Can a Ketogenic Diet Reverse Chronic Disease?

Today we find out from Doctor Vyvyane Loh, Founder  of the Transform Alliance for Health and board-certified in Obesity Medicine and Internal Medicine . She graduated from Boston University School of Medicine and trained at Newton-Wellesley Hospital.

Unlike most physicians on our program or anywhere she is also an accomplished choreographer and fiction author who won the Bunting/Radcliffe Fellowship in Fiction in 2006, a Guggenheim Fellowship in Fiction in 2008, and was shortlisted for the 2005 international IMPAC Award in Literature.

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Robert Lufkin  0:01  
Welcome back to the health longevity Secret show with Dr. Robert Lufkin. Can a ketogenic diet reverse chronic disease. Today we find out from Dr. Vivian Lowe, founder of the transform Alliance for Health and board certified in obesity, medicine and internal medicine. She graduated from Boston University School of Medicine and trained at the Newton Wellesley hospital. Unlike most physicians on our program, or indeed anywhere, she is an accomplished choreographer and fiction author who won the bunting Red Cliff fellowship in fiction in 2006, a Guggenheim Fellow in fiction in 2008, and was shortlisted for the 2005 International Impact Award in literature. Now, please enjoy this interview with Dr. Vivian low. Then Dr. Vivian Lo, welcome to the show. Hey, thanks so much for being here. Before we before we get into metabolic health, and obesity, and all these interesting things, I want to take a moment and just take a look at your your history as we said in the introduction, unlike most physicians on this program, or indeed most physicians anywhere, you are an accomplished choreographer and fiction author who won the bunting Radcliffe fellowship in fiction in 2006, a Guggenheim Fellow in fiction in 2008, and were shortlisted in 2005 for the International Impact Award in literature. That’s a fascinating and very unusual background. How did you come to explore such diverse endeavors at such high levels of accomplishment?

Vyvyane Loh  1:58  
Oh, well, I you know, I’ve always been interested in writing, dance most of my life. So these are just parts of what I did since I was a child. And I actually got my MFA in fiction right after I finished my residency. Very shortly after I finished my residency, and I started my first job. And I actually went into burnout quite shortly after that. And I always say it was a gift, because I burned out early. You know, I burned out maybe two years after residency. And I had to face the fact that, okay, I’ve just gone through med school, I’ve gone through residency, you know, I’m working as a doctor, I’m not going to last. That was

Robert Lufkin  2:53  
turned out to be clear, right. So it was, I mean, you did an intensive residency in Internal Medicine, and then a fellowship in obesity medicine, also.

Vyvyane Loh  3:03  
So with obesity, medicine, there’s no fellowship. But you know, I, and I’ll get into how I got into. Yeah, I realized very shortly after finishing residency that, okay, you’ve done all these things, but you’ve got to last or you’re not going to have a career, you’re not, how am I going to survive the X number of years that are ahead of me, and I was already burnt out two years out from residency. And that was a huge smack in the face. And at that time, there were practically no resources for burnout. And you remember the whole, you know, grit your teeth and bear with it, and the stiff upper lip, and you know, so that was the climate that I had been working in. And I just had to look at myself and go, You know what, this is going to be a problem, you’re not going to make it just at this rate. So I really had to take a big step back. A huge step back I, at the time, right before that I had applied for my MFA in fiction. And I won a scholarship, a full scholarship to do that. So this was all around the same time, and I found out that I had gotten the scholarship. I was going to start the MFA, but then there was still work. When I realized that I couldn’t, you know, continue practicing the way I had been practicing. I took a huge step back and I actually quit my job. I quit my full time job, which was very scary. It was extremely scary for a number of reasons. And I’ll just be very open here because there’s nothing to hide. I was here on a on a work visa. If, and my my employer at the time was applying for a green card for me, so quitting the job wasn’t just quitting the job and quitting a salary. I basically became out of status. Right now. Yeah, so I was illegal, and illegal. Alien. And, and, you know, for someone who’s, you know, I went to medical school I always did well, in school, I always follow the rules. And this was terrifying. You can imagine the, I wasn’t sure what to do. And then I had to figure out also how to patch together a living, because now I didn’t have a salary, right. So I had the school, the scholarship, but I still need it to live. And so I remember at the time, I had been working out at a gym, and for some reason I had taken a certification in in a spinning course. And I was at the front desk, and I overheard them talking. And they were saying, you know, that spinning instructor isn’t going to be able to do you know, the next few weeks and blah, blah, blah. And I said, I can do this. So they said, Okay, can you audition and I made up a tape, you know, music and everything and auditioned. And this is sure you can teach the class I taught the class and then they said, Hey, can you teach aerobics? Never done aerobics in my life. Oh, yeah. Yeah. I went to the library. Oh, Jane Fonda to memorize the routine, right? It’s harder than you think. Because you have to do it mirroring the the person on the other side, you got to speak well, you seem to be pretty fit. Sounds like oh my god, I’m gonna die.

