the cupboard and I shut the cupboard. And I went back to the cupboard and I shut the cupboard up. And I thought, ‘Oh, this is unhelpful’. And then I thought, ‘You know what I need to think about what I'm going to do here because it is calling my name’. So I happen to have out like a twiggy stick thing, this protein and fat. And it's beautiful, we've got this brand in Australia, called Kooee, it makes this really lovely stuff. And I open that up, and thought, ‘I'm just gonna have that’. I know I'm not actually hungry, but I need to do something because I don't want to have that thing calling my name anymore. Anyway, it's quiet now. It's good. It's gone. 


Dr Rob Cywes: But you're exactly right. And that's that unexpected trigger. You didn't expect to see that chocolate there. But it was there, and how do you handle that? And I can tell you, if you're a little exhausted because sleep is a big component of this, if you're exhausted, or if you were stressed out. That's the defining line between crossing that threshold and not crossing that threshold. And I wouldn't necessarily eat that chocolate every day, but if it's there on a bad day, or an emotionally troublesome day, of course, I'm gonna hammer it. And that's the challenge. So that's why it should not be, to my mind, in that environment. 


Now, it's difficult to control other people in the home, but it really is putting those barriers in place because I think the big difference between a diet and an addiction management programme, and the reason why diets fail, is diets demand tight control. Addiction recognises at the first step, if you want to use the 12 steps - which we don't really use - but it's a very similar process. The first step is, ‘I have lost the ability to control my relationship with this drug’. And once you recognise that, then you create distance rather than control. But people who try to practice control, they're fine on easy days, but it's not about the easy days, it's about the emotionally difficult days. What are you going to do then? And when you wake up and you're exhausted because you've had a terrible night's sleep, you're so emotionally vulnerable. And all you want is that comfort? And where do you get it from? McDonald's or that slab of chocolate or whatever drug happens to enter your environment. And that's the vigilance that we're looking for. The awareness and the vigilance are the two things that we preach in addiction management. 


Dr Lucy Burns: Do you know what's interesting, though, and this is something that I'm still trying to get my head around is, as an example, if I open up that cupboard, and it was half a packet of crisps or chips, we call them here, I'm not, I couldn't care less about that. I know that they're still carbohydrates, but it just doesn't do anything for me, it doesn't tickle my fancy at all. Whereas I know other people in our circle, who say, ‘Oh, I couldn't care less about chocolate, but if it was chips or bread, you know, I'm a goner’. And it's interesting, isn't it that even though they're both carbohydrates, I guess one's more savoury one's more sweet? Even within that circle, there's kind of quite specific nuances for people. 


Dr Rob Cywes: You're absolutely right and I think there are certain patterns that we get used to just like, you've got some people who drink beer, and some people who drink whiskey, but they're equal alcoholics. It's the same thing. However, over time, if you are really under emotional duress, I've never met an alcoholic who said, no, no, I only drink whiskey, I'm not gonna drink that beer. Thank you very much. It doesn't happen that way. In the same way, that slab of chocolate belongs to one of your kids, but you would steal it from them to get your high. If that was a leftover salad that they'd made, you probably would not just stuff it down your face, necessarily. So we've got to understand what those triggers are and I think that's just part of the journey. It’s getting to know yourself. That is part of the contemplation phase. 


And the way I look at this, I call my addiction my, it's like a zombie. You know, you can kill them today, but tomorrow, they're waking up and coming after you again. It's daily vigilance. 


Dr Lucy Burns: Yes. 


Dr Rob Cywes: And a large part of the vigilance that we try to get our patients to practise, is to check in with yourself on a regular basis. Take your own emotional pulse. ‘Hey, I'm here, I'm feeling great today.’ If you're feeling great today, nothing's gonna bother you, but if you wake up and you say, ‘Man, I'm a little down today. I'm a little exhausted today. I'm just anxious. I'm just frustrated. You want that little vigilance red light to go off and say, ‘Hey. Be careful today.’ Don't, maybe, go to the break room at work today, even if it's for a cup of coffee, because there's probably going to be doughnuts on the table. Stay out of it. On other days, I can walk in and go and get that cup of coffee and not even see the doughnuts. But the days when I just say, ‘Not today. Not today. It's not a good thing today.’ Because you’ve got to be aware of your own emotional pulse. 


