From Overweight Doc to Svelte Low Carb MD Changing Patient's Lives: 27

Hey everyone, welcome back to the Heal, Nourish, Grow podcast. I know I say this every time and I'm going to say it one more, but I am so excited about my guest today. I just had a little fangirl moment before I hit the record button because I have been listening to Dr. Lenzkes for the last, I don't know, probably ever since they started the Low Carb MD podcast, which was I believe in 2018 along with Dr. Tro. Um, but anyway, today I am talking to Dr. Lenzkes and he is going to share with us some of his personal health history, which he has talked about on Low Carb MD podcast, but not for a long time, I think, really in, in detail. And also some of the cool and exciting things that he is doing in his primary care, direct care clinic to really impact and change people's lives with low carb. So, uh, Brian, welcome. So happy to have you here.

Yeah, thanks for having me. It's great to be here. I can be a fanboy here too of you and what you're doing. I think it's so great because You know, it takes all of us. We're all going to have a different message or a different tone or what we focus on. So it's so important. I love having more and more podcasts where people are trying to help people, you know, I think, you know, from all different areas. I think there's too much infighting and conflict and all that kind of stuff. We, we all have to support each other at some point, you know.

Oh, couldn't agree more. And, and that's, I sometimes I feel like we're preaching to the choir, right? Which is why I didn't want to put low carb or keto in the title of my podcast, but Obviously, it's a big focus of my interest in my work. So while everybody has heard your bio that I kind of read before, the very standard bio, can you just give some color to that and share with people a little bit about your personal health journey and what really led you to get into this low-carb space?

Yeah, you know, for me growing up, I, I was overweight as a kid. I'm giving a talk coming up in Salt Lake City, and, and I was looking back at old pictures like, wow, you know, you start out and, you know, you're eating terrible food, latchkey kid, you know, family, you know, parents divorced at a young age and all that. And you wonder how much of an impact now going back, because there's a lot that we look at is— and I had a pretty good childhood. I didn't have childhood trauma, abuse, that kind of stuff. But, you know, when you have a, you know, broken up family, dad's in another place, going back and forth, all this, you know, this kind of chaos I think contributes a bit. So, you know, growing up, I'd come home after school and we'd just see what's in the, you know, what kind of cereal there is. And you know, we were all doing low fat. So we had Entenmann's cakes and, you know, all this kind of stuff. And so as a kid, I was always like struggling, even though sure, I was trying to make weight for football when you're in Pop Warner and all that kind of stuff. And then over time, I, you know, in high school I started wrestling and played football and I would, I cut a ton of weight. I started losing weight, stretching out, hormones, all these kinds of changes. And then after that, and then in high school I played football. So I'd have to get up to like 205 to play nose guard in the defensive line because I'm like 5'8" and I'm playing with guys who are 6'6", you know? And so I had, I couldn't lose my size. And then wrestling, I wrestled at 165. So I would lose and gain 40 pounds between seasons. So that was the unfun part of my life at that time because I'm like, oh, everyone's going out for pizza. I'm like, no, I'm going to have some sardines or something, you know, run and sweat and go in the sauna and do all this crazy stuff. So I always assumed that messed up my metabolism. So after high school, I started gaining weight. And then, you know, college, you gain that freshman 15, and then, you know, residency and med school and all this kind of stuff. And all of a sudden just started piling on. And my mom's side of the family is a disaster with heart disease. You know, all my uncles died at young ages having strokes and heart attacks and diabetes complications. And they just lived their life. And, you know, it was all revolving around food and drink and parties, right? And my dad's side was very healthy. So I was looking saying, gosh, I'm kind of, I got my mom's genes. My mom's 4'11". So I like, she ruined my football career. But, and my dad's like 6 foot, 6'1". So, you know, anyways, I started realizing, oh my gosh. And then I started practicing and then I, you know, certain things I realize, I observe a lot. And in residency, I knew when I was up, you know, until 2 in the morning stressed and, you know, you're sleep deprived and then you're getting up at 4, you know, sleeping for like 45 minutes or an hour. The next day I was starving all day. And I remember telling my wife at the time when we were, actually we were married, is like saying, hey, I know there's something to sleep deprivation and being hungry all the time and stress and being hungry all the time, because I'm starving the day after the other times I'm fine. But after being on call all night, I don't know what it is. And now we have tons of studies showing, yes, that's in fact the case. If you're sleep deprived, stress beat up, you know, it stimulates the hunger center. So, you know, as a doc, I start gaining weight and I'm working out. I've always worked out my entire life. I'm working out 5 or 6 days a week and I'm gaining weight and gaining weight and gaining weight. And I'm doing the ADA's diet and green shakes. My wife's making me, you know, smoothies for breakfast and all this. And I realized, uh-oh, I'm insulin resistant. So I was actually— the ultimate thing was—

I'll just back you up for one second there. First of all, what, what kind of like— there was— there a light bulb moment where you suddenly realized? Was it something that you were seeing in your patients and you're like, oh crap, that's actually what I have? Or how did you kind of get to that realization? And if you could maybe just give people a little sneak snippet of what insulin resistance is just for people that aren't as familiar with it?

Yeah. So, so really that, that's kind of what took me down the road is observing patients. Because for me, I have to look and see what's working and not working. So I know, I don't know how many years I would have an overweight middle-aged female bring in her husband, go, you need to talk to my husband. He's not eating right. And I go, what are you doing? He goes, yeah, he's a construction worker. And he goes, doc, I'm not hungry for breakfast. I don't eat breakfast. And then at lunch I'll, I'll grab a sandwich or have something. And then I have a dinner. So he's eating too. So he's basically doing intermittent fasting. All of his labs are normal. His A1C is normal. Everything's fine. I'm like, well, maybe you should start doing what he's doing. And, but you don't think that you say, well, you know, if you skip breakfast, that's the most important meal of the day and you're gonna shut your metabolism down, all this stuff. I'm telling this as an overweight doctor to my skinny patient who is fit and healthy, right? He's exercising. He's eating 2 meals a day. He's, he's doing intermittent fasting naturally. And so it's working for him and, and all of his labs, everything's normal, cholesterol, triglycerides, everything's fine. So, you know, so what happened with me, I was gaining weight. I'm thinking, wait a minute, I'm doing the ADA diet. I'm doing green shakes. I'm doing stuff. I'm having like Melba toast with no butter on, you know, that kind of stuff and rice crackers and living on this stuff. And then one of my patients comes in who I've been taking care of for years and he lost like 20 pounds. I look at him like, what's going on? Like, first thing we think of is cancer or diabetes, right? Especially in a middle-aged guy or, you know, he's like not middle-aged anymore, like in his mid-60s and all of a sudden loses 28 pounds or something like that. And he said, well, I'm doing this crazy fast diet. And then, you know, I fast 2 days a week, 500 calories or less. And I said, oh, what about the other days? He goes, I eat whatever I want. But I said, yeah, if you fast on Tuesday, you must be eating everything on Wednesday. He said, no, the weird thing is I'm not hungry the next day. Well, that doesn't make sense. You're not eating. You should want to eat twice as much if you haven't eaten the day before, basically.