Oh, you know, I was able to kind of cobble together for next thing I knew I was teaching all these classes, I made up some classes, I did get certified as a personal trainer. So I did all these things, right. And at the same time, I was going to school now the program I was in was a long distance program. So it meant that I went on campus twice a year for 10 days. But the rest of the time I worked intensively with a professional writer. And every I think it was three weeks, we had to send in what we called out packets back in the day, and I was substantial chunk of writing and reading and essays and stuff like that. And then we would get very, very good detailed feedback. I was in the Warren Wilson program, which is quite well known. Anyway, so it’s doing that. And then I still needed a little bit more, you know, income just to survive. You can’t just, you know, teach aerobics all day, you wear your body. So I also started to moonlight. And I bumped into a surgeon who was at the time the chief of bariatric surgery at the residency program that I had been in, and he said, Hey, what are you doing these days or nothing? He said, Hey, I don’t think he took me seriously. But he said, You know what? He’s a surgeon. He says, I like to do surgery. I don’t like to actually see patients. So why don’t I do this obesity clinic I have to do once you see once you cover for me. I said really? Okay. I didn’t know anything about obesity. And I went in and covered and did the best I could and came back he said, Yeah, you know what the staff like you the patients like you, once you take all my clinics. Okay, so that’s really how I got started. But I got hooked up very quickly, because it was the first time in my career that, you know, I would go in and take people off medications, right, I would go in and see people’s blood pressures improve that they were getting better over a period of time, and it wasn’t adding another layer of medications or whatever, right, or a medication for the side effects of that one, but the side effects of that one, and you know, chasing that. So I got hooked pretty quickly because it felt great to actually feel that you were helping people and that they were on a track towards real health. Right. So I did that I also did some hospitalist moonlighting and I at the time, took on some jobs and dance and choreography and teaching so I basically did everything taught anything, can you teach English? Can you teach Portuguese and English? So, you know, I spent that time you know, cobbling together a living but at the same time, I as I said, I had to figure out now how am I going to last the course. So this is when I realized, okay, this is ridiculous. I have been in training in med school in residency and I didn’t know how to take care of myself. Absolutely ridiculous. When you think about it. You’re Dr. And you don’t know how to take care of yourself? How stupid does that sound? I was saying that to myself and I, yeah, that’s bad. Because here we are pontificating to our patients, and you should do that. I can’t do it myself. Right? Who am I to lecture them? I can’t even help them because I don’t know what it means to be healthy. Right? Yeah. And when I decided to take a deep dive into what it means to be healthy, so reading, exploring, you know, learning as much as I could from that point on.

Robert Lufkin  10:35  
And that was the that was the beginning of sort of your, your continuing interest in metabolic health and chronic disease and all. So metabolic health, metabolic disease is, you know, arguably the greatest epidemic we face in the world today. COVID-19 notwithstanding, what, what did you learn about metabolic disease, in your, in your studies there that you didn’t, that you didn’t learn in medical school, or residency or what? What clicked with you there?

