Episode 250: Prescribing Lifestyle: How Dr. Avi Charlton Uses Low Carb, Keto & Lifestyle Medicine to Reverse Diabetes

Dr Avi Charlton on staying curious, eating real food and the breathing habit most people miss

TL;DR

• Dr Avi has unlearnt a lot since medical school, including "eat less, move more". Hormones, stress and life stage all play a part.
• In her view, low carb simply means eating real food: meat, eggs, chicken, fish and veggies.
• Tools like glucose monitors can help you learn how your body responds to different foods.
• Her one-thing advice is nutrition, and her breathing tip is LSD: light, slow and deep, through the nose.

Introduction

Dr Avi Charlton is a Melbourne GP who has been practising for about 20 years. She's also a breathwork coach and the founder of the Melbourne Low Carb Clinic. Her biggest message is to be curious. She's unlearnt many things she was taught at medical school and relearnt new ways of helping her patients.

Her own journey started about 10 years ago, when she began running and exercising. Her gym instructor introduced her to an eight-week body transformation challenge using a low carb, ketogenic approach. She weighed her food, followed it to the letter and lost 4 kilos and 4% body fat. That got her looking into the science. She did courses through Low Carb Down Under and the Nutrition Network and became a metabolic health practitioner. Now people travel from around Melbourne, the country and interstate to see her.

Please note: this is general information from Dr Avi's perspective, not medical advice. If you have diabetes or another health condition, or take medication, talk to your doctor before changing your diet.

Lesson 1: It's not as simple as eating less and moving more

Insight: Dr Avi used to tell patients that to lose weight, they needed to eat less and move more. She's since unlearnt that. She says many factors are involved, including hormones like insulin and leptin, hunger hormones and stress hormones like cortisol. She's going through perimenopause herself and knows hormonal changes play a part too.

Everyone is their own "n equals one", she says. What works for one person may not work for another, so sometimes you need to tweak and troubleshoot to find your ideal approach.

Action: If something that used to work for you no longer does, treat it as information. Ask what's changed, whether that's stress, sleep, hormones or your life stage.

Outcome: You stop blaming yourself and start looking for what your body needs now.

Lesson 2: Low carb is eating real food

Insight: Dr Avi says many health practitioners believe low carb is dangerous, inflammatory or unsustainable, and worry it raises cholesterol. She thinks there's a lot of misunderstanding. To her, low carb is simply eating real food like meat, eggs, chicken, fish and veggies. She also believes sustainability comes down to mindset and support.

She explained the differences as she sees them:

• Carnivore: animal foods only. She supports patients who choose it but says it can be hard to stick with.
• Keto: mainly protein and above-ground veggies, usually under about 20 grams of carbs a day, so your body burns ketones.
• Low carb: usually under about 50 grams of carbs a day.

She also pointed out that bread, pasta and potatoes break down into glucose in your bloodstream. If your goal is weight loss or blood sugar control, she says cutting back on them, including sweet potatoes, can help. It always depends on your goal.

Action: For one week, build your meals around a protein source and veggies, and notice how your energy and hunger change.

Outcome: You get a feel for how your body responds to more real food.

Lesson 3: Learn from your own data

Insight: Dr Avi suggests using tools to understand your body. There are urine strips, breath ketone meters and finger-prick meters. She uses a finger-prick meter that reads both glucose and ketones, and says above 0.5 indicates ketosis.

Continuous glucose monitors, which sit on your arm for about two weeks and connect to an app, can show how particular foods affect you. If your glucose stays fairly flat, that's great. If a bowl of pasta sends it up and it stays high for a long time, you've learnt something about how that meal affects you.

She gives patients a green, yellow and red food list. Some like to track with apps like Carb Manager or Cronometer, some keep a food diary and others note how they feel. All of it is useful data.

Action: Keep a simple food and mood diary for a week. Note what you ate and how you felt afterwards.

Outcome: You get personal evidence instead of relying on general rules.

Lesson 4: Choose good fats and avoid ultra-processed food

Insight: A lot of people fear fat, but Dr Avi says there are healthy and less healthy fats. She sees avocado, nuts, seeds and even the fat on meat as good options. She's more concerned about processed foods and industrial seed oils.

She also talked about food addiction, especially sugar and processed food. She says many processed foods are engineered to hit a "bliss point", which is why you can't stop at one or two chips. Her approach to addiction is self-compassion. If you slip up, it's not your fault, and you get back on track without blaming yourself.