Right?

So I started looking at who did I come across? Jason Fung. And I see this guy and I'm like, what is this guy selling? And at the end of the video, he's not selling anything. And he says, look, intermittent fasting, this works. I'm like, how's intermittent fasting working? It has to be calories in, calories out. Like we all know, right? Like you're taking in less calories, obviously. But then I started looking at it and I say, oh, there's physiologic effects of insulin. And so I actually reached out to Jason Fung and he was very cordial and said, hey Brian, look, check your, these pre-diabetics, look at their insulin level and see what it looks like. So then, so insulin resistance in a nutshell is basically saying, look, if you think, think of it in terms of a moving van, if you have a moving van and you're moving, which I had to do a lot during my residency when we're trying to find the cheapest place to live. You know, you have a moving van at first, you go, oh, this is easy. We have plenty of room. Everyone just start throwing stuff in there. And then all of a sudden when it starts getting full, you think, uh-oh, we still have a lot more stuff left to put in there. So you could think of the workers as insulin. So if you only have, if you have an empty truck, meaning fat cells and liver cells, you can start throwing a bunch of stuff in there. It's not a problem. So young, healthy people, they eat extra sugar. No problem. We'll just shove it in the empty moving truck. But what happens when we get older and we fill up that moving truck now, now you need a ton of people trying to move stuff around and shove things in. It takes forever to get that extra sugar in. So what we see is we see that in the bloodstream remaining behind as extra energy. And that's diabetes. Once your sugar gets over, you know, your A1C, we call it 3-month sugar average, gets over 6.5, or your, your sugars start rising up, then we pick it up. But we have a 10-year warning signal. Ben Bikman from BYU, who's one of my favorite professors, he showed that, that you, your insulin goes up and up and up and up before you get diabetes. So the question becomes, how come we're not checking an insulin level on every single patient, especially when we look at cardiovascular risk and bypasses and all that?

I mean, don't you think that really should be standard of care at this point? Because now, from what I've learned from you and Tro and from other doctors that I listen to— another great one is, um, Diet Doctor— and all these people that really interview people like Ben Bikman, people doing the research, people seeing these things, and people like you in the clinic seeing it every single day, yet it's not part of our standard of care, which is really frustrating. But even me as like a layperson, non-doctor, the people that I work with when we're talking about this stuff, I mean, I shout it from the rooftops. I'm like, first thing you should do is get a fasting insulin, even if your A1C is normal. And it's really cheap. I have a lab service that I— you can just do it out of pocket. It's like, I don't know, $29. I mean, for your health, for me, that's a pretty small investment. So I think it's worth it. I might steal your analogy in the future.

Yeah, well, oh, please do. Anything, anything to help people. It's not me. I mean, Jason Fung's been talking about this stuff. We just use different concepts, right? So that's when, when I started understanding insulin resistance. And then, so for me, getting back to my story was, hey, I was in Guatemala and I had to hike this big volcano. I've always been a fit, active guy, even though I was overweight, I've been an athlete still, you know, I played basketball, doing stuff. And so I'm in Guatemala and, you know, the other docs with me are pretty fit and thin guys. And we were starting this climb on this volcano. And the guy looks at me, he's like, you're not going to make it. You need a horse. And I'm like, I don't need a horse. He goes, you're going to need a horse. He goes, look, he's debating me about it. I go, I will die on the mountain before I take a horse up the hill with all my buddies. There's no way in heck that's happening. He goes, if I go halfway up the hill and I have to come back down the volcano to get your horse, I'm charging you double. I'm like, okay, charge me triple. I don't care. I'm not doing it. So anyways, I make it. But then now I looked at the picture. I was like, holy cow. Now I see what the guy is saying. My clothes, my shirt, well, like my stomach was pulling the buttons apart on my shirt, you know? And so, you know, I made it, but I sweat like a horse and, you know, it was crazy. But I made it still, right? So after that, I go, okay, that's it. I'm changing what I'm doing. Then, then that patient comes in. I see that and I go, okay, I'm really changing what I do. So then I went low carb and I started losing weight. Then the problem was Professor Noakes and Gary Fettke were going through trials and my patients were asking me, doc, what are you doing? You look great. I was like, uh, I can't really tell you, right? It's not the standard of care. Here's what I'm doing, but it's not the standard of care and here's why I'm doing it. But you know, I realized in that model, it was really hard to explain all this stuff in 15 minutes or 8 minutes or 10 minutes. So, you know, it was a frustration because I wanted to help everyone then when I started having success. And within 6 months I had 11 people come off insulin, which I had never seen before that. So I said, wow, there's something to this. It's, you know, I used to, I remember having, you know, chiropractors would say, oh, we could take your people off insulin. I was like, yeah, right. You're crazy. It's going to kill people. This is dangerous. And then when you start seeing it, you go, oh, now I know what those guys have been talking about. And so that's why I think a lot of these, you know, what we call alternative practitioners have gotten it way before us Western medicine. People do, because we're looking for a pill for every problem. You know, if your cholesterol is high, you have a statin drug. Your blood pressure is high, you get a blood pressure med instead of saying, you know, why is this happening? So one of the great things that's happened to medicine is we've had some of these, like Ivor Cummins, some of these people who are scientists saying, wait a minute, you guys have been doing the same thing for years, but it's wrong. And here's why. And looking at what we call root cause, right?

Yeah. When things aren't working, it's always kind of surprising to me that we can't make a quick flip, but because of the way our medical system is set up and because of standard of care and because of— I mean, for example, how much— you've talked about this before— how much nutrition training did you get in medical school? How much do you focus on alternative lifestyle things like the stress and the sleep, as we know are huge, and yet they just want you to prescribe pills? I mean, I, I think whenever you've said in the past that you've got like about, I don't know what, 5 hours of nutrition training or something in medical That's just amazing to me.

It was basically low fat, eat a low fat diet. That was it. That was it. Cause you're going to have a heart attack if you eat fat. We know it clogs the drains at home. And so that was the problem. And then you look and you go, wait a minute. So let me look at my patients. And that's why when you come across people like Philip Ovadia, who's a cardiothoracic surgeon, who's carnivore, or Shawn Baker, and you go, why are these guys dumb? Is this fad or what's going on? But you start looking at their science and what they're saying is, look, high insulin level. Dr. Ovedi, who does, you know, bypass surgeries, says, I've never done a surgery on people with— on a person with normal insulin levels. I've done a lot of bypasses on people with normal LDL cholesterol levels. So you start looking and say, okay, what else are the factors that we can look at? Because we know diabetes is the killer for all this stuff because it's causing damage to endothelium, it's causing blindness. And you know, it's the number one cause of every disaster that we see. And I had had enough. I saw enough where I say, look, if I can't really help people, Uh, prevent these damage. I don't want to see it like, you know, like I also tell some of my patients is like, look, you're asking me to get on a ship with you to sail out in the middle of the ocean. And I see cracks in the hull and I see it taking on water and all this stuff. We gotta fix those problems because it's gonna sink. We have to fix that problem because you really just, you know, like taking insulin, taking all these medicines is just a patch. And then you're gonna need more. And I've seen it over my career. And it's just one of those things where We were taught that diabetes is a chronic progressive disease. And now I'm saying that's, that's just not true.

