Transcription
Along these lines though, what spec, what supplements do you personally take?
Yeah. So, even in Florida, I wish I didn't have to take vitamin D, but you know, there's the every data point says if it's less than 50, you are compromising brain health. So, uh I've gone through seasons where I'm like, I'm going to do it. I'm going to do it without supplements and then boom, back down to 32, 45, you know, even in a ketogenic state. So to me, uh, K2-D3 has been something that is on my list and I'll probably never get off of it.
And you and I agree completely. I take it November the 1st to April the 30th. And then I'm in the Florida sunshine. But the difference is you're female, I'm male. We have a slightly different bone mineral. Uh, I mean, you fell off the cliff with hormones. I'm >> there with the hormones. So that's the difference. But I I fully endorse the the D3K2 as a combination. Personally, other things that I take, I'm a big methylene blue user these days and I'll tell you why that I mean I have enough ADHD in my history of if I want to, you know, to just hone it in and really concentrate, um, I mean, I um, I started out with the dropper and I would have yellow teeth and or blue teeth and blue.
So I then found a couple of people who put it in a super concentrated wax form because you definitely do not want to do first pass metabolism methylene blue. You want to get it either under the tongue or in that esophageal or gastric lining absorption. Well, you got to really absorb it quick. So, the liquid does that. But, um, so these little wax squares, oh my gosh. I mean, the first time I took, I mean, I felt high. I was leading a class and I went back and watched myself on the recording and I'm like, I'm speaking at two times speed.
Right. Right. Right. Right.
So, do I do that every day? No. But especially if I'm feeling energy changes, uh, I've done, you know, I've ebbed and flowed on that. Creatine is the other brain supplement that I really have been, you know, looking at in different places. I the data is amazing. It is incredible. But to sip on creatine for 3 hours in the morning, uh, that is not.
I use 5 to 10 milligrams in patient or grams who in patients who are exercising. But I I'm less convinced about the superior the brain. My philosophy is let's get you into ketosis. Let's get rid of that brain fog first. But for my athletes, for the people that are working out a lot on days they exercise, I'll go 5-10 but not the 20 to 50. Well, especially any like jet lag or any of that, you can see a nice short-term boost. But I'll tell you what, many patients, I mean, if if they if you haven't really restored that gut health, they just poop out what you swallow. It's just such a laxative for most patients that I'm like, all right, there's more nuance to this than people want to talk about. And when you're, you know, you know, Rhonda Patrick and healthy and your gut biome is perfect, she can have the 15 to 20 milligrams and not get diarrhea. It also means you must probably consume it over the course of 3 to four hours and not do like what I would do.
Yeah. Exactly. Exactly.
Down and be done.
You know, and part of is a lot of my patients are just not athletic enough and the output is not there. So now you're forcing the liver to metabolize something that it wasn't really designed to deal with, especially if you're still trying to get better. Um, the the one other one is fish oil. Do you do you take fish oil or not?
Yeah, I I have them measure omega-3s and we want to get that up there into that, you know, at least plus seven. So, if they're not if they're not big fans of uh of sardines, but even if they are, it's a lot of sardines.
And again, it's it's for me it's because I've got a strong family history of Alzheimer's. So, I'm empiric in my DHA.
I will tell you when I'm 100 years old whether or not it worked. If I can tell you that that I at 100 that it worked, then it worked. But, um, you know, I'm going to go out with Alzheimer's. I know that and I'm doing everything I can to stall or reduce that. So, it's sardines. It's the not only sardines, but all of the fish the the seafood type products where I'm getting those in, but I also supplement.
Yeah, the supplement of those is is um definitely the.
Um, there's plenty of evidence that you're going to have to eat a lot of those little fish to get what you get.
And I I rely on on um uh Steven Cunain's work with Alzheimer's on that's his that's his script. And the MCT oil also comes in there for cognitive impairment.
As a physician practicing in the metabolic space, I often get asked, "Well, I'm not in ketosis. I can't get into ketosis. My body's not producing ketones." That's okay. You don't have to be producing ketones all the time. But if you ever feel like keto works, but not every day, that there's good days and bad days, that's because making ketones is a complex process naturally in the liver. And there's lots of little influences from adrenaline all the way through to your diet. Uh, making ketones is tough and it takes time. Well, one of the answers there to augment that is to use ketone IQ. A slug of this stuff, which I use on a regular basis, strategically and episodically, a slug of ketone IQ gives you ketones on demand. So, it fuels you up, but because it goes directly to the liver, it also affects the liver's ketone production and enhances the ongoing production of ketones. So, while you see the spike in ketones, if you're measuring them, you stay in relative ketosis at a low level for a prolonged period of time um even when your diet is not optimal. So for mental clarity, for for uh continuous working where you need stamina, this really fits my real life demands and I use ketone IQ together with a carnival-based ketogenic diet.
