I want to talk about stigma on a ketogenic diet. Now, those listening, there are going to be two groups of you. One group who have lived that stigma and know that what I'm talking about carries serious weight in gravity. And there's going to be another group who have not lived that stigma. And I'm probably thinking of all the stigmas in the world and they're really complaining about this one. Are you making a mountain out of a mole hill? I hope for that group, after listening to this, you have a little bit more empathy for stigma on a ketogenic diet. Anyway, I will make some general points at the end and I promise after going through a run of kind of pessimistic storytelling, I will uplift to end on a positive note. But I think the best way to start is by being vulnerable with you and sharing three personal examples, perhaps an increasing death. So the first one's a little bit goofy and lighthearted. It's a memory from my first year at medical school. I was in a class and by this point, my entire class knew I was on a ketogenic diet, at least my peers, for therapeutic reasons. I went keto for my inflammatory bowel disease. And I've been pretty public about it, but not all the professors knew. So one day, a professor went a ketogenic diet as a topic was raised in an academic setting, referred to the diet as bizarre and a weird eating pattern. Because everybody knows on a ketogenic diet, everybody either looked at me on my peers or worse, awkwardly tried to look away from me, which I picked up on as well. Not really knowing how to handle a situation, I turned to humor. So I made dagar eyes and then turned my gaze towards professor. And as I did so, I turned my chair and the chair creaked really loudly and everybody just broke up laughing and that kind of diffused attention. So it actually ended on a positive note and I was able to impart unintentionally use humor to diffused the situation, but you can realize how uncomfortable that could be for me, that I'm in a setting where we're talking about really what is a metabolic therapy that I've used to effectively recover my quality of life. And my medical school professor has internalized the message that this is a weird eating disorder. And then unintentionally throwing shade at me in front of my entire medical school class. Not exactly a comfortable scenario, but that's the easy one. Moving a level deeper, there has been times when in romantic relationships I've had a partner disclosed to me that they don't really like going out to eat with me, which can be a stretch for me, but I'm able to manage and I'm able to go out and eat certain foods like if I go out, I'll just order sashimi if we're getting sushi, maybe a little amachi kama, maybe a little miso soup, or if we go to a steakhouse, I'll just get a steak, just plain steak, nothing else. And that's how I'm able to participate in the social event while maintaining my quality of health. But you can't fully participate if you can't do all the food activities that everybody else is doing. So in this case, my partner told me that because I wasn't able to participate in everything, the bread rolls, then the appetizers where we would all share things, mostly carbohydrates loaded with things that I wasn't comfortable eating. And then after, you know, entrees, which we would or wouldn't share, deserve. So I'd sit there and sit tea while they have apple pie or something like that. And because I wasn't able to fully participate in the event that is going out to dinner, especially when you're a young, generally healthy or healthy appearing person, that created an uncomfortable social situation where they felt I wasn't enjoying myself. When actually I really was, that then made it hard for them to enjoy, you know, the activity. And so let's say it just like killed the date vibe. Now that's pretty hard to hear from a partner because what do I do with that? I can't change. I have a binary choice here to make. Eating a way that makes me really uncomfortable and quite honestly ill in order to, you know, given to peer pressure and play key to social situation and social norms or eat in a way that is perceived as dysfunctional and make my partner feel uncomfortable, a partner who I really respect. That's uncomfortable and there's not an easy solution to that. It's just the reality that I live. Now that was the second example. Let's go to the third, a level deeper when it comes to even my own family. My mother saw what I went through with inflammatory bowel disease, saw me basically on the brink of death. It was a point that was in palliative care. She flew over from the United States. I was an Oxford at the time to see me in the palliative care ward. She saw how scary that was and she's seen how my life is transformed through therapy to carbohydrate restriction. And nevertheless, she still has internalized a stigma against ketogenic diets that I perceive. At least that's my perception. And I perceive it in little moments. So for example, if I'm back home and I eat something that she wouldn't necessarily perceive is on my diet plan, she gives me positive reinforcement. So for example, if I'm home and I have some cocoa nibs with some frozen dark cherries, there's some frozen pitted cherries you can throw in the freezer, well, they're frozen. And they're just the right amount of sweet for me. And I can have two or three and they're fine. That could be a dessert. And when she sees me do that, she'll be like, oh, good for you. In a way that is meant to be loving. And I know that she's excited that I'm expanding my normal palate and thinks that it's something that, you know, um, represents an advancement. But when you say, oh, good for you, it gives the implication that what I'm doing at baseline is dysfunctional and unsatisfactory and even disordered. So even those positive remarks, what are apparently positive really hurt, even if I don't necessarily talk about it with her because what are you supposed to say? That's your mother and she's being loving. She's not trying to be harmful. So you're just kind of taking it on the chin and move on. So those are some personal examples. And what's pervasive through all of these is that the underlying message, even in especially when it comes from those closest to you is that how you eat, how I eat is weird, dysfunctional, disordered. And that's a very heavy burden to carry, really carry for years with the prospect of having that burden being something you have to carry really forever. For as long as you're going to use this dietary therapy to live your life. And when framed like that, it's not a surprise that some people give into social pressure. So, well, now that you're probably down, I do want to lift you up. I think it can be difficult living in the society we live in and one with a food environment and culture that is wrapped around carbohydrates. But there are communities rising up because people have lived the kind of life I've lived and now are, you know, coming together, gravitating together to build communities to support each other, which is one of the beautiful things about social media, Facebook groups, you know, corners of Twitter where people can come together, share their experiences and support one another, recognize each other's strength, living every day on a lifestyle plan that isn't necessarily accepted by society and recognizing that each of us every day is making a adult binary choice between putting our health first and putting what society expects of us first. And that choice, I think when you kind of, you know, just do the compare and contrast, is often very clear, especially for those of us who have real motivation, not to eat carbohydrates, executeosis and get incredibly ill. It's very clear if you have to choose between, for me, being in intensive care with profuse bloody diarrhea versus making, you know, somebody uncomfortable because you're not eating bread. When you present it like that, the choice is very clear. Nevertheless, it can be a lot to deal with then and day out. Building community helps, I think, bring that contrast to the form. Be like, yeah, you know what? It is what it is. I'm an adult and I'm going to put my health first. I have the self confidence and strength to, you know, decide my health is my priority and, you know, disregarding or overcoming the need for everybody else's approval because you're never going to get that in life. So really in this video, I wanted to just recognize that. Keto stigma is a thing. I don't think it's going away anytime soon, particularly with media misrepresentation and deception aimed at ketogenic diets. It's an easy way to score points and get clicks. And that's just the reality of it. Keto bashing is basically a sport. So it is what it is. I think with advancements in the literature, the scientific literature, we will see that overturned in time. I think those of you who know me know that's part of my mission, make metabolic health mainstream, including making ketogenic diets socially acceptable, but for the time being, it's a choice. And really, I think the thing you need to ask yourself is what's more important, getting people's approval or your health and well-being. And only you can make that decision every day. Thanks for listening. you