Yeah. And you're even getting banned from some channels for it. I do post these on YouTube, so we'll have to see. I think so far this has been a very, um, you know, non-controversial conversation, but certainly when you do start to question, uh, this narrative and then the system, you actually ended up doing something that some people would consider pretty risky. Like, pretty late in your career as a doctor, you kind of divorced that system and went into what do you call it, a direct care model, right? So maybe you could talk about that a little bit, because I think it feeds right into what you're saying. Like, you're watching people go down this road, and yet because of the standard of care that's in place, you weren't really free to share what was working for you, share the new things that you were learning from all this, you know, wonderful new science that's coming out. You couldn't even really promote that in a way.

Yeah, I think that's the problem. And that's why we started the podcast really. Low Carb MD was saying, hey, look, here's two docs. We're going to talk about what our experience is and what we're seeing and what we're doing. Right. And we're not going to embellish things. We're going to say what it is. And if we have to change course, we will, you know, based on the science and the data. And I'm telling you over the last month, I've learned probably more than I have in the last 5 years, just looking at different aspects of health. And sometimes things we think are helping, it may be helping by a different mechanism than we think they are. Right. It may not all be about insulin and cortisol, all this, but I do see some chronic, some common, some common, uh, uh, factors, right. That in my patients, because, so, so getting back to your question, sorry, I get excited, but you know, the point is, look, you know, in that model, it wasn't working for me. I was stressed out. I was working 16-hour days, not sleeping. I'm getting up at 4:30 in the morning to try to get a workout in before I head off to the office or, you know, most of the time didn't have time in the morning. Cause I had to go see patients in the hospital, run to my office, see, you know, 25 patients and then get back to the hospital, then come home. If I ever got home. And so I started thinking, it's like, you know, if I'm looking at extending my life, if I'm working sick, ultimately what happens, a good friend of mine, you know, he was asking why we haven't been to get, gotten together for dinner for 3 years. I'm like, look, dude, here's my schedule, right? And he goes, Brian, if you were your own patient, what would you tell yourself? I said, I would tell myself to get out of that situation. So for me, the reason I was working so much, it wasn't because of love of money. It was really saying, gosh, I got these people that I know they're going to get diabetes and I know I can help them. But I'm scheduled for an 8-minute appointment. So I would put them before lunch and go, okay, I'll see you. And I worked through lunch this whole time. And the frustrating thing is by working through lunch, trying to really help that one person, they were part of the system where they go, just doc, why are you telling me to give up my cookies and donuts? Just give me my, my, my endocrinologist says they'll just give me more insulin and tell you to screw off basically, because I don't need to do what you're doing. I'll just take more meds. And then the question becomes, Do you think insulin just makes that sugar disappear? It's, it goes back to the initial thing is if your moving truck is full, I could hire more and more people trying to shove more stuff into your truck. But the problem is your truck is full. That's the underlying problem. We have to empty the truck out. How do we do that? Get enough sleep, get exercise, you know, watch your stress levels, all these other things we're talking about of emptying your truck. So if you empty your truck, yes, you don't need as much insulin to put more in. And then you don't burn out your pancreas because the pancreas, the beta cells make insulin. So the problem we get into is our sugars start going up. We start making less insulin. Then it, we, it's a snowball effect where you have to take more and more drugs to try to make you more sensitive to insulin. And ultimately the truck is full and you can't put more stuff in there. That, that, that's the simple answer. So I started realizing, gosh, I'm spending all my time. And then really the, the epiphany really for me is we were doing the podcast for a little while and I was invited to speak in Boca Raton, Florida. And I'm there and Rob Sivitz, who's one of the legends, a really brilliant guy. Gave a lecture and I started talking to him afterwards and then I realized, and we're friends, and so I realized there was people waiting in line to see him. I said, oh my gosh, I'm so sorry. We're having dinner in an hour. I'm so sorry. We were just, I just got lost. And so I went to leave and the lady said, no, I'm here to talk to you. I said, me? You don't know me. And I hadn't spoken yet. I've never spoken publicly really yet. And she said, you saved my life. I said, what? She goes, yeah, I'm from Mexico City. And I'm like, who are all these people? That's my husband. He came off his diabetes. Here's my son and her whole family and her neighbor. And it was ridiculous. I was like, wow. And I thought like, wow, I'm having more impact on people that I've never even met than— or I could talk to someone in my office one-on-one for an hour and they don't get it, right? And I have someone else who's just— they choose to listen. So that's kind of where I started looking at this direct primary. Plus, Troy was a huge influence, my partner on the podcast. He was doing direct primary care and I saw his lifestyle. I'm like, oh my gosh, if you have people who really select and they want what you're selling, Right. It's way easier because they're going to educate themselves and they're, they're bought in because if you're of the mindset of I'll just take more drugs, then you're always going to be sick and you're always going to be dependent on drugs. And that's the problem is, so I, I'm cheating now because I'm selecting for people who are saying, look, I want to do low carb. I want to do keto. I want to do a vegan keto, whatever, you know, and I'll try to make it fit your life and what works for you, right? If you hate meat, I'm not going to tell you to be carnivore. If you eat vegetables, I'm not going to tell you to be vegan. So it's kind of say, okay, how do we really— ultimately, the way I've always viewed it is, is get rid of all the processed garbage foods and fall to the end of the spectrum that works for you ultimately. But the big thing is getting rid of all the processed stuff that your body just can't deal with very well. Yeah.

So I couldn't agree more. Cause that's where, again, in the, in the idea of, because I think people can be scared away when they hear these extremes at first. And if they're not quite, you know, you mentioned mindset and you're selecting for a certain set of people that are already there. Well, sometimes we're talking to people that are just starting to dip their toe into that, and I hate to scare them off. So I'll be like, hey, even if you just eat whole foods diet, that is vastly— like, that'll get you 90% of the way where you need to be, probably, if you just stick to whole foods. Um, but yet, you know, I think sometimes, especially those of us who are in this space where we definitely have a little bias towards low carb or keto or what whatever we want, carnivore. And, um, I think if we present it in that way, unfortunately it probably does, you know, scare some people away. But I think that, you know, part of the thing that you and, um, Trove talked a lot about on the podcast that you're starting to, I think, talk about more lately now that you've been in this longer is, um, mindset and sort of giving people other tools. Like, you lead hikes, I think, in your practice where you get people together. So it's like bringing in the community aspect, bringing in these sleep and stress aspects, teaching people to meditate— meditate, not medicate, but both if they need it. But, um, definitely meditate. So bringing in some new things that are, you know, people know about them, they know that they're good for them, but I don't know if they've quite tied it together as strongly with their health as you're starting to now with, you know, what you're doing in your practice.

