Katie: [00:00:00] Hi, everyone. Welcome to the Paloma Health Monthly Speaker Series. We do a monthly event on a topic related to hypothyroidism. And this month, we are talking about the fundamentals of weight loss.

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My name is Katie. I am part of the team at Paloma Health. I am co-hosting this event with Mary Shomon, who I will introduce to you in just a moment.

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Paloma Health is an online medical practice focused exclusively on hypothyroidism. And for those of you that are new to us, we offer at-home thyroid test kits, which include TSH, free T3, free T4, and TPO antibodies. We offer virtual consultations with thyroid doctors and thyroid nutritionists, and we also offer, prescription and supplement management.

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So that's a bit about who we are and who is hosting this event. Like I said, we're talking about weight loss tonight and we're actually doing something kind of special over this week and next. We're doing two sessions this month on weight loss. Tonight we have Dr. Pouya Shafipour who Mary will introduce in just a moment. And then next week we have Mary Shomon and Evelyn Dedominicis talking about weight loss again, and some of the practical things you need to do to get your mind and body right before you start on your weight loss journey.

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Mary is here with us. Mary is an Advisor to Paloma Health. She's a hormonal health advocate. She's a New York Times bestselling author. And she has Hashimoto's herself. So she is very committed and dedicated to making sure that patients like you have the tools and resources and education that you need to live well with your condition.

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I'll let Mary take it away in just one second. We have time at the end tonight for live Q&A with Dr. Shafipour. So you'll see a chat feature at the bottom of your screen. You can go ahead and start putting your questions in now as he's speaking or afterwards, when we're doing live Q&A, we may not be able to get to all of your questions. We're going to do our best. We'll try and consolidate, and get as many questions answered as possible because we know that's the real value. So Mary, I will let you introduce yourself and then introduce Dr. Shafipour.

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Mary: [00:02:08] Thank you, Katie. It's so much fun to be able to be part of this incredible speaker series with Paloma Health, and we are so committed to getting information out to the thyroid patient community. And tonight we are really thrilled because as Katie said, it's part one of a really special two-part speaker series on weight loss, which is as many of us know one of the big challenges for thyroid patients and certainly for people's health in general.

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We are looking at really a number of different issues, but tonight we're going to really dive into the medicine, the physiology, the biology, and as our guest tonight, we have the incredible Dr. Pouya Shafipour. He is a Santa Monica based board certified family medicine specialist who is especially trained with a specialty in obesity medicine.

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He is the guy who knows what we want to know about losing weight. Dr. Shafipour works with medication based treatments that are complimented by dietary nutritional changes, behavioral support, and exercise and counseling. So the big picture that puts it all together. For successful weight loss.

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Dr. Shafipour has extensive training from the American Society of Obesity Medicine and has studied with the prestigious Harvard Blackburn Obesity Program. So he's got all of the credentials that we need to know that we going to get some really incredible information tonight. Dr. Shafipour's practice in Santa Monica focuses on working with patients to develop healthy weight loss and sustainable maintenance of that weight loss. That's always the issue:  we can lose it, but can we keep it that way and have a healthy weight for more than just the initial period after that diet and Dr. Shafipour is going to tell us more about how that can be done.

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Without any further ado, I want to introduce and thank Dr. Pouya Shafipour for joining us tonight. It's such a pleasure to have you. Thank you for being with us.

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Dr Pouya Shafipour: [00:04:24] Thank you. Thank you for that generous introduction. It's my pleasure to be here. I've been practicing obesity medicine, since 2008,  and I use mostly diet and behavioral modifications and if necessary different drugs supplements, but a majority of it, we try to do it through diet and behavioral modification and a lot of, fasting and, different timing of eating and stuff.

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It's my pleasure to share that with everyone tonight. Our objective is to talk about  what causes fat gain and weight gain. And, what are some of the evidence related to carb restriction to improve health, improve longevity, as well as thyroid function and how to support these, lifestyle changes to fasting and, some of the other tricks that we've learned to eating the right time and circadian rhythm.

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So as we know, dieting gets confusing. There's about over 6,000 diets out there. And, there's a lot of contradiction, you know— do we do low fat, low carb, keto, paleo vegetarian, vegan? There's thousands of different, fast, fasting mimicking, I don't know, cranberry juice fast, a celery juice fast. There's a lot of things.

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So there's a lot of information and definitely our current weight problem is not just because of lack of effort. There's more gyms, there's more, awareness about nutrition, about exercise, but as. We know now about 40% of us are obese— about 60-65% of us are overweight.

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And, this is a really big epidemic. And, the other side of it is that food industry spends millions and millions of dollars each year to make the food more satiable, make us go back to it, and make the food more addictive, raise the dopamine levels, the addiction hormone.

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So it's not, it is very challenging to lose weight this time. And also not all calories are created equal. So this whole concept of, you know, a calories is a calorie. So if you go on a low calorie diet, you should be able to lose weight, does work in short term, but it's not sustainable because it's basically ignoring that mindset of:

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What are the effects of different calories on different parts of our body and what are the macronutrients that we need to eat at the right amounts? So just, I always start my weight loss consults with imagining you're just very hungry. You're starving, and you can only pick one type of food.

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And we have a thousand calories of chocolate, thousand calories of broccoli, which is about 5.7 pounds of broccoli, a thousand calories of chocolate is about seven ounces, an apple, as well as rice, or you can pick chips, avocados, and salmon, or some type of animal protein. And if you think a thousand calories of chocolate, you probably will be able to finish that.