Vyvyane Loh  11:13  
I think it understanding, you know, our physiology and how the body tries to compensate, when we’re living lifestyles that go against our physiology. So for example, takes sleep. Because, you know, as physicians, we know that we are chronically sleep deprived. And we do that in training. And we think we get, we sometimes pride ourselves on how little sleep we can get by on. And, actually, it’s sort of one of the dumbest things to do. But, you know, so you have the brightest people in the world, going to med school, going to residency doing the stupidest thing possible for their bodies, right? And you’re like, wow, yeah, great system that we have, right. So learning about how we actually work against ourselves in terms of our lifestyle, sleep, nutrition, obviously, lack of activity, the types of activity we choose, and then just kind of pace that we put ourselves through on a daily basis. So all these things, they look very general, but you know, if you take a deep dive, you can spend time in any one sector, and really just kind of, you know, go crazy with all the information that is out there. What I’ve always said is, unfortunately, we got plenty of great research, you know, lab bench work, you know, that kind of stuff. But a lot of that isn’t taken into the clinical aspects of our career. So we don’t know how to apply that information. You see what I’m saying? So there’s a big, tween, you know, the knowledge base, and what we have clinically. So if you imagine if you had a kid who wants to go to school to learn to be a programmer, and you want to pay some expensive college fee, this kid’s gonna go off and learn to be a programmer, it’s worth it, because he’ll have a great career. And our first day of school, they give him some index cards, and they give him a little punch, and they say, Look, you know, you just punch these holes, right, which is how we used to code, we would just punch these cards, and then the computer would be several rooms wide, because you have to store all these cards, right? So you as soon as you found out that this is what he or she is learning, you’d say, okay, out of there. I’m not paying, I know, an ungodly amount of money for you to have obsolete information. Correct. Now, you know, what we’re spending in medical school today. They were studying 40 years ago, I don’t know it’s, we’re obsolete in the curriculum, really. And we, you know, but the research, the science has moved far ahead. The clinical aspects of clinical applications are still like, ya know, where my focus right now, so that’s a big disservice to everyone.

Robert Lufkin  14:13  
Yeah, when I went to medical school, I remember and, and my early years of practice, I remember studying diseases like dementia and or groups of diseases dementia and stroke and heart attack and obesity and diabetes and some forms of cancer as essentially isolated diseases that people got and maybe maybe stroke was related to cardiovascular disease, of course, but but it’s it’s fascinating now that we’re seeing all of these diseases linked at a basic level through metabolic pathways and the same things that that predisposes someone to dementia may also predispose them to heart disease to even some forms of cancer. I wonder Again, in the, in the early days of my career up until about the 80s. The number one cause of I think fatty liver disease was alcoholism and all and then suddenly that’s now changed, and metabolic diseases just exploding with with epidemics of obesity, diabetes, etc. What? Why is that happening? What? What causes? What caused that? What are we doing differently now that we didn’t do 10 years ago, 20 years ago? Is it? Is it all about sleep? Or what other factors are there that that we’re doing?

Vyvyane Loh  15:40  
So, I mean, I think the first thing to point out is that things don’t change on a genomic level, vastly within 2030 year, span of time, right. So this is clearly a epidemic that is secondary exposure to something right, and probably multiple factors, I think the key one for me would be poor nutrition, you know, poor nutritional choices, and then also the whole lifestyle, where it’s around our ability to, you know, utilize our circadian rhythms, the way it was meant to be, we seem to resist that and push against that. So we’re, you know, hell bent on working against our own internal rhythms. Right, that and, you know, we could put in things like pollution, for example. And, you know, inability to regulate our emotions and our arousal in, in our day to day activities. So you call that stress, but it’s really, really this inability to cope with the environment. So that we try to compensate in ways that might not, in the long term, be healthy in the short term might work for a little while, but long term problems.

Robert Lufkin  17:05  
So it’s really multifactorial, as you say, and like, like you say, our genome hasn’t changed in 50 years. So it really the environment and and choices we make in our lifestyle. It seems like lifestyle has sort of gotten a bad rap that because I remember for years, people saying, Oh, you just need to improve your lifestyle. What does that mean? Well, it means exercise more and eat less. You know, and it didn’t really work for a lot of people. And it’s not really actionable. So people say, well, lifestyle, you know, doesn’t work, just give me the status or give me to hypertension meds or something like that. How is how is? How are you approaching lifestyle? Now that’s different with actionable items.

