Hello but then it raises some other questions too for example well what is a low carb diet how did they define it in here and I think you'll see that they defined it fairly loosely and once you start getting into that I mean what's a diet is it a change in lifestyle permanent change or is it a six-month thing that comes up in in this article as well another thing that comes up is very low-carb diet because one of the things they found was the "very low-carb diet" didn't seem to work as well now what does that mean and why would a low carb diet but not a very low carb diet work was the very low carb keto and is this saying that keto doesn't work a lot of questions on this article and I'm very excited to cover it today I think it uh again deals with some very critical uh indicators some drivers of our health that people are just either they're ignoring or they're confused about uh we're gonna go through a few things before we do that as usual we'll cover a few things in terms of uh other content that we offer as usual since uh COVID-19 is one of our major determinants of health right now especially for our population the baby boomers the folks that are starting to get insulin resistant and therefore starting to become at risk for heart attack and stroke and guess what COVID-19 cytokine storm so we can't be focused on baby boomer health and not cover some coveted stuff so we've got a lot of stuff on that but we get into things like we're talking about today as well diet you know the USDA just made a big failure on the USDA guidelines yet again and why did they do that was it because they were too friendly with their uh the folks that were the the industry that was uh funding them big food big pharma okay so before we do uh get into the uh the program again a couple of other uh comments as before we've each new year new year is a big time for us in terms of actual patient care because people say new year's resolution I'm going to finally get my health in order and more than anything else that ends up involving I'm going to change the way I eat that's a big deal both in terms of managing your health in terms of uh new year's and we always try to help people out calcium score now James you said that you you joined us you came sliding in home right at the last minute you and I were talking about the show before it came on did you want to make a comment about calcium score well good morning Dr. Brewer um good show yes you know the calcium score the reason that you offer this help for those who are listening that may have had a calcium score or in those that have not and don't really understand the funnel of sales that happens in healthcare as listeners may know you and I have run healthcare systems before the calcium score is a legitimate test and it tells you of course whether you know the condition of your arteries but it often not always but often it's the top of a funnel cell cycle that the health care system is getting you in it can disturb you with the calcium score and suggest the follow-up might be a stress test you can speak to how often stress tests are actually false positives it's a significant amount of time so because of that we need to probe a little bit deeper and do an angioplasty and then of course with an angioplasty it's an expensive and somewhat risky um a procedure to go through and then based on what they find there you may have a sin uh put in when in fact maybe there was a lifestyle change that that calcium score should trigger some just a disturbing event in your life to make some changes but would you not say Dr. Brewer that instead of getting on that financial cycle that funds the world of cardiology always put your phones on sign up before you start a YouTube channel that's a good idea instead of funding that uh system you might find a lifestyle change is uh may accomplish everything that you need and so that's the reason we're emphasizing if you have a positive calcium score and you're disturbed good you should be disturbed not good that you had a it is what it was but there is an alternative that is proven in studies is healthy alternative to address most conditions once you have a positive calcium score you can tell more about how we treat that what we do for individuals to you know once they've identified that they may be at risk so you bring up several good points um I don't have the statistics and I can't say for sure but it's just an impression I think more patients come to see us because they've had a positive calcium score than anything else another one yesterday and this individual was a gentleman 75 years old and he had a positive calcium score as you began to dig deeper he was like so many of our patients over half he had weighed 20 30 pounds more just about three or four years ago back in his early 70s uh at this point in time he had no he had no um he had significant calcium but uh and obviously some old plaque but it was all uh stable which you're not going to see on a calcium score a lot of people have compared my channel to um to Ivor Cummins um until the COVID thing came up and then Ivor and I took two different directions he became more of the he went a different direction but I think both of us would agree that calcium score is very a very appropriate test I tended to use a lot more CIMT but simply because I had a couple of good sources I've really only found three good sources for a reliable CIMT uh in the country the reason I used CIMT is that it was able to tell me like in this gentleman yesterday he didn't have any soft plaque now here's the big issue and and you may have thought I was about to ignore it the big issue is going down the rest of that wrong path if you look at what most people do where most cardiologists take people it's okay you got a positive calcium score most cardiologists are still not using calcium score but when they do let's do a stress test and guess what uh just google it uh what 1.5 million out of the 8 million stress tests that were done prior to the prior to COVID per year we knew the NIH said we knew was going to be either a false positive or false negative well guess what whether it's a false if it's a even if it's a false positive and we knew that about 25 of them would be false positive you're still going into the cath lab and guess what if you've had those two things what's the probability of seeing plaque and guess what if you're a hammer everything looks like a nail if you see plaque in there you make an assumption that I'm going to put a stent in there and the stents going to stop that prevent a heart attack now 10% of stents do something good they're treating actually treating a heart attack the other 90% of stents are put there to "prevent a heart attack" and if you look at uh the the studies that have been done over the past three to five years it's really clear stents don't prevent a heart attack over the past year so it's also become clear with the ISCHEMIA trial that even bypasses don't prevent heart attack so you get into a situation similar to what I'm sure happened with Tim Russert he goes in he gets a a stress test now he was on the other side he had a "negative" stress test so he goes home thinking you know what I know I've gained a little bit of weight I'm up over 40 inches on my waistline now but my stress test says I'm okay so I'm good I can breathe a sigh of relief and continue those business