Below is an interview a colleague and friend of mine, Brendan O’Brien, did with me at the beginning of 2015. It was printed in the newsletter for the nutritional therapists of Ireland (NTOI) and will hopefully give you some good insights into my work!
In this edition I talk to Patricia Daly on the launch of her new brand, her journey from cancer survivor to specialist, the production of her book…and where to next!
Ed: I’d like to start by saying that I personally, (and I know I speak for other NT’s too), am deeply inspired by the story of your healing journey. Having left your home in Switzerland some years ago to settle in Ireland, you went through what I can only imagine was a terrifying ordeal when you were diagnosed with ocular melanoma. Yet despite the challenges of raising a family, and studying to become an NT no less, you faced the situation head on, took hold of the reigns of your life and reinvented yourself to triumph over the kind of adversity that has taken down so many others. You have recently returned from your presentation and debate at the 3rd International Conference on Exercise and Cancer in Munich where you helped spread the message of hope to so many people by sharing your story and the science behind the approach that worked for you! I’m guessing there must have been a deeply satisfying sense of the wheel of life turning full circle for you?
PD: It’s just amazing that my illness has turned out to be one of the biggest opportunities in my professional and of course my private life. I always knew I wanted to have my own business when I studied entrepreneurship and business in Switzerland, but was never really sure what area it would be in. Cancer answered this question for me! The other day, I did a little bit of an analysis on the opportunities and challenges I’ve had so far in my life and funnily enough, they were a match! I think that’s what life is ultimately about: accepting what happens and turning it into something beneficial. In Buddhism, we say “Turn poison into medicine”. It’s very true but also very challenging of course.
Ed: You have recently released your new website and programme to the wider world, what has your response been so far?
PD: I’m working on increasing traffic to my website and participate in quite a lot of marketing activities at the moment to spread the word. The response has been super positive so far. The other day somebody got ticked off with me because my Google ranking wasn’t better and accused me of “withholding my amazing information from the world”. I took it as a compliment! It’s hard work though. When I decided to go online this year it felt like starting school and relearning everything from scratch again. My programmes are only just starting. I’ve decided that I no longer want to work on a one-off consultation basis therefore I ask people to commit to at least 4 sessions with me up front. I do make exceptions in certain cases but generally, this is how I want to work because it’s the most beneficial way for both me and the client. From a marketing point of view there are downsides to this, but if anybody complains about my fees or about having to commit to 4 sessions up front I can also point them to my free eCourse that I have put together, also I have a very affordable eBook they can buy, plus lots of other free information available on my website.
Ed: Are you only working with cancer patients now?
PD: Yes, I only work with cancer patients now but I make the odd exception…if someone insists! Most of the time I refer non-cancer clients on to my colleagues, so the more I know about all your special areas of expertise, the easier it is for me to refer!
Ed: Given the interest in ketogenic diets for neurologic degeneration, have you worked with Alzheimer’s or Parkinson’s patients and the Ketogenic diet?
PD: No, not really! I don’t feel comfortable enough with these conditions right now and don’t have the time to dive into this research either. I learned a lot from ketogenic experts specialising in epilepsy but I adapted their protocols a lot for cancer. Just recently I saw an MS patient but she’s nowhere near ready to go ketogenic. Getting her off artificial sweeteners, a high carbohydrate and very low fat diet is challenging enough for her at the moment!! I also have somebody pencilled in with autism and although I made it very clear that I’m not an expert in this field he’s adamant that he wants to try the ketogenic diet- with or without me.
Ed: As functional medicine goes we are urged to remain flexible in our approach to clients, because we need to remain open to other types of diets and approaches in case they better suit a client. But it’s tough to be on top of all options I’m sure you agree, so specialisation may become the modus operandi of NT’s going forward I suspect. Have you made a decision to specialise only in Ketogenic diets?
