#2: Dr. Brian Lenzkes (@BrianLenzkes): Talks About His Appearance on the Documentary Fat Fiction, Diagnosing Diabetes, and Getting Patients Off Insulin via a Ketogenic Diet.
Summary
Dr. Brian Lenzkes practices internal medicine in San Diego, CA and has had a TON of success reversing his patient's diabetes through a high-fat, low-carb diet. He was featured in the documentary Fat Fiction and he founded the LowCarbMD (https://www.lowcarbmdsandiego.com/) in San Diego. His success as a doctor and his personal experience on the ketogenic diet has led him to start LowCarbMD and become an active member in the Low Carb community across the US. Dr. Brian is also one of the nicest and genuine people out there - give him a follow on Twitter if you don't believe us!----------Topics discusses: - Ketogenic diet- Fat Fiction- Low Carb diet- Diabetes- Getting Patients Off Insulin Get full access to The Meat Mafia Podcast at themeatmafiapodcast.substack.com/subscribeHello, and welcome to the Playing with Fire podcast hosted by the Meat Mafia. On today's episode, we have on none other than doctor Brian Lenskes. Doctor Brian practices internal medicine out of San Diego, and he has had a ton of success reversing many of his patients' type two diabetes diagnosis and getting them off of insulin for good. Doctor Brian brings a wealth of experience onto the podcast. We've got the fire nice and hot, so pull up a chair, sit back, and enjoy.
Speaker 2:Doctor Brian, how are you, sir?
Speaker 3:Hey. Great. Thanks for inviting me, guys. Great to be here.
Speaker 2:We're we're both honored to have you on. I I think I speak for the both of us. We're we're huge fan of yours. We came across you in Fat Fiction a few months ago, and we're obviously inspired by just seeing what you were doing, helping to get patients off insulin. And you're the first guest on the Playing with Fire podcast.
Speaker 2:So we have, we have high hopes for this episode.
Speaker 1:That's number one.
Speaker 3:Wow, man.
Speaker 2:That's number one. Numero uno.
Speaker 3:It could put you in the tank right away. I don't have to worry about tanking your ratings if it's the first one, but, man, thanks. It's an honor. I appreciate you guys having me on.
Speaker 2:Yeah. It's it's pretty cool because, I mean, we've obviously we both had a few conversations, and now you're getting to meet Clemenza. It's interesting how there's certain people where even though you've only had a few conversations, you feel like you know them better than you really do. And I think it's awesome how Twitter got to to connect us, and now here we are having this conversation.
Speaker 3:Crazy. I saw your story. I was like, how come everyone's not talking about this? This is your story is amazing at what you guys are accomplishing together. And just hearing you about you guys being buddies and supporting each other and helping each other, that's a huge deal.
Speaker 3:You know? And then being in poor health and saying, okay. What am I gonna do? Do I do you live like, you look at the trajectory of what your life could be and where it is now. You know?
Speaker 3:And it's it's amazing. And and that's what I see in you guys too is giving people hope and saying, okay. I don't have to suffer. I don't have to be miserable. Finding a way out.
Speaker 3:And that's what you're offering people. That's really cool.
Speaker 2:Yeah. We and we appreciate you saying that. And that's why we also think your story is so powerful. And I think they do a fantastic job of portraying that on fat fiction, which we'd love to get into. You know, you're helping these patients, you know, trying to help get them off insulin, and then you're following the standard American practices, and you're like, well, crap.
Speaker 2:I I don't feel great. I don't I don't look great. I wanna lose weight, and you go on your own journey with low carb. And now I think it's more of a carnivore diet, and it's it's pretty incredible just to see your own personal journey. And people relate to that, the vulnerability, and actually to have a doctor that's, you know, that has an MD that believes in this and is curious.
Speaker 2:It's it's incredibly powerful.
Speaker 3:Yeah. I think when when things aren't working, you have to start looking at other options. I when I heard about Sean Baker, I laughed. I'm like, this guy's a nut. Don't tell Sean I said that, by the way.
Speaker 3:He'll crush me. But we've become friends, and I have a lot of respect for him. I had him on my podcast. And to hear his backstory is just unbelievable. This guy is not just some, you know, guy who just said, oh, I'm just gonna eat meat to, you know, be controversial.
Speaker 3:He looked at the data, and he was really understanding the science. You know? Even though he's an orthopedic surgeon, I I tease him about that. But, you know, he he's a big buff dude. So he could really get away with a lot of stuff that we couldn't get away with, you know, but, but look at him and and what he's accomplished and the heat he's taken and, you know, he's been through a lot, this guy.
Speaker 3:You know? So, you know, the fact that he could help you out by his story, him standing up helped you to get to where you're at too. You know, it's amazing how all these little stones like, we we come across each other's paths, and it's for a reason. You know? We get to help each other out.
Speaker 3:So it's pretty cool.
Speaker 2:It's it's awesome. I think that's a a perfect place to start. I mean, kinda simply, we'd love to just tell the audience, you know, who you are, what you do. I know we mentioned that you're a doctor. We'd love love to learn a little bit more about how you found your way into into Western medicine.
Speaker 3:Well, Western medicine, I kinda just stumbled into that studying hard. You know, I had good grades, and I thought, what am I gonna do? And then I was at UC Irvine undergrad, and one of my friends who was going to dental school, he said, hey. These doctors are doing this this outreach to Mexico. Do you wanna go?
Speaker 3:I was like, yeah. I don't really like doctors. I don't know. I was thinking about going to physical therapy or something like that. And I go, yeah.
Speaker 3:Let's go. We'll go down to Mexico, hang out, maybe, you know, grab a drink or two or something. And then so we went down there. These guys were they happen to be from USC where I ended up going, but they were the coolest guys. One of one of the guys was actually from Nigeria, and he was here.
Speaker 3:And he put himself through med school, was paying his own way, and he told his parents that he was just a waiter and kinda doing odd jobs and all this stuff, and he was so excited to go home and tell his parents that he was a doctor because in Nigeria, that's a huge, huge accomplishment, especially from his family, from being really poor. So anyways, I started hanging out with these guys. I go, these guys are cool guys. And, you know, I just kept studying, and then I ended up, applying to USC and getting in. I wanted to stay on the West Coast.
Speaker 3:And, yeah. So it was just kind of a crazy thing. And I realized, you know, doctors, if they're doing the right stuff and they're doing it for the right reason, they're cool. They could be they could you know, I didn't I I always thought of this image of doctors being really arrogant and pompous, which may be true in in some circumstances. But, you know, a lot of them are like Sean Baker, just cool guys that you like to hang out with and they're you know, they they have great life experience.
Speaker 3:And I think, you know, being a doc, you know, and I now have been in practice for almost twenty years now, about seventeen years in standard practice. And I started looking around saying, wait a minute. Like, you know, I realized relationships were were were like friends of mine from high school. It's like one of my buddies texted me and said, hey, Brian. Are you still mad at me?
Speaker 3:I was like, the last time we he was my best man. I was in his wedding and everything, and it was one of those things where it's like, still mad at you. Is this about that when you fouled me in basketball in third grade? That was a legit foul, actually. But we haven't had a a fight, but he said and I said, what do you mean?
Speaker 3:He goes, we haven't had dinner together in three years. I was like, well but he's a pastor now. And so I was like, I work all week. You work on the weekends, and we never have time. Right?
Speaker 3:And you start realizing you're working sixteen hour days all the time. You're getting up at four in the morning to go to the hospital first, you know, trying to get your workouts in, trying to spend time with family and your wife and kids and all that stuff. And you start realizing, man, you can't I started realizing I was on a treadmill that was going too fast, and I couldn't keep up. And I think a lot of people are in that situation. So what he told me was, hey, Brian.
Speaker 3:If you were your own patient, what would you tell yourself? Right? If I had someone working sixteen hour days and they're stressed out and running around beat up and and, you know, not getting enough sleep and not exercising enough, you know, I would tell them, hey. Find a new job. Find out what you love to do.
Speaker 3:And then so then I started getting into the low carb world and and, you know, you know, one thing snowballed after another. And I started realizing I hated seeing patients getting sicker, and I hated seeing amputations, and I hated seeing chronic wounds from diabetics. And, I I I saw some major suffering, and and a lot of it was frustrating because I would always think, man, if I had this patient, like, ten years earlier, if we could have intervened, we could have prevented this. Now we're trying to treat everything, and we're really good at treating everything. But I'd rather change the oil and, you know, change the spark plugs and not rehaul you know, do an overhaul on the engine.
Speaker 3:So in medicine, we've gotten really good. You know, if you're in a trauma, we're the best in the world as as far as I'm concerned in a trauma center or if you get shot or if you need a bypass surgery or things like that. But, gosh, it'd be a lot better to prevent it in the first place. So then I started realizing that and looking at at factors in in my life and saying, okay. I I need to reassess and do something where I really love it.
Speaker 3:Because I realized I love what I did. But when you're seeing a patient every six minutes, you know, every eight minutes or twelve minutes or whatever it is. Some systems, it's they have eight minutes with a patient. So how are you gonna talk about stress and lifestyle and all these things? You can't.