The flip side is, if you're feeling a negative emotion, anxiety, distress, depression, whatever it is, how am I going to treat this? How am I going to deal with this today? Is today a day where my dog gets a really long walk? Is today a day where I just hold up my Spotify account and listen to my favourite music? Is today a day where I pull out an easel and start painting or drawing or doodling? What do I do for emotional restitution, because I recognise the need for it. So many of us are so busy eating or accessing food we’re not even in touch with emotion. All you are seeking is that instant relief. And one of the things to be aware of is, there are two parts to addiction. There is the “substance abuse” for instant gratification, but then there is also what I call a “process addiction”. Things that we do that give us emotional gratification.  It is a proven outlet for that instant gratification and yet it has awful consequences on the back end. 


There are two things that we do, as part of process addiction, which the keto diet or no diet programme really takes into account. A snack is always always always an emotional event. So if you're snacking, it is never because your selenium levels are low, it is always because your head needs relief. And then the second thing we do is binge eating. And this is a problem I see with some of my people in the carnivore space.  All because something is a steak. It doesn't necessarily mean it's okay for you to do it. My buddy Shawn Baker does eat eight pounds of steak in a day, but Sean's working out, you know, 26 hours a day. Binge eating is a little bit like cutting. You know what cutting is, where you intentionally cut yourself for that relief on the back end. A lot of adolescents do that.  Well, binge eating - “Oh my god, I'm stuffed. I shouldn't have eaten as much! So much!” Well, I'm overeating for that bizarre sense of pleasure on the back end. And while it may not necessarily cause tremendous weight gain if it doesn't contain carbohydrates, it interferes with weight loss, which is interesting. 


So why am I stranded? Because I'm overeating. I don't want you to count calories, but I also want you to be aware of satiety signals that our entire existence we've overwritten. So it's not, you know, portion sizes. They have just grown and grown and grown all over the world, in defiance of what our body is giving feedback to our brain. So our brains preemptively decide how much we think we need to eat. We sit down. We eat that and if our belly’s trying to tell our brain, “Dude, I've had enough!”, you just ignore it. You override it. And just to come back to the GLP-1 agonists, what they do is they magnify that satiety response. So you start out eating that big steak, but you get a few bites into it. Oh, man, I'm feeling awful. I'm feeling really queasy. Well, that's GLP-1 telling you that you've had enough. And that drug makes you feel terrible, so it gets you to eat less. That's the mechanism by which it works. So it's one of the mechanisms by which it works. But you can learn that innately by eating sequentially, by having a little bit and then going to have some more. 


So it isn't just carbohydrates, it is also the pattern by which you eat. It's the pre-emptive nature. It's not having a snack, but having something to drink. I've seen you sipping on your tea. I'm actually quite anxious here because my coffee is about two metres away from me. And I don't have access to it right now. So it’s like “Hrrmmm! What am I doing here?” We all have those quirks, and it's helping our patients to understand how to evolve, how to slowly transform that pattern. Because our brain needs that relief, but you're getting your relief from a sip of tea, not a little block of chocolate or three m&ms right now. And that's a change. It's a removal and a replacement. It isn't a removal. It isn't trying to control just having a little bit. That's the beauty about the lifestyle approach as opposed to the diet approach. 


Dr Lucy Burns: Yeah, I totally, I like a million times agree. And I think one of the other things that comes up for a lot of people is childhood conditioning, particularly around sugar. Because you know,  sugar is part of… In Australia these days, and probably, I'm sure in the States, every kid who has a birthday brings a tray of cupcakes to school. So if you've got 30 kids in the class, and there's 30 times where there's cakes, and there's lollies and everyone goes home with, you know, lollies, snakes and all sorts, like so much more sugar than when I was little. But the sugar is used as a reward. It's used as a bribe. It's used to celebrate. It's used if they're sad. It's you know, it's used for everything. And, you know, no parents are using heroin to cheer their children up, or giving their nine year old a glass of wine because they've had a bad day, but they will give them ice cream and cake. 


Dr Rob Cywes: Well, you're absolutely right, and I think addiction starts in the womb. When Mom is distressed, a pregnant mom is distressed and she eats some ice cream to calm herself down. Or she's just having a bad day and she eats a bag of chips to calm herself down, that's already imprinted on that foetus because you're having glycemic changes in that foetus. So very often that imprinting happens very, very early on. But in the first four years of life is where we really establish our lifestyle patterns. 


We all, in the first few years of life, develop a pattern of emotional restitution. You've got the quiet child, you've got the needy child, you've got the bothering child, and very often, the parents use an instantly available reward for that child or thing that they give that child to shut them up. So, so often, those carbohydrates aren't there for the child, they are there for the parent to be able to manage the child. If the child is running around screaming, and you give them a bag of chips or a cupcake, they get so invested in the cupcake, that they are behaviorally modified. They go sit quietly and eat their cupcakes and they leave Mom and Dad alone. So most often addictions like carbohydrates are used, not for the child, but for the parent. And it's a management system for the parents. Well, for example, our little - I've got a little 22 month old who has been a carnivore since he was an embryo. So food, eating is just not something that happens and quite frankly, he's never, ever eaten carbohydrates. So even if he did have access, he would know what to do with them. But, what we do now and understand that it can be a problem,  well it is a problem. He'll watch something like Cocomelon, or in the old days with my older kids, they would watch, what were those Australian, the four guys?


Dr Lucy Burns: Oh the Wiggles?  


Dr Rob Cywes: The Wiggles? Oh yeah, the Wiggles were a huge part of our lives growing up and we would put on the Wiggles or put on Cocomelon when I'm changing my son's diaper or his nappy. The first thing I do is I give him the Cocomelon and he is paralysed watching Cocomelon so I can change his nappy very easily. So you know, a lot of parents would give that child some candy, or some chocolate or some chips to keep them quiet. And is one better than the other? I'm happy to discuss that. I'm not certain it is, but we have to be able to manage those kids with something. And then all the screen time is limited beyond that very little bit. Those are, a lot of the time that carbohydrates are used for those kids as a way to control them. It's a dysfunctional form of parenting, rather than of benefit to the kid. And then yeah, it's a ‘treat’. So what you're actually saying to your kids, here's a little diabetes for you, here's a little obesity for you. Go and enjoy that, and that's part of what we have to recognise as parents. Why am I doing this to my child? I'm struggling with my own obesity, why am I giving my child the very thing that made me fat? It doesn't compute. 


Dr Lucy Burns: And you know, and again, I guess this is where education comes in. And people just, they're just modelling their parenting on how they were parented. And you know, that's how the cycle continues. But, it's tricky because I also think in the world there are people out there who espouse the, “Everything in moderation. Don't demonise food. Food has no moral value”, blah, blah, blah and I just think, well, no two year old needs to be eating Maccas or KFC, like they just don't.  They're not worried about missing out on it.  They don't give a toss about it, but the parent is giving it to them, so they don't miss out, thinking what? I don't get that. 


Dr Rob Cywes: And I think that that is a very, very important but subtle point. That you kind of tongue in cheek said, ‘We're not going to give our kids heroin or a cigarette at two years of age, but we'll give them some sweets or candy or chips’, or even some, you know, mac and cheese or whatever it is, the majority of these kids are living on 80 plus percent of their diet being carbohydrate. However, when we get older, I don't know what the drinking age is in Australia, but when I was a late teenager, actually, even at a younger age, we had alcohol because I grew up in an alcohol producing wine, producing part of the world. If you want to smoke a joint when you're older, if you want to have a cigar every now and then those things from time to time, can have beneficial value. If they're done in, and I’m going to use the word I hate here, moderation. But as something you do as an adult.  If it's something you start to do, if the dependency is toward instant gratification as a young person, then that becomes your exclusive tool in your emotion management toolkit. If smoking a cigar, or having a glass of wine happens a couple of times a week, it has asset value without liability. But if you're drinking a bottle of wine a day that is problematic. So it's a difficult thing to be absolute about.