PD: To be honest, specialising in ketogenic diets just sort of happened: initially I didn’t actively pursue it. Up to about 18 months ago, I refused to guide cancer patients through the ketogenic diet because of a lack of clinical trials in humans. But one day I got a phone call from somebody in the US who said: “Patricia, I’m going on the ketogenic diet whether you help me or not. Chances are I’ll do it a lot better with your help.” And that’s when the penny dropped; I got over my resistance and started keto coaching for cancer patients. Medical professionals have to understand that cancer patients – or any patient with a life threatening disease – often don’t have time to wait for results of their studies. They need solutions NOW, not in 2 years’ when they might not be around. That’s when I decided to move from an evidence-based to an evidence-informed approach when it comes to keto. There are a few things we don’t know yet and that hopefully will be clarified by clinical trials in the next year or so, but there is so much data on mechanisms, safety, results in animal studies etc., for me that’s good enough for now. I very much take the “first do no harm approach” – my keto clients need to do regular blood tests to make sure no negative markers change dramatically (whatever about the positive changes, which I don’t mind!!), they monitor blood glucose and ketones and many of them also track their meals. So no, I don’t put every client on ketogenic diets. For many people, it’s just 10 steps too far and would become too stressful to change so much in their lives while going through cancer treatment. I usually only go ketogenic when somebody explicitly asks for it and books sessions specifically for it. Even then they sometimes can’t do the diet due to contraindications. More and more US patients have the support of their oncologists, which is amazing and much easier for me. But generally, I very much work within the FM framework. I tailor each programme to the client and set different priorities depending on where each client is at. Of course it also depends on what stage of treatment a client is at – and nutritional approaches vary hugely for the different stages. It’s a moving target.
What I really care about with all cancer patients, though, is that they reduce their blood glucose levels, and this can be successfully achieved by many low carb approaches along with lifestyle changes, which, as we all know, often have a bigger impact initially. I’ve built quite a network of very skilled colleagues who can help my clients in this area.
After treatment and in the long-term management of their cancer, FM becomes even more important and we work our way through the different systems. I constantly research and incorporate the latest finding in my protocols.
Ed: Dealing with cancer means you will come into contact with people closer to death than the average NT does…barring perhaps those dealing with advanced cardio metabolic dysfunction! Is there a stage where you will refuse a client access to your programmes…or has that ever happened?
PD: Yes, it actually happens a lot! Often it’s their relatives and families who want them to go on a radical diet and they have absolutely no interest- all they really want is leave this world. That’s not okay; I NEED to have the patient on board, not his/her family. Also I often get calls from people who think I can cure them, that have a magic wand to solve all their problems. When I get real with them, they sometimes lose interest. And that’s totally okay!
Ed: Can anyone try out a ketogenic diet without supervision…maybe from reading a book for example? What tends to be the most difficult aspect of it?
PD: No, definitely not! It can actually be dangerous because many people really are pretty clueless about macronutrients. They tend to get ratios wrong and sometimes really screw things up! Unless someone has very solid nutrition knowledge I don’t recommend doing a DIY job. In my experience, people start consuming nuts and eggs like maniacs because they don’t know what else to eat and end up developing food sensitivities. In my eBook, I emphasise that readers should get professional help, at least in the initial stages.
The most difficult aspect is compliance. People who follow the ketogenic diet need to learn a lot about food, cooking and nutrition. There are no shortcuts, there are no 80/20 rules- either you’re in ketosis or you’re not. It’s pretty black or white! The interesting thing is that many of my clients are men, which is quite unusual in NT. They love the fact that they can measure something, they tend to be very compliant, they like tracking, and are delighted they can eat their (small) steak and other hearty foods and don’t have to spend their day juicing.
Women seem to struggle more and tend to be bigger sugar addicts in general, so they are often looking for alternatives. Many actually send me photos of supermarket products and try to haggle…”would it not be okay to have a tiny slice of this bread in the picture?”
Ed: Switching gears a bit, I’m interested in your take on the interaction between VLC diets and thyroid function. You are probably aware of the ‘potential’ effect of low-carb diets on the thyroid function of some people purportedly due insufficient insulin on the one hand, which is needed to activate thyroid production, whilst on the other hand the potential effect of hypoglycaemia inducing the stress response which pulls in cortisol to rescue the low blood sugar. Have you come across this? Is it an issue within Keto circles per se?
PD: Oh yes, thyroid function is an ongoing debate in the keto world! Currently there is broad agreement that we need between 30-50 grams of glucose (equivalent to approximately 200 calories) in the long term for good thyroid function but this can be very individual, too. And I agree that the 12g that are generally recommended for cancer patients can be super challenging- not just in terms of thyroid health, but other systems, too.
I guess it’s all a matter of priorities: if somebody has aggressive cancer, we want glucose and insulin levels low because this hormone has been shown to increase tumour growth. When cancer is the top priority I don’t actually look at somebody’s thyroid/adrenal function.
Once the “emergency” is dealt with and the client is in remission, I then start looking at other functions. A ketogenic diet aims to keep blood glucose at steady low levels but it shouldn’t be confused with hypoglycemia. Once a body is keto adapted, it knows when and how to make glucose from glycerol and ketones but also from lactate and pyruvate without inducing a stress/cortisol response. There is no such thing as glucose deficiency!