Vyvyane Loh  17:54  
So when my patient comes in the first time on what I call my initial console, I always ask them, okay, so you know, we get you we reverse your metabolic disease, we get you to a much better place, what’s life going to look like, for you from that point onwards, like the rest of your life? How are you going to live? And they always come back with something like, Oh, I’m going to have to have a healthier lifestyle, you know, I’m going to exercise more and eat healthy. This is generally what I get. So what does that mean? What does it mean? I mean, do you have any sense? Can we break it down into concrete, daily activities? And most times, they look at me like, I don’t know what she Selmer. So I always tell them, Look, I don’t expect you to know. But, you know, people always say that they want to have a healthy lifestyle. But what they don’t realize is there is a cost to that. Right. And most people when presented with the bill, don’t want to pay, because they don’t have that sense of value for what health means, right? We’re usually taught in school, as we’re growing up in society to look at financial costs of something, we’re not looking at total costs, total costs, which include your health costs, your emotional health, you know, social cost mental, so we don’t know how to look at that total cost. So we only go with, let’s say a number in the bank account. So when they realize that they have to make different choices, but in order to make those different choices, then you have to walk it back. And it starts with, you know, what’s your grocery list gonna look like? What’s the rhythm for making sure you get those groceries? What’s your meal prep rhythm? Is there one, you know, what are you willing to do in a social environment? That’s different from what you do now? Right? So nobody wants to talk about the nitty gritty. Everybody wants to say well have a healthy lifestyle in our heads. We have this image of ourselves in some yoga room, you know, meditating in lotus position, but that’s really you know, just the image. It breaks down very concrete steps that most people can’t even visualize. So, you know, there’s the science part, which we do, but then I work with my entire team to help, the patients actually get to a point where they are executing those steps, right. And we tell them how they’re doing. Well, they all get report cards from us. And the first time we present them with a report cards, I give them a few weeks, because I always tell them, I assume zero skills when you start. So fair enough, I don’t care. If you’re a doctor, you’re you know, it doesn’t matter. I assume zero skills. But you know, after you know, the around week, four or five, you know, we start you know, grading you, then you get your report card. And when they get the report card, all hell breaks loose. You know, my manager dress, he knows this, like they’re getting the report card that week, lock the door, because they’re lining up outside. So going, I only got five points, and I should have gotten one more. And I did get my homework in. And it was 506. I know, you said five o’clock. And they argue for that one point. So, you know, but I think they’re shocked at how poorly they’re doing. Because in our heads, we think that, you know, we’re doing well, when when we look at it, oh, you know, actually, you’ve skipped half your meals this week. Right. And people don’t realize that. So they think they think I’m doing well, I’m eating healthy. But that has no meaning if you’re not measuring it and presenting patients with the feedback,

Robert Lufkin  21:33  
even even the the concept of eating healthy is challenging to patients is I think, because there are so many different definitions of what healthy is and sort of competing diet camps that are almost political and, and the patients, you know, they turn to the food pyramid, and they look at that, and this is from my government. So it must be trust, you know, trustworthy advice, or they they look at other things. How do you? How do you sort through all the conflicting opinions about what’s healthy, and you know, drink orange juice, you know, it’s fat, it’s full of sugar. And it’s like,

Vyvyane Loh  22:11  
yeah, so the first part, obviously, self education. And we do that on a continual basis, my whole team, and we try to make sure that our knowledge base is as up to date as possible. So actually, we spend a huge amount of time on the tutorial review, I consider that part of my job. But then when someone wants to work with me, it’s mandatory. We have these classes. And it’s mandatory that they attend these classes, we set them up in 12 week blocks, and it’s three hours a week, three hour, you can’t do three hours, and then you know, they tell you Oh, yeah, my health is number one, it’s a big priority, I really need you can’t do three hours and 168 hours, it’s not a priority. Right? Yeah, no, Netflix for three hours, and you don’t think about it. Right. So you know, I mean, we do try to make sure they get good value. And most patients, you know, we I try to be a little entertaining, and, you know, joke with them. And, you know, they seem to enjoy the classes, but we spent a lot of time with the science education. And then we also spend a lot of time with the behavior work, right. So using cognitive behavioral therapies, based, you know, techniques, DBT, and so forth, you know, just to help patients, because a lot of this is inability to regulate and cope with the environment, and then they use a substance or behavior to to help them cope, right. So if you’re not going to give the patients those tools, then you sending back the patient to a similar environment, because after all, they live in a family unit, they live and work in a group environment, right? Most people. So it would not be very helpful. You’re not giving them some tools to also deal with that. But the signs that we you know, I have a curriculum, so I will talk about metabolic disease, I will talk about insulin resistance. And then I will also talk about, you know, body composition, muscle health, because we really don’t evaluate our patients on a weight or even a BMI really, I heavily go with a body composition, we’re very lucky we have our own DEXA. So all my patients get a body comp by DEXA. And we follow them that way. And we train them to look for the right numbers, right? Because the numbers they’re taught to look for is that number on the scale. And that could that’s not really very meaningful. You know, I was I would give them the example where someone came to me with it was just someone we were doing a DEXA scan and he had a BMI of 31% body fat was pretty good for male was 20% and then he came back three months later, his BMI was 33 is percent body fat was 17%. So he dropped the fat he increased his muscle mass. So this one actually got better metabolically. But if you looked at that BMI, it’s meaningless, right? And then just one point, because I did mention that 20% and 17%. And all these people are probably going, Oh, but my trainer says, I am 10% body. That is a bioimpedance tool. It’s very inaccurate. And please know tell me a 4% body fat you must be dead