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And most likely within half an hour-45 minutes, you're going to get hungry again. You're going to get very kind of hypoglycemic and crave something more. Probably, if you're having chips, Cheetos, you know, nachos, something like that, same thing is going to happen that we're going to get hungry again. But with apples, nine apples, nine medium-sized apples is a lot of apples. It has fiber. It has water. And, probably if we can finish it, we're going to feel full for a long time.

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With broccoli, 5.7 pounds is a lot of broccoli, so probably a cup of broccoli or two cups we're going to feel full. Broccoli does have calories, just takes a lot of it to get to a thousand calories.

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With avocados, four avocados are a thousand calories. Half an avocado to a whole avocado, we'll probably feel satiated. We feel full because avocado is mostly fat and fiber.

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And with salmon, 18 ounces of cooked Atlantic salmon. But beef, it's about 10 ounces. So that's a big piece of protein that if we eat that probably for a long period of time, we're going to feel full and satiated.

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Type of food, type of calories, and the effect that they have on the body is very important. And if we look here, both of these meals are 1,870 calories, but the one on the left is a happy meal with a milkshake and a burger and fries. The other one is a lot of food.

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So you think probably the one on the right. You can eat that the entire day and feel satiated and but the one on the left probably that's a meal. And the type of food that's going to make us go for more food than get hungry pretty shortly. And the effect that they have on the blood sugar, on insulin, in the blood is, different.

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So we have to focus on this source of calories and their effect on insulin. And I'm going to explain why insulin, timing of food is very important. So we're going to talk about that. Towards the end of the talk and, the state of one's metabolism, but should then goes within some resistance and thyroid function as well as environmental factors.

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So, what is insulin? Insulin is a hormone that when you hear it, you might be thinking about diabetes. The diabetes type one, type two, people are getting insulin shots and stuff, but insulin's main role in the body is it's a growth hormone. So in kids until puberty and a little bit after we want the incident levels to go up, because it causes growth of cells after that.

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It's basically once we're done growing, we don't want the insulin levels to be very high. It's primarily a storage hormone. It stores energy and the secondary function of it is lowers the blood sugar. So diabetics that are type one or kind of progressive type two, they require insulin to help lower the blood sugar, blood glucose, but excess insulin can cause a growth of cells and, post pubertal.

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So it might increase growth of smooth muscle cells. We have what's cause heart disease for coronary arteries get thicker or also. It causes, cell growth. So we see that in a lot of metabolic cancers, such as breast cancer, colon cancer, pancreas, prostate cancer, esophageal cancer, that if the people are at the high insulin level, they're at more risk of developing cancer.

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When we look at the way different types of foods affect insulin. So again, if you go back to broccoli, bread, avocados and salmon, for example.  The more simple carbohydrates affect the blood insulin level a lot. So you can think we have this big spike in insulin. The body is storing fat is basically gaining weight.

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Whereas with protein, the bump is still raises insulin, but not as much. And with fat, it barely affects the insulin. So on a higher fat diet, you don't really affect the insulin as much. And they don't. They make us feel full for longer periods. They're more sustainable. When we eat a lot of carbohydrates, when we go in this kind of excess insulin, with every meal, body releases more insulin, we cause more growth and we store some of the fat and when there's too much insulin, the body becomes resistant to it.

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So some cells become resistant, some cells go into growth and we develop more insulin resistance, which causes more weight gain. And if we, again, look at this from another view, if we consume a lot of carbohydrates, body goes into this fat storage because it has all these excess calories that doesn't know what to do with it.

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So liver stores, some of it, different parts of the body, stomach, fat muscles, and some of it and in the liver and once that stored, we feel hungry. And we go into another fat storage. We eat more going to another fat storage and the cycle just continues. What are these dietary sources? And we're going to the very, simple sources. Glucose and fructose are our big source of our fat gain mechanism.

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And  both of them are very abundant in our diet. What are glucose and fructose and what are the differences between them? Both of them are simple carbohydrates  They're kind of end, breakdown making the, and cells from breakdown of carbohydrates and glucose is the energy of life.

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Body makes glucose from acids and fatty acids so it's not essential. And through a process called gluconeogenesis, we can make it. Fructose is a part of it's the vestigial to our organisms. It's rudimentary. It's more of a storage form sugar in plants. And both of them, if we consume a lot of them, they cause aging reaction.

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You can see this with, if you leave an apple or if you leave a banana out after a while. It gets brown. It ages when we consume a lot of it that also makes our body age, it causes also causes that browning reaction in the body. However, fructose, which is the fruit sugar causes the browning reaction seven times more than glucose.

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So it facilitates, aging and inflammation. And also causes fatty liver glucose. There's a hunger hormone. That's called grelin. So basically when the ghrelin levels go up, usually three times a day, we feel hungry. We feel get the urge to eat. Then when we consume  glucose, grelin levels drop, but fructose does not affect the grelin.

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That's why, if you're having a soda which has high fructose corn syrup, you can drink 10, 20 ounces of it before you really feel full. Whereas with the older, sucrose  sodas like Mexican Coke, you might feel full, faster and earlier. Glucose is metabolized mostly in the brain and area called sensory motor cortex, but fructose lights up the reward centers, the same place that cocaine and heroin and a lot of addictive drugs and alcohol, light up.