Speaker 3:It's impossible. No matter how smart you are, you can't get it. And you have to document your notes so people are writing their notes. So now a lot of people listening will identify. The doctors have their back to them and they're typing the note the whole time.
Speaker 3:They're like, you didn't even look at me the whole time I was in your office, you know, and that and I didn't wanna be like that. So, you know, I started realizing about 20% of the people I could really help, and 80% said, let's just give me a pill. And 20% said, look, I wanna be healthier. So now I've gone into direct primary care where I spend more time with the patient. And so I cut my patient low from over 2,000 patients to less than 350 or so.
Speaker 3:Right? So now I have more time to spend with patients to do research. If they have a disease that I need to learn about, I could have time to go do that. At the end of a sixteen hour day, you're not really inquisitive about low carb or carnivore. You just go, that's crazy.
Speaker 3:Don't do that. Right? Because of what you've heard. And so a lot of this is just out of ignorance of not looking at it because you don't have time.
Speaker 1:So it sounds like there was a point in time where you you wouldn't have been open to low carb. What was the sort of breaking moment for you? Was it a personal experience or was it was it something that you were seeing in, you know, in patients or online that sort of had that spark for you?
Speaker 3:Yeah. It was really I started looking at I mean, really what happened is I had a patient come in, and he had lost 40 pounds. I was like, what happened? I was first thing I'm thinking is, like, you have cancers. He's older.
Speaker 3:He was forty pounds. And And he said, well, I'm doing this this it's called a fast diet. You're not gonna like it. I go, what is it? He goes, I fast two basically, he was fasting two days a week, and the rest of the week week, he was eating whatever he wanted.
Speaker 3:I said, this doesn't make sense. How could he possibly be losing weight? And I'm struggling with weight, gaining weight. I'm working out every day, gaining weight. I'm having my green shakes.
Speaker 3:I'm doing, like, the the ADA diet. My three month sugar average is getting higher. And I'm like, how am I gaining weight all the time? And this guy's fasting two days a week and he's losing weight. Doesn't make sense.
Speaker 3:And I said, well, okay. Let me get this right. If you're fasting on Tuesday, for instance, Wednesday, you must eat twice as much to make up for it because you're starving. He said, no. It's weird.
Speaker 3:I'm not even hungry the next day. How can that be? You know? And so I start going down this rabbit hole of trying to figure out what this guy is doing. Instead of saying what you're doing is crazy, I said, well, let me look at it.
Speaker 3:It's working. So let me look at it. So in that process, I come across a guy named Jason Fung. You guys may have heard of him. You know, he's done a lot for diabetes.
Speaker 3:And so I I go, I'll just reach out to this guy. It sounds crazy what he's talking about. And then I started looking at it and realizing the importance of insulin resistance and high insulin levels. And so he was saying, Brian, look. The day before your patient gets diabetes, their insulin level is through the roof.
Speaker 3:And what do you do? You're treating with insulin. They have high insulin. It's just not working anymore. Right?
Speaker 3:So then I start looking into insulin resistance and and saying, okay. Once if you count all the process. And and also I'm observing the whole time with our diabetics, we dose our insulin based on how many carbohydrates. So we say, okay, breakfast, how many carbs are you having? Okay.
Speaker 3:Take that much insulin. Lunch, how many carbs? We'll give you insulin. So I was like, why am I giving carbs and then treating them with insulin? Why don't I just get rid of the carbohydrates?
Speaker 3:Right? And then I don't have to give them a bunch of insulin because if someone has cookies, they need more insulin than if they have salmon, for instance. Right? So then I started looking at that saying, well, this is kinda crazy. And then I started working out.
Speaker 3:And, I mean, I was always working out, but then I I started changing my diet. I have from losing weight. My patient started asking me, hey, doc. What are you doing? I was like, well, I can't really tell you, right, because it's not the standard of care.
Speaker 3:So, you know, in medicine, we get messed up. The standard of care can be terrible, but it's still the standard of care. Right? Because everyone said, well, if you don't follow the ADA diet and they're diabetic. And so I would get into you know, some of the doctors would get upset with me, but then they would be watching my patients.
Speaker 3:In my first six months of doing low carb with my patients, 11 people came off insulin. Right? In sixteen or seventeen years before that, I had never seen it once. And then I come across doctor Unwin. You know, he's he's in England.
Speaker 3:He's done the same thing with his patients. So, you know, professor Noakes, Tim Noakes, who was one of the the spearheads, and then Gary Fedke. And there's so many great ones that came before us that have been on this, you know, bandwagon for so long. And then, you know, everyone would say, oh, it's a fad. So I go, let me look back.
Speaker 3:I happen to collect a bunch of old medical books. I go, let's see what how would they do in the eighteen hundreds to treat diabetes? They didn't even have blood tests. They would have them pee on the ground, and they would see ants coming. Right?
Speaker 3:Or they would taste the urine to see if there was sugar, and they go, okay. You got diabetes. That's what they would literally do. And so what they would do is they put them in the hospital, cut their carbohydrates down until they weren't peeing sugar anymore. They go, okay.
Speaker 3:This is what you should eat. That was it. That's the science that they had. They didn't have ins then insulin came around in in, I think it was, 1912 or something like that. And then all of a sudden, everyone got insulin, so they forgot about all the dietary stuff.
Speaker 2:Wow. Fascinating. So prior to this low carb journey or to a few years ago, what would the ADA prescribe to someone that had diabetes? What was, like, the dietary template that they would have a patient follow?
Speaker 3:It it's I actually have infographics on it. It's amazing. I believe it's around they were they were saying 50 to a hundred grams of carbs with each meal. Each meal. Right?
Speaker 3:So we're shooting for 50 or less if we can do that, you know, depending on the patient and metabolic health and all that kind of stuff. So you start realizing, like, what am I doing here? It get it gets crazy when you see patients just eating sugar. Like, well, they'll say have, oatmeal, and no one's just gonna have oatmeal by itself because it tastes terrible. So they're adding honey to it.
Speaker 3:They're adding all this other sugar to it, brown sugar, or they're adding, whatever they're adding, you know, peanut butter to it or whatever. And all of a sudden, their sugars are spiking all the time. So you could look and we've never, until now, really looked at continuous glucose monitor. So I use that daily now in my practice. Because then you would check it once or twice a day, but you'd you'd miss stuff.
Speaker 3:You you wanna know what's happening in the middle. What happens when you're stressed? What happens when you're tired? What happens if you're you're you're having a hard day? What if you work out?
Speaker 3:What happens to your sugar? So we started realizing, like fat fiction, they did such a good job of looking at that and you can see it. And then you know, oh, okay. That's what my sugars do when I'm stressed or what it does when I eat too much or when I eat certain things. So it allows the patient to have control now.
Speaker 3:Right? And they could see. And even diabetics, if they don't do any education and they just put a continuous glucose monitor on them, they'll start changing their habits because they look and say, oh my goodness. My sugar is going to three eighty. Right?
Speaker 3:And they say, okay. I don't wanna do that. I'm gonna eat half of that. Or once if I eat a steak, what happens? It doesn't do anything.
Speaker 3:Right? Or it'll go down a lot of times. So those are kind of the things that that I started looking at saying, wow. This is kind of intriguing. Then I went to a low carb meeting and, just to learn more about it before I really jumped into this thing.
Speaker 3:And I saw psychiatrists there, orthopedic surgeons, all kinds of people, and, oncologists, people in all different areas of medicine say, hey. Cutting processed food helps you. So So, like, well, okay. Has anyone ever died of a processed food deficiency? Right?
Speaker 3:So then, you know, I started looking from that perspective, and then Sean Baker was coming around at the same time. Like, okay. This guy seems like a pretty fit guy. He looks pretty healthy. He's a big stud.
Speaker 3:Okay. Let's see what his coronary calcium score is. Let's see what his labs look like. And I'm like, oh, he's pretty healthy. You know?
Speaker 3:And so, you know, you start looking at that, then you have to say, okay. Everything I've been told, let me reassess that. Right? Especially for the diabetics. You know, really, I mean, that that that's the number one killer.
Speaker 3:Diabetes complications, you know, cardiac disease, all this, all it's all connected.
Speaker 1:Do you, so is there, a a corner that you see us turning with this whole institutional aspect of, like, the 88 guidelines and how you guys are really creating some serious change? Are are they getting acknowledged that like, it's getting acknowledged in certain corners of the world, but is it everywhere?
Speaker 3:Well, low carb diet is and people don't know it. They they quietly put it into the ADA's guidelines. Right? Low carb diet is the most studied approach to diabetes management. Right?
Speaker 3:But they had to sneak it in there because if you look at all these World Health reports and all these, they say it's the worst diet in the world. Okay. The ADA doesn't agree with you. Right? So that gave us that really was a huge step because, again, it's the standard of care.
Speaker 3:Even if it's working, you know, you really have to have something where you could say, look. This is in the guidelines. So once it was in the guidelines, which was a huge thing because the head of the ADA was actually she has diabetes and it was. Now she's resigned, moved on. And so, yeah, you start realizing it worked for her, so she was more she pushed it more because she saw the benefit.