Yeah, and I think that's the big part of it, really. My— what I realized in my old practice was, look, this is a labor-intensive upfront investment I'm making in that patient. I'm basically— direct primary care is like, you know, I look at it the same way as like AAA, right? I've been paying AAA for years and years and years. I've used them like 3 times in like 35 years, but when I call them, they're there and help me, right? So, but if I have a terrible car, if everyone on the road has a terrible car that breaks down all the time, guess what? AAA goes out of business. They cannot function that way. They're betting that you're going to upgrade your car every once in a while, that you're going to have a functional car that's not going to be breaking down every day. Because otherwise they can't tow everyone at the same time and it's a disaster. And I think that's where our healthcare system— everyone needs towed every day, pretty much. So I've seen patients over and over, and in the insurance model, there's a vested interest on seeing the patient more often because you get a copay and you get all this stuff every time you see the patient. For me, it's like, hey, if I can make you healthy and you don't need me all the time, guess what? Then I can— I'm freed up to help all those other sick people who need to get on track, right? Who are invested in themselves and who want to get better. Because The cost of direct primary care for most of us, you know, it's $100 a month or $150 depending on age and comorbidities and all that kind of stuff. But it's like, if you're paying $500 a month on medicines, that's it. And we can get you off medicine. That's it. You're saving money every month and you're getting Cadillac care because instead of having 2,000 patients, as I did in my old practice, I have about 400 patients. So guess what? I have way more time. Just think about doing an annual exam on 2,000 patients. That's what doctors are up against. You have an annual exam that people are doing every year. So that just that with 2,000 patients, do the math and see, and then all the sick people and acute problems. So these doctors are just— physician burnout is the next pandemic that's coming. It's here. And doctors are burned out. They're a cog in the wheel. But when you realize, look, I could be more effective if I have fewer patients and take really, really good care of them. Right. And because, and I'm saving the system at the same time, because look at the diabetes complication, number one cause of blindness, number one cause of heart attack, right? Number one cause of amputation, number one cause of early death. All these things that we're seeing and kidney failure, dialysis, all those kinds of things. So saying, okay, let's do preventive care. It's not sexy, right? You're not going in and fixing the engine and say, I'm gonna replace your engine. It's like, well, let's just gonna change your oil and change the spark plugs every once in a while and do these things to keep you running well. And when people are running well, they start feeling better. And then guess what? Like you're saying, it's so easy to overwhelm people, but saying, hey, can we start like just giving up soda? I have a guy who lost 36 pounds in 6 weeks, just giving up soda. And I look like a genius, right? As I'm not that smart. I just say, look, you You can't drink 6 sodas a day and lose weight. It's a disaster, you know, for your gut microbiome, for your, your, your, your system, your teeth, everything. So those kinds of things, you know, if you're eating cereal 5 times a day, can we cut down to 3 times a day? If you're drinking every day, can we do it 2 days a week, whatever to start with? And then what happens is over time, when people get healthier, they say, yeah, I really just don't have an urge to drink all the time. I don't need to have soda all the time. And then what happens a lot of times, I see this, we see this progression where once they get metabolically healthy, they go, Yeah, I don't need to eat 4 meals a day or 6 meals a day anymore. I feel great with eating 2. I'm not really hungry till 2. So I just eat then and I stop. And it's not a big deal. It's not like they're using willpower and struggling because the physiology, if you get healthier, you're not starving all the time and you're no longer a slave to food and food calling you all day. What am I going to have for a snack? And you panic if you miss a meal, you know, those kinds of things, which, you know, I remember being at my desk and I was so busy and I would shove a sandwich down and shove stuff down really quick between patients real quick because I thought I was going to die if I didn't eat lunch. You know what I mean? So you, and maybe at that time I would have, if I was so metabolically sick, but you start realizing we really have to do better in medicine because the upfront investment is what's going to pay off down the road. Right? When someone says, look, I'm going to make these lifestyle changes and just like anything, some people are going to want to jump in the pool and start swimming. And other ones are going to get slow in and out until they get used to the water temperature. So it's what works for you. And I think that's the biggest thing that we've missed is We're not mice, believe it or not. So people do mice study, they go, look, you get 500 calories a day and you do this and you do that. And they're fine. It's like, well, mice aren't getting divorced. They're not losing their jobs. They're not dealing with COVID They're not stressed out about what they're seeing on the news. So we have to be able to say, okay, how do we manage our stress in a different way? How do we make sure we're getting enough sleep? How do we simplify our life a little bit? Right. Because, you know, trying to keep up with the Joneses when they're multimillionaires is going to be kind of tough on your stress levels. And that all plays into this.

No, I, I'm so glad to hear you. If you ever— I mean, not that you would, but if you ever read some of the stuff that's in the one book that I'm working on, it's like you just said so much of it. And I think, you know, I think it's trying to prevent people from overwhelm is one of the greatest kindnesses. All we are is like, what, 5 years kind of ahead of people on this path of, of doing these things and eating low carb. But that means we've had 5 years of practice, and so we know And, you know, some of the things that you mentioned, like you thought you were going to die. I was— I'm telling people kind of in case people haven't heard the word hangry. I think everybody has by now, but I described that in the book and I'm like, that was me. I never imagined that I could go an extended amount of time without eating. Like, I really— I would get hangry and grumpy and it was kind of a big joke in my family. And my, you know, it was always every time I'd see my dad, they're like, oh, we can't miss a meal. You know, we want Cheryl to be happy. You know, so Even though I was never severely obese or severely overweight, I definitely still had markers of living a high-carb, snack-wells, low-fat, you know, being brought up in all that existence. I would have loved to have seen my fasting insulin at that point because I guarantee it was not healthy. But speaking of healthy, you mentioned metabolic health, and this is something that's definitely a big buzzword in our community that a lot of people are talking about, there's a standard definition that I've talked about on the podcast before that involves waist circumference, your LDL cholesterol, um, a couple of other factors that are—

triglycerides, blood pressure. Yeah.

Thank you.

Yeah. Yeah. Like metabolic syndrome. Yeah.

Would you— are there any things that you've been seeing in the practice where you might change that characterization a little bit if you were in charge of what is really metabolically healthy?