What about magnesium?
So I I'm a big believer that magnesium should be supplemented especially in uh times of fasting like that muscle cramping is really easy to prevent. I love the the the, you know, the Epsom salt floats, the part where it displaces you because the salinity is so high in that float and just I find it really that like it's the whole person improvement where you slow down, take a break, vacation in an hour and by the way, when you do that routinely in this kind of sensory deprivation, you know, pray through that, improve your life in so many different lanes than just swallowing the pill of magnesium.
Right.
Now I I've I've kind of gone through seasons in life where it was easier to get to that magnesium float and not uh in the meantime, there's magnesium in my cupboard and in my home. So yes.
Right. Right. Anything else? Any other.
Oh, what about what a controversial one? What about iodine? I assume that do you use iodized salt or do you use some like Redmond's or a.
I do I do Redmond's. Here's the other part that iodine is every it is in your cells. It is not something you're allergic to. I've I've read the books and.
Right.
Yes. I I really did like the experiment that I've I've done with a few patients. I did it on a few family members where you rub that iodine on the bottom of your feet. And if you do get a histamine response, it might be that you're low on iodine, but it is a short-term fix. It's easy for this to be restored in your body. I mean, and I have had some cognitively slowed fibromyalgia, been in the ditch for a long time that I bet iodine has been part of their deficiency, but it is a rare person that that it is not as I I don't see it as common as other pe other people claim it is.
Yeah. And I I because I use Redmond, I do supplement not for my thyroid, but for my brain.
Yeah.
And the, you know, again, it comes to my it's part of my cognitive impairment algorithm, but very little. I'm six foot tall. I use two drops Monday through Friday. Very of the 2%. My wife and my son get one. So, it's a very low dose, but to me it equates iodized salt. It's a little bit higher than what there is in iodized salt, but that's adequate because it gets concentrated in those two tissues. And I'm not going to biopsy my thyroid or my brain at this stage to find out what my levels are. So, again, it's an empiric thing for me. But, yeah. So, anything else that you're taking or strongly recommend?
Yeah, those are, you know, I I'm a big big proponent that if you have instead of testing everybody for the MTHFR gene, I look for that um methylonic acid and if it's out of the range, just put don't waste the money on the gene. One in three people have this, you know, methylation issue. Just supplement with that. My husband.
In fact, I've taken it even down further. I just look at B12 and folate levels. And again, I you can look at homocysteine, you can look at MMA. I'm just going to look at those numbers and I don't want people to be through, you know, unmeasurably high. I'm very blood work centric, but that's where you use the a low dose chelated folate and B12 and it takes because ultimately that's going to be your call to action is B12 and folate irrespective of what the testing shows.
Um, but I but there are folks out there that are selling way too much product and you become a victim of the product, especially when 100% of your testing is positive. Now, I don't want to open the rabbit hole of all the GI stuff and all that kind of thing, but it's.
It's easy to get.
You want to be healthy enough that you don't need a lot.
Right. Amen. I and I think people get really I mean, it's the same paradigm shift where you say go to the doctor to find out what's wrong with you. Yes, we have the ability to do that, but let's start with repairing your body in a ketogenic state for give me six months and then we can start spending your money if you think you you want to chase some things.
Yeah. Fill a deficit after you've corrected everything else, not hoping that this is going to correct things.
Right. Amen.
What about another really controversial thing? What about cannabis and all the cannabinoid products that are used for everything from sleep to pain to what are your thoughts about that?
Well, I am that mom uh that I went to every middle school in my kids' uh school district to say, how long does THC stay in the human brain? Uh, and what does that do for the inflammatory processes of the brain and its development? Do you know the answer? How long it takes?
I don't, but I'm sure it's going to be a very long time.
Three months.
Three months.
Three months. Yes. And we have the ability to measure that. It's incredible data. It's not, you know, soft science. This is very good science. And when you have that fat soluble molecule in your brain for those three months, your brain does not get to mature or develop. So, especially when they're in developmental years, it is it is so much worse than alcohol. Uh, it's it just doesn't have a good PR team. Uh, but on the other side, if you want to have uh fat uh defects in the human brain, and again, I encourage you to go to Dr. Almond's site and look at what happens with chronic THC users, whether you get that in gummies or whatever form, that fat soluble molecule does cross the blood brain barrier. It does hang out in your in the melanocytes and in that um myelin sheath. Uh, that fat attracts fat and now you have a hole in the fat when that disintegrates in three months. So to me, there's a beautiful imagery to say this is not helpful for your brain. And you know, very early in the ketogenic space, I had a few of the Duke uh, you know, neuroscientists saying, when people come to me for, you know, my child has seizures, should I put them on marijuana? Uh, you know, the Duke scientist said, when you're done playing that game and you actually want to help that child's brain, you come back to me, but I'm not playing this game that that's some type of.