Speaker 3:Like, it's hard. But the problem is when you're as for learning, as as become abundantly clear, is there's a conflict of interest. Because if I'm the American Diabetes Association, say I'm being sponsored on one side by pharma, on the other side by big food, do you think I'm gonna say bad stuff about either one of those two? And both of those guys are happy because if I'm if I own a company that will clean up oil, I'll say Jewel like crazy. And if it spills, I can clean it up for you.
Speaker 3:Right? And I make money and they make money. So it's a it's a big problem when you start stepping back. You know? There's I just saw something just now right before I came on with Project Veritas talking about the funding that's coming in for the FDA, and you say, uh-oh.
Speaker 3:Like, if you step back, when I was my chief resident at, at a hospital here in San Diego, it's in the Scripps system. We weren't allowed to take pens from drug reps. We weren't allowed to get, you know, go on, you know, go golfing and do all that. They stopped that. They arrived and became chief resident.
Speaker 3:But now I get it. I look and I go, yeah. If someone's giving you pens and giving you stuff all the time, he's like, oh, I like that drug rep, so I'm gonna start using that drug. And that's what happens still all the time. But, we realize when they're getting paid a lot of money, then there's obviously gonna be bias.
Speaker 3:Right? So it's a it's a trouble. So I think medicine right now is is in a purification phase because doctors see it. The frontline doctors, when I say frontline, I'm just talking about doctors who are treating patients say, wait a minute. My my my, obligations to the patient.
Speaker 3:Right? I gotta help my patients out. So that's that's we're starting to step back and say, who who who do we follow? What do we do? Right?
Speaker 3:Because you you can't just keep adding drug and drug and drug on top of each other, and that's what we've gotten really good at in in medicine. As a matter of fact, a friend of mine, Mark Cucuzzella, who's one of the leaders in in in using continuous glucose monitors and also deprescribing medication. There was no article. There was no such thing as deprescribing medications, right, until low carb came along. Because now what's happening and and trust me, I I've had to had have battles with insurance companies because I've had patients now for three years.
Speaker 3:Their three months sugar average is in the totally normal range. But their mindset is once you have diabetes, you always have it. Like, woah. Does that mean that? If if you change your lifestyle and you start exercising and lose 30 pounds and you start working out, should you always have to be on these meds anymore when everything's normal?
Speaker 3:Right? So insurance companies charge you more. Everything, life insurance, everything is more expensive if you have diabetes. So I've had people have it expunged from the record that they're diabetic, especially if you're a pilot. You can't fly if you're diabetic.
Speaker 3:Right? And so there's there's restrictions. So you say, okay. This guy's you know, one of my friends is actually at the FDA said, okay. You're no longer considered diabetic.
Speaker 3:And I was shocked. That's the first time I ever saw that. So, yeah, that it's you know, I think we're at a time now if we really take control of our health, we can reverse a lot of these things. Right? And and that's why, you know, like hearing Brett's story, like, if you would have told me that story two years ago, I'd be like, this guy's crazy.
Speaker 3:There's no way that happened. Right? So you start realizing, you know, coming off these big huge medicines would have tons of side effects by making lifestyle changes and having a friend support you. And and and it's amazing. But, you know, it's it's just so, it's these stories are not told enough.
Speaker 2:Yeah. Once you start to see thousands of people that are curing their autoimmune issues from a particular type of diet, I mean, you have to at least have the curiosity that you had of, like, there's gotta be something here. These people don't have anything to gain. They're not trying to sell a product. They're just talking about the way that they've healed their colitis or their Crohn's or I know like Mikaela Peterson had a I think she had like a double ankle replacement or something like that.
Speaker 2:And now she can live and operate as a normal person on her, lying diet. It's it's just unbelievable to see.
Speaker 3:Well, and not only that, depression, anxiety, stress. I mean, those and in fact, fiction, one of the things and I'm gonna yell at them one of these days about it. I never really I I I don't wanna, you know, get anyone upset. But what happened was during the scene where all my patients were up there talking, they were telling their story. And I think back then, it was controversial maybe.
Speaker 3:I'm not sure exactly why it was cut out, but it was one of the most emotional times of my career. I'm sitting there watching five people, and one lady said, you know, it was like when I went she went on a low carb because of diabetes. And her whole life, she was depressed and anxious and stressed and a recluse. She stayed in her house. She never cleaned her house.
Speaker 3:She just was, you know, like a a hermit. And she said one day something it was like, I could see the light. I could see the birds. I get the sun was on me, and I felt warm, and I felt happy for the first time in my life. And someone else says, oh my gosh.
Speaker 3:Me too. Me too. Like, all of the people up there said their mood, anxiety, stress got better. And, like, for a doctor, like, when you see someone's life's better, you can weigh three hundred pounds and be happy. That's cool.
Speaker 3:Right? But if you're miserable and depressed your entire life and you see someone get better, you go, wow. And she said, she was, yeah. Reversing my diabetes was great, but the big thing was my mood thing. But, you know, so that's a huge deal and I see that all the time.
Speaker 3:My patients are happy. They're less stressed. They're enjoying life. Their their back doesn't hurt. Their knees don't hurt.
Speaker 3:It's like a country song backwards. I always say it's like it's funny because instead of losing everything, they start getting their life back. And to be freed from being hungry every two hours, right, of not being able you know, like, throw my partner on the podcast. He couldn't he had to get the extender seat to go on the on the seat belt to go on an airplane. He couldn't go on certain rides at the amusement park.
Speaker 3:He's like, wow. So I see people that you know, one of my guys, he goes, I could go to Disneyland again with my family. He goes, how embarrassing is it with your with your kids? And they go, sorry, sir. You can't go on the ride.
Speaker 3:You know, those kind of things. And to see these things get better, it's like, man, that's inspiring. When you talk about physician burnout, which is a major problem. When you see your patients getting better and they're and and you can help them and intervene, man, that's what we went to medicine for. You know, to take medicines away.
Speaker 3:So all the time, I'm taking medicines away and being happy. Like, you don't need that anymore. I have a lady just the other day. We took out four medicines. It's gone.
Speaker 3:Right? And and someone like you coming off meds, like, huge doses of meds are really expensive. You go, wow. That's pretty pretty cool. I think one of the other things that made me happy was, you know, my my old practice, I had five partners.
Speaker 3:And, you know, we would just sign you when the drug reps you sign and they leave meds, you know, samples and stuff like that. And so everyone's signing us. Oh, do you need my autograph? I was joking with her like, hey. Do you need me to sign?
Speaker 3:She said, you're doctor Lentskus. Right? She said I said, yeah. She said, you're off my list. I said, oh, really?
Speaker 3:Why? She goes, whose product are you writing? I go, what are you talking about? She goes, you don't write insulin our insulin anymore. Whose insulin are you writing?
Speaker 3:I said, I'm not really writing it. I'm really taking people off meds. And she started laughing. She said, you can't take people off insulin. I said, well, actually, you're right.
Speaker 3:I can't, but they can. Right? If I guide them, I can help them. Patients can go out of insulin. It happens all that like, to me now, it's like especially if you just went on it a week ago.
Speaker 3:Oh, that's gonna be an easy one for us. Right? So a newly diagnosed diabetic. But if you've been off for ten or fifteen years, it's gonna be a lot harder. But one of the ladies that was on on Fat Fiction, you know, she was on massive doses of insulin and she's off it now.
Speaker 3:She's been off it for the last couple years. Her peripheral neuropathy is getting better. She's happier. Her her diabetic retinopathy got better. Her her eye doctor was asking her, like, are you injecting meds in your eye?
Speaker 3:What are you doing? Like, he was blown away that no one has seen these things. But, yeah, she they took it they took it and said, okay. I'm gonna I'm
Speaker 1:gonna be healthier. This might be the perfect time to ask this question. So pretend I'm a fifth grader. What is diabetes? And how would you go about or how would you explain it to your kids to sort of avoid getting on that track?
Speaker 3:Yeah. Diabetes really I mean, there's different types of diabetes. So type one diabetics are very thin. They don't make enough insulin. So or they don't make insulin at all.
Speaker 3:It's an autoimmune condition, so you stop making insulin. So then you're stuck. You gotta you gotta take insulin, right, to to put the sugar into your out of the bloodstream into your cells. The problem that we become if we talk about type ones, what we've done to type ones now for the first time in history was we say, you know what? Eat whatever you want, and we'll just give you extra insulin.
Speaker 3:You wanna eat cookies and donuts and cake and all this other stuff? No problem. We'll just give you insulin, and your sugars look good. But the sugar has to go somewhere. So the insulin grabs the sugar, shoves into your tissues, shoves into your eyes, to your kidneys, to all these places where you're gonna get amputations later on.
Speaker 3:So that's not the way to and I've seen it. I've endocrinologist and I I've had an endocrinologist in town who said, tell doctor Lenses to screw off. You can eat whatever you want. I'll control it with insulin. But then guess what?
Speaker 3:Guess who's getting leg ulcers and going blind and having kidney problems? Because you can't control. You can make it look better. It's just like if you have termites in your house. Right?
Speaker 3:I can repaint your walls all day, but you still got termites in your wall. You gotta fix it. So so that's it. So type two so type two diabetes means you have too much energy in your system. You can't get rid of the extra sugar.