Robert Lufkin  25:38  
so for for nutrition for managing patients with with metabolic disease, do you find that one? One approach works well for everybody? Or is it some people are keto? Some people are? You know, I don’t know high high carb? Or is there one general philosophy for your practice?

Vyvyane Loh  26:00  
So if you look at the RDA for carbs, and I don’t really go by RT, but just let’s just put that out there, right? It’s around 120 130 grams of carbs a day. And the average American manages to supersize it to about 400 grams a day. Right? So if we just look there, everybody will benefit from cutting the carbs. Because even if we use the RDA, right, which, again, I don’t really go back, but if we went by the lowest standard possible, everybody’s still failing. Right? See how I sneak that in the lowest standard possible? Yeah, okay. Anyway, we were the lowest standard possible was still failing. So I do as an as a start, get most people off the extraneous carbs, especially in the process, carbs and so forth. So it’s a good approach, population wise here, I would say, and then beyond that, there are other you know, things to consider, because I do look at that protein intake pretty carefully. And because I’m very interested, personally, right now, what we’re, we go into these phases. So right now we’re into the sarcopenia phase, right? And sometimes these phases last six months a year for me, and then I just go into a deep dive and things like that. So I’ve been interested in body comp and sarcopenia for a long time. So you know, prioritizing the protein, how do you dose it, you know, frequency, that kind of different age populations? Because, as you know, as we’re older, we have more anabolic resistance. So how do you deal with that? Right, maybe, and then

Robert Lufkin  27:39  
define, excuse me, define sarcopenia for our audience, if we’ve heard that we’ve talked about it before, but just remind them?

Vyvyane Loh  27:48  
Yeah, interestingly, well, sarcopenia I think a lot of people have been taught to think of it as deep, low muscle mass or lack of muscle mass, right. But there’s also a strength function in there used to be called Dinah Pina, but now the European Working Group on sarcopenia and older people, elderly people, what, why would you have an acronym like that? Whatever. Anyway, then people in Europe decided they were going to combine strength and mass and, and just lump that together in terms of that term, sarcopenia. In general, I do the easiest way, of course, you can use, you know, those little squeeze things that nanometers for strength, grip, and so forth. But one of the easiest ways to quantify sarcopenia would be to look at the muscle mass, because we do have other, so we will use that. And, you know, you want to make sure that you’re not losing your muscle mass as you age, which is the normal tendency, you know, three to 8%, post your, you know, 40s every decade, right? And if you’re sedentary, it’s even higher. So, and people don’t understand that that muscle mass is your glucose sink, right? You shrink the reservoir, you shrink your sink, and immediately, you know, your blood sugar control is going to change drastically. So muscle mass is is really important and most diabetics have accelerated muscle loss. When you look at all chronic diseases. You look at, you know, people with cardiac, chronic cardiac illnesses, pulmonary disease, cancer, right? You have these terms of cardiac cachexia, pulmonary Qixia, or cancer CAPTCHA worker kexi is a profound wasting syndrome, right? And what we’re primarily worried about is the wasting of the muscle mass. Right. So once you lose that muscle mass, metabolically you’re very different creature. That’s number one. And secondarily, secondarily, it’s indicated that there is a chronic inflammatory process that’s happening, right that is out of control and really hard to kind of take Hold off. Now the challenge is because we have 42% prevalence of obesity in this country alone. And you know about over 70% of people are overweight or obese. If we’re just going by BMI, we go by percent body fat, we are closer to 95% 90% 95% of people in the obese category is going by percent body fat. Okay, I can just very confidently say that because I see this day in there, always people coming in with the normal weight of a normal BMI, and you look at the percent body fat and they are nice, which something I call normal weight, obesity. So now let’s just take someone BMI, let’s say 36. Okay, this person goes through chemotherapy, you know, several rounds, BMI is coming down. 32. But you take a look at this person like us, that looks pretty good. You can, you would never suspect that this person might be undergoing cancer cachexia. Why? Because we started with a high BMI we, we don’t know how to separate fat mass from lean mass. So we look at that person we go, yeah, you’re doing okay. Right. But they may have had profound for kicks in lost a lot of muscle mass, that is not good. And we miss it. You know, the best time to treat something like that is when they’re protecting, you know, but by the time they get to, like 5% loss in their muscle, very hard to treat, right. And they have the profound wasting and 20% of all cancer patients die from the wasting, not from the cancer, not from the treatment. So 1/5 of cancer patients will die from the wasting. Wow. Wow. Right. And we know that. And then we see that in cardiac cachexia pulmonary cases, you know, the COPD years, and they just kind of shriveling before your eyes. But we’re not doing anything to prioritize that muscle. Wow.