But it's heavily promoted because there's so much money in the industry and it's it's a big concern for me and again, peptide princesses love their little oh, but I'm taking it for my back pain or, you know, we you can create a pretext for anything, but.
Yeah, so I'm I'm absolutely against all that that THC stuff really bothers me because I think the education on.
And it is so rotten. Just go to go look it up. It's this is not new science. It has been around for a couple decades that we are very sure about this.
So let's go back to our discussion of GLP1s because that industry is just going gangbusters because of the stock market, Eli Lilly's pricing. We got Red True Tide coming down the market. We've got all these ancillary ones.
Um, I like your approach to it. Are you going to advocate for Redda? What is your position there? How do you feel about that?
It's a great molecule coming our way and the the phase three trials are underway with some very promising things from Parkinson's physicians, meaning people who don't specialize in metabolic health. They specialize in brain repair. And again, that was the first uh, you know, major lane that I.
Well, let me let me stop you for a second because I reverse engineer that. If these GLP1s are working well for brain issues, especially cognitive impairment or the Parkinson's type stuff, then and we know that its primary focus is reversal of insulin resistance, then doesn't that connect the dots backwards that Parkinson's and and Alzheimer's are insulin resistance contributed to or even causal uh diseases and does a ketogenic diet not then fit that model? So by extrapolation back and forth. Sorry, I just wanted to throw that out there.
No, I mean, I think that's great because of course that's what you and I would do is saying, okay, so why does it work? What is the underlying um and many times patients don't care and I'm not here to kind of, you know, proselytize that. They have to think like I do. But it is the outcome where they show up and their Parkinson's is onset at 68 years old. you are going to be in a nursing home and you're going to be trapped in that body unless we do something very significant that is persistent to keep you from the edge of that decline that I've seen, you know, Parkinson's win over and over and over again. I'm very hopeful for that. Do I think it's a metabolic disease? Absolutely. But how do you reverse it in them any faster than you would the guy who's 100 pounds overweight? Uh, well, it it, it isn't easy.
But it's not always about reversal. Some because it is a progressive disease and even if if we can arrest it early, that's a win.
Right. I've got several of them where they were on five of the Parkinsonian drugs, now they're on one and they are they're using Trespathide, but that that, you know, that fat-forward chemistry, that ease of keeping them in a ketogenic state and they are all cards on deck. They show up every week for the support group training that I run. Uh, and it is it is a life journey to say, can we reverse your symptoms of Parkinson's to keep you out of the nursing home and living your best life till the day you hop in that grave. And, you know, that is my prayer for the people suffering with that. When I see that it, you know, what do I what is my goal when I'm doing these classrooms full of 12 weeks of Trespathide? Not only is it to send a healthier patient back to a primary care physician and have them, you know, hopefully wake up and see what's in front of them, but it is to gain enough knowledge quickly about how these drugs are working at a metabolic level so that I can help take care of the sickest of them over here in the, you know, brain deterioration, ALS, you know, um, metabolic diseases, putting them on a ventilator every night. Um, that I don't think, um, time waits for them. It's how well can the physician team understand the tools that are coming our way. I am very excited about what will happen with Redat True Tide. And.
Let let me let me stop you for a second because you said something right now very important to me is that a lot of physicians are inquisitive but petrified.
That we don't have peer-reviewed published data from five different studies that tell us this. You're you and I are comfortable because of the results we've seen with our patients. But you you use the phrase time stands in the way. We don't have the time in my opinion or the fiscal well-being and the uh uh um really the ability to do these studies to the point of peer review. Are you comfortable enough with the anecdotal results that you've seen? It sounds like you are to support this as a narrative, especially when it comes to shared decision-making to say, "Hey, this is what I've seen.
What is the downside?"