breakfasts those business lunches continue to pack it on but I'm running so I'm go and my stress test is okay so I'm good and we all know what happened to Tim and if you don't know what happened three months later he had a heart attack and died in at his place of work so stress tests are not a great way to go they just take you down that path uh anything else before I uh move on James no that's great in our newsletter for those who are signed up for our newsletter uh you will see that we mentioned this week uh how to use how to do a brachial test so you may talk so you talked about CIMTs carotid internal medial thickness test uh but you also uh in this month's newsletter discuss how you can uh take a blood pressure cuff so if you want to pitch that a little bit it's very similar to look and see what what may be occurring using uh something you may already have at home to run an ad hoc test it is I have to tell you James uh oh in some ways I've had mixed emotions about putting that video up there because one of the things that that's done it's been a very popular video for us uh do-it-yourself plaque detection using um using ABI uh ankle brachial index looking at the the blood pressure in your uh arm versus your ankle with the assumption that plaque at a significant level is going to change the the ratio there here's the problem and I don't think I was strong enough on talking about the problem with that a) it doesn't rule out plaque b) uh you can have plaque which doesn't impact this at all and still it'd be enough plaque that cause a heart attack or stroke and so it was really more of a question is this a do-it-yourself plaque detection and again I don't think I made that case well enough I think that's one of the things we need to keep our eye on in terms of our own content to get back and make that case stronger that uh a negative you can't use it to rule out plaque you just cannot well let me ask you something well I know we're down a bunny hole pardon me I'll tell you this even though I apologize for going down bunny holes a lot a whole lot of folks then come back and say the bunny holes are the best part so far well Steve Mitchum in the questions ask and this is a good time to answer it while we're on the subject is a cat scan with contrast as good as a CIMT so actually if you go I don't know if Gilbert is still showing my screen there's a reason I went to my screen prevention myths it's the book the upcoming book that I keep promising and uh my co-author the three of us my co-author and my publisher and I can't seem to get our act together the last this past week there were problems with one of them being in Mexico with uh being ill and the other waiting on each other anyhow bottom line is that this book if you have an interest in the topics that we've just covered this book goes into detail it starts off with that Tim Russert's story but it goes way deep into plaque plaque is what's uh you know it's causing the problem now there are several different ways and it's like James started out your typical progression is Framingham from Framingham if you've got risk go to statins and to the stress test well the Framingham is based on old data and it results in way too many people going on statins uh stress tests we've already talked about major problem um getting us a needle stuck into your groin in a in a tube catheter up to your heart that's not fun and that's got its own set of problems and then that leads in almost inevitably to a stent which doesn't prevent a heart attack so that's what this book talks about it goes into the details on how these things were developed but more importantly and back to your question on this bunny hole what are the ways of evaluating plaque and how should we do it and we talk in depth about three ways one of them is the CIMT which we just discussed for a minute the second one is calcium score which you just brought up and the third is what the the question that just came up CT angiogram a CT angiogram is um it is the up and comer even the the a lot of the guys in the standard medical community have already begun to embrace CT angiogram one of the key things that the CT angiogram does if you go back and you look at the COURAGE studies and a couple of the studies that compared this what they did was they said look we're going to have the cardiologist do whatever he or she would normally do that's usually going to be a strip Framingham stress test all that other stuff but in this in the study arm we're going to have them add a CT angiogram SCOT-HEART study was the other one the two big ones COURAGE trial and SCOT-HEART I think uh here's what they found that they there were actually a few more procedures early on in the uh the study group the CT angiogram group overall the procedures done were the same so it wasn't the procedures but here's what did happen and here's why you saw more procedures early on the CT angiogram is better than any of these other technologies it's showing you where you've got plaque we had a fellow that worked with us for about a year or two about a year his name is Gerry Kurth and he said Ford you got to look at my CT angiogram he said I mean it was ugly but that was perfect here's what I did with it I took the image and I taped it to my refrigerator door so what what that does I mean as you see James it continues to go back to this theme small amounts of plaque can cause this problem uh the typical ways of looking at it Framingham stress tests angiogram really are not working the simpler ways are working but they're still not leading to procedures so much as they're leading to recognition that I have plaque and changing the lifestyle so that's where uh I've given you uh uh what a three three to five minute summary of the book well uh just remember they're all saying things that may not prevent a heart attack do pay for Cadillacs in any other comments before we move to uh on to the next phase we're going to try to script skip through some of these just to let you let make you aware though we've got we're continuing to get uh content out on our uh uh on on our website it's continuing to work it's continuing to become a destination website where people actually go and learn right and um and I would I would emphasize right now again another good time is we're giving away the CVI course so you can sign up and take the CVI course for free which will cover a lot of this so I recommend everyone that's listening go take the CVI course for free learn learn the baseline of uh what we're doing at PrevMed what Ford's model is and it's reversing it's reversing uh disease reversing chronic disease you can reverse this stuff you can you can you make a 180 degree turn in your life most people can make tremendous uh improvements and that's a great course to start with and it's free you're making it available free good point I pulled up the courses while you were talking there's a reason why these are the courses that we have they're the core curriculum you don't need to know a whole lot more than the plaque evaluation course the insulin resistance course in terms of what's the root cause and cardiovascular inflammation you know am I in danger now or if you if you want to get all three of them and get more of a a comprehensive course we have the the conference proceedings all of which are available so let me move on and if you're one of those guys that rather