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That's why it was such a miracle. The high fructose corn syrup that's cheap as a miracle for the food industry, because we keep on going for more and more. What are the sources of fruit? Those dried fruits are a big source,  honey, a lot of the sauces are a big source, soft drinks, and salad dressings, pastry.

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And there are a lot of fruits that have a lot of fructose, that if you're trying to lose weight, or if you would've been diagnosed with insulin resistance or fatty liver, you want to initially in the weight loss phase, avoid those . High fructose, sugars. You can, fruits, you can see more on the left side, like bananas and some of the melons and, pineapples, dried fruits, definitely again, but the ones that grapefruit, kiwis, lemons, most of the berries, some apples have less fructose.

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So again, in the weight loss phase, it's better to have the lower fructose fruits. What you want to do is to reduce the fructose content. The way to look at the fructose, if you're asking your doctor, we usually measure the fasting blood sugar, and we measure hemoglobin A1C, which again are markers of glucose, but for fructose, there's no  direct test.

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And ways to look at it with the uric acid levels and the liver enzymes— the ALT. And, try to get the fructose mostly from whole fruits to reduce this kind of insulin rise and exercise drinks. A lot of the exercise, drinks and sodas have high-fructose corn syrup, which is  not good for us.

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If you look at the current dietary recommendations, it has been around since the nineties, when the rate of obesity really went up, it's a low calorie diet that is low in fat, but does include vegetables, legumes, fruits, a lot of fruits, whole grains and fat-free or low fat dairy and plant-based oils.

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And it's limited in animal protein, saturated, fat, trans fat, and added sugars. And the typical recommendation is to have three meals and two snacks, and try to work out about 30 minutes a day, five days a week. but we've seen since the nineties is that the weight gain and obesity and overweight has significantly gone up.

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If you look at the food pyramid. That again has been around since the, late nineties, very heavy, concentration of, whole grains and, some fruits, vegetables. And then when we go to fats and fatty sources, it's much less, but again, what we've seen as we've gotten bigger, we've gotten that we develop more abdominal fat.

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So we can tell that the current dietary recommendations are failing us and to adhere to a low calorie, low fat diet, and long-term is hard. It's challenging if you think about diet, the first three letters DIE. So a brain  automatically wants us not to die. So we need to think about something that's sustainable and we can stay on for longterm.

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So when I talk about a lifestyle, I said, you know, you have to think about patience, about lifestyle, that is a marathon. We focus on a long-term plan that initially might be a little bit more restrictive and challenging once your body gets used to, it starts utilizing the internal fats. Then it gets easier.

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And we look at this as a sustainable multi-phase program. And our body is an expert in, in storing fat so insulin. But unfortunately we never get to utilize this fat and limiting carbohydrates, glucose, fructose, simple starches really helps the body get into this fat burning mechanism. That's called, ketosis.

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So fat fatty cells when they're released, they, some of them are used for energy right away in the form of free fatty acids. Some of them go into the, liver cells and are turned into ketones and our body gets into ketogenesis and the ketogenesis everyone gets into. So if you get an early blood test in the morning and give urine, most of the fasting urine has a little bit of ketones, but depending on the diet you're on, you can get into this stage more.

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What is the difference between ketones and glucose? Ketones, as we can see here, release a little bit more calories. So they're more sustainable form of energy. They're antioxidant, and they enhance age from holding cells and they burn slower. So we don't go into this rollercoaster of feeling hungry.

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Whereas glucose does promote aging. It is used by all the cells in the body, but does promote aging. And it is something that, if the body needs, it can make it from, fatty acids and amino acids. True gluconeogenesis ketones can be used where all the body cells can be by muscles, but it can be used by, the joints.

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And usually when we're burning fat, we feel more sustainable. We'll feel less inflamed. So when people go into even milder stages of ketosis, they feel they have more energy and they have less joint pain and they have less inflammation. There are a lot of, old, tribes that are still, on very high fat diets— the Inuits and Massai warriors— and the rate of heart disease and diabetes in these societies is extremely low.

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So what constitutes a low carb diet? Because when I talk about ketosis, a lot of you might immediately think about, oh my god, it's Atkins, it's a lot of, I don't know, bacon and sausages and fat and stuff.

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No. So anything under— there's no real definition— but anything under 120 and 130, or even under a hundred grams of carbohydrates, is considered a low carb diet  Standard American Diet is about 300 grams of carbohydrates. At least half of that if not not a little  bit more. It's not a high protein diet because a lot of people, again, think it's a protein diet.

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So average person that's on a low carb diet consumes about 10 to 14 ounces of protein, but it depends on the age and physical activity of the person, but it does contain more fat and the fat could be from animal protein, but there are vegetarian and vegan ketos could be saturated fats, monounsaturated fats, like avocados, olives, macademias and nuts as well.

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So if we look again, lots of vegetables, some animal protein, eggs, and natural fats and cheeses, but depending on the type of low carb, this could vary a little bit. What are the different types of low carb? There's the ketogenic diet that could anywhere from 10 to 50 grams of carb and in extreme forms it's used, initially was used to treat, resistant epilepsy for pediatric population and still, common.