Robert Lufkin  31:52  
For the for the obesity patients. I mean, the numbers you gave are are just incredible. How effective are lifestyle changes for obesity? For example, we hear people talking about using a ketogenic diet to suppress appetite and weight loss that way, is that something you found effective?

Vyvyane Loh  32:15  
Yes, it is. With some caveats, right, the World Health Organization talks about the double burden of obesity. And by that they meant that the same people who might have an increase weight right in excess calorie, also are malnourished, I see see Mount nutrition in the same person who has over nutrition, we’re just looking at different components of the nutrition. So they may have more, more excess energy intake, but they’re not taking in good quality, you know, nutrition. So they’re deficient in a lot of the micronutrients for example. So if you don’t correct the micronutrients, very hard to have long term correction of of that obesity as well. So yes, in general, I find that putting people on on a low carb diet is helpful, very hard to get people to ketogenic, right. Every keto I get a lot of keto books, people, you know, keto diet, books, recipes, and patients always bring them in. And look, I found this, you know, you turn the page, you see quinoa, done, throw it away, right? It’s not gonna work. You know, the other thing we do, we try everything out on ourselves. So if I can’t do it, or if I can’t figure out a way to do it, or it doesn’t work for me, I don’t impose it on someone else. Right. So you know, and we, the entire team, I don’t ask my team to do it, but we kind of have a similar mindset. So we’re always running these protocols on ourselves. And then it’s fun, because we can jump in the decks, you know, measure painting, so it’s fun that way, but I always, you know, before I bring something to a patient want to make sure I can do it, I can do it reasonably, and it’s not going to be a fifth job, you know, and you want to make sure it’s affordable, that kind of stuff. So all the basics, I so I do like to keep them low carb, it’s very hard, as I said, to keep them ketogenic. And in general, I don’t see the need to long term unless they have some, you know, very strong medical indications that they have intractable seizures as one right. So you can do that. However, with so with that, if you give them low carb, you know, it does help with satiety, I will tell you that. I always tell my patients, right, this physiologic physiological hunger and emotional hunger. Many people will complain of hunger, but it really isn’t a physiologic hunger. And if you can’t distinguish that then you’ll be running in circles because your patients constantly telling you that he or she is hungry. And you know, you keep trying to, you know, arrange the macros and change things out. And you realize, no, we’re not talking about the same thing. Also, having done this for so many years, many patients are afraid of the sensations in their body that maybe are indicating that okay, you know, I maybe will in the next hour or so need some nutrition. So any just slight, you know, indication that, oh my God, my stomach gurgled. And they panic, they really do because they don’t know what it means. And so they will eat something you all often will hear people go, I have hypoglycemia, yeah, eat more sugar, and you will make sure you have lots of those episodes. Right? So but they they’re thinking, I have hypoglycemia, and so they get terrified. And, you know, maybe they felt a little tired. And now they’re gonna you know, obsessively drink the orange juice, because they don’t want to get that state. You know, yeah, you have managed those things as well.

