In this episode, Dr. Geo is joined by Dr. Steven Freeland to discuss the powerful intersection of urologic oncology and metabolic health. Dr. Freeland shares groundbreaking research on how dietary interventions—specifically low-carbohydrate protocols—can slow prostate cancer progression and counteract the metabolic damage caused by standard treatments like Androgen Deprivation Therapy (ADT).

1. The Metabolic Growth Signal: Why insulin and Insulin-like Growth Factor 1 (IGF-1) are considered "fuel" for prostate cancer cells and how reducing sugar can starve that signal.
2. The 20-Gram Protocol: Insights from Dr. Freeland’s study on ultra-low-carb diets, where participants saw a 20-pound weight loss and a significant slowing of PSA doubling time.
3. Combatting ADT Side Effects: How a metabolic approach can improve insulin resistance by 30% and surprisingly help preserve bone density during hormone therapy.
4. The "Slim-Fat" Reality: Why your BMI might be normal, but your visceral fat (adiposity) could still be driving inflammation and cancer growth.
5. Clinical Markers to Watch: Why patients should ask about HOMA-IR (Insulin Resistance) and Hemoglobin A1C rather than just focusing on PSA alone.

1. Dr. Steven Freeland: Cedars-Sinai Faculty Profile
2. Research Paper: Ultra-low carbohydrate diet and prostate cancer progression (referenced as the "20-gram study").
3. Recommended Diet Protocol: Induction Phase Atkins (as used in the clinical trials).
4. Clinical Markers: * HOMA-IR: (Fasting Insulin $\times$ Fasting Glucose) / 405 (or 22.5 in SI units).
5. Hemoglobin A1C: A 90-day average of blood sugar levels.
6. Wearables: Fitbit, Oura Ring, and Whoop (discussed in the context of tracking "active steps" and sleep quality).

1. [07:35] Breaking down the 20-gram carbohydrate trial and patient adherence.
2. [13:45] The impact of...