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Also Atkins was a ketogenic diet, about 20 grams. We use it now for Parkinson's, Alzheimer's, some brain cancers like Cleo blastoma, and we also use it for treatment of some cancers in addition to chemotherapy. Paleolithic diet is a low carb diet. Autoimmune protocol that some of you might be familiar with for treatment of autoimmune diseases like Hashimoto's is a paleo diet with specifics—  things that we're going to go over. Mediterranean diet is low carb. Zone was one of the original low-carb diets and some vegan and vegetarian. So I think, keto-tarion is the vegan ketogenic diet.

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When we look at the macronutrients in the low carb diets, I'll go through them one by one, but carbohydrates again are the source of energy. They are building blocks. But as I said before, it's not essential. Our body can make carbohydrates true. No acids and fatty acids through this process of gluconeogenesis. So the recommendations on a low carb diet would be non-starchy vegetables, some nuts and seeds, some berries. Dairy has lactose, which is a form of sugar, fiber, which is free in any type of low diet because it's a good filler and reduces the absorption of sugar.

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And some legumes. Legumes have a lot of fiber and whole grains, and we want to avoid, really sweet fruits and, alcoholic drinks that have a lot of sugar and simple white starches and obviously chocolate. So the processed foods.

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Protein. So protein, is basically the building blocks of proteins are amino acids and there's nine of them that are essential.

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And our body uses them to make hormones, enzymes, tissue maintenance, repair growth, and immune cells are proteins. So these are essential and we need to get them from different sources and fat are a source of energy. So again, fatty acids like Omega-3 and Omega-6, which are mineral leic and linolenic acid.

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Those are essential and we don't make them ourselves. Cell walls are made out of fat insulation and the body fat soluble vitamins, and also fat basically is a source of energy and protects the vital organs. So a typical, low carb diet, if it's a pescatarian or a ketogenetic would look something like this.

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If you're vegetarian or vegan would look more something like this. So definitely has a lot of vegetables, healthy oils and healthy sources of fats. And, if you're going up to a hundred grams, it could be some whole grains and legumes in there as well. And this is kind of a keto vegan diet that is getting popular as well.

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And the autoimmune protocol again is a paleolithic diet. Let's say there's a low carb diet that includes vegetables— except nightshades tomatoes, potatoes, peppers, and eggplants— as well as fermented foods, lean meats, a small amount of fruits and oils. And also it's very low in grains and legumes and dairy, as well as eggs. It is a diet that's shown with celiac and a lot of autoimmune diseases to show a lot of benefits.

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What are some of the side effects of the ketogenic diet or low carb diets? When you go on it, depending on how much carbs your body starts, secreting a lot of salt, it starts with we called diuresing.

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So the first couple of weeks, muscle cramps, headache, sleep problems, maybe heart palpitations, hyperglycemia, because bodies weaning out of blood sugar are common, but having a little bit of extra salt, like sea salt or pink salt, and hydrating and taking it easy should  reduce this stuff. It kind of gives a little bit of flu like symptoms that are temporary.

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If people are on any type of medications for diabetes, high blood pressure, definitely this is something that needs to be done under supervision of a doctor, because some of the medications might need to be weaned off.

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Now we're shifting gears and going to Hashimoto's. So Hashimoto's as a lot of you might be familiar, it's one of the most chronic autoimmune diseases. And it's an interaction between genetic and environmental factors and high iodine, selenium, and iron deficiency. Vitamin D deficiency and high glucose, gluten content of food have been contributing factors. And a lot of people, despite being on medications, especially the most common medication would be levothyroxine, they still have symptoms of hypothyroidism and fatigue and a lot of things that was impacting their quality of life.

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They always complain that just being on medications is not effective. They did a study with the AIP diet, that showed the Hashimoto's significantly improved physical and emotional functioning of people and reduce the C-reactive protein. But it doesn't didn't really affect much in the thyroid function. Quality of life goes on, but thyroid function was addressed more with  medications.

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One of the common perceptions that I see as a primary care doctor and also as a weight loss specialist is that hypothyroidism is responsible for obesity, especially when you look up hypothyroidism, weight gain is one of the side effects, but what we see in practice is that yes, if someone has overt hypothyroidism, TSH is really high, 10, 50, 20, 100, 20, 30 pound weight gain is possible, but there isn't much evidence with subclinical numbers that are like three or five or 10 or up to 10, causes hypothyroidism.

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In obese patients. The TSH might be a little bit higher so we need to check the TPO antibodies to diagnose hypothyroidism. Now we go to the other methods, other exciting stuff that are around.

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So what is medical fasting? It's not eating fast food, obviously. Fasting means we're basically limiting food intake to anything more than 12 hours in a day.

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And it's been around forever. A lot of religions do it and as more time goes by, initially we thought that a body would go through this starvation mode and fasting had a lot of poor outcomes on the body. But now we see has a lot of benefits in longevity and also makes dieting makes adhering to the diet a lot easier.

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There's a lot of benefits. It causes autophagy, which is the destroying the bad cells, causes the STEM cells to go up, rises in ketosis to help with fat burning, energy diversion, and it's also really good for resetting DNA, resetting metabolism and for gut microbes, for the gut flora.

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So there's different ways to do it. The most common one is probably what people call intermittent fasting, or time restricted eating that you limit the food intake to an eight hour window. There's also, you can extend that to 24 hours, which would be called the old OMAP or one meal a day diet. Fasting mimicking diet that I'll refer to in a little bit later is a common one and people do longer water fast.