that prefers to hear on podcasts we've got plenty of information on the podcast as well but let's uh let's get a water ball uh Gilbert and then we'll go into a transition actually I messed up I did have one more slide it's our uh totally unrelated science issue slide a quick one slide bunny hole I got to put I got to make a comment about it and here's my take on it uh I have volunteered to become a uh I'm a physician uh trained in prevention I taught prevention I know how to give actually when I was at Kroger in the little clinics I ended up testifying to the FDA on methods of mass vaccination I volunteered here at Lexington Fayette several times to help them give vaccines I haven't heard back I volunteered uh for over uh at Louisville Louisville Kentucky about an hour away what I got was I ended up one of the calls I made was to the state COVID line and they said yeah we really need help we really need help but here's the number to call got nowhere so here's my perspective state and local governments uh and and local hospitals tend to have huge bureaucracies and they're you know they approach things bureaucratically unfortunately bureaucracies are not built for efficiency tens of millions of lives are currently depending on their ability to efficiently get that vaccine out there and just one there was an article I read recently is about Southern California their vaccine lines aren't moving either there are many barriers there's no part-time shift available so the only available shift is ten and a half hours for a doctor to volunteer or a health care person it's really going to be more nurses than anybody else there's a lot more nurses available to do this than there are docs but they only take uh 10 and a half hour shifts so they get plenty of volunteers on Saturday but not on Monday through Friday there's just a huge number of bureaucratic processes that's jamming this thing up in LA the health website requires seven to ten clicks before clinicians can sign up I found the same thing here in Lexington Fayette I had to look and look and look and I went to multiple websites I finally found a tiny little statement at the bottom of one of the back pages are you a health care person you want to volunteer to give vaccines I did I clicked on it I filled all that out over a week ago haven't heard from anybody the frustration isn't only in LA two former San Diego county medical association presidents have been trying to volunteer as well but they've been thwarted by a confusing array of steps and processes too many forms county officials failing to take them up on their offer and some look just like Lexington Fayette failed to take me up on my offer in some locations doctors are to go through training and a quiz to verify they know how to give a vaccine injection this is keeping the vaccine from being from getting into arms so James I'm go unless you have any other comments about that space I'm going to move on to the uh to the program for today about low carb uh one quick comment and that is uh how good last week uh I was joining I was watching I was ill and um and I appreciate your the good doctor got me back healthy uh after last week's event but last week's vaccine show with Dr. Vigerust was extraordinarily good so anyone that hasn't seen that show it's archived they should go back and watch it you and Dr. Vigerust had fantastic chemistry together great knowledge
uh it was it was my favorite show maybe that should tell me something about being on here maybe more but it's a great show we covered a lot about vaccines on that show um and a lot about the virus so I highly recommend if you're interested in this subject go back find that show and watch it with Dr. Vigerust and Dr. Brewer I highly recommend it it's a good point uh thank you very much James and uh thanks for your humility as well glad to have you back glad you're glad you're feeling better one of the things that we didn't cover and we uh I just sent uh one of the articles to Chris to talk about uh the projections for the mutant uh one of the mutant variations one of the new variations to to be dominating in the US and right now the CDC's uh projecting that that'll be by March and I think they're referring to the UK variant which now has a new name sort of like the artist that was formerly known as Prince it's the variant that was formerly known as the UK variant so anything else before we get to the content for today the program okay type 2 diabetes reversed with low carb diet you know whenever you see stuff like this it's helpful to start saying okay well how do they define each of these things how did they define type 2 diabetes how did they define reversed and then how did they define low carb and how did they define diet so these are all questions to be thinking about as we go through the details so uh people with type 2 diabetes have a low tolerance to carbohydrates well you would think but again you get into some of the folks that are just uber plant-based they say it's really all fat that causes the problem I don't agree with that but we'll get to that a little bit later we'll that's one of our discussion points eating excess carbs increases blood pressure levels I mean blood sugar levels it eventually requires people to take insulin or diabetes medication according to Mark Cucuzzella a professor at the West Virginia University School of Medicine has published several studies on dietary changes and diabetes their bodies do not metabolize and respond well to carbohydrates well that's the truth and the end result is high insulin levels and hyperglycemia or high blood sugar levels yes that's true as well and either of those things high insulin levels or high glucose levels can cause inflammation which in turn causes the inflammation of the causes a burn of the lining of the artery wall that burn of the lining of the artery wall causes cholesterol at whatever level your cholesterol happens to be to seep through that lining it won't go through the next layer the media or muscle layer so it gets stuck it gets stuck between the intima layer the lining and the muscle layer the media layer that's why we look at CIMT the carotid intima-media thickness test you're measuring the amount of plaque in those two layers however restricting carb intake to management type 2 diabetes is a controversial topic believe it or not largely because trial results have so far been pretty inconclusive now that's an interesting question which we can discuss again later if there's an appetite to do so so here's a couple of the articles one is BMJ again one of the the major medical journals in the world you can criticize it just like you can criticize any of them but here are the two topics efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission systematic review meta-analysis now one thing I'll stop and say remember meta-analysis is not just one clinical trial it's a study of all the other clinical trials and studies that have been done and published meta-analysis of published and unpublished randomized clinical trials the other one is nutrition therapy for adults with diabetes or prediabetes a consensus report from Diabetes Journal to better understand the impact of a low-carb diet researchers that published in this BMJ article analyzed the data from 23 trials that involved 1,357 patients with type 2 diabetes the new meta-analysis was published in BMJ researchers found that type 2 diabetics who followed a low-carb diet for at least 6 months experienced greater rates of remission than those who did not I'm going to stop and make a editorial comment if you read Jenny Ruhl r-u-h-l runs an award-winning site for diabetics it's called Blood Sugar 101 she wrote a book called Blood Sugar 101 you can learn an immense amount just reading the first 60 pages depending on how quickly you read spend about an hour with that book you learn a lot about prediabetes she wrote another book it was called Diet 101 and in that book she had a couple of key things to say one of them is eat to the glucometer and if you're eating to the glucometer which James has become a passionate uh supporter of if you're eating to the glucometer there you're not going to have many arguments about eating a low carb versus high carb diet the other thing that she brings up which is a critical point in Diet 101 is it's not a diet it's not six months if and that's the problem with randomized clinical trials with a randomized clinical trial you've got to get someone who's agreeing to eat a certain way and they're only going to do it for a certain time period it has to be a permanent change in a lifestyle the way you eat so it's almost if you begin to understand that it's not a diet it's a changed lifestyle you begin to understand the problems in saying we're gonna do a randomized clinical trial for diet who's going to stay there for for over six for even six months that's the problem when you start looking at randomized clinical trials so the BMJ findings are consistent with the ADA's 2019 recommendation on carbs reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evident or the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences now that may sound like a little bit of weasel wording uh to you it does to me especially there at the end and may be applied but that's actually a huge improvement over where they were 2018 and before at 2018 and before ADA folks were saying uh carb it up yeah a whole different set of battles which I'm not going to get into because you know we've only got like an hour so previously the the ADA warned against diets under 130 grams of carbs a day because people would be deprived of "essential nutrients" so not going to make more comments in that space so researchers first so let's go back to this this uh excuse me BMJ study low carb diet how did they define it I've asked that question a couple of times they defined it as 26% of daily calories coming from carbs well James you know maybe you can be doing some of the math on a 16 to 1700 calorie diet and you know how many carbs would you have to do how many grams of carbs so I'm going to give you a few minutes to do that while I finish this this uh this part of the presentation and then they had the very low carb diet 10% of daily calories coming from carbs and is that really like a more of a keto kind of diet and again I can't help you know when I'm asking questions and trying to sift out fact versus misunderstanding there's really no definition of carbs here here or here and it reminds me of the conversation that I had with David Meinz who is in this same space cardiovascular prevention but for and he was a public speaker for like over 20 years and he talked about he was one of those as well he talked about carbs carb it up you know the the typical old old style until about a couple years ago he and I were sitting in his car prior to a meeting and he said Ford I just I have to tell you it's so frustrating and embarrassing I'm a professional in dietetics and for so many years I've been telling people to eat carbs so part of the confusion there was just about six months ago he and I were or six to 12 months prior to that conversation he and I were in a debate at one of our meetings I was I was on the low carb side he was on the ADA side at that point this was about three years ago and it and I was said something about decreasing carbs and he said are you telling me to decrease uh broccoli to decrease cauliflower to decrease asparagus because these are all high carb foods they're made of nothing but carbs so again pardon me for the bunny hole but we've got to be careful about what we're defining no wonder we have so much argument as humans we can't define things very well so um at the end of the day uh I think we have to be more careful about saying low carb or glycemic so participants were evaluated at two intervals at six and 12 months the primary outcomes were type 2 diabetes remission well speaking of definitions what did that mean uh if for their study it meant as a person who has previously been diagnosed with type 2 diabetes now has a hemoglobin A1c of less than 6.5 well those of you who followed our channel know that it's there's a significant challenge in terms of comparing A1c's between people it's impacted by hemoglobin fasting glucose less than seven millimoles or 126 milligrams per deciliter or with or without uh diabetes medication so that's not the way I would define uh full-blown diabetes well that's one of several ways I wouldn't use the A1c I would use the fasting glucose but most often I use the peak glucose on an OGTT oral glucose tolerance test they also talked about weight loss A1c fasting glucose and adverse events in terms of trying to define someone as quote in remission for type 2 diabetes they also looked at secondary outcomes too health-related quality of life biochemical laboratory data but as you see they really where's the stuff about heart attack and stroke which is one of the key things that we want to look at six months the low-carb diets achieved a 32% diabetes remission which is higher than the other diets remission was defined as we said A1c less than 6.5 fasting glucose less than 7 or 126 smaller non-significant effect occurred without a diabetes medication additional benefits for the low carb diet include large improvements in weight loss significant weight loss and I can tell you from doing this for a living there is nothing like losing body fat to improve this situation prediabetes diabetes insulin resistance you're usually going to get a significant decrease in triglycerides and again those are the three things that they're talking about large improvements in weight loss triglycerides and insulin sensitivity so they may have been using some slightly different definitions but they're still we're all focusing on the same issue researchers acknowledge weight loss as the primary driver of remission I do too again I do this all day every day and weight loss is king however while low-carb groups lost more weight compared to the control groups around 7.4 kilograms so what is that 15 pounds or more 20 pounds the weight difference as well as remission disappeared by 12 months remember what we talked about these are clinical trials in other words you're randomized to okay for six months I'm going to agree to this diet they're not committed to making a change on their lifestyle the decrease in benefits may have occurred because patients stop sticking to the diet over time well that's what we just said more research as most of these things do they they end up calling for more research to be done in exploring long-term adherence and effects I will say this in my own experience I have a few folks who do very well on a ketogenic diet more folks more often do better on a kinder