Speaker 3:So what do you do? You know, you think of it as the way I I explain it to people that that's a simpler way is, like, imagine you have a moving truck. Right? If you have a moving truck, you could put so much stuff in there. You know, at first, you start throwing everything in there really easy.
Speaker 3:It's not a big problem because you have so much room. And then all of a sudden you look behind you, you think, oh my gosh. I got the chairs and the couch and TV and all. It's not gonna fit. So instead instead of having a couple of guys, which is insulin, just throw the stuff in the truck, which is easy.
Speaker 3:Once it starts filling up, you need a bunch of people to start moving stuff around. It's not you have 14 guys doing all the work. And so sooner or later, these guys get tired down. They go, forget it. There's no more room in the truck.
Speaker 3:I have nowhere else to put this extra stuff. So that's the sugar that stays in your bloodstream. Right? So if you keep your truck empty all the time, if you're working out, exercising, watching your stress, getting enough sleep, not eating too much sugar, it's easy to put stuff in the truck, take it out when you need it, put it in the truck, and take it out. But once it gets overly full so the problem with diabetes is your cells are overly filled with sugar.
Speaker 3:Right? So if you keep putting more sugar, no matter how much insulin you take, at some point, you you still can't get rid of it. There's nowhere else to put it. Right? So this is what we're talking when we talk about insulin resistance.
Speaker 3:It's it's it's basically if you think about it this way, this is how I explain insulin resistance is, like, say, if you come in and go, okay. Look, Brian. I'm drinking 12 beers a night, and I can't get drunk. And I wanna get drunk with my friends. What should I do?
Speaker 3:Well, the western medicine is saying, well, if you're not drunk with 12, then have 14, then 16, then 18, then 20, and then 30, and then keep going up until you get drunk. But us us guys looking at the diabetes a different way, we're saying, okay. If you wanna go with your buddies and and feel well, then what you do is you're like, let's cut down your alcohol for two or three weeks. If you're working out and you don't drink, and then in two or three weeks, you go out with your buddies, you have one beer and you feel it. You don't need 30 anymore.
Speaker 3:So if your body's sensitive to insulin, if you put on muscle mass, that's the most sensitive tissue to insulin. So what happens, we think now, is is is we put on a little bit like, we start out thin, and then we put a little visceral fat. Like, we put fat in the love handles first because that's a safe place to store it. Then once you run out of love handle space, it goes to the visceral fat around the organ. So what I've noticed in my practice, which made me crazy at first, was I would have people of Indian descent, Asian descent.
Speaker 3:They're a hundred and forty, hundred and fifty pounds. They have type two diabetes. I'm like, how can these they're not fat. They have diabetes. Well, it's because they had no fat tissue externally to put it in.
Speaker 3:So all the extra sugar they went to their visceral organs. So around their around their liver, fatty liver disease, which is a precursor to the diabetes and fat in the in the omentum, which is the the tissue around the the intestines. And so some people can be six hundred pounds and not get diabetes because they have a place to put that extra sugar. They have if you can imagine, like, the moving truck, they have 30 moving trucks. Some people only have one.
Speaker 3:Right? They're getting around space faster. So you can't just look at someone and say they're metabolically healthy. I've I've had guys with six pack abs that have type two diabetes. Right?
Speaker 3:Because they had no they they couldn't store subcutaneous fat at all when this and and that's why it's interesting because, say, we all went out and got liposuction, that's subcutaneous fat. Now you take away your subcutaneous fat. The only place you could store this is visceral. Now you're in trouble because that's what causes increased inflammation. As a matter of fact, an interesting thing along the line of COVID is there's something called TRP b r two.
Speaker 3:It's a hormone given off by visceral fat only. Subcutaneous fat doesn't give this off. So when I was trying to look at the difference between the different types of fat, guess what? TRP b r two, if we block that and get rid of it, you don't die of the cytokine storm, which is what kills people. So it's a massive inflammation that we get from storing all this visceral fat.
Speaker 3:So that that's a huge deal. So you say, okay. What do I do? Like, working out, putting on muscle mass like you guys have, it's gonna burn the visceral fat preferentially and you start, you know, getting rid of that and you you you're just metabolically healthier. And so people you could see it like someone like Sean Baker.
Speaker 3:That guy wanted to have cookies every day. He's not gonna get fat for a long time. He's not gonna get metabolically sick for a long time because he's so metabolically healthy. But if you have a four hundred pound diabetic, you can't eat you can't do that. You're you're you've already all of your storage units are full, so you can't buy more septum and put in the storage units.
Speaker 3:Right? You guys have empty storage units, so you work out, you eat, whatever, it's just gonna go in your muscles, like, that extra glycogen. Who cares? It's not gonna hurt you. You know?
Speaker 3:So, basically, it's not the point that you can't have carbs. It's you can't overfill the the truck. If you fill it up three quarters away and you empty it, okay. Three fill up to the top and then you empty it, okay. No big deal.
Speaker 3:But if you keep pushing people on there, then you're in trouble. You sooner or later, you're gonna run out of space to put it.
Speaker 1:That's exactly analogy. I guess the one thing that's a little bit confusing is the six pack dab guy has could could potentially get type two diabetes. So, like, for someone who doesn't have the medical background, it's like, but what is healthy? Right? It's it's a little bit of this, like, con confusion around when optically, they look healthy, but,
Speaker 3:you
Speaker 1:know, beneath
Speaker 3:Yeah. Is it they call it toffee, like thin on the outside but fat on the inside. And I've I've a lady I I've I've seen. She's of Samoan descent. She is three hundred sixty pounds.
Speaker 3:I saw her at the she's three hundred sixty pounds. Her visceral fat was, like, 0.8 liters, which is nothing. I see people twelve, fourteen, six zero. She's, you know, over three hundred pounds, and she's, like, got no visceral fat. And her insulin's normal.
Speaker 3:And her blood like, she's metabolic like, if you look at her labs, like, anyone would take her labs. She's metabolically healthy. Even though she's carrying on the extra weight, which probably isn't good for hip and back, and I go, I got bad news for you. Like, you're metabolically healthy. Meaning, there's gonna be a calorie problem.
Speaker 3:It's not in her case, it's different. That's why I mean, you have to look at the individual and see. But I see, you know, I see guys that are hundred and fifty, hundred and sixty pounds. They have type two diabetes. Like, it it it it's because they have nowhere else to put it or you have no muscle mass at all.
Speaker 3:You think about it. And and a lot a lot of people of Asian and Indian descent just don't have a lot of muscle mass. So you can hold a hundred grams of carbs in your muscles. Right? Your liver can hold about 30 or so, and then your bloodstream has one teaspoon it can hold.
Speaker 3:Right? So you wouldn't have a lot of muscle. Like Sean Baker can fill his muscles up all day, you know, these kind of guys. And and that's what what's important. These wiry, thin guys.
Speaker 3:And that's why a lot of doctors never really had to think about it because they've been thin their whole life. So they go, just do what I do and it works. Well right? If someone's metabolically not as healthy when they're kids because they made bad choices, we I I fight it my entire life, metabolic disease, like, because it's dumb choices of getting, you know, you know, watching cartoons and eating bad stuff and after school with snacking and, you know, all that. You don't realize it at the time.
Speaker 3:But once it takes its toll, it's hard to reverse the ship. So if you're healthy, you could get away with carbs. Like, that's why people get frustrated. They look at their friends and go, look. He eats carbs all day, and he's healthy.
Speaker 3:Yeah. He is probably. I don't know until I see your insulin level because I've been stunned before. Like, get people's metabolic stuff and go, oh, my gosh. Your triglycerides are through your insulin's through the roof, and they they look pretty healthy.
Speaker 2:So for that woman that's over three hundred pounds, what type of program or diet would you look to get her on to try and cut that weight down?
Speaker 3:Yeah. For her, I mean, really, it was really, you know, stress, depression, anxiety was her thing. She was just binge eating, but she would work out like crazy too. She was she played basketball in college, so she's tall too. So she, you know, she's she has the structure of muscle mass.
Speaker 3:So the fact that she worked out, she was keeping her visceral fat. But but if you're eating too much, it's still gonna go to the subcutaneous fat. So she's subcutaneous fat was huge. Right? So she had a lot of subcutaneous fat.
Speaker 3:So I was really trying to get her, like, say, let's get you into an exercise program that works. Let's do some time restricted eating. You know, make it so for her, it was you know, we you'll hear this debate as you talk to people. Is it calories in, calories out? What's the you know, what is the determiner?
Speaker 3:But, you know, there's so much. It's so complicated. So, you know, both sides may be right to some extent. Right? Because people go, oh, you're keto.
Speaker 3:You could eat all day long. And you well, trust me. I've done it. I've gained weight doing keto because if you're eating butter and bacon all day, you're gonna gain weight if you're taking it in 10,000 calories. You You only burn so much.
Speaker 3:But the other part of it is the calories in calories out people miss the importance of metabolic health and gut health. Like, you guys prove, you know, gut health. If your gut is unhealthy, it's gonna affect your brain, and it will affect cravings, it will affect a lot of stuff. So high insulin is a disaster because basically, insulin there's two. I'll I'll explain that.