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We've had patients do all the way up to 45 days of water fast, but very rare cases. So in the time restricted, which is the most common one, usually water, coffee, tea is okay in the fasting time, hopefully half of it you'll be asleep, but the other  parts is two meals and a snack. So what we can see is the body will be in a state of fat-burning, ketosis and with the two meals, we'll get an insulin bump and then a drop so hunger level really goes down.

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With the five-two, two days a week, either back-to-back or separately, eat one meal a day, usually under 500-600 calories depending on the gender. And then the other days would be a healthy diet.

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Fasting mimicking diet is by Dr. Longo at USC was developed. He studied basically longevity in the blue zones and he noticed that prolonged fasting, which is not very easy to do, had a lot of benefits and STEM cell rejuvenation. And, blood sugar control and cancer prevention. So he came up with this fasting mimicking diet that's five days and basically the, the content, even though we're tricking the body and having between 700-1000 calories, it goes under the nutrient sensing radars.

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And also we get a lot of STEM cell production. It works really well for women between 40 to 60 when they're in this pre-menopausal age and they're struggling to lose weight. We usually mix it with some type of a low carb diet, and it's five days that usually includes two soups , not snack and also has some, olives and  crackers by the petty crackers. It's not a ketogenic diet, it's a vegan low carb, low protein diet, but it does put the body into a little bit of ketosis in terms of steroids function.

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For a normal person, when they fast, we've seen that the T3, which is the active thyroid hormone goes down and the reverse T3, which is an inactive one goes up, but for someone who's on thyroid medicine, it makes the thyroid medicine, especially T4, which would be levothyroxine more active also for Hashimoto's patients, because we do get so much reduction in inflammation, it kind of compliments an antiinflammatory diet so the patients feel better. The joints and a lot, the symptoms of the Hashimoto's go down.

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Last topic is the circadian rhythm or the biological clock. So as humans, we are diurnal. We're supposed to be awake during the day, asleep at night. And what studies has shown is that timing of eating is very important. So each hour of the day, it really is important. What we eat at different hours, the metabolism is different.

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So we wake up in the morning.  Basically metabolism starts melatonin, which is the sleep hormone goes down. When we see the light serotonin, which is the happiness hormone goes up and metabolism kind of starts around 10 or 11 and it's optimized between 10 or 11 at about three to four. And then as the sun starts going down, then the pancreas starts going down. Melatonin starts going up and body goes into the sleep. So there is an ideal time for eating, exercise, taking certain medications and people that eat later at night when the body is supposed to be asleep, they have more insulin resistance and  weight loss will be more of a challenge. And a lot of these studies was from rats.

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Rats are nocturnal when they kept trapped during the day and fed them a fattening food, they gain weight and they, basically stopped running. But when they fed the same type of food, at night when they were supposed to be eating. They didn't really have an effect on them and the weight stayed stable and they became leaner.

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Disrupted clock cause the poor sleep quality, which sleep is very important and, hormone regulation also causes insulin resistance and, mood kind of disrupts all the hormones. So very important that for us to eat during the day, And try to get really good sleep for, hormone balance.

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So what we discuss is not all calories are  created equal, and we have to really focus on what calories are ideal to affect our blood insulin level and also excess glucose and fructose, especially a lot of high fructose corn syrup and refined, snacks and drinks are. But they cause insulin resistance can cause fatty liver and fatty liver causes inflammation.

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And also in longterm they can cause risk of cancer. Low carbs diets have been shown to be very effective ways to reduce inflammation and there's different ways to, reduce the carbohydrates. So it's not just a carnivore type diet. There's multiple different ways on anything under a hundred grams of carbohydrates for different people should work.

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Thank you so much, and I'm happy to take your questions.

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Mary: [00:34:06] Thank you, Dr. Shafipour. That is absolutely fascinating information. And I have to say we've done a number of these speaker series and we usually get some good questions. We have a long list of really great questions.

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Everybody is dying to ask you all sorts of information. So I think we're going to jump right into the questions if that's okay with you. They're in no particular order. And if I really, if I pass by somebody, Katie and I were doing our best to cover all the questions, but if we've missed it, certainly circle back around, folks who are watching.

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So the first question is regarding snacking, a lot of people love their snacks. And one of our viewers wanted to know about what you recommend for snacks, because she said she's often eating a piece of fruit and alone as a snack, but wondering if something with less sugar, less fructose, more fat or other macronutrients might be a better choice to avoid storing more fat?

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Dr Pouya Shafipour: [00:35:14] Absolutely. We want to think about snacks as little dessert, so before snack and we always have to think, okay, am I snacking because I'm bored or am I snacking because I'm stressed or anxious or do I really need to snack right now. Because a lot of times we snack because the blood sugar drops and if we're anxious, cortisol level goes up.

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So body goes into this fight or flight and we crave something. And usually for snacking, we crave something sugary. So if, and snacking is also genetic. THhere's some companies that do genetic testing and we can see if you have the snacking gene or not. I know I do because I got test it. So if by nature, you're a snacker.

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Again, we go to the very beginning of the talk— a thousand calories of broccoli is five, six pounds of broccoli. So have a big bowl of vegetables, broccoli, celery, cucumber, cauliflower, you know, whatever you like have a little dip of a Greek yogurt or Baba ghanoush, not hummus if you're trying to lose weight and use that as a snack because thousand calories of vegetables barely affects the, insulin, but if you're snacking on fruits or especially dried fruits that are really high fructose, it could be problematic and can really impact, weight loss efforts.