gentler low carb diet because it's just easier to to stick to this is not a sprint sprint lasts what eight or nine seconds this is not even a marathon marathons last between two and six hours depending on how fast or slow you are this is month after month decade uh year after year decade after decade so this is a permanent change that we have to look for also very low-carb diets were less effective in than low-carb diets for weight loss however this may have been explained by diet adherence people on the very low carb diets had more difficulty adhering to the very low carb diet the idea of diabetes remission is somewhat a new idea I wouldn't say quite new somewhat new we don't have enough evidence yet that remission is permanent so a lot of research is needed I will say this it's really clear that it's not permanent you don't sign with the weight loss will decrease there are a couple of things that impact the receptor the insulin receptor one is your age another is your body fat so if you lose body fat you will improve your insulin resistance um I can't go further without mentioning one other little bunny hole once we get past age 65 we have to be very careful that it's not just losing weight that it's losing body fat because uh you're 65 and older is notorious for maintaining the same uh circumference the same size of your leg but muscle being replaced with fat that is very dangerous and that's one of the biggest causes of cardiovascular inflammation and insulin resistance the amount of carbs people consumed on a low carb diet varied ranging from less than 26% to 45% of daily calories from carbs that's not a low-carb diet to me unless my math is wrong that's a very very gentle very easy diet unless it's including all of those um broccoli you know all of those fiber related carbs this could impact whether some low carb diets work better than others none of the studies control for protein intake many of the low carb diets doubled the calories from protein which could also have impacted the chance of remission none of the studies controlled for medication use making it difficult to really see the impact of low carb diets alone when beginning a low-carb diet it's important to monitor blood sugar levels and to have the assistance of a doctor or registered dietitian who specializes in diabetes and nutrition I would also say when you talk to the doc when you talk to the dietitian find out first if they're if they're open and amenable to a low-carb diet uh more and more are especially over the past couple of excuse me the past couple of years dietitians like David many of them have made that transition even the ADA has made that transition so you're not seeing it so much anymore but you still see it dietitians who say and doctors who say low carb is bad so we're going to go and talk about we're going to get a quick minute or two on this video and then we'll go into Q&A meet Jim Jim's got type 2 diabetes and wants to put it into remission meet Jim Jjim's got type 2 diabetes and wants to put it into remission what's remission to explain let's take a look inside his body the pancreas is a really important organ that makes the hormone insulin insulin travels around the body and helps our cells to use glucose as fuel but in people with type 2 diabetes like Jim insulin stops working properly and there might not be enough a bit at the right times this means glucose builds up in Jim's blood damaging his body Jim used to manage his diabetes with diet but now he needs medication to stop his blood sugar levels rising but our scientists thought there could be another way they wanted to see if type 2 diabetes could be put into remission they believe a buildup of fat inside the liver and pancreas could be the root of the problem they're running our DIRECT trial testing a new remission program and Jim is a trial volunteer with support from a dietitian he swaps his usual food for low calorie soups and shakes which helps them to lose weight quickly after a few months the dietitian helps Jim to keep the weight off by eating the right amounts of healthy foods our scientists looked at what was happening inside Jim's body over time the fats inside his liver and pancreas started to disappear his pancreas is now making the right amount of insulin at the right time and his insulin is starting to work properly this means that Jim's blood sugar levels are healthy without needing any diabetes medications he's in remission Jim still has an annual review with his doctor but he's now much healthier back out on his bike and running after the family he's likely to have a lower risk of diabetes complications like heart disease it's life-changing remission isn't possible for everyone but losing extra weight has lots of benefits better sleep you can move more easily and you can feel better emotionally and physically it can also help to reduce your risk of diabetes complications and you might need fewer diabetes medications the weight management program tested by our scientists is amongst the strongest evidence we have for remission so far but there are different ways to lose extra weight find something that works for you there's still a lot we don't know about remission we want to help people keep their weight healthy and stay in remission we also want a treatment that works for people of different ethnicities or who are a healthy weight already that's why our scientists are working hard to build our knowledge so that together we can make remission a reality for as many people as possible so we've been beating up on the topic and getting uh questioning a whole lot of things again I think as I said before you get a lot of questions in terms of just what is how are they defining prediabetes how would you define prediabetes how do you define insulin resistance how do you define quote remission having said all of that the question still is i think is this significant evidence for a low-carb diet and there's no question in my mind it is it's very significant evidence that low-carb diet is is very helpful and I didn't need it I mean I work with it all day every day James comments uh absolutely agree I've I've done some math for you as well one quick comment for just to get you frustrated because we're still having a delay feed for the people who are watching if they're seeing the same delay feed in the video versus the voice uh we either having a delay feed or you are the world's greatest ventriloquist uh because at times that you're you're talking it'll go silent so we ask our audience bear with us that's it's a streaming issue that we've we've struggled with so can I make a comment about that yes we uh uh Gilbert and I noticed this and I can see it right now according to now I'm uh my video looks like it's about a minute behind my voice um we turned my computer off looked like it had and turned it back on looked like it had cured it again last week we were having the same problem and a little bit the week before it turned out last week that one of my patients that afternoon actually manages home call centers for a large hospital system he said yeah I saw it and yes I do this for a living and you may think it's your RAM you can go back and try to clean that out like we had done and we see this all the time I don't think it's your RAM I think it's local bandwidth issues and I just I just don't think you're going to be able to fix that