Robert Lufkin  36:03  
How effective do you find in your practice for lifestyle modifications for treating things like hypertension, or dyslipidemia?

Vyvyane Loh  36:13  
So that’s my bread and butter, you know, people come, patients will say, you know, but I’ve had hypertension for a long time and diabetes. And like, that’s a pretty boring case. Because that’s all patients, you know, and yeah, we, it’s very effective, we do get the blood pressure’s down quite well. But I’ve noticed that if you’ve, you know, especially if you’ve had some of these chronic diseases for a longer time, then it’s really, really important to get the visceral fat down to certain levels. So I get I set them a visceral fat target, which we measure on a deck. But some, because I know you can’t get below that level, it’s very hard to control the disease. Right? So you know, I always make sure that the patient is aware what we’re going for. But yeah, we have very good lock in or, you know, our history in, in taking people off medications is, is pretty good. It’s more the case that we take people off or reduced doses, then then increase, I don’t think I ever really increase doses. Yeah.

Robert Lufkin  37:24  
That’s amazing. And and just to be clear, these are patients with type two diabetes on insulin and fairly substantial drugs you can you can be effective with those those patients also.

Vyvyane Loh  37:37  
Yeah, and I’ve treated type ones, right. And they’ve done really well as well. In fact, you know, prior to the discovery of insulin, the one thing that did prolong the life of type one diabetics was to go on a ketogenic diet. And it makes sense, right, it didn’t feel died, but it prolonged the lifespan. So and we’re always terrified of, Oh, my God, we can’t cut the carbs in diabetics. And that’s crazy. I have my tech ones coming in telling you Yeah, they want me to eat this and then shut up my insulin, what does this you know?

Robert Lufkin  38:10  
Do you use continuous glucose monitors in your practice, or ketone monitors or anything like that?

Vyvyane Loh  38:18  
The type ones we do, you know, the, the others, you know, this for a long time. And, and honestly, my patients will tell you this, she just look at you and she’ll know. I you. So, you just get a sense of after treating so many patients, you get a pretty good sense. I don’t rely on those things. And, you know, I’ve had patients where they didn’t lose a lot of weight. And I just had one, in fact, and this was this was a lot of fun, because she didn’t lose weight. And she came to me and she said, What do I do? I said, we’re going to add more. I hadn’t a meal. And she looked at me like I said, so we’re gonna do but you know, I have to give it to her. She occurred to her for a while. So she trusted us and she did everything, you know, followed everything carefully. So over a three month period, she lost five pounds. But she really got her VAT, which was about well above where it should be to go. Right? She lost basically all of what she lost in that five pounds was all visceral fat. she increased her muscle mass, her percent body fat came down. So what do you care? It’s five pounds, right? It’s the right body composition. So that’s what I keep emphasizing and that was I know, I probably make a presentation out of that because that was a that was you know, she just kept looking at us. Are you sure are you sure? You added that Neil? Is this you know, gonna hurt My weight loss is I’m not going for weight loss. Right?

Robert Lufkin  40:03  
Yeah, yeah, that’s very powerful. Now, can patients join your practice? Do they have to be in the Boston area? Or do you provide any sort of telemedicine services that patients from around the US around the world can access your services? No, currently,

Vyvyane Loh  40:21  
it’s in the Boston area, although we are actively working on this, this ability to deliver our services virtually. So I would ask people to contact us because we’re very close to having that happen.

Robert Lufkin  40:38  
Oh, great. That’s, that’s very exciting. Well, now, let’s turn the conversation to you a little bit. If it’s if it’s our eye, knowing as an expert in obesity, and metabolic disease and lifestyle changes that you deal with every day with your patients. How has this knowledge informed the personal choices that you make in your life? In other words, what is your lifestyle look like? Vivian, if you don’t mind sharing it with us?

Vyvyane Loh  41:06  
No, I’m happy for you. I always say never ask someone to do something you’re not willing to do yourself. So my patients notice, if I ask them to do something, I’m doing it, or I’m working on it. Okay. So same thing with the rest of my team, we may not be perfect, but we’re definitely working on it. So I prioritize my sleep. You know, I it’s not negotiable. Anybody who wants an early morning, you know, so you know what, Rob, you’re special? Because I usually don’t do anything.