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Mary: [00:36:32] Okay, great. Good advice. Here's another question that relates to snacking? A lot of us when we are on the run or we're looking for a quick snack, we think we're being really healthy when we grab a protein bar. And yet, if you look at the labels on protein bars, a lot of them have high fructose corn syrup and other ingredients that we want to avoid. What's your take on protein bars or power bars or meal bars?

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Dr Pouya Shafipour: [00:37:00] Yeah. So a lot of those bars are very high in fructose high fructose corn syrup. They're also calorie dense and you know, bars are small, so it doesn't really give us a lot of volume. If you're exercising or if that's your meal, sometimes that's healthy, but if we're using it as snacks, that could get very, problematic because also they're very delicious.

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I know a lot of these like thin Atkins power bars, they are tasty so we need to be conscious. And if we are exercising, we can have a little bit of sugar and protein, but if we're using it as just the, to-go again, it could be dangerous. So for those instances, I would, I recommend have a little bit of avocados, half an avocado.

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You can cut it or have some egg whites or something that doesn't affect the blood sugar or barely affect it. And it's satiating. It makes us feel full and drink some water. You know, green tea is a great thing to also throughout the day to have because it has catechins that suppress appetite, a little bit of, caffeine as well.

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Mary: [00:38:07] Okay. now talking about suppressing appetite and getting satiatity, one of our, viewers wants to know about the different fats. So we know olive oil is good. Olives are good. Avocados are good. Wanted to know about grass fed butter and the cholesterol impact of some of these fats.  Is it a problem for your cholesterol levels? And what about that grass fed butter, which is, I know it's one of my favorites and a lot of people love it.

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Dr Pouya Shafipour: [00:38:36] So the fat, the cholesterol in the blood, the cholesterol that your doctor will check the LDL. We all are scared about, the lipoprotein.

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That's not directly related to the fat or cholesterol we eat because that's the cholesterol. The liver makes the fact that we eat basically raises the triglycerides, goes into the liver and then the liver starts metallic utilizing it. So for someone that's on a really low carb diet, and if they don't have familial hypercholesterolemia, that is a genetic condition, having grass fed butter or grass fed because it's healthier, doesn't have hormones and stuff on a setting of a low carb diet usually does not affect the cholesterol, except for people that either have familiar or people that are really lean. But, again, we'd have to look at the family history.

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We have to look at a lot of different things, but I know a lot of people are having, for example, high-fat, what is it like a Bulletproof coffee with a ghee or clarified butter and, coconut oil, if you're trying to lose weight, that might not be the way because, will it prove coffee is like 300-400 calories, but it is good for mental clarity because the body that fat directly turns into ketones.

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So if you're checking your blood ketones, they'll raise it. And it helps with, appetite suppression, but calories do count if you're excessively using them and you're not burning, get on a low carb diet. We're forcing the body to use our stored calories. So when people go on a low-carb diet, usually the amount of calories we're taking goes down, we're really, metabolizing and utilizing our own time.

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Mary: [00:40:17] Okay. speaking of calories, what about diet sodas and artificial sweeteners? One of our viewers wanted to know, can I have that occasional diet soda? What about those diet Cokes? Diet Pepsis. What's your take on the pink and the blue and the yellow packets?

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Dr Pouya Shafipour: [00:40:35] So a few things. FIrst of all, they're processed. There is, some research about aspartame and autoimmune diseases,. Aspartame which is in Coke Zero, Diet Coke. A lot of diet sodas have aspartame. It might make you more hungry. So it might not really trick the body as calories. They did a study a few years ago between a year of someone having, I think it was in England, a regular Coke versus diet Coke, and there was no weight difference.

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So even though one person was having 30, 40 grams of sugar, more than the other, and aspartame, there is, data about, the benefit of the harms of it. And the body overall as Stevia, and, sucralose a little bit less, but sucralose is also kind of a sugar does that doesn't get absorbed. So it might make you crave more sugar.

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I know when I have Coke Zero or Diet Coke that I used to have a lot of it, I would get hungry. So a lot of these, even though they don't have sugar, they make you crave a little bit of sugar and they don't necessarily make us. satiated. So it would be better to wean off of them overall.

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Mary: [00:41:40] Okay, great. One question that has come up and I know that I had it in a couple of, other of our viewers had similar questions is the issue of the protein sources and, my question really relates to the issue of beans, because I know personally as a thyroid patient with Hashimoto's, if I make beans one of my primary proteins, I gained weight on beans.

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Then we also have the issue of soy because a lot of people then say, I'm going to have soy burgers and soy patties. And soy protein and miso and tofu and they go soy crazy. And then we have people that have issues with that with their thyroid. So what are the good protein sources that are non-meat based in your opinion for optimal weight loss?

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Dr Pouya Shafipour: [00:42:26] First of all, we don't need a lot of protein for, for weight loss. Like I said, on average, you know, And 10 ounces of protein, unless we're exercising a lot. Overall, we eat way too much protein. Then we should, and at a high protein setting, the body proteins are building blocks of amino acids.