Speaker 3:Hopefully, this will make sense. I know it's hard. People can't see, but insulin is kinda like you you look insulin is the it's the top saying, look, I'm gonna keep your temperature from going too high. Right? And so a friend of mine said, you know, we were never designed as humans to be running on ins having insulin determining our sugar level.
Speaker 3:There's another hormone called glucagon. What does glucagon do? It it releases sugar from fat storage and from liver stores so that you can burn it. Right? So you can have energy when you need it.
Speaker 3:So we get fat because we're storing excess energy. Right? So cave if you go back to the caveman, what they would do, they would eat they would kill something and eat the whole thing, and they would they would just gorge themselves till they were full. And then they wouldn't eat for three or four days because they have to go kill something again. Right?
Speaker 3:But during that time, they didn't get weak and tired and fatigued because they didn't have food. They had energy. They were running on their fat stores for that time. They would kill something, fill up their fat stores again, and then go and do the same thing again. They weren't snacking every ten minutes.
Speaker 3:They weren't going to to McDonald's and grabbing french fries. Right? But we think, oh my gosh. If I skip a meal, I'm gonna shut my metabolism down. I'm gonna die.
Speaker 3:Well, not necessarily true unless you're morbidly obese or you're metabolically sick because what insulin tells your body is to get rid of the insulin is saying there's too much energy in the bloodstream. Right? So if there's too much sugar if you if for instance, if we went and drank Slurpees right now and had a donut to wash it down. Right? Your insulin will go really hard to get rid of that sugar.
Speaker 3:Sugar goes high first and insulin goes where they get up that sugar. So it grabs the sugar and shoves it away somewhere. It says, okay. My job is not to let the sugar go too high and I gotta get it out of here and I gotta put it somewhere. So insulin's reacting but it overreacts.
Speaker 3:So what happens, you have donuts and a coke for breakfast. You shut your insulin sugar up. Insulin goes up to grab it all, and then it goes too low, and you're like, oh, I'm starving. I gotta eat something. Give me some chips.
Speaker 3:Goes up high. Then your insulin goes up, and then it goes up. So all day you're chasing your tail. But if that same person would've had eggs for breakfast, right, they're not spiking their sugars and it's flat all day. So you can have a flat sugar reading.
Speaker 3:Like, that's why the continuous glucose monitor is so great. But the other side of the coin is this. For instance, probably an example I can give you. When I first started doing low carb, I was like, my sugar is running, like, one twenty eight, one 30, something like that. I go, okay.
Speaker 3:That's it. I'm cutting my carbs. So for, like, three or four or five days, I'm doing great. All of a sudden, my sugar is getting lower every day. I'm like down to one zero two, then 88, 90 90 two, then all of a sudden it's ninety four, ninety eight, 80 eight.
Speaker 3:I mean, it starts going up and up to a 10. I'm like, wait a minute. What something's wrong. I'm eating low carb and my sugars are going up in the morning. So I called Jason Fung who's the expert in this.
Speaker 3:I go, Jason, my sugars are going up. What am I doing wrong? He goes, oh, congratulations. You're fat adapted. Meaning, now you can release your sugar from your fat stores because when your insulin's too high, it's like it's blocking you from getting to the bank to let shit fat out.
Speaker 3:So when someone's four hundred pounds and they're hungry all the time, they literally are because their insulin's so high that they're starving. They can't get to their fat stores, so they have to eat something to provide that energy. But once you go low carb or keto carnivore, you start lowering that insulin level down. Now you can get to your fat stores. Then you go, I'm not even that hungry.
Speaker 3:Okay. I'll skip lunch. Okay. I'll have dinner later. Right?
Speaker 3:Whatever. So that's what it is. In glucagon, what it does is it sees when your sugar starts going low and starts releasing sugar into the blood stream to keep your sugars balanced. So ideally, we want that sugar to be balanced out, not going up and down and doing crazy stuff all day. So that's what we see on the continuous glucose model.
Speaker 3:When we see a flat reading, we go, okay. That's good. You're not you're not eating a ton of carbs. You're not shooting up your insulin, and we're trying to get that insulin under control. Because once people get the insulin under under control, they feel better.
Speaker 3:Right? Their energy is better. But what happens is let's give an example of, say you tonight. Okay. Say tonight.
Speaker 3:You go home and you go, okay. I'm gonna have, you know, French fries and a Coke and all this stuff. Your your insulin's high all night. So all night your insulin's high. And so what it's doing is grabbing that sugar and and shoving it to the other place, shoving your liver, shoving it to all your tissues and all that.
Speaker 3:So finally by morning, it says, oh, okay. Good. I'm I'm starting to I'm starting to get caught up. And then you wake up. Say you wake up and you have pancakes and syrup for breakfast.
Speaker 3:Your sugar goes up. Insulin goes back up. So glucagon never gets a chance to work. So let's do something else. So let's say tonight we had steak for dinner.
Speaker 3:You I know you guys had steak for dinner probably. Right? You have steak for dinner tonight? Yes. Yes.
Speaker 1:We were we were, turning the fire alarm off right as we started the
Speaker 3:Oh, is that right? So yeah. So so you have steak tonight. Guess what? Your insulin's low already.
Speaker 3:So what what happens when you're sleeping? Uh-oh. You didn't put sugar in your system. You're gonna get low sugars overnight. But glucagon says, okay.
Speaker 3:You know what? Sugar's starting to go a little low. Let me just release sugar all night while you're sleeping. Right? So while you're releasing sugar, your sugar's low, low, low, your insulin's low, and everyone's happy.
Speaker 3:Then the morning, you get up and go, oh, I don't have time to eat this morning. Glucagon keeps working. It keeps kicking out sugar. Fast so you don't drop your sugar to zero when you're not eating sugar because your body has an ability to kick it out. But if you're a person with really high insulin levels, you may not lower it all the way in the morning and you still can't get your fat source to release that extra sugar.
Speaker 3:So you really are getting hypoglycemic and not feeling great. So the key is really give yourself enough to eat so you have energy and then lower that insulin level down. Right? So if you have low insulin, you go, okay, glucan will let me run on, you know, you know, some of these runners, these long distance like Zach Bitter runs a hundred miles right low carb because he can run on his fat. So he's so efficient.
Speaker 3:The guy weighs a hundred and fifty pounds or something and he's all muscle and he just runs forever. He doesn't have to eat goo and candy and all that stuff while he's running, you know. So that's it. So in a nutshell, that's basically it's hard to explain but basically saying, hey, look, you wanna have a balance of getting your your your insulin low. And and one thing that, you know, what we're seeing and and and it may be a factor down the road is some people control their insulin so well that their insulin goes so low that all of a sudden they start getting their sugar start going up.
Speaker 3:Right? Even Sean Baker, sugars will go up. Why? Because he doesn't have insulin to turn off glucagon because glucagon is releasing sugar. So that's like type one diabetics.
Speaker 3:That's their problem. It's not so much that you could be a type one diabetic and never eat any carbs. But because you don't have any insulin, glucagon's always kicking sugar out of your sugar stores. So your sugar is always gonna be high unless you shut that off. So that's why when someone goes into it, like, the first time they get diabetes, they have they would call it diabetic ketoacidosis, meaning they they're just releasing sugar all over the place.
Speaker 3:All that sugar they stored for all these years is now coming out. And so that's why, you know, looking back and you look at, like, some of these guys like, Ben Bickman from BYU, he has graphs of all this stuff. So your insulin goes up and up and up and up, and then all of a sudden you can't keep up anymore, it starts coming down. That's when you get diabetes. So for ten years before we get diagnosed, our insulin goes higher and higher every year.
Speaker 3:More insulin resistant. Right? So what do you do? You wanna lower that insulin down by putting on muscle mass, getting enough sleep, you know, doing what you guys are doing. So that's why a lot of people, are looking at the carnivore diet and looking at lower carb diets because they realize, oh, I'll keep my insulin low.
Speaker 3:Right?
Speaker 1:Yeah. You mentioned, you mentioned time restricted eating there. How does that play into some of this? Because I do I've used that personally as a way to sort of kick start some of stuff. Some some of, like, dieting things.
Speaker 1:Like, if I've, you know, had a few days where I had had some junk food or whatever, needed to get back on track. Fasting has always been a great way for me to just get back on track. I'm curious what you've seen in terms of, like, lab results or patients, who who have used it as as a helpful tool.
Speaker 3:Yeah. And, I mean, lab results get better. Everything gets better. But, acutely, it gets worse. Right?
Speaker 3:So if I took you guys and I said, okay, we're gonna fast you for four days, and then we're gonna check your lipids. It would look terrible. It would look terrible. You'll see it's surprising. Like, you know, it it's amazing because fasting I had a guy as a matter of fact, I'm looking at his labs going, what the heck?
Speaker 3:I'm looking at his labs thinking, man, like, something's not right because I know what they should look like. On low carb, keto, low carb, carnivore, you're gonna drop your triglycerides like crazy. Your HDL goes up. LDL, it depends on where you're at. Metabolical, it can go up and down.
Speaker 3:But generally, you're gonna see triglycerides drop like crazy. And, and LDL doesn't do crazy stuff. But if you're actively losing weight, your LDL goes up. That's why I don't like to check it right away because it's gonna freak you out. Like, you go carnivore, your LDL is gonna go way up because you're losing weight.
