big thanks to @OxCPD for hosting this debate, and to Dr Khurram Ayub for lively engagement! I’m glad the % of doubt increased significantly!👊 #doubtaboutCHO #doubtaboutcarbs

New thread coming soon, watch this space

#AAGBI Association of Anaesthetists ‘Winter Scientific Meeting’ is live - abstracts open access👍#wsm2021 Think Ketosis is always bad? Have differential #perioperative #hypoglycaemia? Know when2 check #ketone in non-diabetics, or whether safe to proceed #GA?-nor do we🧐 …-publications.onlinelibrary.wiley.com/doi/full/10.11…

Watch this space... #metabolicairway is now a thing

How might “Intermittent Fasting” apply to those scheduled for elective surgery? Or, how better to prepare for pre-op fasting?? 2aspects: - practice fasting (skip b/fast) - low-insulinogenic diet: liberating lipolysis makes fasting easier (probably reduces early protein loss)

🧐#Periodontitis associates with... 1. Carbohydrate intake 2. #metabolicsyndrome 3. Poor outcome #Covid19 ... in that order tl;dr: #lowcarb improves #metabolichealth, reduces much downstream illness and improves😁

👊this is attainable #preop Centre for Perioperative Care LowCarbSurgery

"It's time to stop papering over the cracks & deal with the root cause" Wise words from Billal Patel Huge thanks to these incredible specialists for demonstrating that carb restriction is a powerful & safe intervention in T2D & many other diseases 🙏 youtu.be/LTMIpCgIhqo

Silvio Ferro Dr David Unwin Dr Ruth Tapsell Dr Campbell Murdoch Tim Noakes I assume your ‘tongue-in-cheek’ 🥁 Even if that were a thing, I’d advocate #lowcarb 1st-line The ‘liver-shrinking diet’ employed before #BariatricSurgery is #lowcarb -all visceral adipose shrinks (including tongue)🧐 #lowcarb is sustainable if not #lowcalorie👊

Another reason why CHO-dominant metabolic state, and pre-op CHO loading in particular, may be disadvantageous🧐 Stress (eg surgery, fasting) + CHO-dependency: ▶️early glycogen depletion +lack of alternative GNG substrate (glycerol, acetone) =early proteolysis ▶️Lean mass loss

One of my patients today: Sept/21: 60yo male, T2DM since 2019, BMI:29.5, took 6 different drugs qd. HbA1c 7.7%. I stopped all pills except metformin and prescribed a ketogenic diet which he started 6 weeks ago. Dec/21: HbA1c: 6.0%, BMI: 24.5. And he is VERY 😃 Lipid panels 👇🏼

Truth👇 Also, before surgery, if able, walk, walk, walk and fast in the morning i.e. pre-adapt to not eating till ‘post-op time’

Low carb before surgery A MUST. #lowcarb #fitforsurgery “If you fail to plan, you are planning to fail!” You can decide. #cardiacsurgery #surgery #diabetes