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So we are putting ourselves at risk of. Developing cancers and stuff because cancer cells use protein. That's why a lot of these longevity and lose zones, they noticed that protein content of their diet is a lot lower than us. Pea protein, rice, protein, hemp, protein from eggs way. You know, those are healthy sources and are anti-inflammatory. If someone is not vegetarian, obviously, from fish and, grass fed beef and chicken. I usually recommend varying the diet because always eating the same thing, if you do a food sensitivity tests, if you're on the same food every day, you will see that a lot of things light up.

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That doesn't mean you're allergic. To it, it just means the immune system is just getting too much signal from the same food. So varying it, but hemp protein, rice protein are great choices. Soy is very engineered but a fermented soy is a little bit better than non fermented , I'm not a big fan of, excess soy protein, especially really raises the estrogen level and stuff.

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A lot of men that are on the high soy protein, we see that testosterone level sdrop as well. Seitan also. Sometimes it's good, but, does have gluten. People with gluten sensitivity need to avoid it.

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Mary: [00:44:02] And what about the beans? Because that, we're told beans are so healthy. They're high fiber, they're high protein.  

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Dr Pouya Shafipour: [00:44:08] Bean do have carbs, yeah. A lot of carbohydrates. And also some people , causes a lot of bloating. So if you're having beans, you have to make sure, especially a lot of us have small intestine, bacterial overgrowth, which is fairly common. So beans and legumes and those people.

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Causes problems. So sometimes I recommend people take some probiotics, like Saccharomyces boulardii, which helps with, absorption of it and the metabolism of it. But, yeah, in terms of weight loss, especially on the first phase of weight, loss is not. it's not because of the high carb content. Quinoa, also. A Lot of people just go qunioa crazy. And, they will gain weight because it does have a lot of carbs, so they have to be watchful of it.

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Mary: [00:44:58] Okay. we have a question here from one of our viewers about the issue of the cruciferous and goitrogenic vegetables, because there's always a lot of back and forth about it. And we know that broccoli, cauliflower, these are really super healthy foods. But we also know if we are juicing cauliflower and kale every day in a raw form, we can actually slow the thyroid down. So where do you stand on this? Because, people need to know that they can eat some of these foods, but in what way do you think is it makes most sense?

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Dr Pouya Shafipour: [00:45:34] What I've seen practically with my patients that if you're consuming a lot of these, if you're juicing, I'm not a big fan of juicing, just because you're taking away a lot of the fiber and you're making more of the fructose available.

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Fiber reduces the absorption. So it helps, with, getting less spike in glucose and fructose, but my, if you're on a thyroid medicine, you need to be consistent with the amount of cruciferous vegetables that you eat, because that's how we can see if the dose of your porcine Synthroid or levothyroxine or Cytomel is kind of consistent, but if not, then we kind of, honestly, yeah.

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With the symptoms that people are having symptoms of fatigue and lethargy, and we check the levels and we can, adjust, go over their diet and adjust, but I'm not a big fan of having anything in excess and just go crazy with cruciferous vegetables and have a lot of it and not have it for a while.

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So if you're having it consistently, it shouldn't have an effect. I haven't seen personally much of an effect on the thyroid function.

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Mary: [00:46:40] Okay we also have a question about the gallbladder, because I think we've got a few folks in the group  today who have had their gallbladder taken out in the past. And they're wondering what impact that may be having on the ability to lose weight, fatty liver and even thyroid function and metabolism as well.

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Dr Pouya Shafipour: [00:47:02] One of the side effects of fat loss. When people go on a diet and if, depending on how rapidly they lose weight, might be gallstones. And we, in the past, I don't know, 10-15 years, we've only had one person that, he didn't get the need to get his gallbladder removed immediately, but after six months.

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Initially when someone is having gall stones and gallbladder issues that might impact weight loss, but after they've removed the gallbladder, I personally, haven't seen a lot once the body adjusts, because body goes from releasing the bile, which is stored in gallbladder.

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You eat fatty foods, the hormones release, and we release it on demand to the liver. Getting adjusted to releasing bile on demand. Some people might need more bile acids or bile size assaults or digestive enzymes than others. Depends on their reaction to a food, but in general, with a very high fat diet.

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So really ketogenic diet, they might have issues, especially if they have gallstones and I'm usually not a fan of those, unless someone has a bipolar or they're on a, seizures, you know, something that we're putting on really high and usually I don't manage those patients, but I'm more of a low carb Mediterranean, diet and I haven't had the issues with those personally.

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Mary: [00:48:26] Great. What about, several of our folks want to know about dairy? Should they really be thinking about cutting out all dairy or do we leave in fermented dairy? Like the yogurts or kefir? How do we manage the dairy issue and still try to lose weight?

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Dr Pouya Shafipour: [00:48:45] Great question. So milk, I usually say avoid it. You know, where milk has lactose at it has sugar and it's inflammatory for some people that have very high cholesterol levels. Usually if they're, dairy, especially cheese and not some, I haven't seen a lot of issues with yogurt, but cheese might spike the LDL a lot.

So in those people, I usually recommend cutting dairy and eggs to see how it affected. there is cheese is a low carb, higher fat product, and it does help with appetite suppression. For most of the people it's okay. But people with inflammation, especially with other immune diseases, joint inflammation, usually if you cut dairy also with allergy sinus allergies, if you cut dairy, you'll see  benefits.

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In terms of yogurt and kefir, which are fermented, for majority of people they do well on that. But vegans, obviously we switched them to cashew cheese or cashew or coconut yogurt and they do well, but I really recommend having fermented foods as a, part of a healthy diet and usually there are easy ways to get in if we are not wanting to have probiotics.