Ed: Do you find some clients are just not suitable for a Keto diet?
PD: Yes. In my experience, keto doesn’t cause HPAT axis issues but adrenal/thyroid insufficiency definitely keeps you from going into ketosis. That’s why I’m talking about “keto lifestyle” rather than “keto diets” per se, because stress plays such a huge role. If somebody is very stressed then, short of fasting (which I wouldn’t do with them), they will find it nearly impossible to achieve ketosis.
Such people need to take lots of stress reducing measures, sort out their sleep, and just focus on getting better for a while, before ketosis can happen for them.
Other than that there are a number of contraindications against high fat diets. One example is a genetic mutation in the SLC22A5 gene. This causes ‘primary carnitine deficiency’ due to the lack of a specialised carnitine transporter in the plasma membrane which is needed to shuttle carnitine into the cell. If a cell is short on carnitine this inhibits the transport of fats into the mitochondria for oxidation.
Caution is also advised in conditions like liver cancer or elevated liver enzymes, structural changes affecting the GI tract (Whipple for instance) and others. These all have to be excluded before somebody starts making changes towards a ketogenic diet.
In these cases I reassure clients that there are always other dietary and lifestyle changes we can work on and still achieve a lot. As all NT’s know…it’s not just about diet!
Ed: Switching to athletics, as a former endurance athlete how does a Keto diet affect performance?
PD: Ah yes – endurance training and ketosis – another hugely interesting area for me. What has been found for endurance athletes is that they can sustain a much higher carbohydrate diet yet stay in ketosis (because they burn up the glucose).
If somebody has the willpower to do keto (which most endurance athletes have), it can be beneficial. Imagine this: we can store about 2,000 calories or 500 grams of carbohydrates (glucose and glycogen). This means we have to constantly re-fuel during a competition. However, if we can burn fat instead of glucose we have access to about 90,000 calories of energy at any point in time. Keto-adapted athletes have a pretty big advantage and can tap into this bigger energy source without any transition. I know from my athletic days how painful the transition from burning glucose to burning fat can be. The proverbial ‘hitting a wall! I’d much rather be keto adapted!
Ed: Do people need to modify their training regime (even if not dealing with cancer!)?
PD: One’s training regime has to be modified initially in the transition phase (i.e. when people attempt to go into nutritional ketosis) because they might feel more lethargic for a few days, but afterwards they should be able to train as usual.
Ed: Do people living in ketosis actually have lower glycogen storage?
PD: Yes glycogen storage tends to be lower in ketosis. We know that muscles still store some glycogen, and being in ketosis doesn’t completely impair hepatic glycogen formation or export, but alas we need more studies on this.
Ed: You wrote a book…Practical Keto Meal Plans For Cancer. What prompted you to do this? I mean let’s face it these take a lot of work and are never going to make you rich!!
Pd: I mainly wrote it because many people were asking me for it. There seemed to be a real demand and I’ve had so much fabulous feedback from it.
Ed: I’m curious about your experience. What was it like writing and publishing book…what was your process?
PD: It was a great experience. I wrote a lot of it ‘on the side’ for a few months and then put a big effort into getting it finished in January. It’s nowhere near perfect but better than nothing and I’m delighted it has already helped many people from all over the world.
Ed: Did you engage a book ‘expert’ of some sort, did you plan it out or was it more ad lib?
PD: I had lots of experts helping me- my clients! They would tell me which recipes they like, what I could improve on and so on. I’m not a planner but knew roughly where I was going from the beginning so I just started, kept calculating, refining and editing.
Ed: Have you any more planned?
PD: Yes, I have a lot more projects, eBooks, eCourses and other products in mind. I’m confident it will offer a win- win situation for me and my clients. One of my aims is to not have to constantly repeat myself. Instead I can refer clients on to my online products before the consultation, or, if my individual services are too expensive and they need to spend less time with me to save money they will have other options like reading my eBook or doing a course. I’m also writing a book with author, Irish Times food writer and breast cancer survivor Domini Kemp, which will be published in early 2016. We’re planning to spend much of January in the kitchen cooking and writing, I’m really looking forward to this! We learn so much from each other and she makes my recipes much more tasty and interesting.
Ed: Well…thanks for all your time, let’s just say I’m glad you are not charging me by the hour for this interview!! I wish you the very best of success!