I don't think you're going to be able to problem solve that so thank you for bringing it up just for the audience and uh I know it frustrates you a little bit you're doing the best you can um a couple of things on that diet to the point that you mentioned so I think if my conversion ratio is right with carbs it's about a four to one ratio so four calories for every one gram of carbs now I know it certain foods can maybe shift that a little bit but I think that's a good rule in fat is about a nine to one ratio so if you have a 1,600 calorie diet and about 400 of those calories according to that recommendation of 25 being carbs that's going to be 25 simply 100 grams of carbs and I think you and I both agree more importantly you would say that's probably not a low carb diet 100 grams of carbs is probably not a low carb diet when when you look at a nine to one ratio you could do 50 fat and we'll talk about the kinds of fat that would be in my own personal experience and changing but it's about a nine to one ratio so that's the math and we can talk about specific foods in that broccoli for instance that the one doctor brought up broccoli is about 9 to 10 grams of carbohydrates but you might address what are called net carbs you're talking about definition but it's ensured carbs not all carbs are created equal either not all fats are created so as a rule we're saying higher fat lower carbs which got me excited I went out ate Kentucky fried chicken for a week didn't seem to work out so well for me but that was tongue and cheek but talk about net carbs net fats different kinds of fats different kind of carbs and maybe that'll help clarify for some of our listeners and we'll talk about some of those foods if you want that I use and what their fat what their calorie content is well to your point about fried chicken I will uh I'll just tell you as I told you last week I have discovered I've gotten back to my roots and I have discovered a low-carb version of fried chicken I used a pork panko I'm making large masses of pork panko fried chicken now zero carbs because you got the pork cracklin crumbs the uh the avocado oil and the chicken right so actually I'm glad you did the math I don't think I did the math that well earlier I don't really think a hundred grams of carbs uh per day is that bad but again I'm assuming we're talking about total carbs and not just net carbs right um what I would suggest Gilbert is maybe you could find pictures or stills of me and James and when we're lagging like this uh just put a still picture up so it's not quite as distracting well um I'm not lagging but if you're gonna put a picture up Gilbert find Tom Selleck or Brad Pitt or something like that let's stop a picture if they're going to look at us and it's live I get it if you're going to put pictures off make a slightly better looking that's my only suggestion for it I'm not sure I could tell the difference between you and Tom Selleck I didn't want to be ugly to you Ford so if you're going to be make us all uncomfortable yes just put one over Ford's picture uh that would work anyhow we've gone down a bunny hole that I'm not sure is that uh productive for folks um but uh so I'm again I was a little bit surprised when you did that math uh I do actually tell people that one good way of dealing with this is not overdoing it not saying uh I'm going to restrict myself to 25% to 50% carbs total because that's too hard now to get back to your point well total carbs versus net carbs so the FDA and their infinite wisdom has and I'm being sarcastic in case now so in their infinite wisdom has said look we have to present if you look at the organic chemistry um fiber plant fiber is a carbohydrate it doesn't matter that it doesn't impact your blood sugar at all in fact if anything it tends to help control it by slowing the dumping of of sugars from your GI system from your stomach into your bloodstream so uh when you look at a at a uh food label you'll often see uh things like cauliflower and broccoli listed as a carb now though now that we're getting more health conscious more glycemia conscious you'll start to see net carbs you'll see carbs you'll see sugars you'll see total carbs and sometimes even net carbs so what they're doing is they're taking that fiber out of the total carbs and that's really much more realistic any comments about that James no other than so if you do the math you and I often talk about you talk about stealth cards and that's usually what catches people uh for instance if you if you need to limit to 100 net carbs and and maybe lower a diet excuse me a regular Coke from McDonald's is 65 grams of that so you're you're gonna get most of your carbs just in one Coke a day uh a Starbucks with a frappuccino mocha wafferino is gonna throw you out of your carbs so it's those one or two little things an apple is 21 grams of carbs and getting that out maybe the fiber a little bit but it certainly affects your blood sugar great certainly do so um that's the math it's four to one and then you've got to determine whether it's fiber or not I think that is how we get our definitions aligned correctly very good I see your Aunt Martha's aunt yes Daryl is that her husband Daryl is my uncle started using the Freestyle Libre uh we've had a couple of other people comment about the Freestyle Libre uh we actually have a program for it you might mention that we have a program they can reach out to us for subscription to the Libre from PrevMed so you might want to address that because people ask that question uh you know where can we get the subscription prescription excuse me for a Freestyle uh so do you want to comment on that quickly sure sure uh the big question most people ask is how much does it cost I don't know you may know but here's my view on it that um again I used to think I wasn't that political but I'm hearing myself being sarcastic about more and more government agencies I was always anti-big government but anyway the FDA in its continued infinite wisdom has decided that a Freestyle Libre needs a prescription why they decided that I have no clue um I think what they may you know they're always you know how bureaucrats tend to look for potential danger and I think the potential danger that some bureaucrat on the FDA committee may have said was well look people are going to try to adjust their insulin based on this and that's dangerous well you know it's dangerous to drive a car at 90 miles an hour with your eyes close too I mean that people do a lot of dangerous things but what they've done is they've made continuous glucose monitoring uh unavailable for the masses unless you can convince a doctor to write you a script and that's just flat wrong and so I've got licenses in over 40 states I'm totally comfortable writing Freestyle Libre for folks if you have an interest in getting a script for Freestyle Libre give us a call 859-721-1414 that's 859-721-1414 and the bottom line is knowing what your blood sugar value is is critical on a day-to-day basis how does it respond when you go for a walk how does it respond when you eat lentils how does it respond when you eat you get up and you have that "healthy" breakfast of orange juice and oatmeal versus that really bad breakfast of bacon and eggs well I can tell you you'll be surprised if you think that the first is healthy and the latter is unhealthy um major major surprises