Yeah. I mean, it is as I look at what are what's your role in medicine? I mean, each of us takes on a different one and I kind of see my lane as this this mass educator. How do I learn what the education is and how do I fact check myself in a in a in a in a puzzle that is ongoing and changing in front of me? What is the clinical application of a ketogenic diet? Well, that's what I've been doing for 10 years. What is the clinical application of a ketogenic diet in an advanced therapeutic ketogenic state plus microscopic doses of GLP-1? Well, there's nobody out there teaching that or studying that. But it is my responsibility as a provider to say, let me do this in a careful and thoughtful way, but not in a way that's so afraid of uh what what this patient's life will not have access to in any other place. Uh, and and, you know, it is my I actually had a discussion last week with some other providers saying, you should write up some clinical case studies and I'm like, okay, do you know what.
Oh, that's easy. They're not in the, but the biggest cost is actually time.
Exactly.
And then going through the whole peer review process. I mean, one of the problems with the current existing status is the FDA is such a roadblock to getting good things in. You can't get startups just don't have the money and um, the the entire system and we can complain about the system all day long, but I am comfortable enough sharing that decision with the patient saying, look, these are the the risks, the benefits, the alternatives. They can access the drug black market or through self-pay compounding pharmacies or through Eli Lilly direct that we can as physicians can no longer regulate that. Mexico, it's over the counter, you don't need.
Honest to God, it is the world is changing very quickly on that and I do think it's it's up to you and I to say, what is that what's happening in your practice? Can you outline it enough to share? So some of that's talks from a stage. I I'm doing my best to write some. My goal for 2026 is to write 12 cases and put it on Substack. Like I don't need a peer review. Yes, I'm not being arrogant there. I'm just saying no, that's another layer and another step in the process that I don't need to slow it down. I have real life cases right in front of me that between, you know, you know, I'm asking Ben Bickman for a little advice on how do I make this, how do I do this.
Right.
Because getting really communicating what you and I are seeing, it's part of our medical responsibility, but you have to actually put it in the place where you don't you can still pay payroll at the end of the month. I mean, you got.
Right. And you know, we also treat individuals. We are not treating populations. And over time, you want to corroborate this, but if nobody ever did the first heart transplant, we still would be waiting for a study that says it's okay. So, you know, I I grew in an era, Chris Barnard lived in our house for a long time. I grew up in an era where he said, "What's the guy's going to die? Louis Wash is going to drop dead. Let's at least give him that option." Patient agreed and heart transplants were done. So, I I followed that, but it was carefully thought out. It wasn't a crazy idea. It wasn't totally crazy. Um, you are one of the throwbacks where you talk about a ketogenic diet, an era where carnivore and carnivore-based has become very sexy.
The the the what I'm learning with humility is that whether you go from pure carnivore to near vegetarian, um, it comes down to the fat and carbohydrate ratio more so than anything else. And there are benefits and and issues with both. I personally follow a carnivore-based diet. We're heavily, but that's a choice. I also learn from my patients because I don't speak about myself. I speak about the patients that I encounter, which is different than what I advocate for myself. Too many people out there are an N of one speaking about themselves.
Oh yeah. And I think that's the privilege of the seats that we sit in, right? Like, okay, yes, we are doing this, but then you have this, you know, 200 patients every, you know, you know, every six months that I get a brand new slate to say, can how can we get outcomes for them as well? And I think.
Well, right. So how do you how do you approach, okay, either religiously I'm vegetarian or I'd like to stay vegetarian, I think it's a good idea. How do you work with that person to kind of get to a keto phase? Um, and what are the essentials that belong in their diet in that regard?
Well, so, you know, how when you meet somebody, you're going to know within short order if you love them or hate them. Uh, when I have a vegetarian uh who comes to me and says that they want me to to conjure up their menu, I tell them, I'm not your girl. Um, to get to a sustainable palatable menu that keeps you in a ketogenic state without using animal products, I'm not your gal. I don't know how to do that. I don't want to know how to do that. I think it's not if you want to talk about not sustainable. That is not sustainable. And I just, I, you know, I think there is something attractive about when you're learning from somebody. I know the lane I'm in. Okay. I am about what are your morning fasting glucose and ketones in the morning? Whether you call that keto or carnivore or keto or you've got 20 carbs or 50 carbs, what I really care about is how insulin resistant are you? And if you're trying to reverse it, we're going to look at your chemistry first thing in the morning to set up a plan that works. And part of that attraction is I've got the math figured out for how I reverse medical problems and I hope doctors learn from it. It's not it's not an original thought. It's using this and applying it. But I also am not going to spend what I would call waste my time learning how to satisfy a vegetarian who I think has a hairbrained idea that thinks a human could live without meat. I'm not your girl.
Yeah. And the challenge I I hear you there and it's an issue for me. However, I have an international population of patients and I know your spirituality sits at the top of your life. You live the life outwardly. And.