Yeah. I think, you know, and that's the thing. You know, I think really looking at it, I saw a lady yesterday, she's 423 pounds, but her visceral fat isn't that high. And I don't have her labs back yet, but I'm saying, well, based on her visceral fat being pretty, which is visceral fat's the fat around the organs, the subcutaneous fat's the love handles, the butts and thighs and all that kind of stuff. So in a premenopausal female, you're predisposing to, uh, most people there's genetic differences, but you, you're going to store more fat out in the, in the breast tissue, in the, in the butt, hips, you know, outside where we can see it. The problem becomes once you become menopausal, we get dysfunction in that and you lose estrogen progesterone effect. And then it starts going viscerally. Then heart attacks go up and stress and strokes and inflammatory markers and all those things start going up. So yeah, you can look at someone and say their metabolic— and I see it by the same token. I see people who look healthy and you get their labs and you're like, oh my gosh. Yeah. One of my guys was 160 pounds, 158 pounds. I'm like, you're He's of Indian descent. He, his A1C was normal. All these other markers look pretty good except his triglycerides were elevated. That's one of the markers, low HDL, right? That's one of the markers. And his insulin was 58. I was like, it was, it should be less than 5 if you're healthy.

Right.

So I was like, oh my gosh, you're sick and you don't realize it. He was, yeah, but my A1C is 5.2. Don't worry. I'm like, yeah, but your train, your truck is full. Right. I'm explaining this to him. So he says, doc, don't worry. And I said, let's see in 3 months, 3 months, his A1C went from from 5.2 to 6.4, 6.5 is diabetes. So at 160 pounds, you know, like, look, you're having naan bread, you're having yogurt. Yeah. You're having like, uh, I mean, sugary yogurt, uh, uh, uh, mangoes with sugar sauce on it. All he's eating, rice, everything, tons of carbs. I go, you're in a ton of carbs. You're in trouble. Your dad has diabetes. Your brother has diabetes. And you, you have diabetes now, right? 6.4. Tomorrow you're going to have diabetes at 6.5, right? So he goes low carb. We get him down to a 5.1 A1C, drop his insulin from 58 to like 22 or something like that within 3 months. And he's doing great. Then he's lost for follow-up for a year, comes back, A1C 7.9, went back to his old diet habits, right? Now the guy is a machine. He went low carb and he's crushing it. I mean, his numbers are stellar. I mean, you look at me like, oh my gosh, I can't even believe it's the same guy. It's ridiculous. So that's exciting. And his, his metabolically healthy. So There's a lot of factors. And I would say, look, you know, some of the biggest thing, a good friend of mine, Ben Bikicchio, who's a workout guy, says, look, muscle mass is the biggest thing. But having muscle mass, because you could be skinny and have no muscle mass, guess what? You're in trouble still, right? You gotta put on some muscle mass. You, this from an osteoporosis standpoint, you know, broken hips and all those kinds of things, keeping that insulin level as low as you can. So Ben Bikman, who I respect a great deal, and he, he actually may have saved my life in a way because I met him at a medical conference. He's one of the metabolic health guys at BYU. And so he says, you know, I said, Ben, look, if I want to live a long life, what do I got to do? And he goes, oh, Brian, it's easy. 5 things, right? Number 1, don't run around like you're stressed out all day and, you know, be stress intense. I'm like, this is back when I was stress intense working 16, 18-hour days every day. You know, knock, knock, knock, doctor, hurry, there's 5 people waiting. You got to hurry. You're working through lunch. You're going to be, honey, I'm not going to be home for lunch, for dinner. I'll be, you know, that kind of stuff all the time. That was the standard of care, right? And then he says, okay, get enough sleep. I was like, I live half an hour from my office. I was driving and now I live 2 minutes from my office, right? I can walk here and whatever. So I'm like, Ben, I don't like your rules. I'm 0 for 2. And he goes, yeah, that's why doctors die younger than everyone else. I go, what's number 3? Eat real food, right? Cut out processed food, eat real food. Next one, uh, don't smoke or drink to excess and exercise regularly. He goes, that's all you have control over.? And you look at that and you go, okay, these are important things. Let me try to simplify my life. Right? So that's why I had to go back and say, okay, I'm going to take a financial hit and that's going to be stressful a little bit, but I'm not going to be working 16-hour days. I'll have control of my schedule. If I need a day off, I can take a day off. If I want to go see my dad, I can go see my dad because I had no flexibility. I was booked out. This is what— so people have compassion for your doctors. I was booked out a year for annual exams. So if someone called me tomorrow and said, I need an annual exam, it'll be a year from now when you get it. Now people call me and they go, hey, I need an exam. I go, do you want to come today or tomorrow? Right? I have openings. Like, I have a place to put you. It's not a big deal because I'm not working 20 hours a day. Every once in a while I can work, it's, you know, 16-hour day. I don't care. So, you know, having accessibility to medicine is really important. And I think that's what's happened, you know, looking at the whole system and you go, gosh, we've lost our ability to keep people healthy. So now when everyone's a train wreck, you're spending so much effort and time The problem is really there's a vested interest. You know, before I left my old practice, I was pretty much the number one money maker for this HMO plan. And I said, hey man— and I trained with the guy— and I go, hey, uh, I'm leaving and here's why. Because, Brian, are you having a midlife crisis? What's going on? Are you buying a red sports car? What do you know? Well, no, I'm just looking at the system and it doesn't make sense because every year you make me jump through more and more hoops. I'm here trying to help my patients. I'm working tons of hours. I'm killing myself doing it. And you're penalizing me for not seeing enough patients. Right. But if I see more patients, I can't spend time to explain lifestyle that can save their life. And then all I'm gonna do is have all these— I said, look, come to my— come look at my charts. I, and at that time, I think there was like 58 people that I could document saying, look, based on this, this, and this, they were going to get diabetes. They were going to get diabetes. And we, we prevented it. And I said, do you know how much money I'm saving you in amputations and blindness and all this crazy stuff? And he looked at me, said, well, Brian, you don't understand the system. He said, you're costing us money. I said, how am I costing you money? He's because once they get diagnosed with diabetes, we get paid this much more from the government, right? We get paid more for the bad diagnosis. So the sicker the patient gets, the more we get paid. I'm like, do you not see that as a conflict of interest? That's why I can no longer be in this system because my job is to my patient to keep them safe. But you're saying—

took an oath for that.