Moderation works for certain people. But as Gary Taubes says, ‘If that dogma has failed you because you're not capable of moderation, then don't keep striving toward it, then understand that it's abstinence, that that is necessary for you’. And that's why it's, too many people in our space, especially if they did this themselves, and then want to re-represent what they are in their own clients or patients, they create one model. And that is the wrong thing to do, because we are different in terms of how we function as human beings. The patterns are the same. The carbohydrate relationship is the same, but there are different approaches to it. I think as a practical therapist, or someone helping to treat these patients, we have to understand where the patient is. We have to be empathetic to their needs and their position. We have to stand in their shoes and look at what they're capable of doing. Not trying to force them to do something they're not capable of doing. So therefore we have to vary the steps we take to get them along a pathway. 


I think the other concept is that there is no endpoint or goal to this pathway, because there is no goal to lifestyle. It is something that ends about 10 minutes after you're dead and until that time, it's always forward progress and the beauty is that this is a journey. It isn't something you do for a little while to not be fat. To do, “Okay, now I've lost my weight. What do I do now? Do I stop?” No. 


Dr Lucy Burns: Yeah!


Dr Rob Cywes: You keep going. You keep challenging yourself.


Dr Lucy Burns: No. It's like the smoker. I often say that the smoker when they're giving up, they're in their quitting phase, and then they just move into a nonsmoker phase. And that's it. There's no change.


Dr Rob Cywes: Right! And it's the evolution - distance over time - because you know, one of the things is you can't break a habit if you are still doing it and you can't create a new habit if you don't do it repetitively each day. So really addiction management is about habit transformation. So if you’re still having a little bit here and there, you're not breaking the habit. You know, if the smoker’s smoking one cigarette a day, that’s still smoking. The carbohydrate addict, still eating their drug of choice. Now there are carbohydrates in some of the food we eat. Vegetables are all pure carbohydrates but they don't trigger that addiction because they don't biologically get absorbed to the extent that the other stuff does. But if you're still having that square of chocolate at night... Some people can cope with that. Most people can't. And yet, they keep that as a security blanket. You know, the two year old needs their security blanket, but when you're 10 years old, you probably don't. Same thing with that little square of chocolate at night. You're still keeping the relationship alive, and you're very vulnerable to relapsing back to it. 


Dr Lucy Burns: Indeed. Indeed. Rob, this has been a brilliant talk. I have really enjoyed myself and I'm really grateful that you have shared your insights with your practice and your patients to our audience. So, thank you and I hope you enjoy the rest of your wonderful day in South Africa and the weather is kind.


Dr Rob Cywes:  Thank you. 


Dr Lucy Burns: And I guess just before we finish up, have you got any final tip that you would like to share? 


Dr Rob Cywes: Well, I think that the most important thing is to look at yourself in the mirror first. In other words, get to know who you are and how you function. No piece of advice from somebody else is perfect for you. So what you want to do is go out and understand who you are objectively - as objectively as you can, and work with somebody who understands who you are, not who they want you to be. And then slowly make that transformation. But it's the recognition and the ownership. And it's like peeling an onion. The first layer is very hard and brittle. The second layer may make you cry as you give up your carbohydrates. But then every layer you peel back gets sweeter and sweeter and sweeter along the journey. There will be some days where you have little speed bumps, but if you keep peeling that onion, there's always another layer. There's always something more to do. And challenge yourself to do a little bit more each day and not to be perfect. It's being comfortable with those little baby steps. You don't have to be the rabbit. Be the tortoise and you will go a long way!


Dr Lucy Burns: I love that! I love that! Thank you so much. Thank you. It's been wonderful. 


Dr Rob Cywes: Thank you very much. 


Dr Lucy Burns: Lovely listeners, I will be back next week with another episode of Real Health and Weight Loss. Have a wonderful, wonderful week ahead. Bye for now. 


So my lovely listeners that ends this episode of real health and weight loss. I'm Dr. Lucy Burns,


Dr Mary Barson: and I'm Dr. Mary Barson. We’re from Real Life Medicine. To contact us, please visit rlmedicine.com and until next time, thanks for listening.

Dr Lucy Burns:  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.

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