I've got to be cognizant of my Hindu population. For example, I just did a um a podcast with somebody who's 10 years free of diabetes on a version of a vegetarian diet. So.
Seriously. Wow.
Yeah. I mean.
I'll send them to you.
Well, I I'm happy to take them, but the interesting thing is vegetarians, not vegan. So, what they're doing is they're incorporating some eggs. And here's the the frustration with the US. For example, when we talk about cottage cheese, the best you can get is 4% fat.
Paneer, which is Indian cottage cheese, is 30% fat.
Oh wow.
And they will I bet that tastes awesome.
Right. So, you know, again, that is where I've learned with humility that yes, it can be done if they're willing to make a few compromises to doing some dairy, to doing some eggs, and raising that fat threshold. But I I've I've I've had to with humility not be so close-minded about, oh, carnivore is the way to go. Um, what is your ideal ratio of, if you could write the script, what is your ideal plant versus animal product? How does that look? How does that optimal diet for you look? So, I've I've walked through this and had seasons of changing my mind a little bit, but I keep landing back on what I want the patient or the person on the other side of that YouTube video or where book to be able to do is apply it in their own life. And of course, 25 years of seeing the sickest of the sick patients, the stack of medical problems we talked about at the beginning, how sick are they? Well, they will know by are you eating too much protein? I don't know. Wake up in the morning and look at your fasting glucose and your fasting ketone together. And if you have, you know, a GKI or what I call a Dr. Bos ratio, which is dirty math.
I love the Bos ratio. Yes.
If I get that Dr. Bos ratio north of 80 every time, they've got too much insulin around. Whatever you're doing is either too late, too high in carbohydrates, or too high in protein for some of the.
In protein. Yeah.
Yeah. So, what I what I quickly learned to do is say, I'm not going to design your menu. find somebody else for the exact menu. What I will be able to tell you is did what you eat yesterday improve your health or did it stay the same or make it a little worse. When you can see that morning like what was your metabolism doing while you slept first thing in the morning check glucose ketones we're going to be able to make some solid decisions from that number. And when every morning you wake up your ketones are 0.3 and your glucose is north of 100, you're doing it wrong. You have too much insulin secretion for whatever the heck you ate yesterday. We got to we got to switch that. I patients really want to box me in a corner saying, "Well, how what's the percentage of that?"
And you can't because I am not you. You are not me and we're different on a regular basis. I I love that. And that is a good diversion from a little bit of a trap that I set because one of the things I really dislike when somebody comes in with this mathematical formula of exactly what they're eating every day. The human body doesn't work that way.
Well, you know, the other part that I always remind them of, especially if we're talking protein, is you see autophagy is recycling of that protein. And when you think you're not getting enough, I promise you what nobody is calculating is how much protein did you recycle because you you you reused protein.
And you know, I'm like, the best way you can do that is to make sure you're in a ketogenic state. So, let's start there. And then when you come to me with that protein question, which I get probably six times a week from my team saying, "Can I still tell them this?" I'm like, "Yes, this is the answer. Look at their numbers to predict their health."
Yeah. And if there's anything I learned from that vegetarian eating some some cheese and and eggs is that their GKI, their Boss ratio is really good and they're eating way lower protein than most of the internet tells people to eat. So you're absolutely right. And the human body. I what I tell patients is the biggest recycling company in the world. Uh, you're recycling stuff all the time and all you're doing with your diet is adding in and supporting that little bit of a loss. And most people if you're trying to get healthier, you're trying to under-eat to allow that recycling to be a positive state. However, should you be in ketosis all the time?
Me um I mean I look at my personal life and most mornings my Dr. B ratio is 60 or less. Are there seasons I'm going to go on a cruise next week? Do I think I'm going to be in ketosis the whole time? No. Uh, but what I want to know is how quickly can I flex back into a ketogenic state? So, instead of saying I should be in ketosis all the time, what I care about is when you drift out of that, are you healthy enough to get yourself back into a state of ketosis intentionally? When I have somebody say, "You know what? I had chocolate ice cream last night, but for the next five days, I couldn't get back in ketosis." What that tells me is your production of insulin is way off the chart. It's still off the chart. And to move it back down to healthy, it takes a few seasons of doing the right thing. When I hear people say, "I want to carb cycle." I'm like, "You're not healthy enough for that yet." You have to be at ideal body weight for enough of a season to be able to say, "Are you flexible enough to mess it up a little and bring it back in in a reasonable I mean within a day or two. If I can't get back in ketosis within a day or two, then I really messed up on that cruise."