Her shopping tips:

• Don't shop when you're hungry.
• Stick to the outer edge of the supermarket, because the middle aisles often hold the processed foods.
• If something has no label or ingredient list, it's probably real food.
• If it has more than five ingredients, it's probably processed.
• Use subscriptions, like a meat or veggie box, to save time.

On dairy, she said it depends on whether you tolerate it, and good-quality dairy can be great. Organic is good if you can afford it, but non-organic real food is still much better than processed food.

Action: On your next shop, fill most of your trolley from the outer edge of the supermarket.

Outcome: Less processed food ends up in your house.

Lesson 5: Start with nutrition and keep meals simple

Insight: I asked Dr Avi what one thing she'd focus on if someone could only change one area. She chose nutrition. When you eat better, she says, you get more energy, which makes you more likely to exercise, get outside and sleep well. It's all connected. And you're going to eat anyway, so it makes sense to improve it.

She's time poor too, so she keeps meals simple. Put some ghee or olive oil in a pan, cook a steak, steam some veggies, and that's dinner. If you don't love steak, use chicken or beef patties from a reputable butcher. Grilling lamb cutlets takes about half an hour, and a steak takes even less.

Action: Pick one simple protein-and-veg meal you can cook in under 30 minutes and make it this week.

Outcome: Eating well stops feeling like a big production.

Lesson 6: Breathe light, slow and deep through your nose

Insight: Dr Avi got into breathwork after hearing Andrew Huberman talk about it on a run, then hearing breathwork coach Jared Stevenson speak at a keto retreat on the Gold Coast. She later did an online course with Oxygen Advantage, and now uses breathing in her general practice.

She says many people breathe through their mouth, and she encourages nose breathing while working, exercising and sleeping. She shared a story about a man with asthma, snoring and restless legs who started practising nose breathing after seeing one of her social media posts. He told her it saved his marriage, because he stopped snoring and his wife was happy to sleep next to him again.

Her acronym is LSD:

• Light: breathe so gently you wouldn't feel it if you held a finger near your nostril.
• Slow: many people take 15 to 18 breaths a minute. Slowing to six, about five counts in and five out, shifts you towards a calmer, rest-and-digest state.
• Deep: breathe down into your diaphragm rather than your chest.

I'd add that if you can learn to control your breathing during a workout, you'll recover faster and get more out of each session.

Action: Try five minutes of light, slow, deep nose breathing today, about five counts in and five counts out.

Outcome: You give your nervous system a chance to calm down.

Lesson 7: Build a morning routine by stacking habits

Insight: Dr Avi gets up at 5:30, brushes her teeth, makes a coffee and sits down for breathwork or meditation using the Insight Timer app. That's five minutes on busy days, or 20 to 30 minutes on weekends. She treats it as a morning meeting with herself to plan the day. Then she logs the previous day in her Whoop app, reflects on what went well, practises gratitude, exercises for 30 to 45 minutes, showers and takes the kids to school.

Her advice is to build on what you already do. If you already have a coffee every morning, add breathwork while you drink it. That's habit stacking, an idea James Clear writes about.

On medications like Ozempic, she said she's not against medication, and still prescribes it. She sees a place for both lifestyle and medication, but believes people need informed consent. In particular, she says if you're using it, you need to strength train so you don't lose muscle and bone along with fat.

Action: Attach one new two-minute habit to something you already do every morning.

Outcome: Your routine grows without needing extra willpower.

Quick wins

• Shop around the outer edge of the supermarket.
• Cook one simple protein-and-veg meal this week.
• Practise nose breathing while you work.
• Add a few minutes of breathwork to your morning coffee.
• Keep a food and mood diary for a week.

Closing insight

When I asked Dr Avi what she'd get every person to do, her answer was simple: don't eat processed foods. Eat real food. Then stay curious about how your body responds, and keep learning.

Connect with Dr Avi Charlton

Visit the Melbourne Low Carb Clinic or Breathe in Health, or follow her on Instagram and YouTube. She also hosts the Prescribing Lifestyle podcast.

Listen to the full episode

The full conversation is on Spotify, Apple Podcasts and YouTube, or press play at the top of this page.

Related episodes: Cholesterol Explained with Dr Avi Charlton and What I Learned From 5 Powerful Podcast Guests