We took an oath for that. That's what we were called to medicine to do. So like, look, if I lose a few bucks, but I'm helping people and they come in and we can have fun fun, like all the time now in direct primary. This is why I love it because before I was like going, oh gosh, cognizant of saying, okay, I got people waiting, I gotta hurry. So yesterday I had two patients tell me, hey doc, you know, I'm having a good time, but I gotta go. I got a meeting I gotta get to, right? Like online. And it's funny cuz it's such a switch. And I'm like, oh, okay. Yeah, go ahead. Like, oh, I got free time. I can go do research for 20 minutes then if you don't need your whole hour. Right. I'm, I'm here for an hour. We, we can BS and talk about the kids and have fun. And, but, but you had mentioned like we, you know, I get together with my patients and we go for a hike every two weeks. And then between that, so every week we're doing something. So between that, every 2 weeks we do a Zoom meeting. We get the whole community together and say, okay, what are you struggling with? Some people are just starting out. Some people have been doing it for 2 years. And so we say, oh, you know, you're, you're hungry when you get home from work. Well, what are some tricks people do? I can shut up and step back and let them all talk. And they help each other and they all want to help each other. Cause they say, oh, that used to be my problem. And here's what I'm doing. And, you know, so anyways, so getting back to your original question of metabolic health, I think it has to do, there's a lot of it, but I think mental stability is a huge one. The biggest shock I had Troy and I talked about it early on, on the podcast was that people are coming and saying, yeah, I'm laughing more. I'm having fun. I'm not as stressed. I'm sleeping better when they change their diet. So I was like, well, if you're sleeping better, guess what? Your stress gets better. Like I said, in the beginning, if you're sleep deprived all the time, you're always going to be hungry and you're going to be hangry and grumpy. Like what you're talking about saying, okay, if we can fix that sleep problem, great. If we can fix the sleep apnea problem, right. And that's going to affect the stress hormones. We can get you healthier. So when people are sleeping better, they're enjoying life, they're taking care of themselves. They know they're on the right path. Even if they have a long way to go on the path, they're on the path. When you know you're off the path and you know, you're just out of control, that is a really scary place to be. And so, you know, that's what's so great. And with direct primary care, we can hold their hand a little bit more and going, look, you're having struggles. Some people, as you, as you'll learn, it's a personality. Some people, it's just like with alcohol. Some people can have one drink and they go, okay, I'm done. I had a drink and I'm good. Other people have one drink and they're, you know, they're going to end up in the back alley, you know, DUIs and have all kinds of trouble. So it's really figuring out for yourself, what type of person am I? What type of person am I? I have some people that say, look, doc, I'm not— I love sourdough bread. So I'm going to have a piece every couple of weeks. Is that okay? Is that a deal breaker? I'm like, no, that works. But guess what? After 2 or 3 months, they go, yeah, I really don't need it anymore. They don't care. Right. But if you say, no, you can never have it again. And then it causes so much stress. And that's a big thing we have to like understanding that individual in front of us, right? When you understand the patient and look, I have my struggles, we all have our struggles and you go, okay, look, we're on this boat together. But you know, I think when you get out for a hike together with people, just talk about life, what's going on, you're going to learn way more about that person. And I could do it with 12 people at one time. And we could say, hey, I'm having marriage struggles too. Here's, you know, what are you doing? How are you getting counseling? Whatever, you know, and not just being stuck in an office environment. You know, there's something about just being outside and being healthy and, and you're walking and you're exercising at the same time. So I'm like, hey, I'm going to do it anyways. We might as well do it together.

Yeah. I love that so much. And you touch on so many wonderful things right there. I hope that people really take it in because I try to talk about this a little bit. I've been a big fan of hearing some of you doctors talk about the struggle with the system. And it really illuminates to me, like, it's not your doctor's fault that they're not up to date on all the latest research because they literally— like the days that you described before you went to your Model Now, you literally had no time for that. Now you have the ability to talk to interesting doctors all over the world, do research, read, read whatever is the latest study coming out and really learn how the, you know, take what's the latest science, not stuff that we've just been told for 30 years and put it to work. So I hope that people really take that in that, you know, we want to have obviously empathy for our doctors, but at the same time, like hold them to a little bit of a standard, like, you know, bring something to your appointment where like, if you're really trying this and it's working, you never know where somebody like me coming in and being like, oh, I lost 20 pounds and my A1C is all good and blah, blah, blah, blah, blah. And you might— it might be like you, what happened to you where you said, hey, there's something to this. I should maybe look into this a little bit more.

Yeah, absolutely.

And I think the balance there, I think—

yeah. And that's the frustration. You know, you see, I have patients— there's a major HMO plan here in California, across the nation, and they will not order an insulin level. They won't order an A1C. I've had patients come to go, I've been begging my doctor just to get an A1C. It's like my whole family has diabetes. They said, no, it's not part Because the system is so screwed up that the doctor gets penalized if they order different tests. Right? So people don't want to order stuff. So it's like me, like, what do you want? I'll order whatever. Yeah. I don't care. Like, as long as I can interpret and understand it. But the problem is the doctor doesn't understand the test. They don't understand the implications of a high insulin level and insulin resistance. They just say, okay, once you cross over and you can see it. And it's so frustrating because I can look back when I get the records, I'm like, man, this, this diabetes that you have was coming on for the last 10 years. I saw it like a train coming 10 years ago. And here's why, look at this and look at this. Look Look at your triglycerides, look at your HDL, and you could see it without even getting an insulin. You could tell pretty much based on the labs and, and exercise levels and sleep and stress and all these things. So it's frustrating because we wait. It's like, who wants to wait to say, oh yeah, you just blew up your engine. Now we're going to start changing oil. It's too late. That's the problem is once these people get up and you have to realize from the patient's perspective, once I diagnosed you with diabetes, guess what? Life insurance rates are going up. Long-term care goes through the roof. Everything's— the patient gets totally destroyed in the system. And the doctor's thinking, oh good, I get a code a little bit higher, right? So the doctor's making a little bit more money every month off you and the system's— and that's just the truth of what it is. So it's— I don't even think it's controversial. I mean, you ask any doctor and they'll tell you that's what it— I mean, they may not say it publicly because I'm outside the system, so I can yap a little bit, but that's the truth is you look and you go, who am I working for? Because ultimately I had to decide I'm working for my— that patient in front of me. I don't really don't care what the With the nutritionist things down the road. And I really don't, I hope that I can bring them on board and I'll be cordial to you, but you know, slap on a continuous glucose monitor, do your diet and do mine and see what happens. Right. And you know, Fat Fiction, the movie does a great job of showing that. So I'm telling you, I love it because my patients will call me, hey, did you see my sugars? Look what happened. Guess what I had? Orange chicken. Good luck. I've never seen, I can tell you for a fact, certain things you will not eat Chinese food without spiking your sugars like crazy. You will not eat Thai food. You will not have pho. Vietnamese soup. It was like—

I have an orange chicken version that he can actually eat.