Yeah. And I think part of it is the you deal with a lot of patients in that therapeutic arm where you really want to be in ketosis all the time because you're making sacrifices to correct a problematic insulin. But once you're there, once you're years into this, then it is okay to cycle each day through a ketogenic dominant period and a glucogenic because you're insulin sensitive.
So, uh, there are times when you're eating that you want that sugar to be distributed to your cells, not just turned into triglycerides in your liver. So, it depends on your stage of adaptation. Um, you are very big on fasting as a tool, as a weapon. And is that just to get you into endogenous ketosis or what is the what is the primary purpose of fasting? Um, and when is it okay not to? Now, I'm not talking about intermittent. I mean, it is ridiculous that somebody can't go eight hours without eating.
No, I don't use the word fasting until you're at 36 hours.
Okay. So it's extended fasting or beyond that. The rest is just food cycling, right? Um, when when is when should you fast and when should you not or is it okay not to?
So, I don't like patients to fast until I know they're making good ketones. Like, if you look at some of the cases where people fasted just they just tried, you know, >> balls to the wall. I'm going to do it all. I'm going to do this and all they did was hurt themselves. When I look at a ketogenic state is something you should establish before fasting. And that is how you get these endocrine hormones of satiety where fasting isn't this punishment that that if you are insulin resistant and you're full of insulin, it it hurts. It's not fun. It really is difficult.
But I also know that if you've been around the sun enough times where you're that 60, 70, 80, 180 pounds overweight, that excessive time spent in insulin resistance to reverse that, I don't want to take the next 40 years to do that. I need you to give a pulse of your meta metabolic stress frequently enough that you start reversing medical problems. That means a cycle. I mean, humans love a pattern. They love a rhythm of life. So to say you're just going to fast a couple times a year, then you're just doing it for show. But if you're trying to reverse medical problems and you're in a ketogenic state, again, that keto continuum gets up to those steps of 9, 10, 11, and 12, which look at how often are you doing a 36-hour fast? At the end of a 36-hour fast, are you celebrating? That's not what we're doing this for. It's not a badge of honor. It is a journey where you used your endocrine system to empty out some cells and repulse re repush that metabolism that you prime that pulse uh frequently enough and that's how you reverse medical problems. But if you do that before you're in a ketogenic state, and I don't mean for a day or two. I mean you've got a season where your fat cells open up like they're supposed to while you're sleeping, adding fasting will accelerate the reversal of those medical problems as long as it's done routinely and as long as you are first in a ketogenic state before you start to do that.
Perfect. And um, you mentioned this earlier just in in passing, but what impact, how much do you address adrenaline and cortisol because they override all the other hormonal states? And I know we're talking for a long long time. So if you want to if you want to end it, let me know. But I adrenaline, cortisol is so often used as a pretext. What is the truth about cortisol and adrenaline? And how do you manage those states? Those high-intensity, high energy states that override the fright and flight, overrides normal uh ketosis.
So that the cortisol state is actually funny you bring that up because my I have a Do you know what the meme is for cortisol? There's a meme for cortisol right now.
Don't know it.
Have you seen it? I didn't either. My kids showed it to me and I thought, >> huh? It's it it is this it looks like a a stock market uh chart where it's this white background with a red arrow that goes up and when when in my son's fraternity if somebody's having a bad day they'll send like 15 emojis of this dang thing that says you're triggering me.
And I'm like, gh so, but one of the best parts is they think it is, you know, it's just um, it's just another hormone that goes offline when your metabolism is bad. But, you know, cortisol, a very big part of how we how we live and we live in a place that is in excessive amounts of stress.
So then what's the right way if you've got excess cortisol to to make it better? Well, it's the same thing with any hormone. You must.
Stress it to get it to come down. Uh, and that is a dirty little trick to try and help patients who are cortisol fatigued. They mean their body is they are they are way off the charts for excess production of cortisol, way too much stress in life, not enough reset downtime and and repair time. Uh, you know, as I teach about that, I almost never use the word cortisol. I talk about sleep, hygiene, sleep, what is the time you go to bed, what's the time you wake up, do you need to wake up with an alarm, how many night times did you wake up in the middle of the night? It is that history and and action uh placed things like this is a place to reset your brain and if you think I can fix this uh with sprinkling some ketones into your body, you're part of the problem. We need to set up boundaries, right?
Yeah.
So to me the the cortisol um I mean it's all the rage apparently like h you're triggering me there with my cortisol like.
Yeah. What are your offs? What are your emotional offs to?
Yeah. And and so often, as you said, it's not stress, it's continuum of stress.
Right. I mean, it's also why one of my assignments for high cortisol is you go for those magnesium floats. Go for five floats in in three weeks. It's an hour of decompression. And as I as I do that, I mean, and you know, pray.