No, you know, but it’s a straight? No, that’s not gonna work for me, right? So I really protect my sleep time. And then timing of meals. I am, you know, we’re going we go by the clock. So I log my meals. But I also keep my intervals pretty, pretty stable, because you do set your circadian rhythms by your meal timing as well. Right. So the secondary clock set was the primary being the SCN. So I use as

Robert Lufkin  42:13  
being in there with the meals, any gaps or intermittent feeding.

Vyvyane Loh  42:19  
I used to do that. But here’s a couple of things. Right? First and foremost, I think the main benefit is that we get people to get to a slightly chaotic stage when they do the intermittent fasting. So we know with most of my patients, they are pretty low in carbs anyway, I’m not sure if there’s a huge benefit to that. But the biggest thing is this, my patient population, I have some younger ones, but I do have primarily people from their 40s. And above, right. So we’re talking about the stage where they have anabolic resistance. Now I need to get a certain amount of protein in per day. And I need to dose it by per meal. Okay. So if you’re going to do that, you have already some constraints if you’re going to have a long non feeding window, right, because you’re not going to eat and some people will try to like lump in all the it doesn’t work, and it doesn’t work that way. So you know, pacing them out. So I will in general try to keep a 12 hour fasting window, you know, overnight. But if I can’t on a patient because I’m prioritizing the protein, then so be it, you know, so I do that for myself, I watched that I don’t really keep a long window, probably like 12 hours now. Mandatory every day, I start the day, one hour of meditation, and then I do an hour and a half. So it’s an hour of exercise, mostly resistance training. And I experiment with different things. So we just did a protocol with blood flow restriction, but we will try different things. But I do that and then I I have half hour for mobility and flexibility work

Robert Lufkin  44:04  
for one hour of meditation is yes. Is that I guess you’re probably not using any apps for that, for that length of time and what school of meditation do you use or what philosophy is to

Vyvyane Loh  44:23  
the person and I also fairly frequently do mantra meditation. So, so between the two generally, but I feel that the meditation also extends into the workout period. Because you know, as a dancer, you go into a dance class and you’re working on technique, you have to feel every part of your body to feel that integration. So when you’re working out you know, it’s that being present in the body. I’m very interested in the space the phrase that I just recently heard that the body is the mind. Right and this is by someone called Elliott Hulse. It’s just a wonderful way to capture the fact that, you know, your everything that’s in your mind is actually reflected outwards in the body as a dancer that resonates. So, yeah, so in that moment in the exercise period, I consider it an extension of the meditation because it’s really embodied, you know, an embodied practice.

Robert Lufkin  45:22  
Wow. So an hour of sitting meditation and then segwaying into an exercise space. Wow, that’s, that’s fascinating.

Vyvyane Loh  45:31  
I hadn’t the flexibility and you know, tendon, tendon work and things like that. So

Robert Lufkin  45:38  
wow, that’s, that’s great. Well, whatever you’re doing it’s obviously working well, Vivian, how can how can our listeners follow you on social media, or we’re going to list your website on the on the show notes, but maybe you could just tell us the name of the tell them how to get to the website, also for people who are just listening to this.

Vyvyane Loh  46:02  
But it’s transform dash, a f In terms of social media. So now this is the next trick, right? When our medicine came out exercise half hour stretching, where we put the social media in there. It’s a little lacking right now working on it. Yeah, we are working on it. Probably will get some help with that. But mostly our website, I do have a very small YouTube channel. I actually have a lot more videos, but we don’t post. So again, meditate post.

Robert Lufkin  46:43  
Well, thank you so much for taking the time to spend an hour with us today. It’s great to get to know you better as well. And I want to stay in touch and hopefully, we’ll speak again soon.

Vyvyane Loh  46:57  
Yeah, maybe we’ll have a joint meditation session next time. I love it. I love the sound everybody.

Robert Lufkin  47:09  
I’m gonna I’m gonna put that on the calendar. At the end, we’ll see you soon. Bye bye.

Vyvyane Loh  47:17  
Take care. Bye.

Unknown Speaker  47:19  
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