Speaker 3:But if you did two or three days before you had your test done, if you ate cookies and donuts over the weekend, believe it or not, your LDL will drop like crazy. Right. Because it's it's shifting it back to the cells. So I have sugar to run on. Okay.
Speaker 3:I'll put the fat back in the fat cells. So all you're doing is seeing the transition, and and Dave Feldman has brought this to our attention like no one else. He's done amazing work, but showing if you fast, your LDL goes up. It does. So is that dangerous when you're not eating anything?
Speaker 3:You're not even eating any cholesterol and it's going higher because your body's releasing it. So I've seen I could tell you, you know, you guys would be interested because you're athletes, but I I've seen, you know, CrossFit athletes with crazy LDL cholesterols and crazy a one c levels. Sugar's high. Everything's crazy. I was like, what do I do?
Speaker 3:I was like, okay. Let's cut back on the exercise a little bit, and let's liberate liberalize your carbs a little bit, and their their numbers normalize. Because they're just they're so thin that they're just pulling fat from wherever They can't shove it into the bloodstream. And I'm looking in your bloodstream, that's what I see. Right?
Speaker 3:Instead of looking at the whole body stores of everything. So, yeah, it's amazing. It really is amazing what we see on labs. So one of my guys' labs were crazy because, you know, I go, did how long did you fast for it? He goes, oh, like, three days.
Speaker 3:I was like, oh, sheesh, man. No wonder your LDL was through the roof because you fasted for three days. Like, let's do it again and have you eat normally, and then just fast overnight, and his LDL totally normalized again. In the same week. It wasn't like he waited a month.
Speaker 3:It was the same week. So you can make that. And that's why I was saying, well, we're basing lifelong treatment on one lab test because it could change drastically if you're sick or you're tired or you're stressed and all these things can make it you know, it's funny. Like, after the Super Bowl, people's triglycerides, I've seen it so many times. These young guys come up like, your triglycerides are like 600, man.
Speaker 3:There were a hundred last year, now they're 600. Then he goes, oh, you know, I was at the Super Bowl party. We had guacamole and chips and, you know, drinking beers and tequila or whatever. So you go, okay. Let's wait a week and re and you recheck in a week, it's a hundred again.
Speaker 3:It's amazing how, like, acutely that happens.
Speaker 1:So what's, as a doctor, like, the normalizing the the blood glucose or or normalizing the lab results to make an accurate read is obviously important so that you can give the right advice. But at the same time, at a certain point in time, their blood work looks terrible. So how do you make that call?
Speaker 2:Like, is it
Speaker 3:I I think experience when you look at it, you know what's gonna happen. You know, let's give it three months. Let's take another look and see where you're going. Because it could be the person's cheating. Could be, you know, there's a lot of confounders that can happen.
Speaker 3:So I think just being patient looking. And and if I have someone if I have someone who's lost 30 pounds, I expect their LDL is gonna be crazy. Their triglyceride is probably gonna go down. Their HDL is gonna go way up, but their LDL will go up. And once they stabilize their weight, the LDL goes down because now they're not pulling so much fat out of their fat.
Speaker 3:They're living on their fat, so you're burning stored energy. So you have to realize liver tests can get crazy at the beginning. Right? So that's why I told people, look, if you check-in the first six weeks, it's gonna look crazy. Let's just wait three months and check it, or or six weeks at least, and see what they look like.
Speaker 3:Or once your weight stabilizes, because a lot of people in the initial stages, what they're doing really the way like when people go, yeah, I lost 10 pounds on keto the first week. Well, usually, that's because you're dropping water weight because high insulin level there's a lot of stuff that we're seeing that that is amazing, but high insulin level makes you hold on to salt. Insulin acts on the kidneys to make you hold on to salt. So when they say, my doctors tell me to get a higher fat diet and eat more salt, everyone goes, this doctor's crazy. But the point is when they're eating a higher fat, higher protein diet, they're dropping their insulin level down.
Speaker 3:When you drop your insulin, what do you do? You pee out the extra salt that you're not holding on to anymore. So the biggest thing we see I mean, I see that's why I like to monitor, you know, blood pressure because people feel terrible and you think, oh, the keto flu is like, oh, your blood pressure is 80. You're on three blood pressure meds. Let's start getting rid of those.
Speaker 3:This is the deprescribing. This is how we can do it because we can monitor and go, look, your blood pressure is, like, it used to be a 80. Now it's, like, less than a hundred. We gotta fix that. Let's get rid of meds.
Speaker 3:Right? And so that's and that's what else is interesting where people get sugar cravings like crazy, on a low carb diet. And sometimes what we do is we say, hey. Eat more salt and see what happens. Like they add salt to their food and their sugar craving goes away.
Speaker 3:They go, what why is that? Well, because your body knows if you eat more sugar, it spikes your insulin. Insulin makes you hold on to salt. Right? So your body really wants more salt and so you're raising your blood pressure by eating more sugar to raise your salt.
Speaker 3:Right? So when they say, well, if you have high blood pressure, don't eat salt. Well, it depends. Where's your insulin level? And they don't no one checks an insulin level.
Speaker 3:I'll tell you that that's frustrating because if you look at cardiovascular risk, all those things, high insulin level is a huge, huge indicator. It's like a it's like a flashing red sign in front of you. So if you have really high insulin, you're in trouble. You could look great. But if I see someone with high insulin, like, we gotta fix this problem.
Speaker 3:That's the big problem we gotta fix first and we worry about all the other stuff later. Yeah. You know? We talk
Speaker 1:about that. So in just in terms of practical advice, like, the sodium level when you go low carb, like, it's so key.
Speaker 2:It's huge. Yeah. We we both know especially with the running that we do, if I ever if I ever have a period where I bring my carbs up too much or I'm eating a little bit crappy and then I try and go low carb, that's the first thing that I notice is you almost feel I feel a little bit more fatigued than normal on my runs. And then if I start mixing in some of those elements or sodium packets, it really starts salting my food a lot. I notice a massive difference.
Speaker 2:It, like, it just balances everything out.
Speaker 3:Yeah. And and I think that's true. And for me, you know, I have to look at it because I'm I'm born I'm naturally insulin resistant. I gotta put on muscle mass. I'm I'll gain weight so fast on a on a on a high carb diet or even moderate carbs.
Speaker 3:So I know that. But for instance, on Saturday mornings, I go ride my ride bikes with my buddy and I'll do an element. Right? I'll take it with me. But if I do that and they go in the afternoon, oh, you know, maybe I'll have another one.
Speaker 3:I've done it, man. My my ring won't come off. My hands are swollen. It's too much salt for me. But for you, you you could have two or three packets of that and you're good.
Speaker 3:So just kinda saying, okay. Where do I feel good? And, you know, so then I'll just have more water in the afternoon, not add more salt in necessarily. Right? So yeah.
Speaker 3:It's it's all and a guy like you who's sweating out a ton of salt, like, working really hard is gonna be totally different than someone who sits at their desk all day. And that's what I kinda come back to and say, okay, what's the best approach? What works for you? If you hate steak, I'm not gonna tell you to be carnivore. Right?
Speaker 3:And I just had that conversation with a lady, and she's vegan, and she's super cool, and it's not for, like, ethical reasons necessarily. She doesn't like the idea. And I talked, I go, why is it explained to her? Because I like to know get in people's brain and say, well, why why while I was having health problems, I was having different things. And and, she I don't like the idea of of, cows that are raised, like, cramped together and, you know, chickens in a in a in a warehouse.
Speaker 3:And we're like, yeah, me either. I'm totally with you on that. I like to have, like, a local guy who raises animals. Right? Like what you guys did.
Speaker 3:Right? Going to the farm. I mean, gosh. What's the name of the movie? Sacred Cow.
Speaker 3:Excellent. I mean, you watch that and you go, wow. That's how it should be. Like, the cows are out there doing their thing, and then they they go to the bathroom, and then they can grow stuff there. And then, you know, how it all works.
Speaker 3:Like, if you overstrip the land and you make it so crazy, you know, I think we all agree on that. Say, hey. You wanna have ethical treatment of animals and you wanna have them out in the pasture and having fun and doing their thing and, you know. And so, for her, she goes, yeah. I'll have salmon.
Speaker 3:So I'm like, well, that's cool. If that works for you, good. Like, eggs. Like, you know, you figure out what works for you and not say, no. You have to have this.
Speaker 3:You have to eat sardines five times a day, and that's it. You know? And so I think being militant on stuff, we're saying you'll never have a piece of bread in your life. It's like a guy's like you is like, go for it. I wish I could get away with it like you could.
Speaker 3:Right? Big deal. It works. Yeah.
Speaker 2:And to that point, do you have any recommendations on just blood work or markers that people should have insight into to understand maybe what foods they can get away with or their sodium levels or I don't know if it's testosterone. Are there anything are there any main points that people should really look into or have good insight into with their markers?
Speaker 3:Yeah. I'm pretty much a minimalist on initial labs a lot of times because I go, okay, look. I know what the big problem I'm I'm worried about, hormones, all that stuff tend to solve themselves. Right? But high insulin level is a big issue.