But that is as that is right, that is as spiritual as it is physiologic. And it's just that reset.
Lipidology. Should we care?
So, you know, what's coming out this Friday? And I don't mean to ruin your time stamp.
No, that's fine.
The Cholesterol Code comes out.
The Cholesterol Code is is they've already had the previews. That's Dave Feldman's uh.
It comes out on Friday on Amazon. If your people haven't listened to it, by golly, they should.
Because it really I mean, even as many times as I've tried to explain this, I came out of that movie, I just saw it last last Monday. I came out of that movie and said, "Oh.
Is that with Philadia's group?
That yes that.
I said I'm stealing a couple of the ways he explained that it was such a better job. I mean, do I think that that is the way cholesterol was designed to be used in our bodies? Absolutely. That it should be the fuel that is cycled around and then recycled back into the liver that quickly. Uh, I I loved it. Um, and I I think lipidology has it is full of uh politics. It's.
Yes. Yes. Politics and money economics. Yeah. And.
I'm not here to say you should never listen to your doctor. That's not what I'm saying. I am saying that a metabolic health is about how quickly you can deliver fuel, specifically fatty acids, to a part of your body that either needs the extra energy or wants to repair. And to me, the lipids, so lipidology should be the study of that. And what it has turned into is the pathology of that.
Right. Right. Right. Right. You know, the little simple phrase that I use is one of two things is happening. Either you produce cholesterol in your liver as a kill switch. God says you've lived enough, we're going to kill you, or maybe it's physiologically necessary. And uh, insulin regulates that. So when we correct insulin, we correct the lipids and we can track that correction as a marker of insulin resistance. But markers are not causes of disease. They tell us about healing.
Yeah. So, so you and I in synergy there. And I think that if we focused a half as much on glucose and and uh insulin as we do on lipids, we're going to be a hell of a lot healthier as a society.
Well, and I just want to say if there were more physicians who had that humility like you do, Dr. Cyus, the ability to say, "This is what I used to think. Here's what I'm doing now. Here's what I'm learning now." And I just think that humility is what is missing in the leadership of medicine today. And may we both continue to say this is how we're going to make our families healthier. The patients that are in the wake of trusting us. This is how they're going to get to learn. And whatever we're saying wrong right now, have the grace to say we're trying to figure this out as fast as possible for you.
Last little kind of topic I want to get into is if carbohydrates are a drug, which I think you and I are very much they're being used as a drug. They are not a drug, but it's our use of them that follows drug-seeking behavior, endorphin reward behavior, instant gratification behavior rather than a food source. We are human because of carbohydrates, but we've we've using them now as a drug. And when you have let's say type two diabetes, obesity, that relationship is chronic, excessive and often exclusive. When you remove that, whether it's a season or in a short period of time, I love your seasonality because it defies a time constraint. However, when you remove a drug, whether it's alcohol, nicotine, or carbohydrates, you're left with a massive emotion management deficit in your program. Do you advocate specifically for replacements of the role of carbohydrates as something that somebody positively puts effort into or do you allow them vicariously to develop alternative strategies?
No, I think you you can't again when they first come into that conversation, they don't want to hear that you're replacing anything with that. They don't really even often appreciate how how dependent their emotional um, you know, vigor is on that burst of of dopamine from the carbohydrates. So to say when you move out of the seasons of that highly dependent se time uh, there should be about 15 different neural pathways that deliver joy in your life and when you were 12, if you had the perfect life, you were developing all of them at once. Yes, your hormones were coming into play and you're going to have uh, the the sex hormones are going to be part of how joy comes into your life over the next few years. But you were also in the seventh grade where competition and winning a competition should have given you pleasure. You should also have been introduced to stories that are deeper than the the primary school stories where they they ignite something in your in your mind. Uh, these different little lanes of reward start out at spiders threads and if the only one you ever use to reward uh, that that um, thinking is exercised, the other 14 become they don't get developed. Now you're an adult and you need to find a way to nourish friendships and competition and achievement and storytelling and um, you know, game playing that those those spider threads need to be developed neural pathways in your brain. And if the only thing you're you've learned or the one you've overlearned is alcohol or carbohydrates, whatever drug you want, uh, that that number nine wire, that big thick wire in your brain needs to have competition. But that means you need to practice it. So you're not going to sit down to a game of cribbage and find it enjoyable the first time you do it. You will need to practice something that says somewhere I'm trying to find pleasure in other things. And that means at the beginning, they're not comfortable, but keep going. And I think, you know, AA does a great job of this where it is in the acts of service. It is in the relationships, it is in the friendships and it is in that development that spiritual development that that really what does it become? What does recovery really look like? And it is the peacefulness of knowing that was a tool and it was a a friend of mine that I abused and I don't want to use that friend for the rest of my life. I want to find other ways to feel joy. And we spend a lot of time, you know, talking through that again, that mirror neuron when they've never seen somebody talk about behavior that way. It's it's weird and they're like, it's like, you know, going to church for the first time, like you guys are weirdos. Um, and then you start to say, but look at the look at the richness in someone's life who has uh those options for saying life isn't going well. I am down. I am sad. I am grieving. What are the ways where I can get to the end of six months and find that I have restored this hole in my life? And it is not through carbohydrates or booze. Uh, I mean, those those are not the tools that healthy uh impactful people use to get past such we're all going to have those dev those devian those side uh gigs in our life. How do you.