people get when they actually start using it in fact to go back to the car analogy uh the FDA decision to make this a prescription is analogous to taking away a dashboard a speedometer on car for health you know you it's like having a speedometer there and you really need it you need to understand what how your blood sugar responds to what you eat and what you do and by the way to your point Ford that I agree with you because sometimes I see common sense you don't have to have a script you can you can get your hands on all types of measuring meters you know the finger stick kind so if someone wanted to play that game they could do that they would just have to they just have to take their fingers more often you know create more pain but if someone wanted to say I'm gonna I'm gonna manage this myself and not work with my health care provider well that that option is already available that abuse is already there you're not changing the ability of someone who abuses it you're simply you know making their life more unconquered I'd be careful there's a couple of things if you're going to do that one is you still don't figure out what's going on you should get a decrease in your blood sugar about three four in the morning right before that cortisol dump happens um and you're not going to find that just by doing repeated finger sticks the other thing is be careful which finger stick device you get the cheapest ones are often so wrong as to be worse than worthless um none of them are perfect but I think Contour for example is sold by either CVS or Walgreens I think it's CVS and Contour is really really bad um on the other hand there are some that are really good um the uh Abbott Freestyle now I'm not talking about the Libre just the Abott Freestyle devices there's a Neo there's a couple of others and no I do not have any financial uh link to Abbott or the makers of any of these things I'm not the ultimate expert in this area either that would be Richard Bernstein he's a physician living about 10 miles from where I used to live in New York the father of diabetes self-care a lot of the comments and questions uh we're gonna get into relate to this we're getting a lot of great comments and one of them is we'll jump ahead around oatmeal and since we're talking about the meters you know the debate around whether oatmeal should be netted out for the fiber well the Libre the continuous glucose monitor helps you determine that so if you get a continuous glucose monitor and you really want to find that answer out for yourself you can you can eat oatmeal now I can tell you in my own personal history years ago when i worked with a personal um exercise assistant I had a trainer and she recommended that I eat oatmeal in the morning eat oatmeal in the morning and I needed to lose weight I wanted to exercise well I was exercising like a madman because I was paying somebody to help me and I was eating that oatmeal eating that oatmeal and it really wasn't losing a lot of weight you'd think I'd know better this is 10 12 15 years ago she said well what kind of oatmeal are you eating well sometimes I have the brown maple sugar oatmeal sometimes have the strawberry and cream oatmeal I should pour that sugar down me you know with all the sweeteners that were in the paper oatmeal so of course you know I'm just spiking my blood sugar in the morning and just burning when I'd exercise I just burn the carbs out of my blood bloodstream not really affecting uh any weight loss so using the Freestyle Libre and then eating the right kind of oatmeal you know not pouring sugar or sweets or honey or anything that increases that glycemic index you'll be able to see very quickly I've done it I still do it you'll be able to see very quickly the impact that food has one hour two hours three hours after eating and you will find a lot of surprises yes you will uh some of the some of the worst oatmeal to eat is the instant oatmeal the rolled oatmeals the things that have been powdered uh because it just grinds up those uh those carbohydrates where they can hit your bloodstream all at once I'm looking at my picture it looks like I'm looking at my foot or something well there you go pick the most opportune time to freeze didn't it you know Gilbert if you if in the future if you can find a picture of Doogie Houser or Doogie Houser and just whenever he freezes just put that picture up there and everyone will think it's all the same so that's how we'll solve that question what a headache you know it it's we've talked many times it's like spouses can't live with them can't live without them uh technology is just can't can't live without it anymore but it can be a headache too or on to the questions we ran a lot of bunny holes we burned up the hour already today um but we covered a lot of the questions as well some of this conversation was both of us checking this and seeing some of these issues so you can scroll through them and maybe hit some of these questions about the diet if you want uh since we've used up a lot of our time already I did see one question from My Bjj uh I think that was the again my system has gone wonky again I think it was My Bjj that asked the question about uh atorvastatin he saw I think he said he saw a study where atorvastatin was banging on the beta cells uh it may actually do that it is um it's well known that the um that all of the statins except one push you down that insulin resistance highway that diabetes highway so why would you give any statins at all because I give statins for example I give them for another reason for cardiovascular inflammation the other thing is I don't use atorvastatin at all atorvastatin doesn't do as much positive work for inflammation as some of the others there's one one a couple of other comments about statins when I use them I tend I almost always use a very low dose statin because low doses will impact that cardiovascular inflammation that immune system storm against the against plaque but they don't have nearly as much impact on the beta cells or the insulin receptors there is one statin uh we're using more and more now that it's becoming affordable and that is pitavastatin or Livalo that among the statins it's the only one that does not increase insulin resistance there was another comment from one of the uh again I can't find it now it was question about the uh the COVID vaccines and here's just a real quick question Doc what's your what's your perspective on the vaccines uh I would take any of the vaccines I could get and I would almost even take the Chinese Sinovac vaccine and I expect to get a lot of haters on that comment but here's the thing every vaccine no matter which one you're talking about even the absolute best one can cause problems uh one of the reasons I wanted to go ahead and respond to that question about about vaccines is that we're starting to get a little bit more clarity on uh those problems they tend to be associated uh when significant problems happen they tend to be more of an anaphylactic type of of um reaction and it's people that have this rare anaphylaxis to lipid layers you know these are put out in a lipid pocket and there's a simple um there's a simple old product that's got lipid in it or fat in it James you are fat or wax my wife was telling me about it yesterday we have a family member who's got nut allergies and was talking with an allergist