Speaker 3:Thyroid being out of whack. And and really, I've learned a lot from people recently, t three and t four, looking at those as factors. Like, you know, I've had endocrinologists tell me, oh, just TSH matters. Well, I'm telling you, if you're super stressed, you have high cortisol levels levels all the time, you can have normal t TSH, normal t four, and your t three is in the tank. And that's where you get your energy and your focus.
Speaker 3:And so I've had people, I go, let's just add a little of that and see what happens. You're a high stress. I mean, trust me. I mean, stuff makes me rack my brains. And what makes me rack my brains the most is when I see, like, a a middle aged stressed out, right, professional female.
Speaker 3:Like, is so stressed about her weight and she wants to lose weight so bad and she doesn't lose weight. She's stressed and tense and she can't plan ahead and she's like, it's just constant add like weighing yourself five times a day. Relax. Let the pot boil a little bit. Chill a little bit.
Speaker 3:Just feel better. Yeah. Tone into that. Get enough sleep. Watch your stress.
Speaker 3:And so that that's a huge factor with cortisol and all that. And I typically don't check it right away unless we're we're, like, going, what's going on? But, yeah, Fasting insulin for sure, a one c, three months sugar average so we can compare those two together. Lipid panel, you know, just to see where we're starting and we could follow that over time. I like to get an inflammatory marker like a CRP, c reactive protein.
Speaker 3:If my patients can afford, I like to get a coronary calcium score to see where they are as a baseline before we start because, you know, if you go carnivore, you wanna know what's happening because sometimes I'll get people say, what do you think my coronary calcium? Like, I don't know because it I don't know what it's been for the last ten years. It could have been like this for ten years. You haven't progressed because progression is the issue. Right?
Speaker 3:So we need to have data. And and Dave Feldman and Sean Baker, they're doing great work looking at this. Say, let's look at it and see. Maybe we reassess what we're doing. But having a baseline coronary calcium score, hormone levels if needed, you know, if you have normal menstrual cycle and everything's normal, I don't go too crazy on the hormones because it's not my area of expertise.
Speaker 3:But, you know, blood counts, liver, kidneys, electrolytes, you know, those kind of things. And and magnesium is a useless test for a blood test. I just supplement people on magnesium generally because most of it's intracellular. So you have to be really, you know, depleted. But some of the signs of low magnesium, people get palpitations, they get anxiety, constipation.
Speaker 3:They're not sleeping. Say, let's give you a little magnesium. They're like, oh, I feel good now. Right? Little things like that that people d three, you know, I I I I don't check it very often just because it's so expensive.
Speaker 3:You know, my cash pay allows, like, for an insulin level is $12.95 in my when I order it. Right? It's not a lot. But in, vitamin d is, like, sixty six dollars or something. Cash pay, like, if you go to a regular lab, it's, like, a hundred and something bucks for, just you could take vitamin d the rest of your life and go out in the sun and go do stuff unless you're worried about overshooting it.
Speaker 3:Right? But those are the main ones really. Just the the routine labs and and, you know, sometimes testosterone guys, they're they'll be interested in in in that. But, but I think the the big thing is really I'm looking at insulin level, three months sugar average, and metabolic stuff. You know, looking at kidney function, liver test, and all that.
Speaker 3:Liver function test for sure because, you know, a lot of people come with crazy liver test after a few days on as a matter of fact, one of my patients, we just talked about it. She, you know, her doctor is all like, when she said she was doing low carb, the doctor's like, you're crazy. You already have fatty liver disease. It's gonna make it worse. I can guarantee you it doesn't.
Speaker 3:We have tons of data saying it doesn't. High carbohydrate diet makes it worse. High sugar, high fructose, corn syrup, all those things are gonna store in your liver and cause fatty liver. So if you eat a lot of fat, you're gonna get subcutaneous fat. Yes.
Speaker 3:Way more. But, you know, look at the liver fats, but we're worried about metabolic health. So it's, you know, it kinda tells you. And the insulin level tells me a lot because your insulin's normal and your a one c and all your stuff's normal. It's like, okay.
Speaker 3:You don't have to be radical on your carbs. That was more of a calorie problem
Speaker 1:Right.
Speaker 3:Probably. Right? Like that lady we were talking about earlier, she's it's more of a calorie problem. It's like you can't just binge eat at night before you go to bed. Right?
Speaker 3:It's not doing you any good. So those kind of things we have to monkey around a little bit. But, yeah, I don't think you need an extensive lab. But the other thing I don't I'm telling you, this is I I think this is a really right now, I'm really pumped up about this. And and, Brett, we talked about it too, is, I'm really, really interested in looking for parasites.
Speaker 3:Right? A lot of people, like, they're talking about up to seventy percent of The US population. Right? And I've seen some crazy stuff with eczema getting better. And and I'm I'm kinda dry.
Speaker 3:My job is to observe stuff and go, why is that happening? So if you listen back to the Low Carb MD podcast from the beginning, I say, you know, the dang carnivores, they're happy. They're happy. I've seen people that majorly depressed, you know, major, like, major depressed. Like, I've I've interviewed them and they go, oh my gosh.
Speaker 3:My life, 80 degrees changed. I'm like, why is that? Why is it that they're happy? Why is it that they're enjoying life and their joints are hurting? Their stomach's getting like, well, your stuff, the intestines getting better.
Speaker 3:Like, struggle with stuff your whole life and it go gets better. And so I'm wondering how much this has to do with the gut flora. Right? How much it has to do with the microbiome and just taking out the pros I don't know if it's taking out the process junk makes your brain work better. That's part part of it.
Speaker 3:But it might be that your gut microbiome adjusts to what you're eating, and I think that's more likely what's happening. And so, like, in your case, Brett, the reason I I was intrigued because being on what we're treating Crohn's disease and ulcerative colitis, all these conditions is with immunosuppressants, rheumatoid arthritis, all these autoimmune things. Like, once we have something in your gut that's causing all this inflammation and you're trying to knock down your immune response to something that's causing the problem, the root cause would be get rid of the inflammation. Right? If you're if you're if you're, you know, ripping your scab off all the time, I say stop ripping the scab off and let it heal.
Speaker 3:So that's interesting to me because I've seen I've found enough people now with that have parasites. And we treat it, and guess what? Their eczema goes away. And I had a I have a mold allergy, and my mold allergy is I think it's gone. I don't know.
Speaker 3:I haven't experimented much, but treated for a parasite that I got when I was doing medical work overseas, probably. And, now my other symptoms got better. You know, it's kind of a crazy thing, and you think about candida overgrowth, and you wonder, like, why is it that the carnivores say they don't crave sugar anymore? Once that they start out candida in their gut, and the candida was giving off messages to make you eat more. And then they go on, they go, okay, Christmas time, I'm gonna eat bad stuff.
Speaker 3:And that's hard to get back on track. Why is it so hard to get back on track? Right? You guys know what to do. It's like, could it be that they're they're giving you a little envy?
Speaker 3:When you start I mean, if you there's actually a a a some YouTube videos on parasite parasite experts and, like, oh my gosh. It is crazy, like, what they can do to to the human physiology. To us, it seems like we're talking about aliens or some crazy stuff. But, you know, it's more common than we think, especially if you have pets and animals and you swim in a lake and you do whatever. You could pick up some crazy stuff, but we we're just not but the reason I'm in tune to is when I go to Guatemala, I treat people all the time.
Speaker 3:When I'm in in the jungles, like, these kids are weak and they have asthma, and I give them one pill of albendazole or something or, you know, ivermectin. I don't know if we're allowed to say that anymore. But we would give them that in the in the third world, and these kids get better and their asthma gets better and their allergies get better. I'm like, what the heck is this? I would give them one pill and it's good for a year.
Speaker 3:And they're like, yep. It's good for a year, doc. When you come back next year, give them another one. I'm like, wow. And they're drinking out of ponds and they, you know, so it's it's pretty wild.
Speaker 3:Yeah. I was
Speaker 1:gonna ask you, what do you attribute the the collection of parasites from? So but it sounds like just kind of being outside doing things that you
Speaker 3:Yeah. I mean, it's crazy. You get it from anything. You can walk in dirty and get it and you're thick. Some can go I mean, it's I was just talking to as a matter of fact, at lunch today, I talked to a parasite expert because I'm like, tell me about this stuff.
Speaker 3:I'm intrigued by this. He goes, yeah. He goes, you wanna believe you could get it just from food. Like, you eat food and someone has a problem. As a matter of fact, I'll tell you, going back, I was like, we had a new puppy and I'm like, I'm at work and I'm just not feeling great.
Speaker 3:All my stomach is blown. I'm just and I I have a rock stomach. I never have problems. And I was like, this is the weirdest thing. I feel like garbage.
Speaker 3:And I was blown. I just felt like anything. I'm burping all the time. Like, what is wrong with me? I'm trying to figure out.
Speaker 3:I'm like, if I didn't know better, I would say I have giardia. I'm telling my partner, I go, I think I have giardia, man. I go, I haven't been hiking. I haven't done anything. I had to pick up giardia.
Speaker 3:I feel like that. It's just like this it's a nasty thing. And so the next day, my wife calls me. He goes, hey. Guess what?
Speaker 3:I got the dog has been having loose stool. Guess what? The dog has giardia. I'm like, oh my gosh. I got it from the stinking dog.