My— oh yeah, if you could do it. Yeah, if you make it yourself, it's totally different. My medical assistant, she gave me permission to talk about— she weighs like 96 pounds. She's young, healthy, fit, and all this stuff. And we have a CGM on her, and it's hilarious. She goes, did you see my sugars? Look at this. I had a Snapple and I had an orange chicken. Look at that, was like ridiculous, right? I mean, over 200, and a young, healthy, you know, a young, healthy female. And she's looking like, what's that gonna do to a diabetic? Forget it. You're done. It's a disaster. So then you're going to say, oh, my sugar's high, shoot more insulin. And then you get insulin resistance. Then you get into this, this snowball, this cycle, and you're hangry all the time and you're tired and you're fatigued and your joints hurt. And, you know, I think, you know, I would say the biggest, the biggest thing that, that kind of goes with what we're talking about and is worth looking into is the effect of the gut microbiome. I'm telling you, I just had William Davis on. He has a new book and I don't have any financial interest in him, but I do have a lot of medical interest. It's called Super Gut and it's astounding the amount of medical problems, autoimmune disease, depression, anxiety, stress, uh, uh, um, food allergies, all this stuff that have to do with the gut microbiome. And in my research, cuz I, you know, for me looking at it, I see people who go through, like, I, I've seen it so many times where people cut their life stress for 2 weeks, like over the holidays I've had people and you look in their, I see their continuous glucose monitor. I go, oh my gosh, you're eating terrible stuff. And they lose 8 pounds, 6 pounds, 4 pounds, 22 pounds. Cutting stress out. Stress is a killer. And I've known that. And guess what? High insulin, high cortisol screws up the gut microbiome and it messes with your, with your ability to digest food, right? And your satiety signaling. So you screw that up. I mean, it really comes down to satiety, right? Calories in, calories out sounds great, but look how many obese people are trying to— they're counting their calories, they're exercising, they're doing all this stuff. But if you don't fix the underlying pathology, You're in trouble. So I have a lot of people who've done liquid diets. They lost 50 or 100, 150 pounds, but they gain it back every single time. It's not sustainable because your body is telling you, oh, you're, you're starving. You need to eat more. You need to eat more. And sooner or later your brain gives in. You cannot, you can't, it's not sustainable. So having muscle mass, having protein, you know, keeping your, your, your mental functioning good, getting good nutrition. Cause if you're eating all processed food for 500 calories a day, Good luck. It's going to be a disaster. You're going to look good for a little while for the wedding or whatever you're trying to get to, but health-wise, it's a disaster metabolically. I see people very metabolically sick, even though they're losing weight. So it's not necessarily about the weight. It's about the body composition of muscle and fat and visceral fat. Right. So it's a big picture. And I think we're going to learn a lot more over the next couple of years, but, you know, I think we all learn from each other and it's really critical to do that.

Yeah. I'm really excited about all of that. And that's something that I have learned from the people that I listen to and talk to every day is the importance of muscle mass. And, and when I've spoken recently, like keto diet and stuff, that's what I'm talking about. Like, I always talk about fasting and changing your diet, at the very least going whole foods, but talking about, of course, keto and some of the benefits of ketosis. But the benefits of having muscle mass— you can— I think part of the reason that, you know, we talked about people in their 20s and 30s, you can get away with a lot more because the moving truck's open. Well, people in their 20s and 30s also have more muscle mass, and that gives you more capacity in the truck. Like, instead of going around in a little U-Haul, you've got the giant cross-country mover thing that you can put things into. So it just— it exactly makes it that much easier when you have muscle mass. So for people like me hitting, you know, into menopause, going into 50, it's, it's even more because I have not been as good about it over the years, even though I've always known that I need to be lifting weights. I just hate it. I want to go on hikes. That's what That's what I want to do. I want to be outside.

And you could do that. There's a lot of stuff you can do if you hate certain exercises, but you know, like Ben Bikicchio, I love the guy. He does a 15-minute workout, weight-bearing exercise, and it's been shown to be beneficial in so many areas of medicine. Right. And my, my, sorry, my voice recorder started messing me up. I don't know how it automatically kicked on. Sorry. It has to do that right in the middle of podcast. Well, it's okay.

I was just going to say, because I know you have a patient coming in. So like, check me on time here. Cause I could just let you, I mean, you have so much more.

You can let me just ramble on and go on tirades here. Um, yeah, no, I think I'm good till, uh, for a little bit, unless you got to go.

I'm no, I'm, I'm, I'm here. I'm here for it.

Let's keep going. All right. Awesome. Let me just double-check my schedule and make sure I'm not causing trouble. No, I'm good for, I'm good for about 15 more minutes, so we can, you can cut it whenever you're free, but yeah. So putting on muscle, if you hate exercise, go, okay, can I do 3 minutes a day? Can you, Can you stand against the wall like this while you're on the phone? Yeah. Right. You can just squat down. You don't have to squat all the way down to 90 degrees, just stand there. And we have people that will go into metabolic, you know, their heart rate goes up and they start sweating just from that. You know, because they're so— can you stand up and sit down on the couch? Can you, can you do a couple squats before lunch or after lunch or whatever? Those kinds of things pay huge dividends. Can you do a standing desk for a few minutes? Right. So, so looking at it, and there's also something that's very intriguing. Called zone 2 training, right? That people are doing. And I always thought it was kind of like, I don't have time for this kind of stuff. I do interval training. But what I'm finding is my ketones go through the roof, meaning you're burning fat when I'm doing a sustained, you know, keeping your heart rate at like 180 minus your age, doing that for 45 minutes. I'm seeing huge, huge benefits. And, you know, and then looking at the gut microbiome and getting your gut health, right? There's so many things we could do, just, just sipping bone broths or green tea and things like that seem to help. You know, along those lines. And so there's a lot we can do. And I think, you know, when I started realizing the impact of stress, stress is the killer, right? Of all of this. I mean, that is the common denominator. Like I said, screws up the gut microbiome, screws up the stress hormones, you know, more likely to get colitis and all these autoimmune problems because stress will destroy the gut lining. And then all of a sudden you're absorbing all these things and it sounds like crazy hocus pocus stuff, but There's something called lipopolysaccharides that are in the bad bacteria in your intestine. And when you start killing them off, you absorb those. If you have no protection, you absorb that systemically, depression, anxiety, stress, you know, fevers, you feel like you're dying. And they did a study in Germany. They injected people with a little bit of this lipopolysaccharide. They're young, happy college students. So the world's great. And then within hours they're depressed and anxious and stressed. So you wonder, gosh, how many people are just getting poisoned by their own gut? Right. And what can I do to protect that? But things like sauna, meditation, prayer, yoga, whatever, all this stuff that people go, I don't have time for that stuff. Well, you can better make time because that's going to help you more than, you know, I'm telling you, I see people on a low carb diet, keto diet. They're doing pretty well. Sugars are flat. They're not losing weight. So how's life? I'm fighting with my husband all the time. I'm miserable. I hate my job. And I was like, you gotta find some enjoyment. You gotta find something you enjoy. Like you having passion to write a book and do this stuff. And you, you put it down on paper. It's creativity. It's a pain in the butt, but it's, It's a good thing, right? It's going to— because you know the final event is you're going to help a lot of people. You're not going to make a ton of money writing a book. I know that from my friends who wrote books.

But you know, I don't have any letters behind my name. Yeah, but you know, I think that I could be a little freer with it.