immunologist and she said no I don't have any concerns with you she said it's if you have an allergy to blank and it was the old household product you don't happen to remember what it was do you no no I have not seen that I'll have to look that up I meant to to do that for this channel but uh again the the major underlying response is number one there's no question that um if you're gonna get exposed to that spike protein sooner or later if it's not within the next sick for most of us it's going to be within the next six months uh for very few of us it may be more than six months before we get exposed to that spike protein so if you're going to get exposed to the spike protein you got to ask yourself the question which poison do I want to take do I want that spike protein to be associated with a whole virus or do I want it to be something that's been cleaved off and got all the problems with vaccine production and vaccines etc and all the politics etc or do I want to do I want to go head-to-head against the whole virus I think once you start looking at it that way uh you begin to get a slightly different perspective regarding the politics and the all the other junk that can go and the big pharma money all the other junk that can go with the vaccine James I know you've got a slightly different perspective on vaccines I've sarcastically called you an anti-vaxxer you corrected me and you may want to restate your position and uh maybe give give your reaction to the comment that I just made no we agree my own wife brought that up this just last night she's because someone called and asked me if I'd which one I was recognized I'm not I'm in level two I'm over 50 but under 60 and I don't have any underlying health conditions but other than mental health incapacities so I'm still at two in our county is still in one a they haven't completed all the vaccinations but when the time comes I'd be vaccinated I'm more comfortable to have waited in the scene I was doing a lot of preventive things around not getting the virus if possible you and I both you know we can say the reason I was out last week is I was sick and we thought for a while I probably did have the virus if I tested negative twice but I had come to find out people still get colds flus and sinuses and allergies and sicknesses but when the time comes I'll get the virus I think I'm more concerned about children under 16 getting the virus and I was more concerned and I am still concerned with why the you know they passed the virus out to healthy people who were politicians like Congress people giving them the shots when there were nursing homes that hadn't been tested yet so I think I'm just more measured in watching than I am anti um this particular vaccine um and I am I am one of those I think studied concerned about children under two getting a lot of vaccinations piling it on prior to age two I'm more of those the Japanese approach you know to you know stretch it out over the first four years of their life and don't bunch them all up we'll bunch them all up don't don't yeah um because it's not the vaccines I'm not one of those that think that they're assault or the other things are I just think there's something and it goes back to a lot of research we did at MyGenetics and a lot of the studies we read that it's something to do with the same mechanism we studied a couple of weeks ago on this channel about what may be occurring in the immune response that some people seem to have a system that once that switch is fully up it's hard to turn that off and so you get some respond adversely uh more severely and if you over challenge the system I think uh that may be where some of these anecdotal stories are coming from because I believe in that there are some stories we know there are some stories because there's a uh there is a fund that pays people who are harmed you know from bad vaccines Guillain-Barre is a real result as to what happens sometimes it's rare you know and but I'm not certain that it's a shot as much as my response to that shot just like the anaphylactic response is uh to these vaccines it doesn't mean the vaccine is bad but I may not be you know I may be my response may be the issue so I'll certainly be vaccinated when when the time comes I'm not going to jump in line in front of someone else but when my time comes I haven't had the virus yet I'll be vaccinated you bring up a good point and I want to uh to emphasize Guillain-Barre it's you know that sounds kind of dry and clinical uh if you if you look it up you can get a really gut level picture of this look up iron lung and vaccine when I was in when I was at Hopkins and uh studying uh public health as a student that's one of the things we talked about is that that fiasco that problem and there's no question that a lot of people have been damaged permanently and a life-threatening damage from vaccines there's absolutely no question about that and I um but millions and millions and millions of lives have been saved and so that's the balance that we have to go through there is no denying that polio the world has changed because of polio vaccines the world is different because of the measles vaccine I mean there are just absolutely tremendous good that's done you know we banter and joke I take the adversarial approach just for simple conversation most of the time but there's great and good that's done we don't deny that it's just you've got to be aware and just like with your own prevention everyone's responsible for their own health and becoming as informed as they can to the choices they make with their own body you brought up you took the words right out of my mouth that's exactly right it's when these physicians and public health people study the iron lung problems that happened with uh the vaccine what 50 years ago 40 years ago it's similar to pilots looking at and uh they do you know looking at airplane crashes when you look at the aftermath of an airplane crash and the bodies laying on the ground it's ugly but people still get back in the airplane and we know why uh and it's the same analogy we have we have risks with every decision that we make I want to do a quick shout out to Type One Talks he's made several comments very helpful comments let me just read one I use Freestyle Libre as well it's been a game changer for me showed me so many things about how my blood sugar reacts real time to all kinds of food that I had no idea about he goes on uh to say he's not just a he's not just a prediabetes patient he's not a type 2 diabetes patient he's had type 1 diabetes for what 30 years plus so it's really helpful uh Type One Talks when somebody like you comes on you make a few comments you share with others because it's one thing for people you know like James and me who have the maybe the temerity or maybe the lack of good sense to get up and talk about things uh as a self-appointed expert in an area as a guide but it's very different for people to hear from someone else who's on that same journey at the end of the day when you look at what we're doing it's you guys it's your journey it's your life we are trying to help the goal for this show is to to help you in your journey your comments help us immensely in terms of doing that and we appreciate your views we appreciate uh more than anything else your feedback absolutely and Dr. Brewer is temerity over the counter o
2021-01-27