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Mary: [00:50:04] Okay. And we've got time for another one or two questions. One of our viewers wants to know about the potential downsides of any kinds of intermittent fasting or time eating on hypothyroidism because her doctor may have suggested that it wasn't good for people with an underactive thyroid to do any kind of timed eating or fasting protocols. And I'm wondering if you had any thoughts on that?

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Dr Pouya Shafipour: [00:50:32] I have a lot of patients with hypothyroidism that are doing it. And, again with Hashimoto's patients, especially people with hypothyroidism that have fatigue, we see great benefits. And if you're on a thyroid medication like a levothyroxine or Armour, those forms, it usually makes the absorption better.

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But at the same time, there is research that shows the T3 does go down. Does that mean we feel more lethargic and fatigued? Honestly, I haven't seen that because we're utilizing ketones. We think because the body is utilizing ketones, thyroid doesn't need to work as hard when we're doing some type of fasting. You know, I recommended it.

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Prolonged fasting, there's not a lot of research  out of it. With ProLon, what I personally have seen is that if I put someone with Hashimoto's on ProLon, there is a good chance with younger people that we reduced the dose of their medications.

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I had a, female, 37, 38 year old, that was on 200 micrograms of level thyroxine. And in eight months we basically were able to wean her off of it. And she lost about, I think, 70 pounds, but she, if she had Hashimoto's from Lyme disease, that you got in New England, I think, or Connecticut and, basically the Hashimoto's resolved, but, with the fasting mimicking diet and a ketogenic diet.

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Mary: [00:51:56] Terrific. All right. We've got two more questions, before we finish up. And my last sort of technical question is one that comes up all the time with our thyroid community. And that's the issue of, do I need to cut out gluten? If I want to lose weight, especially for both hypothyroid patients, but in particular, the autoimmune, the Hashimoto's patients or the Graves' disease patients who've been treated and are now hypothyroid, is gluten a no-no or is there a role for some gluten in the diet? What's your take on that? As far as weight loss is concerned.

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Dr Pouya Shafipour: [00:52:31] Okay. So for weight loss, if your going gluten free, but you're not going completely off of, legumes and starches gluten-free foods, statistically have more carbohydrates. So if you're getting gluten-free bread and gluten-free products, you're probably not going to lose any weight.

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If not, you might gain weight because gluten-free products, statistically gluten is a glue. So it's a protein that glues things together and it's more satiating. So if you're trying to lose weight just by going gluten free and I'll have a lot of people that say I went gluten-free and I didn't lose weight, then you know, you're not going to lose weight.

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Usually low carb diets don't have any grains or legumes initially. So they are gluten-free you know, all the grains are down, but for Hashimoto's, for inflammation, as we saw, the research has shown people that go on a gluten free diet, they do feel better in terms of joint pain and inflammation and bloating and get a lot of the, so they, the quality of life goes down C-reactive protein, which is an inflammatory marker goes down.

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And another thing that's important for us to realize about gluten is that gluten in the U.S. Is a lot more a process than if you're having gluten, let's say in Italy. You might feel bad here, but you might go to Europe and have beer or have, pasta. And you're like, I feel great. It's because of the process, it's not the gluten itself, but the way they process it.

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Mary: [00:53:57] Great. And then, the last question that we're getting is from, some folks who want to know if there's a way that they can get it touch with you, because I think you've got a lot of people that are looking to, to work with you. And, so I'm going to let, Katie jump in on this too. And, but how do people get in touch with you? Where do they find you?

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Dr Pouya Shafipour: [00:54:19] I'm in primary care and I do obesity medicine. I see a lot of thyroid patients. I'm also part of Paloma. So I see patients through Paloma as well. If you're in Los Angeles, you can book a visit and see me. And also you can reach me if you're in California, through Paloma Health as well.

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Mary: [00:54:39] Fantastic. So I think that we are coming up to the end of our one hour webinar, and this has been an outstanding session. Dr. Shafipour. I learned so much incredible information and I think we could have gone another two hours with all the questions that we have coming in.

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But I want to let people know too, Dr. Shafipour got us started and then next week we'll do part two where we're going to get into more of the nitty-gritty on some of the questions that you have about what fillers are in what thyroid meds and how to keep track of this and that. So we'll be getting into a lot of those additional details. And talking about what's working and what's not working as thyroid patients.

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So make sure you jump in with us next week, same time. And we'll be doing another session. Stay tuned because we'll have information for you on how to sign up for that, fairly soon. Thank you, Dr. Shafipour so much.

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Dr Pouya Shafipour: [00:55:35] Thank you so much, everyone. I really enjoyed it as well.

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Mary: [00:55:39] And I'm going to turn it back over to Katie to take us out for the evening.

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Katie: [00:55:46] Thanks, Mary and thank you, Dr. Shafipour. If anyone's interested in learning more about Dr. Shafipour or Paloma Health doctors, you can go to www.palomahealth.com.

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We will send out a replay tomorrow with this event and we will include an invitation to next week's event. All of Dr. Shafipour's slides will be included in that replay— I've seen that question come up a couple of times. And then we hope you'll join us again next week to ask more questions and learn more from Mary and Evelyn. Thank you all for being here and for giving us time on your Monday night and we'll see you soon.

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Mary: [00:56:13] Thank you.