Speaker 3:Right? The dog licks your face and they have giardia. The dog was, you know, the it was a puppy and she was grow she, you know, they she was born on a farm. And she she she's drinking out of the old buckets that are sitting there and they get all the water and they get giardia then they give it to you. So people don't realize those things happen, and it sounds so crazy.
Speaker 3:But I'll tell you, I that I I'm telling you, it's just funny. Because I I really started looking at this in the last month or so, and I found about 12 people with major parasites that we treated, and they got better. One guy had chronic constipation. He's 80 years old. And, anyways, he he had he had he had a I'll tell you this story because this is true.
Speaker 3:He he he went he got vaccinated. He was fine. He's he's golfing three times a day, super fit. Then all of a sudden, he goes, doc, I can't bend over to get my golf ball out of the hole. I fall down.
Speaker 3:I'm dizzy. I got all kinds of stuff going on. So I go, okay. We gotta figure this out. Send him to neurology.
Speaker 3:They started getting a rash, and then his constipation got worse. And I was like, oh my gosh. Let's so I started thinking, once if your whole immune or if you get sick with something and your whole immune system looking for that thing and it forgets about that parasite that's been sitting there for ten years or fifteen or twenty or thirty years. Right? Once that starts to rear its head again because you can't fight it efficiently.
Speaker 3:So I go, you know, this is gonna sound crazy, but why don't we just check you for parasites? So we check them, comes act positive. I treat them. And I just talked to him yesterday, and he goes, hey, doc. You know my chronic constipation?
Speaker 3:My bowels are normal. For the first time in fifty years, they're normal. He said, I don't even wanna say anything out loud because I can't believe it. His neurologic stuff hasn't improved much yet, but he said, my stomach is a hundred percent better. He goes, it's and he goes, I can't believe it.
Speaker 3:It's normal. Right? And then so other people I've had talked to and and I've had similar stuff with eczema going away. And and I've seen it. You know, carnivore diet, I've seen lifelong eczema go away.
Speaker 3:One of the residents who've rotated with me, he had eczema like crazy. They had he did all kinds of crazy stuff gone. You know, Sean Baker post these picture. You look at him and go, how can that be? You know, but it's kinda cool.
Speaker 3:You know, it's kinda cool. And you don't know if it's just taking away an irritant or whether the the meat is providing some kind of nutrient that we're missing. I don't know. I mean, that's why we have to look at this stuff and try to figure it out. The the information The
Speaker 1:disruptive that if you can get on that consistent diet that you're feeding yourself something similar, it it allows your body to find that equilibrium. At least that's, like, my Yeah. For personal, like, you know, practice experience. It's like, once I am consistent with it, then you really start feeling amazing. Mhmm.
Speaker 3:Yeah. I think that's it. It's it's getting through that really tough part. That's why I told people, I go, look, this is an upfront investment. Because once you get yourself metabolically healthy, you can get away with I have people, like, that's why I love it because I have people right now.
Speaker 3:They'll go, hey. Find where I eat this thing. And and a year ago, I could see it right away. I'm right here. You ate it right here.
Speaker 3:Like, one of my guys at mimosa he had on on his anniversary. Right? Mimosa, it was like sugars worth like $3.20. It was and he's diabetic. I'm like, oh my gosh, man.
Speaker 3:You can't have mimosas anymore. So he hasn't had mimosas in a year. And now all of a sudden his anniversary, I'm like, oh my gosh. It's a good thing you didn't have mimosas this year. He goes, I did on Sunday.
Speaker 3:I go, you did? And when we look at him, like, where? What time? And we it barely barely blipped. Barely.
Speaker 3:So it's a huge because he now his truck was empty. Now he could put stuff in his truck. He can't keep putting his truck in stuff in the truck anymore. Right? So his truck was empty enough.
Speaker 3:Like, I can tell when someone's truck's emptying out because I see their their sugar tracing start changing. And so I have guys that can eat, like, metabolically healthy. You won't believe it, man. I have guys that eat one of my guys eat a ice cream sandwich the day before he saw me. Nothing.
Speaker 3:Nothing. And but I have been the lady, she's doing all of her stuff. Everything's good. Her sugars are perfect. The day before she comes to her, her sugars goes to, like, two sixty or something.
Speaker 3:Like, she runs at seventy and eighty all the time. Like, what the heck was that? She goes, well, she's new and she goes, I wasn't thinking my continuous glucose monitor was working because it was so flat. After she changed her diet, she said, I had 10 hot tamales. And it shot up like nuts.
Speaker 3:But it was by itself, like, in she goes, I was just curious to see what it would do. And she goes, I couldn't believe what it did. And I was like, oh my gosh. I used to go to the movies, and I would say, oh, it's low non fat. Give me some hot tamales.
Speaker 3:I would just eat the whole thing of hot tamales. Like, oh my gosh. I can't imagine what my sugars were doing back then. Oh, yeah. Right?
Speaker 3:You have a slurpy and hot tamales? Forget it, man. I'm not in empty. But if she would've but again, if she would've had a steak and then the hot tamales, I wouldn't have seen it. Interesting.
Speaker 3:Because it would've slowed down the release of that sugar so quickly. So it's the it's not necessarily the sugar. It's the fast release of sugar that screws us up. That's when your body freaks out and overshoots and does all this crazy stuff. So if you slowly release it, it's gonna be better.
Speaker 3:Right? So when they talk about slow carbs or if you're having sweet potatoes, in in you guys' case, if you're having sweet potatoes rather than having French fries, it's gonna be a totally different response.
Speaker 1:How much do you love these continuous food monitors?
Speaker 3:Man, I I love them, man. I love it especially because I was at a medical conference. Mark Mark Cuquizelle is the guy actually. He's he's, you know, a tryout. I mean, this guy's a super skinny runner.
Speaker 3:He's fit. But he had diabetes before. He reversed all of his stuff with low carb. And he goes and and he asked me I gave a talk on the and I would really focus on the CGM stuff, and he goes, Brian, do you think it's really necessary for guys like guys who've been doing it for a long time? And I go, you know, I think it's helpful because I've been tricked a few times, and I think it's good to know because certain things you don't know, And then you look back, like, there was a drink that I had that it it it was Perrier.
Speaker 3:I'm like, Perrier energy. I'm like, oh, cool. Okay. Perrier. They probably put a little caffeine in there.
Speaker 3:I don't realize I'm looking at my sugars. I'm like, why is my sugar spike every day at lunchtime? And then my my office manager goes, well, Brian, you're drinking that drink that has sugar in it. I go, what the one? She goes, the the Perrier?
Speaker 3:I went, Perrier with sugar in it. This is Perrier water. She goes, no. It's look. I'm like, scrub, man.
Speaker 3:So that was what I was doing. So I wouldn't have known. I could have drank that for a year and not know. I go, oh, I'm just doing something healthy and not know. But but Mark, the next morning, we we were at a low carb carb conference and there was this really good looking chocolate cake.
Speaker 3:And I said, well, I'm gonna have a couple glasses of low carb wine so I'm not gonna have dessert. I'll have that. I picked my poison. Right? So he goes, did you have any of that cake last night?
Speaker 3:I go, no. Why? He goes, look at my sugar. They didn't want 200. Right?
Speaker 3:So it wasn't low it may it may have been low carb, but the the people making it thought it was low carb, but it could have had tapioca flour. It has something in there that's not low carb. So all the time, people say, oh, but I'm eating the low carb cereal. I'm like, did you see your sugars? This is not low carb cereal.
Speaker 3:That's not look at your sugars, like and you and they can see it. So a lot of times people will notify, and they'll come to me and go, oh my gosh. Look what happened. I had this, and they don't like, one guy, he's perfect. All of a sudden, it spiked like crazy.
Speaker 3:I'm like, what the heck did you do on Friday? Because he's killing it. He's doing so well. And he goes, I had a salad. I had a salad for dinner.
Speaker 3:And he goes, my wife mixed together a bunch of salad dressing. I just put it so it could be the seed oil, could be there's sugar in one of the dressings or whatever. And he goes, it wasn't even that good. And he goes, yeah. I know.
Speaker 3:I coulda had something better. Right? So then you see it. They go, okay. I'm not gonna have that salad again.
Speaker 3:So you can make choices based on what you're seeing. So a lot of people are having these low carb bars, and they see their sugars go crazy. Half a bar, quarter of a bar, and then you go, okay. It's not worth it. You know?
Speaker 3:So that's good too. There's a lot of stuff that right now when things start to be more popular, they everyone's gonna jump on the bandwagon. This is keto. Well, it's not keto because look at it. Like, look at all this stuff in the back.
Speaker 3:They'll go, if you have one piece, it might be keto. Right? But no one eats, like, one chip. They're gonna have, you know, 10 of them. There's, like, 300 carbs.
Speaker 3:You're like, okay. That's not a very very good idea. You know?
Speaker 1:Yeah. Absolutely. And, you know, I I think we've we've covered a lot of ground today, and may may we we call it there and and set up a part two because this has been so fantastic. And I think we've both gotten a lot out of it. So may we hit the pause button and, shut this one down.
Speaker 1:So, doctor Brian, thank you so much. Appreciate you for coming on, and we'll get you going again soon.
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