What do you do when you're down when you're a little depressed when life is getting at you? How do you escape from that hole?
Yeah. So, I have a few things that are my favorite. So, number one, I I I'm overpowered in husbands, meaning he is my favorite person to hang out with. He's as introverted as I am extroverted. So, we uh spend time together and then and I I'll tell you when I prayed for my husband when I was in a season where I was not going to find another like swearing off boys. I had a broken heart and I prayed to God. I prayed to God for one man who adored me in a way that I had never been adored and God delivered that in a place that I have taken for granted for seasons. We've been married 32 years. Uh, and so to know that that is a place where I do find joy. Uh, other places that our family does great things is we play games. Uh, and so I like I like the competition of games. It also helps me to not think about what I mean I I look at the grieving that happened when my mother died. my favorite person in the whole world and the sadness was so big I couldn't the colors disappeared from the world. Uh, so I did the kind of things that I know I tell patients to, but they didn't feel joyful for many many of those chapters. Um, we played games. I still did that. I hung out with my husband. We still did that. I like to to exercise as long as I'm not alone is a group group activity. So those are places where I did not like that the first five years I did it, but it has become a place of joy that I feel um, that pleasure pleasure when I accomplish it. Um, other things that are really good, I I'm a big prayer. Um, so I I protect myself in a place where I get to really just ask God, what am I supposed to be getting from this? And then I shut up, which you can see I don't do that very well.
So.
Neither of us do. I'm surprised myself being this quiet. It's and that is out of respect for you because I I have that little issue. So, last question for you.
Yes.
Um, and I ask a lot of people this. What's going to kill you? What are you going to die of?
I believe uh that if my husband dies before me, I'll die of a broken heart. It would be the saddest thing I'd ever have to endure. Um, when I look at um health reasons, I mean, I my husband says that my longevity goes up dramatically now that Tesla has full self-driving because I am a distracted driver. And so that one would have been on the list before. But I truly I mean, what is my biggest weakness? What is my biggest weakness is how much of a vacuum my life would have if he was removed. So I've thought about that actually. But the what you didn't say are any metabolic issues cuz.
I check that Dr. Boss's ratio at least four times a week.
Right. So I I mean that, but that is such an important question because most people know what they're likely to die of and some of us do the best we can to push that back. There's a genetic component to it for some of us, but really what you're looking to do is live long, healthy, and wake up dead one day.
Amen. That's a that sounds like a good journey for me.
I absolutely love this. This was this was brilliant and I've learned so much. If I learn from someone like you and I've written down some phrases and things I want to incorporate and transform and make myself better, that's the best we can ask for.
Amen. Isn't that what we're in medicine for? I think that's the loneliest part of being outside of corporate medicine is when you have colleagues where you can see that they're doing amazing things. It's at our few conferences of where I'm like, don't let anybody else talk to them. I would like to just share life with him for a little bit. So I'm really glad we took time for this and I hope your audience likes it. I hope they learn something too.
Wonderful. And we will get into some of those case reports. We just.
Yeah. No. I think this is this is your philosophy, your journey, and you are you may be right, you may be wrong, but the one thing I know about you, you're never in doubt.
You should have been a surgeon. Um, of course, born female man.
But we have to be when we're fighting, not fighting, but when we juxtapose against a healthcare system that is so obviously doing harm to people.
Yeah. I mean, honest to God, uh, it's a place where I hope in my lifetime, we get to have answers for how this uh, how our path of leading patients was it was it vindicated?
We have the answers. We don't yet have the vision.
Right. And and that is what I'm praying for is that more and more people see what is so obvious to you and me every day.
Right. Absolutely.
Well, thank you again. I think this was awesome. Yeah.
Lovely. Thank you very much. Bye-bye.