I think there's a lot of people with a lot of letters behind their name that have no idea what they're talking about. And having life experience is what's important, you know, in business. Having street smarts is going to be a lot more valuable than a big degree. So that, that's what happens. Sometimes the good thing is when you don't have letters behind your name, you have to work harder. Right. And you have to prove yourself and you bring in friends who have letters behind their name too. They say, yeah, what you're saying is reasonable because there's a lot of people with a lot of letters who are giving terrible advice. And that's kind of what Troy and I said, we have to step up and at least say, hey, look, look at this, try it out with your patient. If it's not working, go, go on to the next thing. You know, cuz everyone has seen Dr. Oz and, you know, Oak Bark or whatever, whatever you're hawking this week. All these things have come and gone. They've come and gone, right? Like, oh, I'm gonna have this, you know, the oatmeal diet or whatever you're doing, cabbage soup diets. And you know, you start realizing if you deprive too much, it, it's a big picture. It's a big picture. And we have people like Virta who are crushing it. We have a lot of people who are doing, they're, they're able to reach a lot more people and teach them sound nutritional advice. And guess what? Their medical problems get better. The problem with medicine too is that we've We're saying, hey, look, if someone has diabetes, talk about lifestyle change and diet and exercise. But then the problem is when we talk about that, they say, well, don't talk about that. You're a doctor. You shouldn't be talking nutrition. Let the nutritionists do it. Well, the nutritionist is paid by industry and they're giving bad advice because they're like, if you tell them to eat my product all the time, I'm self-marketing. And so the conflict of interest, and I think that's why I got kind of banned, I think, because really we weren't even, Of all the— I got kicked— for people don't know, I got kicked off YouTube for— I've never been banned from anything in my life ever. And I'm like, and it wasn't even a controversial episode in my opinion, but we were talking about what we were seeing in clinic and, you know, some of the problems with medicine. And they said, well, that's medical— what's it called? Misinformation. I was like, but this is what I'm seeing. How could it be misinformation? I'm seeing it, right? If I see people getting better, how can it be misinformation? It's happening. Am I delusional? And we're all just in a fantasy land here? It's working. So, and that's what—

different conversation on censorship, which is really frustrating right now for a lot of people in the health space. But, you know, one person— you might get banned for this, maybe you'd have to put it on one of those alternative networks— but I'd love to hear you talk to the former American Diabetes Association president. Remember how she went low carb and then shortly thereafter she quit? And I keep meaning to look into this. I don't know if part of that was because of the conflict of interest in her mind after she figured this out? I mean, do you know any background on that or have you ever thought about talking to her?

I don't, but I like to think about it because when she came on board with low-carb and, you know, they put that in the guidelines, by the way, which was a big relief to us. Cause I could say, look, I'm practicing your guidelines, low-carb keto, the most studied for diabetes. I'm not crazy here anymore. Maybe I'm crazy, but not for this reason. But the point is like, what a conflict of interest. Here's the problem she was in. And I knew it was going to be a problem. I'm like, I wonder how long she'll last. Because when you're sponsored on this side by pharma and you're sponsored on this side by big food and you say, hey guys, look, we can decrease pharma's income and we can decrease big food's income and we can make you healthier. Guess what? You lose all your sponsors and that's a financial hit to your company. So that's why on my podcast I don't have sponsors, you know, that I have to cow down to and say, okay, everyone should be eating Nestlé's cookies because they're sponsoring me. No, of course not. It's a conflict of interest. So I think it's those kinds of things. There's so many conflict of interest. Whenever I look at a study, I go, who's, who's paying for this study? Right. And then I know what the, what the, you know, I know what the outcome's going to be. We know the outcome before you do the study is the problem. And so there's a lot of misinformation or sometimes the headline of the study, you know, like we see so many times in the newspaper, the headline doesn't match what the story is. When you read the stories, like, well, that's not what the study is. Yeah. So it doesn't match the study. You're like, wait a minute, that's not what the study is showing. And so people who have scientific backgrounds are looking at it and then A lot of these people don't want to release the raw data. And so there's so many conflict of interest when you look, it's like, okay, where's the money and the power going? And then you start looking at it. It's like, look, I'm not here to support you. I'm here to support my patient. And I think ultimately that's what we kind of start realizing is, look, we have to do what's in our patient's best interest because my patients ultimately are going to look to me and go, wait, you told me this, right? You told me this. You told me never skip breakfast. I'm like, now you're telling me to fast all day, right? I'm like, here's the data that I'm saying. The data at that time. Uh, in medicine, we just pass everything down. We just pass it down and no one says, hey, wait a minute, this doesn't make sense. So I'm shooting my patient with insulin. I'm giving them a bunch of sugar. And then once I stop giving the sugar, then I have to shoot the insulin to get rid of the sugar I'm not giving them anymore. And they go, well, that's dangerous. Well, why is it dangerous? I don't know. It just is. Cause that's what I learned. So, you know, all that kind of stuff.

Dr. Fung did a good job with that finally, kind of getting that thought process and really distilling it for people. Cause whenever he explains that, I'm like, how can even— how can anybody even argue with this man? You know?

Well, you know, and he gets— and I'll tell you, he gets his share. And I— it's funny because he doesn't get to the fray. So in the past, I would just jump in and go, hey, why are you treating him so bad? I would defend him publicly, like on Twitter and stuff. But then you realize all these people are attacking, have an agenda, you know? Like, he got brutally attacked for a week or two. I'm like, what did he do to upset everyone? And then the next week, all these same people were picking on— there was a new obesity medicine drug that came out, right?

Right.

All the same people start pushing. I was like, oh, okay. Right. And I'm telling you, and someone called them out and said, hey, you're taking money from pharma. No, we're not. They said, you're taking money from this company who's representing pharma. And they all deleted their posts, right? There's a conflict of interest. And when someone's paying you to tweet— I've never been paid a dime for any— for anything I do, actually, except my job. But on Twitter Never taken a dime, right? Never taken a dime from me. And I never will because it's my thoughts. It may be controversial, maybe crazy, whatever, but that's what I'm thinking that day. Right? I'm not going to pay someone to tweet for me or put social media stuff up. But I think that's part of it is, is there's such a huge conflict and you have to pick who you're following closely. And the people in the low-carb community, the thing I love about them is their integrity. Like, you know, Dr. Gary Fetke, Tim Noakes, these guys, they could have just walked off in the sunset and been celebrated the rest of their lives. And they said, look, We can't leave with providing misinformation. He, you know, Noakes was the guy who talked about carb loading. That was his thing. And he had enough courage to say, I was wrong. And I think in life, that's a life lesson. I always like to give life lessons. Like, look, be able to say, you know what? I used to think that, but I was wrong. Like my patients, when I went low carb, I'm like, yeah, I used to think that you had to have so many carbs with these meals, but you don't. And here's what we're going to do. And then they get better. So I could say, well, I said this 5 years ago, so I'm going to keep saying the same thing. Or I say, well, Evidence has changed and my clinical experience tells me what's happening. So that's why, you know, I'm, I'm just so excited to be here and thank you for the invite. And, uh, you know, sorry we rambled for so long.